The Friendship Bench programme: a cluster randomised controlled trial of a brief psychological intervention for common mental disorders delivered by lay health workers in Zimbabwe
Open accessAbstract
BACKGROUND: Common mental disorders (CMD) are a leading cause of disability globally. Emerging evidence indicates that in low and middle income countries the treatment gap for CMD can be addressed through the use of trained and supervised lay health workers (LHWs). Few clinical trials have evaluated the use of such task-shifting approaches in sub-Saharan Africa. In Zimbabwe, we have successfully piloted a task-shifting intervention delivered by LHWs. This protocol describes a cluster randomised controlled trial to assess the effectiveness of this intervention. METHODS: Each of 24 randomly selected clinics from a pool of 42 in Harare will recruit 24 participants (N = 576). The clinics are randomised in a 1:1 ratio to receive either the intervention package [a problem solving therapy package delivered over a 4-6 week period by LHWs (N = 24) followed by a 6-week group support programme which focuses mainly on teaching a craft skill] or enhanced usual care, which includes usual care and psycho-education. Primary care attenders aged 18 years and above who score positive on a locally validated CMD screening questionnaire (Shona Symptom Questionnaire, SSQ-14) will be eligible for recruitment and asked for informed consent to participate in the trial. The primary measure is the SSQ score at 6 months. CONCLUSION: This effectiveness trial using LHWs to address the treatment gap for CMD will contribute to the body of knowledge on the feasibility and ability for scale-up of interventions for CMD. TRIAL REGISTRATION: PACTR201410000876178.
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In Friendship Bench, mobile technology in the form of text messages and phone calls is used to reinforce program content and promote adherence, with up to six messages or calls per patient.
“Mobile technology in the form of text messages and phone calls is used to reinforce program content and to promote adherence among patients enrolled in the intervention.27 Lay health workers send patients up to 6 text messages or phone calls during the program.”
From Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally (2019) · cites this paper as [27]
The Friendship Bench clinical team used mobile phones, including voice calls and text messaging, to supervise lay health workers and provide guidance for challenging cases.
“The clinical team also used mobile phones, including voice calls and text messaging, to provide supervision to the lay health workers as well as guidance and support for responding to challenging cases.”
From Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally (2019) · cites this paper as [27]
Friendship Bench lay health workers deliver a manualized six-session problem-solving intervention on a bench outside the clinic.
“Trained lay health workers deliver a manualized intervention to patients on a bench situated outside the clinic.27 In total, there are 6 sessions aimed at teaching the participating patients effective techniques for problem solving.”
From Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally (2019) · cites this paper as [27]
The Friendship Bench intervention is delivered by lay health workers in Zimbabwe and focuses on individual problem-solving for depression and other common mental disorders.
“The Friendship Bench intervention is delivered by lay health workers and focuses on individual problem-solving, and is based on an extensive body of prior research and community efforts focused on targeting depression and other common mental disorders in Zimbabwe.27”
From Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally (2019) · cites this paper as [27]
In Zimbabwe primary care, 90% of individuals accessing services own mobile phones, making technology a promising approach for reaching patients.
“Technology was identified as a promising approach for reaching patients given that most individuals (90%) accessing primary care services own mobile phones.27”
From Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally (2019) · cites this paper as [27]
After the fourth Friendship Bench session, patients can choose a peer group led by prior participants; lay health workers can refer non-improvers after six sessions to a mental health-trained supervisor.
“After the fourth session, participating patients can choose to access a peer group led by prior participants in the Friendship Bench program. The lay health workers can then refer patients who do not improve following the initial 6 sessions to a supervisor with training in mental health for additional support and treatment.”
From Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally (2019) · cites this paper as [27]
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“The Friendship Bench in Zimbabwe, for instance, demonstrated that lay health workers could deliver structured psychotherapy for depression within primary care settings, achieving significant symptom reduction with high acceptability (Chibanda et al. 2015).”
- Authors
- Chibanda, D., Bowers, T., Verhey, R., Rusakaniko, S., Abas, M., Weiss, H. A., & Araya, R.
- Affiliations
- University of Zimbabwe (ZW)
- King's College London (GB)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Chibanda, Dixon
- Venue
- International Journal of Mental Health Systems
- Published
- 2015-05-23
- Volume
- 9
- Issue
- 1
- Pages
- 21-21
- ISSN
- 1752-4458 (ISSN-L)
- PMC
- PMC4940904
- OpenAlex
- W1560790411
- Cited by
- 179
- References
- 20
- Citations by year
- 2026: 17 · 2025: 28 · 2024: 17 · 2023: 36 · 2022: 12 · 2021: 25 · 2020: 11 · 2019: 13 · 2018: 6 · 2017: 3 · 2016: 10 · 2015: 1
- FWCI
- 10.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- International Journal of Mental Health Systems (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Funders
- Grand Challenges Canada
- Medical Research Council (MR/K012126/1)
- Fogarty International Center (D43TW010540)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- common mental disorders, lay health workers, task shifting, problem-solving therapy, brief psychological intervention, treatment gap, primary care, Zimbabwe, sub-Saharan Africa
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