Ingredients for success: Factors associated with successful integration of depression care into non-communicable disease clinics in Malawi: A mixed-methods analysis
Year: 2026
Type: article
Abstract: Depression is a leading cause of disability worldwide that disproportionately impacts low- and middle-income countries (LMICs). Evidence-based depression care options are often limited in LMICs and poorly integrated into existing healthcare systems. Improving such integration is crucial to improving patient outcomes and reducing disability. In Malawi, a cluster-randomized trial of implementation strategies to integrate depression care into non-communicable disease clinics was conducted at 10 healthcare facilities from 2019 to 2021. Some clinics were highly successful in integrating depression care while others were less successful in both arms. This post-hoc mixed-methods analysis (01/10/2023 and 31/05/2024) combined quantitative clinic performance indicators with qualitative endline key informant interview data to identify factors other than the tested implementation strategies that differentiated clinics that effectively integrated depression treatment from those that did not. Most participants reported several implementation barriers that were present across nearly all clinics. These pervasive barriers included access to resources, provider attitudes, and provider turnover. Differentiating factors, which when present allowed successful clinics to overcome pervasive barriers and when absent made the barriers difficult to overcome, included clinic coordinator engagement, management engagement, clinic ownership, and adequate training. Differentiating factors that facilitated implementation of depression care integration, even in the presence of commonly identified barriers, should be prioritized as targets for future implementation efforts.
Source: PLOS mental health.
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,496
Funders: Djavad Mowafaghian Centre for Brain Health, Michael J. Fox Foundation for Parkinson's Research, Bill and Melinda Gates Foundation, American Epilepsy Society, St. Baldrick's Foundation, Center for Selective C-H Functionalization, National Science Foundation, Indiana Clinical and Translational Sciences Institute, Fondation Brain Canada, Japan Agency for Medical Research and Development, National Computational Infrastructure, BC Children’s Hospital Foundation, Foundation for Food and Agriculture Research, Australian Government, Health~Holland, Sick Kids Foundation, Michael Smith Health Research BC, Deutsche Forschungsgemeinschaft, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, National Natural Science Foundation of China, China Postdoctoral Science Foundation, Ministero dell’Istruzione, dell’Università e della Ricerca, National Research Foundation of Korea, Institut National Du Cancer, Ministerie van Buitenlandse Zaken, Vancouver Coastal Health Research Institute, Ministry of Science and ICT, South Korea, Gemeinsame Bundesausschuss, National Institutes of Health, College of Agriculture, Purdue University, Canadian Institutes of Health Research, Biotechnology and Biological Sciences Research Council, Australian Research Council, Chinese Universities Scientific Fund, Postdoctoral Research Foundation of China, National Key Research and Development Program of China, Fundamental Research Funds for the Central Universities, National Institute on Alcohol Abuse and Alcoholism, National Institute of Mental Health, National Institute of General Medical Sciences, National Center for Advancing Translational Sciences, U.S. Army Corps of Engineers, Natural Science Foundation of Zhejiang Province, Sustainability Institute, Ohio State University, Wabash Heartland Innovation Network
Awards: G1124391948, G5844353759, G7899539139
OpenAlex ID: W7118567273