Community Mental Health Journal

, Volume 53, Issue 2, pp 143–153 | Cite as

Lay Health Workers’ Experience of Delivering a Problem Solving Therapy Intervention for Common Mental Disorders Among People Living with HIV: A Qualitative Study from Zimbabwe

  • Dixon Chibanda
  • Frances Cowan
  • Ruth Verhey
  • Debra Machando
  • Melanie Abas
  • Crick Lund
Original Paper


There is growing evidence supporting the use of lay health workers (LHWs) to address the treatment gap for common mental disorders (CMD) through task-shifting. This study looks at the experience of LHWs delivering a problem solving therapy (PST) intervention for CMD for people living with HIV (PLWH) in a primary health care setting. Semi-structured interviews of LHWs (n = 7) and PLWH (10) who received PST were carried out using thematic content analysis. Over a 4 year period LHWs developed indigenous concepts of PST which were: Opening the mind (Kuvhura pfungwa), uplifting (kusimudzira), strengthening and strengthening further (kusimbisa and kusimbisisa) respectively. Using terms locally conceived through knowledge sharing amongst LHWs made it acceptable to deliver PST as part of their daily work. Indigenous terms conceived and developed by LWHs to describe components and processes of PST contribute to the therapy’s acceptability and continued use in primary care facilities.


Common mental disorders Problem solving therapy Lay health workers HIV 



This study was supported through a Grand Challenges Canada Grant Number GMH 0087-04.

Author Contribution

DC was responsible for the design of the study conducting interviews, analysis of data and drafting of first draft leading to the final manuscript. FC was responsible for reviewing the design and reviewing of second and final draft. DM was responsible for conducting interviews, transcribing of data and review of the third draft. RV was responsible for analysis, coding of data of the interviews and review of the first and last draft. MA was responsible for reviewing the design of the study and review of final draft. CL was responsible of reviewing the design of the study, first draft and all subsequent drafts leading to the final manuscript.

Compliance with Ethical Standards

Ethics approval was obtained from all relevant boards.

Conflict of Interest

All the authors declare no conflict of interest.


  1. Abas, M., Ali, G., Nakimuli-Mpungu, E., & Chibanda, D. (2014). Depression in people living with HIV in sub-Saharan Africa: Time to act. Tropical Medicine & International Health, 19(12), 1392–1396.CrossRefGoogle Scholar
  2. Abas, M., Broadhead, J. C., Mbape, P., & Khumalo-Sakatukwa, G. (1994). Defeating depression in the developing world: A Zimbabwean model. The British Journal of Psychiatry, 164(3), 293–296.CrossRefPubMedGoogle Scholar
  3. Akena, D., Joska, J., Musisi, S., & Stein, D. J. (2012). Sensitivity and specificity of a visual depression screening instrument among HIV-positive individuals in Uganda, an area with low literacy. AIDS and Behavior, 16(8), 2399–2406. doi: 10.1007/s10461-012-0267-1.CrossRefPubMedGoogle Scholar
  4. Andrew, G., Cohen, A., Salgaonkar, S., & Patel, V. (2012). The explanatory models of depression and anxiety in primary care: A qualitative study from India. BMC Research Notes, 5, 499. doi: 10.1186/1756-0500-5-499.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Araya, R., Flynn, T., Rojas, G., Fritsch, R., & Simon, G. (2006). Cost-effectiveness of a primary care treatment program for depression in low-income women in Santiago, Chile. American Journal of Psychiatry, 163(8), 1379–1387.CrossRefPubMedGoogle Scholar
  6. Araya, R., Rojas, G., Fritsch, R., Gaete, J., Rojas, M., Simon, G., & Peters, T. J. (2003). Treating depression in primary care in low-income women in Santiago, Chile: A randomised controlled trial. Lancet, 361(9362), 995–1000. doi: 10.1016/S0140-6736(03)12825-5.CrossRefPubMedGoogle Scholar
  7. Bell, A. C., & D’Zurilla, T. J. (2009). Problem-solving therapy for depression: A meta-analysis. Clinical Psychology Review, 29(4), 348–353. doi: 10.1016/j.cpr.2009.02.003.CrossRefPubMedGoogle Scholar
  8. Bere, T., Nyamayaro, P., Magidson, J., Chibanda, D., Chingono, A., O’Cleirgh, C., … Abas, M. (2015). Cultural adaptation of life-steps: An intervention to improve adherence to antiretroviral therapy among people living with HIV/AIDS in Zimbabwe. Journal of Health Psychology (in press).Google Scholar
  9. Broadhead, J., & Abas, M. (1998). Life events, difficulties and depression among women in an urban setting in Zimbabwe. Psychological Medicine, 28, 29.CrossRefPubMedGoogle Scholar
  10. Charlson, F. J., Diminic, S., Lund, C., Degenhardt, L., & Whiteford, H. A. (2014). Mental and substance use disorders in sub-Saharan Africa: Predictions of epidemiological changes and mental health workforce requirements for the next 40 years. PLoS ONE, 9(10), e110208. doi: 10.1371/journal.pone.0110208.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Chibanda, D., Benjamin, L., Weiss, H. A., & Abas, M. (2014). Mental, neurological, and substance use disorders in people living with HIV/AIDS in low- and middle-income countries. Journal of Acquired Immune Deficiency Syndromes, 67 Suppl 1, S54–S67. doi: 10.1097/QAI.0000000000000258.CrossRefPubMedGoogle Scholar
  12. Chibanda, D., Bowers, T., Verhey, R., Rusakaniko, S., Abas, M., Weiss, H. A., & Araya, R. (2015). 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. International Journal of Mental Health Systems, 9(1), 21. doi: 10.1186/s13033-015-0013-y.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Chibanda, D., Cowan, F. M., Healy, J. L., Abas, M., & Lund, C. (2015). Psychological interventions for common mental disorders for people living with HIV in low and middle income countries: systematic review. Tropical Medicine & International Health: TM & IH. doi: 10.1111/tmi.12500.Google Scholar
  14. Chibanda, D., Mesu, P., Kajawu, L., Cowan, F., Araya, R., & Abas, M. (2011). Problem-solving therapy for depression and common mental disorders in Zimbabwe: Piloting a task-shifting primary mental health care intervention in a population with a high prevalence of people living with HIV. BMC Public Health, 11(1), 828.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Chibanda, D., Shetty, A. K., Tshimanga, M., Woelk, G., Stranix-Chibanda, L., & Rusakaniko, S. (2013). Group problem-solving therapy for postnatal depression among HIV positive and HIV negative mothers in Zimbabwe. Journal of the International Association of Providers of AIDS Care. doi: 10.1177/2325957413495564.Google Scholar
  16. Chibanda, D., Verhey, R., Gibson, L. J., Munetsi, E., Machando, D., Rusakaniko, S., … Abas, M. (2016). Validation of screening tools for depression and anxiety disorders in a primary care population with high HIV prevalence in Zimbabwe. Journal of Affective Disorders, 198, 50–55. doi: 10.1016/j.jad.2016.03.006.CrossRefPubMedGoogle Scholar
  17. Cuijpers, P., van Straten, A., & Warmerdam, L. (2007). Problem solving therapies for depression: A meta-analysis. European Psychiatry, 22(1), 9–15. doi: 10.1016/j.eurpsy.2006.11.001.CrossRefPubMedGoogle Scholar
  18. Dua, T., Barbui, C., Clark, N., Fleischmann, A., Poznyak, V., van Ommeren, M., … Drummond, C. (2011). Evidence-based guidelines for mental, neurological, and substance use disorders in low-and middle-income countries: Summary of WHO recommendations. PLoS Medicine, 8(11), e1001122.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Joshi, R., Alim, M., Kengne, A. P., Jan, S., Maulik, P. K., Peiris, D., & Patel, A. A. (2014). Task shifting for non-communicable disease management in low and middle income countries—a systematic review. PLoS ONE, 9(8), e103754. doi: 10.1371/journal.pone.0103754.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Kidia, K., Machando, D., Bere, T., Macpherson, K., Nyamayaro, P., Potter, L., … Abas, M. (2015). “I was thinking too much”: Experiences of HIV-positive adults with common mental disorders and poor adherence to antiretroviral therapy in Zimbabwe. Tropical Medicine & International Health: TM & IH. doi: 10.1111/tmi.12502.Google Scholar
  21. Kohn, R., Saxena, S., Levav, I., & Saraceno, B. (2004). The treatment gap in mental health care. Bulletin of the World Health Organization, 82(11), 858–866.PubMedPubMedCentralGoogle Scholar
  22. Krout, R. E. (2001). The effects of single-session music therapy interventions on the observed and self-reported levels of pain control, physical comfort, and relaxation of hospice patients. The American Journal of Hospice & Palliative Care, 18(6), 383–390.CrossRefGoogle Scholar
  23. Lamprecht, H., Laydon, C., McQuillan, C., Wiseman, S., Williams, L., Gash, A., & Reilly, J. (2007). Single-session solution-focused brief therapy and self-harm: A pilot study. Journal of Psychiatric and Mental Health Nursing, 14(6), 601–602. doi: 10.1111/j.1365-2850.2007.01105.x.CrossRefPubMedGoogle Scholar
  24. Malouff, J. M., Thorsteinsson, E. B., & Schutte, N. S. (2007). The efficacy of problem solving therapy in reducing mental and physical health problems: A meta-analysis. Clinical Psychology Review, 27(1), 46–57.CrossRefPubMedGoogle Scholar
  25. Mynors-Wallis, L. (2002). Does problem-solving treatment work through resolving problems? Psychological Medicine, 32(7), 1315–1319.CrossRefPubMedGoogle Scholar
  26. Mynors-Wallis, L. (2005). Problem-solving treatment for anxiety and depression: A practical guide. Oxford: Oxford University Press.Google Scholar
  27. Naeem, F., Ayub, M., Kingdon, D., & Gobbi, M. (2012). Views of depressed patients in Pakistan concerning their illness, its causes, and treatments. Qualitative Health Research, 22(8), 1083–1093. doi: 10.1177/1049732312450212.CrossRefPubMedGoogle Scholar
  28. Naeem, F., Gobbi, M., Ayub, M., & Kingdon, D. (2009). University students’ views about compatibility of cognitive behaviour therapy (CBT) with their personal, social and religious values (a study from Pakistan). Mental Health, Religion & Culture, 12(8), 847–855.CrossRefGoogle Scholar
  29. Naeem, F., Gobbi, M., Ayub, M., & Kingdon, D. (2010). Psychologists experience of cognitive behaviour therapy in a developing country: A qualitative study from Pakistan. International Journal of Mental Health Systems, 4(1), 2. doi: 10.1186/1752-4458-4-2.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Nakimuli-Mpungu, E., Wamala, K., Okello, J., Alderman, S., Odokonyero, R., Musisi, S., … Mills, E. J. (2014). Outcomes, feasibility and acceptability of a group support psychotherapeutic intervention for depressed HIV-affected Ugandan adults: A pilot study. Journal of Affective Disorders, 166, 144–150. doi: 10.1016/j.jad.2014.05.005.CrossRefPubMedGoogle Scholar
  31. Nezu, A. M., & Nezu, C. M. (2001). Problem solving therapy. Journal of Psychotherapy Integration, 11(2), 187–205. doi: 10.1023/a:1016653407338.CrossRefGoogle Scholar
  32. Patel, V., Chisholm, D., Rabe-Hesketh, S., as-Saxena, F., Andrew, G., & Mann, A. (2003). Efficacy and cost-effectiveness of drug and psychological treatments for common mental disorders in general health care in Goa, India: A randomised, controlled trial. Lancet, 361(9351), 33.CrossRefPubMedGoogle Scholar
  33. Patel, V., & Mann, A. (1997). Etic and emic criteria for non-psychotic mental disorder: A study of the CISR and care provider assessment in Harare. Social Psychiatry & Psychiatric Epidemiology, 32(2), 84.CrossRefGoogle Scholar
  34. Patel, V., Musara, T., Butau, T., Maramba, P., & Fuyane, S. (1995). Concepts of mental illness and medical pluralism in Harare. Psychological Medicine, 25(3), 485–493.CrossRefPubMedGoogle Scholar
  35. Patel, V., Simunyu, E., Gwanzura, F., Lewis, G., & Mann, A. (1997). The Shona Symptom Questionnaire: The development of an indigenous measure of common mental disorders in Harare. Acta Psychiatrica Scandinavica, 95(6), 469.CrossRefPubMedGoogle Scholar
  36. Patel, V., Todd, C., Winston, M., Gwanzura, F., Simunyu, E., Acuda, W., & Mann, A. (1997). Common mental disorders in primary care in Harare, Zimbabwe: Associations and risk factors. British Journal of Psychiatry, 171, 60–64.CrossRefPubMedGoogle Scholar
  37. Patel, V., Weiss, H. A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., … Kirkwood, B. R. (2010). Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): A cluster randomised controlled trial. Lancet, 376(9758), 2086–2095. doi:  10.1016/S0140-6736(10)61508-5.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Perkins, R. (2006). The effectiveness of one session of therapy using a single-session therapy approach for children and adolescents with mental health problems. Psychology and Psychotherapy, 79(Pt 2), 215–227. doi: 10.1348/147608305X60523.CrossRefPubMedGoogle Scholar
  39. Petersen, I., Hanass Hancock, J., Bhana, A., & Govender, K. (2014). A group-based counselling intervention for depression comorbid with HIV/AIDS using a task shifting approach in South Africa: A randomized controlled pilot study. Journal of Affective Disorders, 158, 78–84. doi: 10.1016/j.jad.2014.02.013.CrossRefPubMedGoogle Scholar
  40. Petersen, I., Lund, C., Bhana, A., & Flisher, A. J. (2012). A task shifting approach to primary mental health care for adults in South Africa: Human resource requirements and costs for rural settings. Health Policy and Planning, 27(1), 42–51.CrossRefPubMedGoogle Scholar
  41. Pierce, D., & Gunn, J. (2007). Using problem solving therapy in general practice. Australian Family Physician, 36(4), 230–233.PubMedGoogle Scholar
  42. Pierce, D., & Gunn, J. (2011). Depression in general practice—consultation duration and problem solving therapy. Australian Family Physician, 40(5), 334–336.PubMedGoogle Scholar
  43. Rahman, A., Malik, A., Sikander, S., Roberts, C., & Creed, F. (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: A cluster-randomised controlled trial. Lancet, 372(9642), 902–909. doi: 10.1016/S0140-6736(08)61400-2.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Ruppel, P. S., & Mey, G. (2015). Grounded theory methodology—narrativity revisited. Integrative Psychological and Behavioral Science. doi: 10.1007/s12124-015-9301-y.PubMedGoogle Scholar
  45. Safren, S. A., Hendriksen, E. S., Mayer, K. H., Mimiaga, M. J., Pickard, R., & Otto, M. W. (2004). Cognitive-behavioral therapy for HIV medication adherence and depression. Cognitive and Behavioral Practice, 11(4), 415–424.CrossRefGoogle Scholar
  46. Shetty, A. K., Marangwanda, C., Stranix-Chibanda, L., Chandisarewa, W., Chirapa, E., Mahomva, A., … Maldonado, Y. (2008). The feasibility of preventing mother-to-child transmission of HIV using peer counselors in Zimbabwe. AIDS Research and Therapy, 5, 17. doi: 10.1186/1742-6405-5-17.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Shinde, S., Andrew, G., Bangash, O., Cohen, A., Kirkwood, B., & Patel, V. (2013). The impact of a lay counselor led collaborative care intervention for common mental disorders in public and private primary care: A qualitative evaluation nested in the MANAS trial in Goa, India. Social Science & Medicine, 88, 48–55. doi: 10.1016/j.socscimed.2013.04.002.CrossRefGoogle Scholar
  48. Slaff, B. (1995). Thoughts on short-term and single-session therapy. Adolescent Psychiatry, 20, 299–306.PubMedGoogle Scholar
  49. Steel, Z., Marnane, C., Iranpour, C., Chey, T., Jackson, J. W., Patel, V., & Silove, D. (2014). The global prevalence of common mental disorders: A systematic review and meta-analysis 1980–2013. International Journal of Epidemiology, 43(2), 476–493. doi: 10.1093/ije/dyu038.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Stranix-Chibanda, L., Chibanda, D., Chingono, A., Montgomery, E., Wells, J., Maldonado, Y., … Shetty, A. K. (2005). Screening for psychological morbidity in HIV-infected and HIV-uninfected pregnant women using community counselors in Zimbabwe. Journal of the International Association of Physicians in AIDS Care (Chicago, Ill), 4, 83–88.CrossRefGoogle Scholar
  51. Todd, C., Patel, V., Simunyu, E., Gwanzura, F., Acuda, W., Winston, M., & Mann, A. (1999). The onset of common mental disorders in primary care attenders in Harare, Zimbabwe. Psychological Medicine, 29(1), 97–104.CrossRefPubMedGoogle Scholar
  52. van Ginneken, N., Tharyan, P., Lewin, S., Rao, G. N., Meera, S. M., Pian, J., … Patel, V. (2013). Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database of Systematic Reviews (Online), 11, CD009149. doi: 10.1002/14651858.CD009149.pub2.Google Scholar
  53. van’t Hof, E., Stein, D. J., Marks, I., Tomlinson, M., & Cuijpers, P. (2011). The effectiveness of problem solving therapy in deprived South African communities: Results from a pilot study. BMC Psychiatry, 11(1), 156.CrossRefGoogle Scholar
  54. Walker, J. L. (2012). The use of saturation in qualitative research. Canadian Journal of Cardiovascular Nursing, 22(2), 37–46.PubMedGoogle Scholar
  55. World Health Organisation. (2007). Treat train retain. Task shifting: Global recommendations and guidelines. Geneva: World Health Organization.Google Scholar
  56. Wray, N., Markovic, M., & Manderson, L. (2007). “Researcher saturation”: The impact of data triangulation and intensive-research practices on the researcher and qualitative research process. Qualitative Health Research, 17(10), 1392–1402. doi: 10.1177/1049732307308308.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Dixon Chibanda
    • 1
    • 3
  • Frances Cowan
    • 2
  • Ruth Verhey
    • 3
  • Debra Machando
    • 4
  • Melanie Abas
    • 5
  • Crick Lund
    • 6
  1. 1.Department of PsychiatryUniversity of ZimbabweHarareZimbabwe
  2. 2.University College LondonLondonUK
  3. 3.Zimbabwe Aids Prevention Project, Department of Community MedicineUniversity of ZimbabweHarareZimbabwe
  4. 4.Women’s UniversityHarareZimbabwe
  5. 5.Institute of PsychiatryKing’s College LondonLondonUK
  6. 6.University of Cape TownCape TownSouth Africa

Personalised recommendations