Table 1 Quotes by themes and sub-themes

Mechanisms and context

 Highly varied and need for cultural adaptations based on local infrastructure and population needs

“from my experience of researching trauma and PTSD it’s an extremely culturally dependant phenomenon and a culturally dependant condition, it doesn’t look the same everywhere.” ID14

“So it wasn’t poverty reduction wasn’t a direct goal of the treatment, we didn’t have like a poverty reduction module. But we sort of indirectly ended up working on that and increasing people’s household incomes as a result of using the problem solving therapy module.” ID13

“Because you can develop a superb intervention but there is no one to deliver it in the context in which you have developed it then again it won’t work.“ ID8

“Nepal had a much more sort of community-based activity, in Ethiopia we tried to use existing (10.04) of people employed by the Government in the government sector. Whereas the Nepal group you know they came from a more non-governmental organisation sort of perspective. So, they employed people and got them doing psychological and psychosocial interventions in the community.” ID4

 Delivery agents

“I think generally we’ve always stuck to between 6 to 8 sessions so it’s reducing the length of the sessions and then also task shifting treatment delivery so not enough mental health specialists like psychologists and psychiatrist available to implement. So, identifying you know a pair of professionals to do that and that’s, that has also been different across the different studies.” ID13

“I think you know there is no best delivery agent and I think it really depends always on the context and I think you need to make decisions based on the context.“ ID9

“the CHWs in our setting in our organisation they’ve been equipped to use mobile phones to provide care so it was slightly easier for us because we could integrate the concept of MI into an app and hand it over to the CHWs.” ID5

Barriers

 Cultural barriers and mental health stigma

“I think it just varies by culture or context it’s just again the language that people use around mental health. The kind of explanatory frameworks that people use for why people may be psychologically distressed.“ ID9

“I found things like in India you don’t have the vocabulary to describe a lot of emotions like in English you have so many different words to describe just the concept of sadness, you have grief, you have helplessness, you have loss, just sadness, you have depression.” ID14

“I would go house to house and try to find out the people with dementia and the family would tell me, no no no no one else lives in this house but the neighbour would tell me that there is someone who is there in the backside of the house and kept on the floor. […]. families were developing their own techniques on how to look after somebody that they didn’t know what was happening to the person.” ID8

“in that study we found that even mental even health care providers did not have a lot of training in mental health” ID5

 Logistical barriers

“I know it’s frustrating for aid workers or humanitarians, global health practitioners to work with Governments at all levels of local through to federal and very frustrating at times and depending on where you’re trying to intervene there’s a fair amount of corruption.” ID3

“you may have the best of intentions, you may have the best of protocol, you may have the best of ideas but this gets stuck there because of the research environment is not there, administration is not really geared up for supporting research.“ ID8

“For example, transport issues—if the service user can’t easily travel to the intervention or if there are any physical barriers hindering the service user to come to the intervention.” ID10

“we need some kind of logistical support, like in my case for example the venue for the social engagement is very important. So the Office of the Senior Citizen’s Affairs offered their largest room for us to be able to hold the social engagement.“ ID1

 Lack of Resources

“if you want to be able to reach and be accessible and affordable to everyone you should be able to subside costs for people that don’t have the same resources as someone else.” ID14

 Unavailability of Family carers

“there may also be the need to have a sort of like a support network available that can support carers for example.” ID8

“key is always you know and I think that’s important for older people is also involving the family erm and because you know I see you know older people in low and middle income countries as a as a system. So they live in a family and we are talking about it’s a we are talking about you know a system we are actually targeting. “ ID10

Facilitators

 Integration into existing health services

“in my opinion and in an ideal world implementation work is where we go right away right. So it wouldn’t be about hiring our own interventionist it would be using whoever is in the clinic or whoever is in the community setting.” ID13

“ever since we have been using the same video lecture to continuously train and re-train primary care providers who don’t have any mental health training and the video lectures are also available on YouTube for anybody who wants to access it.” ID5

 Personal motivation

“the reason why it was well embraced by the elderly people because they can relate to it, they can know the significance of it and they know that it can bring about something good to them and they feel very happy you know being doing the intervention.” ID1

“It wasn’t sort of tailored, it wasn’t like a participant came and said I would like to have this or this. But each individual module was tailored to the participant. So with problem solving therapy the participant identifies what are the problems that I want to work on and behavioural activation you go through and you identify what are the person’s values, which they tell you. It’s very much the participant themselves that identifies what matters to them. But the modules themselves were predefined, predetermined.” ID13

 Continuous engagement between research lead and delivery agents on the ground

“having 1 or 2 key persons to bridge the gap between the programme team and the research team and have frequent communications I think that’s equally important.“ ID5

Public and stakeholder involvement

 Adapting to local needs

“co-designing a mental health intervention requires an interdisciplinary approach. So you really cannot do it by yourself” ID1

“the best way to do it is to co-create you know to have recipients of the care or intervention be part of the framing and you know I think we really try to do that as much as possible and we always have. I mean from a disability perspective there’s a very strong approach to sort of the concept of nothing about us without us. So it’s always been co-created but that doesn’t mean it’s effective and there’s always gaps that still happen. So co-design is the right way to do it it’s lengthy it takes a lot longer but it creates a better product and a more effective product at the end.” ID3

“before you begin your research you have to coordinate with the community. I mean you need to talk to made the city health officer, the senior citizen organisation, even the city mayor you know you have to communicate with them and then the ethics committee required me to submit like a memoranda of understanding since I am about to do an intervention.” ID1

“after a few discussions we had conducted workshops where we would talk about the framework and what is the end goal and then we met regularly for I would say next 3 to 4 months err where we shared the updates and like wherever the design team was, co-design team in in terms of the app development and we would conduct meetings and then take the feedback and then go back to the development team and take it based on the feedback and then come to the CHWs and do that over and over again until was ready to be tested out.” ID5

 Continued involvement

“and then also we’ve kind of expanded which we didn’t in catalyst but we found in addition to the Ministry of Health or the other Government Ministries and the policy makers, if we’re trying to think about sustainability. We need to get their buy in because that’s kind of sets the agenda and also the financial planning within the country but we also want kind of what we call community influencers. So who are the people within the community who if they say this is a great thing and we think this will be very helpful to us people will follow suit. So that might be pharmacists, religious leaders, traditional healers within the village, whoever is like the kind of the head of the village or the chief.” ID2

“I think the thing that really stands out is the importance of involving local stakeholders in the provision of care so (07.37) it’s not about just transplanting an existing intervention.” ID14

“that was useful input so all of these different range of community stakeholders were involved and as I say more at the beginning the caregivers of people with mental health conditions were involved and as time went on we were also able to involve people with lived experience as well.” ID4

 Community ownership

“so basically the interventions are not my own decisions. I mean of course my intervention is justified with the literature but the components of the interventions are actually coming from the voices of the elderly and the head of the Office for the Senior Citizens Affairs.“ ID1

“I think that engaging key stakeholders is a must, all stakeholders, both from the supply side, so these are the people are going to be delivering the intervention or the organisations involved in delivery.“ ID8

“Because in the end we want to develop a sustainable intervention and we want to make sure that the intervention still exists after the research has ended and the money has run out.” ID9

 Looking through an ageing lens

“But I think the challenges to working with older adults is going to be slightly different I would say because the issues of access, the issues of logistic and if they are able to receive the intervention or understand the intervention or consent to participation or not. Or even if you are using some digital technology how, how good are they to use those technologies. I think those sort of things would be different but yes I think there would also be a lot of similarities though” ID5

“there may also be the need to have a sort of like a support network available that can support carers for example.“ ID8

“I think that’s important for older people is also involving the family and because I see older people in low and middle-income countries as a system. So they live in a family and we are talking about it’s a system we are actually targeting. So I think we also have to address the needs of the families and support the families in helping to deal with the problem that the older person might have and often they are also stressed and drained.“ ID10