Barriers and Drivers to Stakeholder Engagement in Global Mental Health Projects

Abstract

Background: Engagement with diverse stakeholders, including policy makers, care providers and end users, is essential for successful implementation of global mental health interventions. Despite being a fundamental factor in the implementation process, evidence about challenges and drivers to stakeholder engagement is limited in the global mental health literature. Methods: We conducted semi-structured qualitative interviews with n=29 recipients of global Grand Challenges Canada Global Mental Health funding to assess barriers and drivers to global mental health implementation across a portfolio of Grand Challenges Canada-funded projects. We used framework analysis to identify key themes related to implementation barriers and facilitators. This paper reports on barriers and facilitators to stakeholder engagement, with results related to capacity development and service delivery reported elsewhere in this volume. Results: Barriers and drivers to stakeholder engagement were identified across four themes: 1) Contextual Considerations, 2) Resources, 3) Participation, Uptake and Empowerment, and 3) Stigma. While complex contextual challenges create barriers, mechanisms such as formative research can facilitate a deeper contextual understanding that supports effective implementation planning. Limited financial and human resources and competing priorities can lead to substantial challenges. Investing in and leveraging existing local resources and expertise can help to mitigate these barriers. The challenge of achieving active participation from stakeholders and diverging expectations about the nature of participation were identified as barriers, while providing opportunities for meaningful participation and empowerment acted as facilitators. Stigma at the institutional and individual level was also identified as a substantial barrier to engagement. Conclusion: Stakeholder engagement is critical to successful implementation of global mental health interventions, particularly for promoting scale-up and sustainability. The findings of this study are relevant to implementors in global mental health. They also have implications for global mental health funding agencies and policy organizations, who can support improved stakeholder engagement in several ways. Investing in high-quality formative research, supporting capacity building in methods such as integrated knowledge translation and participatory priority-setting, investing in longer-term funding schemes to support sustainable partnerships and scale-up and supporting researchers to build skills in policy engagement would help to foster successful engagement and thus support effective implementation of global mental health innovations.

Barriers and drivers to service delivery in global mental health projects

“…The framework was populated separately and discussed, using an iterative process, to arrive at consensus about predominant themes. This paper presents findings for the Service Delivery cluster, with results from the other two clusters published elsewhere in this volume [13,14].…”

“…Capacity-building (79%), detection, treatment, care and rehabilitation (76%) were the most commonly incorporated elements to the interventions conducted by the projects. While fewer projects incorporated elements of stakeholder engagement in their projects, findings from the stakeholder engagement paper in this series highlighted how essential and cross-cutting this component was in driving success for a variety of project outcomes [14].…”

“…Stakeholder-driven promotion is another driver that enhanced implementation success through improved engagement within the targeted populations. As described further by Murphy et al [14] in an accompanying paper, integrating positive treatment outcomes into dissemination efforts drastically improved chances of the intervention's success in increasing participant acceptance, adherence and the uptake of services.…”

“…This paper describes results of a qualitative analysis of barriers and drivers to the implementation of service delivery in projects across GCC's GMH funding portfolio [13,14,15]. For the purpose of this study, "barriers" and "drivers" refer to key factors that either positively or negatively affected a project's ability to deliver an intervention as described in its initial funding proposal.…”