Table 4 The programmatic implications of the findings in the context of Bangladesh
Areas of interest | Constraints/Barriers (challenges) | Existing facilitators (benefits) | Opportunities for interventions |
|---|---|---|---|
a. Training programme content | • Inadequate/ short training duration • Lack of previous exposure to MH-related knowledge • Difficulty in understanding training materials/ contents • The training was not socio-culturally customised | • MH literacy increased • Social stigma related to MH reduced • Improvement of peer responders’ well-being • Participatory nature of the PRT programmes, such as-group activities, roleplays and Q&A sessions • Strengthening peer responders’ professional capabilities | • Increasing the number and duration of the training sessions • Including more content • Practical activities/fieldwork to reduce monotony |
b. Service delivery | • Poor understanding and acceptance of MH in the community • Challenges in providing home visits during COVID-19 related lockdown • Peer responders were perceived as outsiders by the community • Difficulty in ensuring privacy while providing counselling services • Difficulty in applying psychometric assessment tools and demonstrating behavioural change communication materials for peer responders with visual impairments • Difficulties in movement from one place to another • Social stigma related to MH and disabilities • Non-compliance/ non-adherence to follow-up consultations • Lack/high cost of transportation | • Contribution to preventing severe MH issues • Identifying and managing mild MH issues • Necessary referral services • Sense of contributing to the community • Positive influence on MH-seeking behaviour • Increased awareness about MH | • Financial support • Capacity building of the peer responders for future peer support programmes • Formal recognition and provision of ID cards • Community awareness programmes |
c. Integration and expansion | • Lack of convenient transportation services for the peer responders • Lack of financial support • Difficulties in providing remuneration to the peer responders due to the small-scale project-based nature of the PRT programme | • Applicable for the disadvantaged/marginalised group of people • Basic understanding of MH issues and referral among peer responders • Available telemedicine and tele-counselling services • Community sensitisation • Medical camps | • Integration of PRT services in mainstream/ existing health system • Multi-sectoral collaboration with governmental and NGOs • Expanding accessibility and availability of psychiatric medications • Large-scale training programme to build the capacity of peer responders • Further research on the effectiveness of the PRT programme • Increasing awareness about the PRT programme at the national level |