Table 3.

Facilitators and barriers to mhGAP-IG implementation success identified by qualitative studies

System level	Facilitators	Barriers
Service user	Ability to see traditional healers alongside biomedical care.31 Community awareness raising.32	Cultural differences with the biomedical model.33 Different perspectives on appropriate treatment.34–36 Rural residence, distance from health facilities, thinking that problems will self-resolve, concerns about treatment costs.37 Resistance to treatment.38
Staff	Health worker motivation.39 Sharing research findings collaboratively.40	Resistance from faculty members.41 Time constraints and workload.42 43 Stigma.38 39 43 Mistrust of informal health providers, cultural misunderstandings.38
Service	Supervision.39 42 44 Onward referral.32 Reliable psychotropic medicine procurement.32 39 44 Trained female community health volunteers.32	Scarcity of specialist staff to deliver supervision.39 45 Lack of financial resources38 41 Limited referral systems.38 Staff turnover, lack of confidential space for consultation.39
Leadership	Strong political and organisational support.35 36 39 40	Lack of institutional support.41