Barriers and facilitators to tele-support psychotherapy versus standard in-person mental health services for youth (15-30 Years) with depression in Kampala District, Uganda.

Authors

Jeremiah Mutinye Kwesiga, John Mark Bwanika, Benedict Akimana, Happy Banonya, Brenda Kabakaari, Sowed Mutumba, Sabrina Bakeera Kitaka, Musisi Seggane, Moffat Nyirenda, Etheldreda Nakimuli-Mpungu

Published in

PLOS global public health. Volume 6. Issue 7. Pages e0006657. Epub Jul 30, 2026.

Abstract

Depression remains a critical mental health challenge among young people in low-resource settings, where financial, structural, and social barriers frequently limit care access. Digital approaches, including Tele-Support Psychotherapy (TSP), have emerged as promising, scalable alternatives to Standard in-person Mental Health Services (SMHS), yet evidence comparing their implementation remains limited. This study explored facilitators and barriers influencing the feasibility, acceptability and engagement of youths with TSP versus SMHS for depression treatment in Kampala District, Uganda. A qualitative phenomenological study was conducted among youth aged 15-30 years enrolled in a randomized controlled trial evaluating both interventions. Data were collected through semi-structured key informant interviews and focus group discussions with participants and lay counselors and analyzed using deductive thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR). In the parent trial, 95 of 154 participants (61.69%) in the TSP arm and 15 of 146 (10.27%) in the SMHS arm engaged with their assigned intervention; these figures provide contextual background for these qualitative findings. Key facilitators for both interventions included strong social support networks and higher income levels. Technological challenges, such as unreliable mobile phone connectivity, hindered TSP, while high costs and limited awareness were barriers to SMHS. Government policies both supported trust in digital interventions and, in some cases, constrained access while lay-counselor attributes, including on-phone session flexible scheduling and rapport-building skills facilitated TSP. TSP presents a viable alternative to SMHS, particularly for youth facing financial and logistical barriers to accessing facility-based mental health services. However, optimizing its delivery requires addressing technological constraints, ensuring consistent government support, and integrating mental health literacy initiatives. Findings underscore the need for flexible and contextually tailored models that leverage technology and address individual and systemic barriers to enhance mental health service access in resource-constrained settings.

PMID:
42531288
Bibliographic data and abstract were imported from PubMed on 31 Jul 2026.

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