Integration of depression services into infectious disease care is feasible, acceptable, and effective in sub-Saharan African settings. However, while the region shifts focus to include chronic diseases, additional information is required to integrate depression services into chronic disease settings. We assessed service providers’ views on the concept of integrating depression care into non-communicable diseases’ (NCD) clinics in Malawi. The aim of this analysis was to better understand barriers, facilitators, and solutions to integrating depression into NCD services. Between June and August 2018, we conducted nineteen in-depth interviews with providers. Providers were recruited from 10 public hospitals located within the central region of Malawi (i.e., 2 per clinic, with the exception of one clinic where only one provider was interviewed because of scheduling challenges). Using a semi structured interview guide, we asked participants questions related to their understanding of depression and its management at their clinic. We used thematic analysis allowing for both inductive and deductive approach. Themes that emerged related to facilitators, barriers and suggested solutions to integrate depression assessment and care into NCD clinics. We used CFIR constructs to categorize the facilitators and barriers. Almost all providers knew what depression is and its associated signs and symptoms. Almost all facilities had an NCD-dedicated room and reported that integrating depression into NCD care was feasible. Facilitators of service integration included readiness to integrate services by the NCD providers, availability of antidepressants at the clinic. Barriers to service integration included limited knowledge and lack of training regarding depression care, inadequacy of both human and material resources, high workload experienced by the providers and lack of physical space for some depression services especially counseling. Suggested solutions were training of NCD staff on depression assessment and care, engaging hospital leaders to create an NCD and depression care integration policy, integrating depression information into existing documents, increasing staff, and reorganizing clinic flow. Findings of this study suggest a need for innovative implementation science solutions such as reorganizing clinic flow to increase the quality and duration of the patient-provider interaction, as well as ongoing trainings and supervisions to increase clinical knowledge. Trial registration This study reports finding of part of the formative phase of “The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building—A Clinic-Randomized Trial of Strategies to Integrate Depression Care in Malawi” registered as NCT03711786

中文翻译：

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马拉维整合抑郁症和非传染性疾病 (NCD) 护理的促进因素、障碍和潜在解决方案：与服务提供者的定性研究

在撒哈拉以南非洲地区，将抑郁症服务整合到传染病护理中是可行的、可接受的和有效的。然而，虽然该地区将重点转移到慢性病，但需要更多信息将抑郁症服务整合到慢性病环境中。我们评估了服务提供者对将抑郁症护理整合到马拉维非传染性疾病 (NCD) 诊所的概念的看法。该分析的目的是更好地了解将抑郁症纳入 NCD 服务的障碍、促进因素和解决方案。2018 年 6 月至 8 月期间，我们对供应商进行了 19 次深度访谈。提供者是从位于马拉维中部地区的 10 家公立医院招募的（即每个诊所 2 名，除了一家诊所，由于时间安排方面的挑战，该诊所只采访了一名提供者）。使用半结构化的访谈指南，我们向参与者询问了与他们对抑郁症的理解及其在诊所的管理相关的问题。我们使用了允许归纳和演绎方法的主题分析。出现的主题与促进因素、障碍以及将抑郁症评估和护理整合到 NCD 诊所的建议解决方案有关。我们使用 CFIR 结构对促进因素和障碍进行分类。几乎所有提供者都知道什么是抑郁症及其相关的体征和症状。几乎所有设施都有一个 NCD 专用房间，并报告将抑郁症纳入 NCD 护理是可行的。服务整合的推动者包括准备整合非传染性疾病提供者的服务，抗抑郁药在诊所的可用性。服务整合的障碍包括关于抑郁症护理的知识有限和缺乏培训、人力和物力资源不足、提供者的工作量大以及缺乏一些抑郁症服务（尤其是咨询服务）的物理空间。建议的解决方案是对 NCD 员工进行抑郁症评估和护理培训，让医院领导参与制定 NCD 和抑郁症护理整合政策，将抑郁症信息整合到现有文件中，增加员工人数并重组诊所流程。这项研究的结果表明需要创新的实施科学解决方案，例如重组诊所流程以提高患者与提供者互动的质量和持续时间，以及持续的培训和监督，以增加临床知识。试验注册 本研究报告了“撒哈拉以南非洲区域合作伙伴关系 (SHARP) 精神卫生能力建设——马拉维整合抑郁症护理策略的临床随机试验”的部分形成阶段的发现，注册号为 NCT03711786