Nkhata Bay

Researchers are evaluating the impact of combining a leadership alignment strategy with a champion implementation strategy compared to using a champion strategy alone to improve integration of an evidence-based mental health treatment model in multiple medical care settings in Malawi. This study addresses the mental health treatment gap in low- and middle-income countries by focusing on ways to better support implementation efforts through leadership engagement and organizational climate alignment. The study compares two groups one receiving an adapted Leadership and Organizational Change for Implementation LOCI strategy plus the champion strategy, and the other receiving only the champion strategy with enhanced usual outpatient care. The LOCI strategy includes leadership engagement through data feedback, leadership training, coaching, and alignment activities, while the champion strategy involves trained district champions who serve as change agents supported by training and supervision. This is a cluster-randomized controlled trial conducted over a 12-month randomized period. Participants are patients aged 18 or older receiving medical care in participating districts who screen positive for elevated common mental disorder symptoms. Researchers will measure outcomes such as screening rates, suicide risk assessments, initiation of mental health treatment, adherence to treatment guidelines during follow-up, and counseling session fidelity over 12 months. Secondary outcomes include mental health remission at 3 months and chronic condition control at 6 months. The study involves behavioral interventions and will monitor integration progress and treatment quality.