The global burden of common mental health disorders is rising, particularly in low-to-middle-income countries (LMICs), where health systems face challenges in providing sustainable care. Indonesia ranks among the top two countries in the WHO South-East Asia region for prevalence of depression and anxiety, affecting over 14 million people. Although effective low-intensity psychological interventions exist, evidence supporting their scalable and sustainable delivery in LMICs remains limited. We evaluated the delivery, reach, and impacts of a culturally adapted low-intensity psychological intervention for depression and anxiety in Indonesia, co-developed with local stakeholders. Using a three-stage cross-case methodology—developing a theory of change, establishing a measurement framework, and triangulating data—we recruited 1,500 patients across 12 diverse sites in Java. The intervention was delivered by 150 trained lay health workers in both urban and rural primary care settings. Quantitative outcomes included HADS (primary), PHQ-9, GAD-7, CESD, and EQ5D (secondary), measured at baseline, post-intervention, and 6-month follow-up. Qualitative data guided by the MRC process evaluation framework, included focus groups (40 participants per site) examined intervention fidelity, patient and facilitator experiences, and impact on service performance and were analysed using framework analysis. This study demonstrates the feasibility and positive reach of a culturally adapted intervention delivered by non-specialist providers in diverse Indonesian primary care settings. Findings offer valuable insights into the contextual factors influencing mental health care delivery in LMICs and highlight pathways to sustainable implementation of psychological therapies in resource-constrained environments.

Authors:
Helen Brooks, University of Manchester, United Kingdom
Herni Susanti, Universitas Indonesia, United Kingdom
Budi-Anna Keliat, Universitas Indonesia, Indonesia
Irmansyah Irmansyah, BRIN, Indonesia
Fitri Fausiah, Universitas Indonesia, Indonesia
Penny Bee, University of Manchester, United Kingdom

About the Presenter(s)
Helen is a Senior Lecturer and lead for the Mental Health Research Group in the School of Nursing, Midwifery and Social Work at the University of Manchester.

Connect on Linkedin
https://uk.linkedin.com/in/helen-brooks-6a7bbb117

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