Table 1 Description of the problem solving therapy intervention

Delivering agent

Lay health workers (Health promoters). Mean age 58, all female, mean years of education 8, previous training in home based care for people living with HIV & AIDS, in community follow-up of persons on TB treatment and in delivering community health education and promotion e.g., through encouraging immunisation and methods to control disease outbreaks

Structure of intervention

Six weekly sessions of 30–45 min delivered through the Friendship Bench over 6 weeks, including home visits where deemed necessary. The first session lasting between 45 and 60 min

Structure of sessions and areas covered

Part 1. Problem identification (Kuvhura pfungwa): (A) Share Shona Symptom Questionnaire (SSQ) information with client, explain symptoms in relation to kufungisisa, (B) Actively listen to clients story, identify and list problems raised, clearly define problem/s. Problem exploration (kusimudzira): (C) understand the story, help client prioritise problems by summarizing and asking if you have missed anything, (D) brainstorm practical/feasible solutions, outline the options available (these have to come from client), encourage client to think over solutions of each problem before having the client decide which one to focus on. Help client to come up with a specific, measurable, achievable and realistic solution (don’t tell client what to do). Agree what the client will do before you next meet and set appointment date Part 2. Reassure (Kusimbisa) (E) Home visit if needed before second meeting, otherwise see again on the bench, how did it go? Went well, then reassure praise encourage. If no progress or new obstacles present then go back to Part 1 contents, redefine problem and goals, what were the obstacles? Problem solve around obstacles and give homework again and reassure, you can phone or send SMS to reassure client (up to 6 per client). Part 3 (kusimbisisa). (F) Summarise session 1, how did it go? Going well then reassure and ecourage. Still having problems with agreed plan? Go back to Part 1 again or if you feel frustrated go to supervisor

Remember

Action plan: (G) Zero in on a specific solution, focus on what client wants to do and not what you think should be done, (H) How, when, what assistance is needed? Referral if necessary (I). Identify activities the person used to find rewarding and which matter to them and encourage these (J), Implementation: (K) How will it be done? Motivate; homework, Refer after 4th session to support group. Follow up: (L) What has been achieved? What were/are the obstacles if any? Go back to Part 1 as often as needed during the 6 sessions (M) Reinforce. What has been achieved, repeat SSQ score. (N) No improvement refer to supervisor. nurse counsellor

Tools

SSQ-14, Friendship bench manual, referral protocol

Supervision

Weekly group supervision by a clinician (Psychologist) or senior study team member trained in PST. Access to direct mobile voice call to support team