Table 1 Key themes emerging from interviews and focus groups with patients, LHWs and the supervisors

Acceptability and potential benefits

‘Because it was like a second home you will be feeling that you have someone you can tell your problems and they listen to what I tell them.’ (Patient)

‘Because of what the granny said, I am going to go start working on my project. I had lost focus. Granny helped to open up my mind.’ (Patient)

‘…they have opened up my mind as I was a person who was in the dark…you have opened up my mind to new things that I never thought of doing.’ (Patient)

‘I was helped a lot by realising that there are some people who still see me as a human being because I was now thinking that I am not even a human being. So my mind is what I can say…is now at a better level.’ (Patient)

‘You are asked about the challenges you will be facing and you are left to express yourself freely and they also understand them help you with ideas of what to do going forth.’ (Patient)

‘I like that when I come they counsel me and tell me that I am just like a person with diabetes and that there is no need to look down upon myself. There is no need to exclude oneself from social groupings based on one’s HIV status.’ (Patient)

‘A patient seems happy by just the progress that we’ve made in that they’ll maybe repeatedly say, “Ok, I am going to try ABCD then I will come and see you on such and such a day”.’ (LHW)

‘You will leave the session feeling better because you would have talked about things.’ (Patient)

‘By talking about why they are there, I open up their mind in that I try and get them to understand that they can get help.’ (LHW)

‘Talk therapy is the best, that’s the best way, you pick up certain stuff that they are saying, you pick up the lifestyle that they are leading, you pick up certain things that maybe they used to do and they are not doing.’ (LHW)

‘Patients that suffer from kufungisisa (thinking too much, a Shona idiom of emotional distress)…all seem to benefit somehow.’ (LHW)

‘Through all this therapy they now manage to continue taking their medication the way they are supposed to.’ (LHW)

‘SSQ helps me to see how the person is surviving because for some they will not even be able to do their work. For some even to take their dishes outside, they cannot even do that. So it helps me to know that.’ (LHW)

Facilitating factors

 Socio-cultural appropriateness of the LHWs

‘The LHWs are respected in the community.’ (Supervisor)

‘They call us Ambuya Utano.’ (grandmother health provider) (LHW)

‘The LHW are really from the same community so they share the same social problems as their patients—like poverty, like HIV.’ (Supervisor)

‘Someone that is mature…holds a position in society, like a role model or mentor.’ (Supervisor)

‘Because through the discussions we had we get to be friends with my counsellor so much that even if I do something at home I can come to talk about it, that something happened which did not go down well with me.’ (Patient)

 Patient-focused and flexible approach

‘These days, the common method of patient acquisition is patient actually going to the LHWs’ home for assistance as they are often viewed as the first port of call for health matters at all hours and time of the day.’ (Supervisor)

‘Women from our community want to sell vegetables in the morning, not sit on the Bench, so we see them in the afternoon when they are ready to talk.’ (LHW)

‘It is like planting a seed, watering it to make it grow and then meeting to remove any weeds that had sprung up.’ (LHW)

‘We hear, talk, empower the patient. We do not tell them what to do.’ (LHW)

‘She is the driver and I am the leader… [I] get in then the driver drives.’(LHW)

‘We offer counselling to empower people to help themselves… When there are changes I feel good that I have helped someone.’ (LHW)

 Supportive supervision structures

‘We work very well just helping each other. If you make a mistake you are corrected and we help each other.’ (LHW)

‘We have one day aside on a Wednesday when every LHW gives feedback on a case that they’re working on, or even issues that are going on in the community.’ (LHW)

‘We work together, we work as one team.’ (LHW)

Challenges to implementation

 Socio-economic circumstances

‘A case I found difficult is when the person needs assistance immediately. One day I actually used my money after realizing that the situation was really desperate.’ (LHW)

‘They come in thinking that any problem, no matter what it is we can intervene, so we are more like a social work office sometimes. We end up being that way- where people are displaced and want to come and get assistance.’ (LHW)

 Insufficient training and financial support

‘I would like to learn about such issues like dealing with a person who wants to commit suicide. …I might have my own way but I would like to be trained so that I do not do anything that lands me in jail after having let someone go ahead with committing suicide.’ (LHW)

‘There is no structure or system that’s there to support me when I’m in a situation like that…’ (Supervisor referring to lack of supervisory support for dealing with challenging clients)

‘The money that we get is not significantly different from those who do not work… There should be a difference… Apart from our uniforms, we need bags to show that we are going to work.’ (LHW)

 Lack of follow and comprehensive documentation

‘The patient is the one who tells me when she wants to come back, maybe after a month.’ (LHW)

‘I do not dictate the pace.’ (LHW)

‘Promoters mentioned that they do a lot of counselling that is not documented or necessarily captured in a structured or formal context of the FB intervention.’ (Supervisor)

‘..it would be much more helpful for the patient and myself to have all those services in one place. We make patients travel from one place to the other especially for medication… maybe you can lose a patient in between.’ (Supervisor)