Table 3 Summary of additional findings on the technical challenges faced by interviewees in the delivery of mental health interventions

Technology

 Limited financial and human resources and expertise to troubleshoot technical issues

 Service disruptions due to infrastructure issues, e.g. poor network service in rural areas

 Some interventions required service users and their caretakers to use mHealth. This required technical expertise that they may not possess

‘..there could be a very fancy technological app that could capture everything […] but that would cost so much, that would need a lot of human expertise, that – that (sic) might not be able to scale it up in for example other resource-poor settings’ (Participant 6)

Logistical difficulties

 Barriers to implementation and travel due to challenging terrain and geography, e.g. rural or mountainous areas

 Unanticipated delays due to the extended periods of time needed to train, deliver interventions and motivate stakeholders to participate

 Difficulties in cooperating with bureaucratic and conventional systems, e.g. a disruption in service delivery if administrative processes are not adhered to correctly and drug procurement problems

‘And some of them, our service users were shepherds which, you know shepherds they come down from the mountains for the services, and then they go back. So it’s very difficult to actually reach them’ (Participant 25)

‘..making sure that there is a supply of drugs is very important. Quite a lot of time is spent with the government trying to see how they can increase that flow’ (Participant 4)

Financial limitations

 Implementing in populations with financial limitations kept their stakeholders from participating when they required money for travel or additional tests

‘..for some of the participants who were living far from the centers it was a challenge to have them come to the sessions because some of them don’t move around a lot’ (Participant 10)