Pre-implementation contexts for the integration of mental health screening and guided action into noma care: perceptions of service providers in Nigeria

BACKGROUND: Pre-implementation activities have been shown to modify planned implementation strategies by uncovering new insights, refining understanding and addressing stakeholders' concerns. This study aimed to determine the pre-implementation context for the integration of mental health screening and guided referral in the care of persons with noma and their caregivers. METHODS: This was a qualitative study utilizing a focus group discussion (FGD) of implementation deliverers (i.e. nurses, social workers, a dentist and a clinical psychologist) and semi-structured interviews of top management officials in the study setting. Both inductive and deductive approaches were utilized to extract transcribed discussions. These were subsequently mapped into the Consolidated Framework for Implementation Research. RESULTS: The pre-implementation discussions with the stakeholders informed the modification of two earlier planned implementation strategies, namely the time for screening and the place to refer those who screened positive. Screening for common mental disorders among patients with Noma and their caregivers was acceptable to the implementers. Key barriers recognized were the culture of stigma, particularly with regard to mental illness, and perceived increased workload, while enablers include well-developed infrastructure, top management buy-in and implementation team readiness. CONCLUSIONS: Our findings show that implementing screening and referral for mental disorders in noma care is acceptable. The modification of the planned implementation strategies buttressed the usefulness of co-designing with relevant stakeholders for successful implementation.