Barriers and drivers to stakeholder engagement in global mental health projects

Abstract

Background Engagement with diverse stakeholders, including policy makers, care providers and service users and communities, is essential for successful implementation of global mental health interventions. Despite being a fundamental factor in the implementation process, evidence about challenges and drivers to stakeholder engagement is limited in the global mental health literature. Methods We conducted semi-structured qualitative interviews with 29 recipients of Grand Challenges Canada Global Mental Health funding to assess barriers and drivers to global mental health implementation across a portfolio of projects. We used framework analysis to identify key themes related to implementation barriers and drivers. This paper reports on barriers and drivers to stakeholder engagement, with results related to capacity development and service delivery reported elsewhere in this journal. Results Barriers and drivers to stakeholder engagement were identified across four themes: (1) Contextual Considerations, (2) Resources, (3) Participation, Uptake and Empowerment, and (4) Stigma. While complex contextual challenges create barriers, mechanisms such as formative research can facilitate a deeper contextual understanding that supports effective implementation planning. Limited financial and human resources and competing priorities can lead to substantial challenges. Investing in and leveraging existing local resources and expertise can help to mitigate these barriers. The challenge of achieving active participation from stakeholders and diverging expectations about the nature of participation were identified as barriers, while providing opportunities for meaningful participation and empowerment acted as drivers. Stigma at the institutional, community and individual level was also identified as a substantial barrier to engagement. Conclusion The findings of this study are relevant to implementers in global mental health. They also have implications for global mental health funding agencies and policy organizations, who can support improved stakeholder engagement by investing in high-quality formative research, supporting capacity building for policy engagement, investing in longer-term funding schemes to support sustainable partnerships and scale-up, thus fostering successful engagement and supporting effective implementation of global mental health innovations.

Applying systems approaches to stakeholder and community engagement and knowledge mobilisation in youth mental health system modelling

“…Therefore, documentation and correspondence of clear objectives and shared vision of the research Program with stakeholders must take place early and throughout the research process. This also requires consistent communication with stakeholders to reconfirm priorities as efforts and interest on common goals can wane [ 9 ]. Initiating engagement early and taking the time to develop shared vision and reciprocity is vital to fostering trusting relationships with stakeholders [ 40 ].…”

“…The importance of community engagement in research has been increasingly highlighted due to the concern of communities being harmed or exploited, particularly in developing countries and Aboriginal and Torres Strait Islander communities [ 39 ]. An effective community engagement framework has been proposed by Lavery and colleagues to articulate twelve points to consider and to avoid potential exploitation by researchers [ 6 , 9 , 40 , 41 ]. We have adopted this engagement framework for our research Program (refer to Fig.…”

“…User-led research and underpinning participatory research methods can lead to improved stakeholder engagement and active involvement in priority setting, knowledge mobilization (KM) and dissemination [ 9 ]. Mental health programs are typically implemented in complex environments where services can be fragmented, agencies have competing health priorities, limited funding and infrastructure, and unexpected crises such as political instability, natural disasters, and pandemics can be disruptive [ 9 ]. Such complex environments pose greater challenges in the implementation of mental health research programs.…”

Participatory Systems Modelling for Youth Mental Health: An Evaluation Study Applying a Comprehensive Multi-Scale Framework

“…Active snowball sampling will be employed when appropriate to enable PAR, whereby the invited participants are empowered to contribute and identify any other stakeholders who should also be invited to participate. Throughout this process, a local chief investigator for each participating site will be identified to play a critical role in both recruiting key stakeholders as well as facilitating the engagement of local communities [ 35 , 36 ]. Eligible participants will be enrolled into the study after providing informed consent through a transparent communication process to ensure that all stakeholders can make their own decisions to participate [ 37 ].…”

Advancing Implementation Science Measurement for Global Mental Health Research

“… 1 Although considerable research progress has been made on the efficacy of mental health interventions, the “know-do” gap persists, limiting the availability of evidence-based care. Challenges contributing to the severity and complexity of the mental health implementation gap include social determinants of mental health, 2 the impact of stigma, 3 limited engagement and participation of key stakeholders including service users, 4 and the need for improved mental health measurement and data collection. 5 The mental health impacts of complex challenges including the COVID-19 pandemic and the effects of climate change further emphasize the urgency of addressing this gap.…”