Feasibility, Acceptability and Potential Efficacy of the Group Problem Management Plus Intervention among adults in Kenya: A quasi-experimental study

This quasi-experimental study demonstrates that the lay provider-delivered Group Problem Management Plus (gPM+) intervention is feasible, acceptable, and effective in significantly reducing depression, anxiety, and PTSD symptoms among adults in urban informal settlements in Kenya.

The Gist

Imagine a neighborhood where life is tough. People are struggling with stress, worry, and sadness, but there are no doctors or therapists nearby to help. In many parts of Kenya, this is the reality: there is a massive "mental health gap" where 75% of people who need help can't get it because there aren't enough specialists.

This paper is about a clever experiment to fix that problem using a "community toolbox" approach. Here is the story of what they did, explained simply.

The Problem: A House with a Leaking Roof

Think of the mental health crisis in Kenya like a house with a leaking roof. The rain (stress, trauma, anxiety) is pouring in, and the people inside are getting soaked. Usually, you'd call a professional roofer (a psychiatrist) to fix it. But in this neighborhood, there are no professional roofers available, and they are too expensive anyway.

The Solution: Teaching Neighbors to Patch the Roof

Instead of waiting for a professional roofer who might never show up, the researchers decided to teach the neighbors how to patch the roof themselves.

They used a specific "repair kit" called Group Problem Management Plus (gPM+).

• What is it? It's a simple, 5-week course. Think of it as a "mental first aid" workshop.
• Who teaches it? Not doctors. They trained 10 local community members (lay facilitators) from a local youth organization. These are people who already know the neighborhood, speak the language, and are trusted by the community.
• How does it work? The group meets once a week for two hours. In these sessions, they learn four main "tools":
  1. Deep Breathing: Like taking a deep breath to calm a storm inside you.
  2. Problem Solving: Breaking a big, scary mountain of problems into small, climbable pebbles.
  3. Getting Active: Doing small, happy things to lift your mood (like watering a plant).
  4. Connecting: Strengthening the bonds with friends and family so you aren't standing alone in the rain.

The Experiment: Putting the Tools to the Test

The researchers gathered 274 adults living in an urban informal settlement (a busy, crowded area in Mombasa) who were feeling down, anxious, or stressed.

1. The Setup: They screened people to find those who needed help the most.
2. The Training: The 10 local helpers went through an intensive 2-week training camp to learn how to use the "repair kit" perfectly.
3. The Action: The helpers ran 5 weekly group sessions.
4. The Check-up: They measured how people felt at the start, right after the course, and three months later.

The Results: The Roof is Fixed!

The results were like watching a garden bloom after a long drought.

• Everyone Showed Up: Almost everyone who started the course finished it. This is rare in health studies!
• The Neighbors Loved It: The participants said the course was helpful, easy to understand, and exactly what they needed. They felt like they could use these tools for the rest of their lives.
• The Helpers Grew: The local teachers felt more confident and skilled. They realized, "Hey, I can actually help my neighbors!"
• The Symptoms Vanished:
  • Depression: Scores dropped significantly (like a heavy weight being lifted off shoulders).
  • Anxiety: The constant "what if" worries quieted down.
  • Trauma: The scary memories became less overwhelming.
  • Life Quality: People felt they could function better, had more friends, and felt happier.

Why This Matters: The "Community Garden" Analogy

Imagine mental health as a garden. Before this study, only a few wealthy people had access to a professional gardener to keep their plants alive. Everyone else's garden was turning brown.

This study proved that if you give regular neighbors a good set of gardening tools (the gPM+ course) and a little bit of guidance (supervision), they can grow beautiful gardens for their whole community.

Key Takeaways for the Real World:

1. You don't need a specialist to help with common stress. Trained neighbors can do a great job.
2. Group power is real. Healing together is cheaper and often more effective than healing alone.
3. Trust works. Because the teachers were from the community, people trusted them and opened up.

The Bottom Line

This wasn't a final, perfect test (it was a "feasibility" study, meaning they were checking if the idea could work), but the results were so promising that they are now ready to build a bigger, stronger version of this program.

It's a hopeful story showing that in places where money and doctors are scarce, human connection and simple skills can be the most powerful medicine of all.

Technical Summary

1. Problem Statement

• Context: Sub-Saharan Africa (SSA) faces a severe mental health treatment gap, with up to 90% of individuals needing care unable to access it. In Kenya, over 75% of those with mental health needs lack access to services.
• Barriers: The region suffers from limited funding, inadequate infrastructure, a scarcity of mental health specialists, and a lack of culturally adapted, scalable interventions.
• Target Population: The study focuses on adults in urban informal settlements (specifically Changamwe sub-county, Mombasa), a demographic characterized by high poverty, food insecurity, and elevated rates of Common Mental Disorders (CMDs) such as depression, anxiety, and PTSD.
• Gap: While individual Problem Management Plus (PM+) has been tested in Kenya, the Group Problem Management Plus (gPM+) format had not been formally evaluated for feasibility, acceptability, or efficacy in this setting.

2. Methodology

• Study Design: A quasi-experimental pre-post study (formative evaluation) conducted between August 2024 and April 2025.
• Setting: Urban informal settlements in Changamwe sub-county, Mombasa, Kenya.
• Participants:
  • Screening: 428 adults were screened.
  • Inclusion Criteria: Adults (≥18 years) residing in the area with moderate symptoms of CMDs, defined as:
    • PHQ-9 (Depression) ≥ 10
    • GAD-7 (Anxiety) ≥ 10
    • PC-PTSD-5 (PTSD) ≥ 3
  • Exclusion Criteria: Acute medical conditions, imminent suicide risk, severe mental disorders (psychosis), or severe neurocognitive impairment.
  • Final Sample: 274 participants (63.5% female; median age 27).
• Intervention (gPM+):
  • Format: 5 weekly group sessions (2 hours each) with 8–12 participants per group (gender-segregated).
  • Content: Psychoeducation, stress management (breathing), structured problem-solving, behavioral activation, and strengthening social support.
  • Delivery Agents: 10 lay facilitators (non-specialists) from the local Mizizi Youth Organization. They had at least 12 years of education and prior community mental health experience.
  • Training & Supervision: Facilitators underwent a 96-hour training program over two weeks, followed by weekly/bi-weekly virtual supervision by local mental health practitioners.
• Outcome Measures:
  • Primary: PHQ-9 (Depression), GAD-7 (Anxiety), PC-PTSD-5 (PTSD).
  • Secondary: Functional impairment (WHODAS-12), perceived social support (MSPSS), general wellbeing (WHO-5), self-identified problems (PSYCHLOPS), and intervention acceptability/feasibility metrics (AIM, IAM, FIM).
  • Timepoints: Baseline, 2 weeks post-intervention, 5 weeks (endline), and 3-month follow-up.
• Analysis: Descriptive statistics, paired sample t-tests for pre-post comparisons, and calculation of Cohen's d for effect sizes.

3. Key Contributions

• First Evaluation of gPM+ in Kenya: This is the first study to formally assess the group format of PM+ in the Kenyan context, expanding beyond previous individual-based trials.
• Task-Shifting Validation: It demonstrates that lay facilitators from grassroots organizations can be trained to achieve competency in delivering complex psychological interventions under supervision.
• Scalability Model: The study validates a delivery model using local civil society organizations (CSOs) and virtual supervision, offering a cost-effective pathway for scaling mental health services in low-resource settings.
• Community Integration: It highlights the critical role of community engagement (involving chiefs, elders, and religious leaders) in overcoming stigma and ensuring high recruitment and retention rates.

4. Results

• Feasibility & Retention:
  • Recruitment: 274 participants enrolled (64% of screened).
  • Completion: 100% of enrolled participants completed all 5 sessions.
  • Follow-up: 88% retention rate at the 3-month follow-up (241 participants).
  • Fidelity: 91% of core intervention components were delivered with high fidelity.
• Acceptability:
  • Participants rated the intervention highly on Acceptability (Mean 18.7/20), Appropriateness (18.9/20), and Feasibility (18.8/20).
  • 100% reported enjoying the training; 99% found it therapeutic and easy to understand.
• Efficacy (Primary Outcomes):
  • Significant reductions in symptoms were observed from baseline to 3-month follow-up:
    • Depression (PHQ-9): Mean reduction of 9.2 points (p < 0.001); Large effect size (Cohen's d = 1.3).
    • Anxiety (GAD-7): Mean reduction of 7.3 points (p < 0.001); Large effect size (Cohen's d = 1.2).
    • PTSD (PC-PTSD-5): Mean reduction of 2.6 points (p < 0.001); Very large effect size (Cohen's d = 2.1).
• Secondary Outcomes:
  • Statistically significant improvements (p < 0.001) were observed in functional impairment, perceived social support, general wellbeing, and a reduction in self-identified problems.

5. Significance and Implications

• Clinical Impact: The study provides preliminary evidence that gPM+ is an effective, low-intensity intervention for reducing CMD symptoms and improving psychosocial functioning in urban informal settlements.
• Policy Relevance: The findings support the Kenyan government's national framework for task-shifting and the integration of PM+ into primary care and community settings.
• Future Directions: The authors conclude that the study design, recruitment strategies, and delivery model are robust enough to support a large-scale Randomized Controlled Trial (RCT).
• Challenges Noted: While successful, recruiting men proved difficult due to stigma and scheduling; however, targeted outreach (workplaces, male-only groups) mitigated this.
• Conclusion: gPM+ delivered by trained lay facilitators is a feasible, acceptable, and potentially efficacious strategy to bridge the mental health treatment gap in Kenya and similar low-resource settings.