Understanding the impact of the PM4M intervention on women’s mental wellbeing in Zambia and lessons for implementation: a qualitative study

Introduction: In low-middle income countries (LMICs), Common Mental Disorders (CMD) limit women's ability to care for themselves and their children. Despite high rates of psychological distress among mothers, Zambia's healthcare system currently can offer only limited support. This study aimed to understand the impact of the Problem Management Plus for Moms (PM4M) psychosocial intervention on mothers of young children and also explored strategies for systemic implementation. Methods: This qualitative study is nested within a larger clinical trial and aims to qualitatively assess the impact, and barriers for implementation of the PM4M intervention through feedback from 53 women caring for children under 2 years old who received the intervention from Wellbeing community health workers (WCHWs) in community settings in Lusaka from May to August 2023. Results: Beyond improving mental health symptoms, PM4M was credited with expanding support networks, enhancing financial wellbeing, and fostering empowerment among participants. WCHWs noted personal growth resulting from training and intervention delivery. Both WCHWs and participants stressed the importance of knowledge sharing and involving romantic partners for maximum effectiveness. Identified concerns included the need for neutral spaces during intervention delivery and addressing suicidal behaviors in women and the community. While highlighting the potential of PM4M to boost economic independence and coping skills, the study recognized obstacles to scaling up the intervention. Challenges included raising mental health awareness, combating stigma, and further adapting the program culturally. Discussion: The study underscores the program's potential impact on CMD in Zambian mothers and calls for sustained efforts in program dissemination and cultural adaptation.