Barriers and Facilitators to Tele-Support Psychotherapy Versus Standard In-Person Mental Health Services for Youth (15-30 Years) with Depression in Kampala District, Uganda

Background: Depression remains a critical mental health challenge among young people in low-resource settings, where financial, structural, and social barriers frequently limit care access. Digital approaches, including Tele-Support Psychotherapy (TSP), have emerged as promising, scalable alternatives to Standard in-person Mental Health Services (SMHS); however, comparative assessments into their relative strengths and limitations remain scarce. Objective: This study sought to identify and compare facilitators and barriers influencing the feasibility, acceptability and engagement of youths with TSP versus SMHS for depression treatment in Kampala District, Uganda. Methods: We conducted a qualitative phenomenological investigation involving youth aged 15–30 enrolled in a randomized controlled trial evaluating both interventions. Data were gathered through semi-structured key informant interviews and focus groups with participants and lay counselors and analyzed via deductive thematic analysis informed by the Consolidated Framework for Implementation Research (CFIR). Results: In the parent trial, 95 of 154 participants (61.69%) in the TSP arm and 15 of 146 (10.27%) in the SMHS arm engaged with their assigned intervention; these figures provide contextual background for the qualitative findings.. This disparity in engagement underscores the potential of TSP to improve access to mental health care. Key facilitators for both interventions included strong social support networks and higher income levels, highlighting the crucial interplay of individual and systemic factors. Technological challenges, such as unreliable mobile phone connectivity, hindered TSP, while high costs and limited awareness were barriers to SMHS. Government policies played a dual role, fostering trust in digital interventions while inadvertently limiting access for some. Lay counselor attributes, including on-phone session flexibility times and rapport-building skills, were critical facilitators. Conclusion: TSP presents a viable alternative to SMHS, particularly for youth facing financial and logistical barriers to accessing facility-based mental health services. However, optimizing its delivery requires addressing technological constraints, ensuring consistent government support, and integrating mental health literacy initiatives. Findings underscore the need for flexible and contextually tailored models that leverage technology and address individual and systemic barriers to enhance mental health service access in resource-constrained settings.

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