Table 2 Summary of 71 factors expected to influence training of Kenyan mental health non-specialist workforce, organized by cluster with mean importance and changeability ratings and Go-Zone quadrant

1 Current workforce characteristics

(20) Resistance from professionals who see task shifting as poor medicine for poor people

3.3571

3.5385

1

(21) High turn-over of trained workers

3.8333

3.9167

1

(65) Do not introduce a new mental health cadre

1.6667

2.3846

1

(1) High staff turnover negatively affects such collaborative efforts

4.3077

4.0769

2

(47) Unmotivated workforce

4.2143

3.9231

2

(18) Lack of clear roles and responsibilities

3.9167

4.25

3

2 Exploration considerations

(31) Ministry of Health view that mental health non-specialist workforce are not a reliable cadre of personnel

3.2143

3.4615

1

(45) Quality of health services

4.3333

3.9231

2

(63) Engage professionals from different fields as non-specialist providers

4.0833

3.9231

2

(3) Lack of ownership and responsibility from the Ministry of Health officials

4.3077

4.2727

4

(17) Limited knowledge about mental illness prevents individuals from recognizing mental illness and seeking treatment

4.4

4.3077

4

3 Preparation considerations

(22) Few satellite research centers to support SMART-DAPPER

3.9167

4.0714

1

(23) Low awareness about the SMART-DAPPER research

3.7

3.9091

1

(25) Negative attitudes toward SMART-DAPPER research

2.5385

4.1

1

(26) Poverty

3.3846

3.1667

1

(51) Scalability challenges

3.6154

4.0833

1

(29) Misperceptions and belief systems about the causes of mental illnesses

4.2308

3.2727

2

4 Sustainment considerations—outer context

(24) Insufficient participant reimbursement rates

3.2308

3.6667

1

(48) Government jobs are sought after

2.9091

2.9167

1

(50) Consider stakeholder turnover during implementation

3.5833

3.6923

1

(52) Sustainment challenges

3.9167

4

1

5 Inner context implementation processes and tools

(2) Provision of electronic navigation

3.6923

3.5455

1

(14) Provide in-person navigation

3.8333

4.1111

1

(39) Addition to EMS

4.25

4.0909

2

(4) Timely communication, both formal and informal

4.4

4.1818

4

(7) Effective treatment of mentally ill patient

4.1667

4.25

4

(58) Supervision for non-specialized providers

4.4

4.4545

4

(15) Follow-up with participants at the community level to better understand access to care issues

4.4615

4.6154

4

6 Local capacity and partnerships

(69) Have a village health team (local people within the community)

3.9167

4.0833

1

(27) Identify partners with shared interests

4.7857

4

2

(6) Community mental health service seeking

4.2667

4.2143

4

(40) Initiate sensitization sessions with stakeholders about mental health service delivery

4.2727

4.5385

4

(68) Ministry supported community health workers

4.5455

4.2143

4

7 Financing for community health teams

(53) Payment for village health teams

3.4167

3.9

1

(57) Engage village health team members to provide care

3.8462

4

1

(34) Facilitate airtime reimbursement

4.0909

3.9091

2

(41) Allocated financial resources (budgeted funds for this scale-up process)

4.4615

4.3846

4

(10) Political will/support

4.5385

4.5833

4

8 Outer context resource allocations/policy into action

(5) Timely mental health assessment and treatment

4.4

4.0714

2

(56) Add mental health education to the village health team manual

4.2727

4.0909

2

(9) Availability of medicines

4.0833

4.2857

4

(16) Survey questions should yield appropriate information about participant needs

4.5455

4.5

4

(30) Engage government (e.g., Ministry of Health, Ministry of Education, etc.) leadership in initial planning activities

4.7143

4.4545

4

(35) Availability of mental health services in all levels of healthcare delivery points

4.8462

4.5

4

(36) Government and leadership policies that promote sustainability

4.6154

4.4615

4

(46) The county's commitment to improving mental healthcare

4.5

4.4286

4

(66) Use existing community health strategy

4.1429

4.3077

4

(8) Availability of drugs, equipment and commodity needed for mental health treatment

4.5

4.6364

4

9 Workforce characteristics to enhance during implementation

(32) Non-specialist workforce should play a major role

3.5455

3.75

1

(11) Workforce capacity—staffing

4.5

4.1538

4

(12) Workforce qualifications, skill level

4.1667

4.2308

4

10 Workforce implementation strategies

(59) Train psychologists to supervise community health workers

3.3636

3.9

1

(42) Capacity building of healthcare workers at all levels in management of mental health

4.5

4.7692

4

(44) Offering continuous medical education to the providers

4.6364

4.3636

4

(61) Train nurses and clinical officers on IPT

4.5385

4.5833

4

(70) Involve educational institutions

4.4615

4.4615

4

11 Cross level workforce strategies

(67) Integrate non-specialists into government service system

3.9

4

1

(71) Non-specialists help address stigma

4.0714

4.0909

1

(33) Availability of human capital in the health products and technology field

4.1818

4.0909

2

(13) Collaboration between the Ministry of Health and mental health non-specialist workforce in implementing training program

4.7143

4.5385

4

(19) Clear definition for identifying the mental health non-specialist workforce

4.3636

4.2727

4

(37) Government and leadership policies that promote continuous mentorship/training for the mental health non-specialist workforce

4.4167

4.1818

4

(38) Collaborative, public–private partnerships to build capacity for non-specialist workforce

4.3636

4.3636

4

(49) Identify who will be trained (e.g., police, teachers)

4.1667

4.2143

4

(60) Have a targeted mental health curriculum

4.2727

4.6429

4

(64) Make the existing mental health cadre more competent

4.6

4.4167

4

12 Training and education recommendations

(54) Training manual should be brief

3.5

4

1

(62) Provide a certificate for IPT

3.6154

4.4167

3

(43) Expansion of mental healthcare from hospital to learning institutions

4.4545

4.4545

4

(55) Training manual should be modular

4.1

4.1429

4

(28) Enhance psychoeducation

4.4615

4.6667

4