Community health workers fostering trust and engagement in a community-based intervention for depressive older adults in Peru: a qualitative study

Abstract

Background: Innovative community-driven approaches, such as task-sharing interventions with Community Health Workers (CHWs), are essential to reduce the mental health care gap. This study explored how CHWs’ actions, experiences, knowledge, and resources contributed to fostering the acceptability and feasibility of a community-based mental health intervention (VIDACTIVA) for older adults. Methods: We examined the role of CHWs (n = 16) delivering VIDACTIVA, an evidence-based CHW-led intervention for older adults with depression. VIDACTIVA integrates Problem-solving therapy and Behavioral Activation in eight home-based sessions. Data included in-depth interviews and field notes collected across a 3-year period of piloting, adaptation, and implementation. An inductive thematic analysis identified key CHW practices that enhanced the intervention’s engagement. Results: Sixteen CHWs (aged 39–72, median 60 years) participated. Three main themes emerged as central: (1) establishing trust with older adults through active listening, empathy, and addressing urgent needs; (2) adapting session settings and creatively introducing tools to sustain engagement; and (3) fostering strong peer support networks that enhanced CHWs’ confidence, learning, and commitment throughout implementation. Conclusion: CHWs play a pivotal role in community-based mental health interventions by building trust with participants, leveraging their community knowledge, and working as a collective that supports learning, self-care, and teamwork, factors that humanize care and strengthen the sustainability of programs. Trial registration: The current trial registration number is NCT06065020, which was registered on September 26, 2023.