Vol. 2 No. 1 (2026)

Research Articles

Community health workers’ perceptions of depression and barriers and facilitators to mental health care in Sierra Leone: A qualitative study {under peer review}

Published 23-03-2026

  • Augustus Osborne
    • ,
  • Abdul Jalloh
    • ,
  • Dimitar Karadzhov

Augustus Osborne
Institute for Development, Western area, Freetown, Sierra Leone

Abdul Jalloh
1) School of Health and Wellbeing, College of Medical Veterinary & Life Sciences, University of Glasgow, UK; 2) Ministry of Health, Western area, Freetown, Sierra Leone; 3) Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone

Dimitar Karadzhov
School of Health and Wellbeing, College of Medical Veterinary & Life Sciences, University of Glasgow, United Kingdom (UK)

Abstract

Background: Sierra Leone has a substantial mental health treatment gap, driven by limited resources, stigma, and a shortage of specialised personnel. Community health workers (CHWs) play an important role in frontline care, yet their mental health literacy and preparedness to support people with depression remain underexplored.

Objectives: This study aimed to assess CHWs’ knowledge of depression, examine their perceptions of barriers and facilitators to mental health care in Sierra Leone, and explore their experiences of delivering care during the COVID-19 pandemic.

Methods: A qualitative descriptive study was conducted in 2022 with 10 CHWs recruited through purposive and snowball sampling from Freetown and Kono District, Sierra Leone. Data were collected through remote semi-structured interviews using a vignette describing depression with suicidality. A hybrid deductive–inductive thematic analysis was undertaken using NVivo 12. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results: Most participants (70%) correctly identified the vignette as depression, although none explicitly recognised suicidal ideation as a major clinical risk. Life events were the most commonly identified causes, while biological, spiritual, and supernatural explanations were not mentioned. Five themes were developed: mental health literacy, need for change, barriers to mental health care, accessing care, and the status of mental health care during COVID-19. Key barriers included stigma, misconceptions, poverty, weak planning and coordination, insufficient government support, and limited community awareness. Suggested facilitators included mental health training, community sensitisation, stronger policies, improved service integration, and greater system-level commitment.

Conclusions: CHWs demonstrated partial recognition of depression but important gaps remained in identifying suicide risk and understanding the broader clinical dimensions of depression. Strengthening CHW training, supervision, community engagement, and mental health system coordination may improve access to culturally responsive and effective mental health care in Sierra Leone.

Keywords

Mental health, Mental health literacy, depression, Community health workers

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