Feasibility and acceptability of lay counsellor-delivered single-session therapy: a pragmatic mixed-methods pilot cohort study protocol

Introduction

Common mental disorders (CMDs) are endemic globally. The availability of evidence-based mental health interventions has grown rapidly, with many services focused on psychotherapy. Most psychotherapies require multiple sessions, resulting in lengthy waiting times due to limited provider availability. These delays can lead to higher morbidity, poorer adherence and less favourable outcomes.

Recent research indicates that single-session therapy (SST) can be as effective as multi-session approaches and offers cost savings. This pragmatic, prospective mixed-methods pilot cohort study assesses the uptake, feasibility, acceptability, appropriateness and preliminary clinical effectiveness of SST in individuals receiving the Friendship Bench intervention. The Friendship Bench is a task-shifting mental health intervention for individuals with low to moderate symptoms of CMDs.

Methods and analysis

We will conduct a pragmatic, prospective, mixed-methods pilot interventional cohort study involving 350 first-time clients of the Friendship Bench intervention in Harare and surrounding periurban areas. We will primarily explore the intervention’s feasibility, uptake, appropriateness and acceptability including the feasibility of a larger follow-up clinical trial. Secondary outcomes include changes in CMDs severity, depression and anxiety symptoms, social connectedness, functional status, hope, resilience, health-related quality of life and therapeutic alliance. Participants will be followed for 6 weeks, with data collected at baseline and at 2, 4 and 6 weeks postintervention time points. A qualitative component will explore participants’ perspectives and experiences with SST. Quantitative data will be analysed using descriptive statistics, bivariate analysis, Cox proportional hazards models and generalised mixed models with maximum likelihood estimation. Qualitative data will be analysed thematically.

Dissemination and ethics

Ethical approval was granted by the Medical Research Council of Zimbabwe. Findings from this study will contribute to the evidence base for SST in the management of CMDs and may inform mental health service delivery in low-resource settings. Results will be disseminated through peer-reviewed publications, conference presentations, social media platforms and policy briefs.

Clinical trial registration

PACTR202605687485459