Stakeholder perspectives on the anticipated acceptability of low-intensity psychological interventions in Java, Indonesia: A theoretically framed qualitative study
6 affiliations
- 1Department of Mental Health Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- 2Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- 3Department of Mental Health Nursing, Faculty of Health Sciences, Universitas Brawijaya, Malang, Indonesia
- 4Marzoeki Mahdi Hospital, Bogor, Indonesia
- 5Faculty of Psychology, Universitas Semarang, Semarang, Indonesia
- 6Radjiman Wediodiningrat Hospital, Malang, Indonesia
Abstract
Introduction: Depression and anxiety remain major, largely unaddressed drivers of disability in low- and middle-income countries (LMICs), where scarce resources and persistent stigma constrain access to care. Scalable solutions are urgently needed. Low-intensity psychological interventions, delivered by trained non-specialists offer a promising pathway to close the treatment gap. This study examines the prospective acceptability of these interventions in Java, Indonesia, an exemplar of an under resourced health system, to guide targeted cultural adaptation and inform optimal implementation. Methods: Using a qualitative descriptive design guided by the Theoretical Framework of Acceptability (TFA), we conducted semi-structured interviews (n = 33) with people experiencing anxiety and depression and 21 focus groups with families (n = 34), health workers (n = 36), and community/religious leaders (n = 37) across 12 sites in Java. Data were collected in Bahasa/local languages, transcribed, translated, and analysed using TFA informed Framework Analysis. 5% of translations were independently back-verified. Stakeholder workshops and advisory panels shaped study design and interpretation. Results: Low mental health literacy and stigma undermined intervention coherence and affective attitude, with many conflating LIPIs with general counselling. Help-seeking was often delayed until distress became severe, reflecting limited understanding of mental health problems and available support. Despite these challenges, strong perceptions of effectiveness and positive affective attitudes were driven by cultural values of self-reliance and community support. Concerns centered on ethicality, particularlyprivacy risks and fear of social judgment, alongside undercertainty regarding the role of traditional healers and the burden associated with time and workload demands. Trust in lay health workers was high in rural areas but more variable in urban contexts. Conclusion: Findings highlight that cultural, structural, and interpersonal factors shape anticipated intervention acceptability. While stigma and low literacy remain barriers, strong perceived need and cultural alignment suggest the potential for promising subsequent uptake. Addressing privacy, role clarity, and logistical burden through tailored adaptations and partnerships is critical. This study offers one of the first theoretically framed qualitative explorations of LIPI acceptability in Southeast Asia, highlighting culturally congruent pathways for subsequent LMIC implementation.
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BibTeX
@article{susanti2026stakeholder,
title = {{Stakeholder perspectives on the anticipated acceptability of low-intensity psychological interventions in Java, Indonesia: A theoretically framed qualitative study}},
author = {Herni Susanti and Novitri Nurimani Asha and Penny Bee and Heni Dwi Windarwati and Budi Anna Keliat and Atik Puji Rahayu and Amy Blakemore and Afni Handayani and Mochamad Ali Sodikin and Helen Brooks},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358869},
url = {https://doi.org/10.1371/journal.pone.0358869},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Stakeholder perspectives on the anticipated acceptability of low-intensity psychological interventions in Java, Indonesia: A theoretically framed qualitative study
AU - Herni Susanti
AU - Novitri Nurimani Asha
AU - Penny Bee
AU - Heni Dwi Windarwati
AU - Budi Anna Keliat
AU - Atik Puji Rahayu
AU - Amy Blakemore
AU - Afni Handayani
AU - Mochamad Ali Sodikin
AU - Helen Brooks
PY - 2026
DA - 2026/09/29
JO - PLOS One
DO - 10.1371/journal.pone.0358869
UR - https://doi.org/10.1371/journal.pone.0358869
AB - Introduction: Depression and anxiety remain major, largely unaddressed drivers of disability in low- and middle-income countries (LMICs), where scarce resources and persistent stigma constrain access to care. Scalable solutions are urgently needed. Low-intensity psychological interventions, delivered by trained non-specialists offer a promising pathway to close the treatment gap. This study examines the prospective acceptability of these interventions in Java, Indonesia, an exemplar of an under resourced health system, to guide targeted cultural adaptation and inform optimal implementation. Methods: Using a qualitative descriptive design guided by the Theoretical Framework of Acceptability (TFA), we conducted semi-structured interviews (n = 33) with people experiencing anxiety and depression and 21 focus groups with families (n = 34), health workers (n = 36), and community/religious leaders (n = 37) across 12 sites in Java. Data were collected in Bahasa/local languages, transcribed, translated, and analysed using TFA informed Framework Analysis. 5% of translations were independently back-verified. Stakeholder workshops and advisory panels shaped study design and interpretation. Results: Low mental health literacy and stigma undermined intervention coherence and affective attitude, with many conflating LIPIs with general counselling. Help-seeking was often delayed until distress became severe, reflecting limited understanding of mental health problems and available support. Despite these challenges, strong perceptions of effectiveness and positive affective attitudes were driven by cultural values of self-reliance and community support. Concerns centered on ethicality, particularlyprivacy risks and fear of social judgment, alongside undercertainty regarding the role of traditional healers and the burden associated with time and workload demands. Trust in lay health workers was high in rural areas but more variable in urban contexts. Conclusion: Findings highlight that cultural, structural, and interpersonal factors shape anticipated intervention acceptability. While stigma and low literacy remain barriers, strong perceived need and cultural alignment suggest the potential for promising subsequent uptake. Addressing privacy, role clarity, and logistical burden through tailored adaptations and partnerships is critical. This study offers one of the first theoretically framed qualitative explorations of LIPI acceptability in Southeast Asia, highlighting culturally congruent pathways for subsequent LMIC implementation.
SN - 1932-6203
ER -