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The systematic use of implementation strategies can enhance sustainable implementation of evidence-based interventions in real-world settings. However, there are little data on the use of implementation strategies in low-resourced settings. The World Health Organization Caregiver Skills Training Programme (WHO-CST) for families of children with developmental disabilities was piloted in a rural setting in South Africa and was called the 'Diamond Families Project'. The goal of this study was to describe systematically the implementation strategies used during the planning phase of the project. Archival project records were reviewed to identify all planning activities, which were coded into implementation strategies using a tailored manual and consensus coding approach. We identified 150 activities representing 33 unique implementation strategies across nine categories. Developing stakeholder interrelationships was the most frequently used category, with the largest number of actors, highest costs, and longest cumulative duration. Developing an implementation blueprint was the most frequently used individual strategy, while promoting adaptability had the longest duration. The Diamond Families Project incorporated a comprehensive set of implementation strategies with a clear focus on building stakeholder relationships. Findings contribute to an evidence-base of implementation strategies for WHO-CST in South Africa, which may inform the implementation of interventions in similar low-resourced settings.

As mental health-related stigma is a significant barrier to seeking and receiving healthcare, stigma amongst non-specialist health workers (NSHWs) towards patients with major depressive disorder (MDD) and substance use disorder (SUD) could negatively affect mental health service provision. This study aimed to explore (1) the level of stigma towards MDD and SUD among NSHWs employed in primary care settings in South Africa, (2) the extent to which socio-demographic factors might be associated with stigma levels amongst these NSHWs, and (3) NSHWs' interest in receiving training for MDD or SUD. Overall, 81 NSHWs completed a culturally modified version of the Social Distance Scale (SDS) that assessed stigma towards a hypothetical patient with MDD and a hypothetical patient with SUD; higher cumulative SDS scores represented greater stigma. With a possible range of 6-24, we found a mean SDS score of 9.0 (SD=3.7) for MDD and 11.7 (SD=4.4) for SUD. Results show elevated levels of stigma towards both hypothetical patients, with significantly higher mean SDS scores for SUD compared to MDD (p <0.001). No socio-demographic variables were significantly associated with MDD or SUD stigma levels. When asked to rate their interest, more NSHWs were “very interested” in receiving training for MDD (90.0%) than for SUD (80.8%); this difference was statistically significant (p=0.027). High levels of self-reported stigma, coupled with a desire for further training, suggest that it would be prudent to incorporate stigma reduction measures into future MDD and SUD training programmes for NSHWs.

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