Primary health care providers’ readiness to implement the WHO mental health Gap Action Programme Intervention Guide (mhGAP-IG) for alcohol use disorder in rural Uganda: a qualitative study using CFIR

Abstract

Background Alcohol Use Disorder (AUD) is a major public health concern in Uganda, yet detection and man¬agement at the primary health care (PHC) remain limited. The World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) provides evidence-based recommendations for managing AUD in non-specialist settings. However, little is known about the multilevel determinant influencing PHC providers’ readiness to implement these recommendations in routine practice. This study examined determinants influenc¬ing readiness to implement mhGAP-IG recommendations for AUD management in rural Uganda. Methods We conducted a qualitative exploratory study involving PHC providers and district health team mem¬bers in a predominantly rural district in southwestern Uganda. Participants were purposively selected to capture variation across professional cadres and health system roles. Individual in-depth interviews were conducted using a semi-structured guide informed by the Consolidated Framework for Implementation Research (CFIR). Data were analyzed using a deductive–inductive thematic approach to examine determinants across intervention char-acteristics, outer setting, inner setting, individual characteristics, and implementation process domains. Results Eighteen participants were interviewed including 15 PHC providers and 3 district health team members. Readiness to implement mhGAP-IG recommendations for AUD was shaped by interacting determinants across CFIR domains. Providers generally perceived the recommendations as useful and feasible for non-specialist practice and expressed strong willingness to improve AUD care. However, limited familiarity with mhGAP-IG and gaps in clinical competencies interacted with organizational constraints, including high workloads, limited medicines and educational materials, weak documentation and referral systems, and inconsistent supervision. Community normalization of alcohol use, stigma, geographical barriers, weak alcohol policy enforcement, and limited financing further constrained readiness. Participants emphasized that implementation would require more than provider training, highlighting the need for practical decision-support tools, integration into routine work¬flows and documentation systems, stakeholder engagement, and ongoing monitoring and supportive supervision. Conclusion Provider willingness and favorable perceptions of mhGAP-IG provide an important foundation for implementation but are insufficient to establish implementation readiness. Readiness depends on alignment between intervention usability, provider capability, organizational capacity, and the broader community and health system context. Implementation strategies should therefore combine competency-based training with practical implementation tools, strengthened documentation and referral systems, integration into existing PHC workflows, district and community engagement, and ongoing supportive supervision.