{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:35:53Z","timestamp":1790289353808,"version":"4.1.0"},"reference-count":52,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"POSSIBLE AFRICA Initiative","award":["POS-24-07"],"award-info":[{"award-number":["POS-24-07"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,22]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This study aimed to examine the contextual barriers that may hinder the implementation of multiple family group therapy (MFGT) in Ghana\u2019s Lower Manya Krobo District.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>An exploratory, descriptive, qualitative study employing focus group discussions and in-depth interviews.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Atua Government Hospital in the Lower Manya Krobo District. Data were collected between February and March 2025.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>12 young people living with HIV (YPLHIV; aged 12\u201322 years), 13 caregivers and five healthcare professionals were selected via purposive sampling.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Four major themes emerged: (1) resource and logistic constraints, including transportation challenges, programme sustainability concerns and inadequate physical facilities; (2) stigma and confidentiality concerns, encompassing public identification fears and community stigma; (3) implementation challenges, involving attendance reliability and organisational instability; and (4) participation barriers, including group setting anxiety and delayed HIV status disclosure. These barriers spanned multiple domains of the Consolidated Framework for Implementation Research (CFIR), highlighting the complex, multi-level nature of implementation challenges.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Successful implementation of MFGT for YPLHIV in Ghana requires addressing interrelated barriers across multiple ecological levels simultaneously. These findings largely underscore the importance of exploring the local context for potential barriers to inform the adaptation of evidence-based interventions to accommodate ecological concerns.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06701942\">NCT06701942<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-105448","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T17:36:42Z","timestamp":1757353002000},"page":"e105448","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Stakeholder perspectives on contextual barriers to the successful implementation of multiple family group therapy in the Lower Manya Krobo District, Ghana: a qualitative study"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct06701942","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6153-1273","authenticated-orcid":false,"given":"Dorothy Serwaa","family":"Boakye","sequence":"first","affiliation":[{"name":"Health Administration and Education, University of Education Winneba, Winneba, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9308-6031","authenticated-orcid":false,"given":"Samuel","family":"Adjorlolo","sequence":"additional","affiliation":[{"name":"Department of Mental Health Nursing, University of Ghana, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"2025090810352460000_15.9.e105448.1","doi-asserted-by":"crossref","DOI":"10.7448\/IAS.16.1.18593","article-title":"Understanding the mental health of youth living with perinatal HIV infection: lessons learned and current challenges","volume":"16","author":"Mellins","year":"2013","journal-title":"J Int AIDS Soc"},{"key":"2025090810352460000_15.9.e105448.2","doi-asserted-by":"crossref","DOI":"10.7448\/IAS.20.4.21497","article-title":"Mental health challenges among adolescents living with HIV","volume":"20","author":"Vreeman","year":"2017","journal-title":"J Int AIDS Soc"},{"key":"2025090810352460000_15.9.e105448.3","doi-asserted-by":"crossref","first-page":"1392872","DOI":"10.3389\/fpubh.2024.1392872","article-title":"Prevalence of mental disorders among young people living with HIV: a systematic review and meta-analysis","volume":"12","author":"Zhan","year":"2024","journal-title":"Front Public Health"},{"key":"2025090810352460000_15.9.e105448.4","unstructured":"Doku PN . The mental health of orphans and vulnerable children within the context of hiv in ghana [doctoral dissertation]. University of Glasgow; 2012. 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