Delivering low-intensity psychological interventions in low- and middle-income countries: A systematic review and meta-ethnographic synthesis of lay health workers' experiences.

Task-sharing psychological treatment to non-specialist providers, including lay health workers (LHWs), is central to WHO guidance in low- and middle-income countries (LMICs). LHWs are community members without formal mental health qualifications who are trained to deliver low-intensity psychological interventions (LIPIs) for depression and anxiety. Although trials show LHW-delivered LIPIs can reduce symptoms, less is known about LHWs' experiences or the relational and emotional demands of delivery. This review synthesised qualitative evidence on LHWs' experiences of delivering LIPIs in LMICs. We searched CINAHL, Embase, PsycINFO, MEDLINE, Cochrane Central, ASSIA and ProQuest Dissertations & Theses Global to June 2025, supplemented by grey-literature searches. We included qualitative, mixed-methods studies reporting interview or focus group data from LHWs delivering LIPIs for adults with depression and/or anxiety. Data were synthesised using meta-ethnography; quality and confidence were assessed using CASP and GRADE-CERQual. Thirty-three publications representing 28 studies from Africa, Asia and Latin America were included. Four themes were generated: doing more than psychological therapy; embedded in the community yet precariously held by the system; growing in the role; and the hidden cost of caring. Task-shifting redistributes not only technical tasks but also relational and emotional labour to LHWs, requiring support through training, supervision, safety and remuneration.