Beliefs, Barriers, and Enablers: A Qualitative Study on Adapting a Low-Intensity Psychosocial Intervention (LIPI) in Eastern Indonesia

Background Mental health services in Indonesia are inequitably distributed, with Eastern regions such as North Maluku experiencing higher depression and anxiety prevalence than the national average. While task-shifting interventions such as Low-Intensity Psychosocial Interventions (LIPIs) show promise, implementation without cultural adaptation may limit uptake. Methods To explore local beliefs and inform cultural adaptation, this qualitative study involved 29 participants (patients, caregivers, health workers, community lay workers/cadres, and religious leaders) in Ternate, North Maluku. Data were analyzed using Reflexive Thematic Analysis at the latent level, utilizing embodied cognition and cognitive load as theoretical lenses to capture cultural assumptions and map implementation needs. Results Analysis revealed a profound epistemological gap Anxiety is framed physiologically as ‘Maag takut-takut’ (fearful gastritis), and behavioral changes are attributed to mysticism (‘Guna-guna’), leading to the rejection of clinical terminology. Participants rejected text-based materials due to cognitive overload, preferring oral and visual tools. Acceptance was contingent upon validation by religious and community leaders. Conclusions Transferring interventions is unlikely to succeed without cultural adaptation. Implementation strategies should prioritize somatic visual tools, align care with religious duties, and formalize the engagement of religious and community leaders to enhance acceptability.