Stakeholder perspectives on the scalability of a psychological intervention for alcohol misuse and psychological distress in wartime: A qualitative study in Ukraine

The war in Ukraine has intensified mental health vulnerabilities, including alcohol misuse among conflict-affected men. The CHANGE intervention, a transdiagnostic mental health programme building on WHO’s Problem Management Plus (PM+), addresses alcohol misuse and common mental disorders among conflict-affected populations. This study explores stakeholder perspectives on the scalability of CHANGE under active wartime conditions in Ukraine. Here, scalability refers to the potential for future scale-up rather than retrospective evaluation of actual scale-up, feasibility or effectiveness. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted online interviews with 20 stakeholders: 13 implementers, 2 adopters, and 5 maintainers. Perceived barriers in the outer setting included limited primary care referrals, lack of policy integration, societal stigma, normalization of alcohol use, competition among service providers, intersectoral trust gaps regarding NGOs and funding instability. Inner setting barriers included psychological distress among implementers and payment instability. Perceived facilitators across CFIR domains included established multisectoral partnerships, a supportive organizational environment, team professionalism, and strong motivation for implementation. The war introduced additional barriers, including service disruptions, insecurity and economic hardship. At the same time, the online adaptation of the intervention, and increased community engagement around mental health needs emerged as key facilitators. Suggested implementation strategies focused on strengthening stakeholder relationships, ensuring continues training and supervision, and engaging service users through awareness campaigns. Overall, findings from CHANGE provide contextually grounded insights for scaling psychological interventions in humanitarian and conflict-affected settings globally.