Background
Health systems in low-resource settings, especially in low- and middle-income countries (LMICs), need scalable models to address the mental health and psychosocial (MHPSS) needs among people affected by cancer. Self-Help Plus (SH+), a WHO program based on Acceptance and Commitment Therapy, offers standardized, audio-visual lessons that teach participants stress management skills and can be delivered by non-specialists in clinics or community settings. We translated and adapted SH+ for Viet Nam (vSH+), condensing delivery into 4 brief sessions supported by slide decks integrated with audios, illustrations, and facilitator notes. We embedded a structured training and supervision package for oncology nurses (facilitators) and cancer survivors (co-facilitators) to enable task-shifting, ensure fidelity, and integrate vSH+ into routine care pathways, positioning it as a system-level approach to early psychosocial support in resource-constrained oncology services.

Objectives

• To assess the feasibility of vSH+ in reducing depressive and anxiety symptoms among patients newly diagnosed with cancer
• To qualitatively evaluate the acceptability of vSH+ among different stakeholders, including patients, caregivers, implementers (oncology nurses, cancer survivors), and hospital administrators
• To inform health systems strategies for workforce training and scalable implementation of MHPSS in low-resource oncology settings

Methods
We conducted a randomized controlled trial among newly diagnosed breast/gynecologic cancer patients in six hospitals in Viet Nam, allocating participants to enhanced usual care or vSH+. Primary outcomes were depression (PHQ-9) and anxiety (GAD-7); secondary outcomes were quality of life (EQ-5D-5L) functioning (FACT-G), psychological flexibility (AAQ-II), and social support (MOS-SSS). Surveys occurred at baseline (T0), 1–2 weeks post-intervention (T1), and 4-month follow-up (T2). After vSH+ sessions concluded, we conducted a qualitative process evaluation, which included in-depth interviews (IDIs) with patients, implementers and healthcare staff, and focus group discussions (FGDs) with caregivers.


Results
The control group (n=51) showed no significant changes. The vSH+ group (n=54) improved from baseline to T2 in depression, psychological flexibility, quality of life, functioning, and social support (all p<0.05). Linear mixed models showed a between-group difference in depression at T2 favoring vSH+ (p=0.038; Cohen’s d=0.35), consistent with a small-to-medium effect. Rapid qualitative analysis of IDIs and FGDs indicated high acceptability across stakeholder groups. Patients valued learning practical stress management skills, which helped them cope with treatment. Nurse facilitators and peer co-facilitators found the training package and scripted materials enabled fidelity and reported the intervention was easy to deliver. Peer involvement enhanced rapport and engagement. Reported barriers included scheduling around chemotherapy and transportation barriers.


Conclusions/Implications
Brief psychological interventions such as vSH+/SH+ are feasible to implement to provide MHPSS in oncology settings. These findings support health systems investment in task-shifted mental health training, integration into care pathways, structured supervision, and fidelity supports. Larger, longer trials should assess durability, anxiety outcomes, cost-effectiveness, and implementation metrics (acceptability, feasibility, fidelity, sustainability) to guide scale-up across oncology services in Viet Nam and similar low-resource contexts.