Tele-mental health for frail older adults in rural Bangladesh: a phenomenological study

Abstract Background Frail older adults in rural Bangladesh face a high burden of unmanaged depression and anxiety due to limited access to mental health care. Tele-mental health services offer a promising alternative to address these gaps. This study explored how frail older adults cope with mental health challenges and assessed a facility-based tele-mental health intervention, including its acceptability, barriers, adoption, appropriateness, and provider insights on feasibility and sustainability. Methods We conducted a qualitative phenomenological study in 3 rural districts of Bangladesh. Purposive sampling was used to recruit frail older adults (≥ 60 years) with depression and anxiety, alongside psychologists and medical officers engaged in tele‑mental health counselling. Data were collected between March and June 2025 through 12 in‑depth interviews with older adults and 8 key informant interviews with service providers using semi‑structured guideline. Results Older adults often viewed emotional distress as part of aging and coped through prayer and daily routines. Stigma, low awareness, and practical barriers especially for women hindered access to mental health care. Those who used the tele-mental health counselling service, initially skeptical, later found it helpful and encouraged peers to attend. Providers described the service helpful for underserved older adults but identified gaps in infrastructure, awareness, and integration with the public healthcare system. Conclusion Participants described facility-based tele-mental health counselling as acceptable and appropriate for frail older adults, meeting their needs and preferences for privacy, empathy, and culturally familiar coping. So, improving support for this group requires reducing stigma, raising awareness, and integrating services into routine primary healthcare.