Caring and thriving: An international qualitative study of caregivers of orphaned and vulnerable children and strategies to sustain positive mental health

•Similar positive mental health strategies were named by caregivers in four countries.•Engaging in enjoyable/meaningful time with children may improve caregivers' emotions.•Caregiver strategies to sustain positive mental health included religious practices.•Caregiver strategies to sustain positive mental health included emotion regulation.•Taking breaks from caregiving was named less often than other strategies.