Abstract
BackgroundFew studies have evaluated the implementation and impact of real-world mental health programmes delivered at scale in low-resource settings.AimsTo describe the cross-country research methods used to evaluate district-level mental healthcare plans (MHCPs) in Ethiopia, India, Nepal, South Africa and Uganda.MethodMultidisciplinary methods conducted at community, health facility and district levels, embedded within a theory of change.ResultsThe following designs are employed to evaluate the MHCPs: (a) repeat community-based cross-sectional surveys to measure change in population-level contact coverage; (b) repeat facility-based surveys to assess change in detection of disorders; (c) disorder-specific cohorts to assess the effect on patient outcomes; and (d) multilevel case studies to evaluate the process of implementation.ConclusionsTo evaluate whether and how a health-system-level intervention is effective, multidisciplinary research methods are required at different population levels. Although challenging, such methods may be replicated across diverse settings.
Highlights
Few studies have evaluated the implementation and impact of real-world mental health programmes delivered at scale in low-resource settings.disorders; (c) disorder-specific cohorts to assess the effect on patient outcomes; and (d) multilevel case studies to evaluate the process of implementation
A suite of four studies was developed to answer the key crosscountry research questions, capturing all the cross-country indicators from the cross-country theory of change (ToC). These comprise: (a) community survey: a repeat cross-sectional community survey to measure contact coverage for adults with depression or alcohol use disorders; (b) facility detection survey: repeat cross-sectional facility-based survey to measure detection of depression or alcohol use disorders and initiation of correct treatment; (c) treatment cohorts: follow-up of patients diagnosed with depression, alcohol use disorders, psychosis or epilepsy to assess the change in a range of individual patient outcomes, with additional follow-up of caregivers of people with psychosis or epilepsy; and (d) case study: a range of qualitative and quantitative methods to evaluate the process of implementing the mental healthcare plans (MHCPs) in each district
A core set of data-collection tools are used across all study designs to ensure that key domains such as patient outcomes are measured consistently to facilitate comparisons across countries between the different study designs and across time
Summary
Few studies have evaluated the implementation and impact of real-world mental health programmes delivered at scale in low-resource settings. Disorders; (c) disorder-specific cohorts to assess the effect on patient outcomes; and (d) multilevel case studies to evaluate the process of implementation. Aims To describe the cross-country research methods used to evaluate district-level mental healthcare plans (MHCPs) in Ethiopia, India, Nepal, South Africa and Uganda. Method Multidisciplinary methods conducted at community, health facility and district levels, embedded within a theory of change
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