Abstract
BackgroundA considerable evidence base has been produced in recent years highlighting the effectiveness of brief scalable psychological interventions for people living in communities exposed to adversity. However, practical guidance on how to scale up these interventions to wider populations does not exist. In this paper we report on the use of Theory of Change (ToC) to plan the scale up of the World Health Organization’s flagship low intensity psychological intervention “Problem Management Plus” (PM+) for Syrian refugees in Turkey.MethodsWe conducted a one-day ToC workshop in Istanbul. ToC is a participatory planning process used in the development, implementation and evaluation of projects. It is similar to driver diagrams or logic models in that it offers a tool to visually present the components needed to reach a desired long-term outcome or impact. The overall aim of ToC is to understand the change process of a complex intervention and to map out causal pathways through which an intervention or strategy has an effect.ResultsTwenty-four stakeholders (including governmental officials, mental health providers, officials from international/national non-governmental organisations, conflict and health researchers) participated in the ToC workshop. A ToC map was produced identifying three key elements of scaling up (the resource team; the innovation and the health system; and the user organisation) which are represented in three distinct causal pathways. Context-specific barriers related to the health system and the political environment were identified, and possible strategies for overcoming these challenges were suggested.ConclusionToC is a valuable methodology to develop an integrated framework for scaling up. The results highlight that the scaling up of PM+ for Syrian refugees in Turkey needs careful planning and investment from different stakeholders at the national level. Our paper provides a theoretical foundation of the scaling up of PM+, and exemplifies for the first time the use of ToC in planning the scaling up of an evidence-based psychological intervention in global mental health.
Highlights
A considerable evidence base has been produced in recent years highlighting the effectiveness of brief scalable psychological interventions for people living in communities exposed to adversity
In a cross-sectional study conducted in a tent city in Gaziantep, Turkey, Alpak et al reported a post-traumatic stress disorder (PTSD) prevalence of 33.5% among Syrian refugees [8]
Three key elements of scaling up were identified which are represented in three distinct causal pathways
Summary
A considerable evidence base has been produced in recent years highlighting the effectiveness of brief scalable psychological interventions for people living in communities exposed to adversity. Refugees are often vulnerable to situational forms of psychosocial distress as a consequence of exposure to war and violence, potentially traumatic events experienced during the individual’s flight from their home country, and exposure to ongoing daily stressors in their new areas of settlement, such as impoverishment, unemployment, poor living conditions, social isolation and discrimination [5]. In a cross-sectional study conducted in a tent city in Gaziantep, Turkey, Alpak et al reported a PTSD prevalence of 33.5% among Syrian refugees [8]. Data from our own cross-sectional survey of Syrian refugees in Sultanbeyli, Istanbul revealed a prevalence of symptoms of PTSD, depression and anxiety of 19.6, 34.7 and 36.1% respectively [9]. Variability of prevalence estimates may result from differences in the conditions in which the respondents were living, and methodological differences between the surveys [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
