Using a theory driven approach to develop and evaluate a complex mental health intervention: the friendship bench project in Zimbabwe.

Epiphany Munetsi,Ruth Verhey,Crick Lund,Dixon Chibanda,Frances M Cowan

doi:10.1186/s13033-016-0050-1

Abstract

BackgroundThere is a paucity of data on how to deliver complex interventions that seek to reduce the treatment gap for mental disorders, particularly in sub-Saharan Africa. The need for well-documented protocols which clearly describe the development and the scale-up of programs and interventions is necessary if such interventions are to be replicated elsewhere. This article describes the use of a theory of change (ToC) model to develop a brief psychological intervention for common mental disorders and its’ evaluation through a cluster randomized controlled trial in Zimbabwe.MethodsA total of eight ToC workshops were held with a range of stakeholders over a 6-month period with a focus on four key components of the program: formative work, piloting, evaluation and scale-up. A ToC map was developed as part of the process with defined causal pathways leading to the desired impact. Interventions, indicators, assumptions and rationale for each point along the causal pathway were considered.ResultsPolitical buy-in from stakeholders together with key resources, which included human, facility/infrastructure, communication and supervision were identified as critical needs using the ToC approach. Ten (10) key interventions with specific indicators, assumptions and rationale formed part of the final ToC map, which graphically illustrated the causal pathway leading to the development of a psychological intervention and the successful implementation of a cluster randomized controlled trial.ConclusionToC workshops can enhance stakeholder engagement through an iterative process leading to a shared vision that can improve outcomes of complex mental health interventions particularly where scaling up of the intervention is desired.

Highlights

There is a paucity of data on how to deliver complex interventions that seek to reduce the treatment gap for mental disorders, in sub-Saharan Africa
Such an approach has been used in the program for improving mental health care (PRIME) [5], a multi-country complex intervention aimed at generating evidence on how to integrate mental health into primary care through the development, implementation and evaluation of district level mental health care plans for priority disorders [16]
This paper describes the manner in which the theory of change (ToC) model was used to design and evaluate a successful cluster randomized controlled trial (RCT) and a scale-up plan [20]

Summary

Introduction

There is a paucity of data on how to deliver complex interventions that seek to reduce the treatment gap for mental disorders, in sub-Saharan Africa. The process of developing a ToC starts early during an initiative with key stakeholders invited to develop a common vision that describes the causal pathway leading to the program/initiative/intervention goal During this process, specific outcomes, indicators, assumptions, barriers and interventions are identified to ensure that the desired outcomes are realized [14]. A series of meetings and workshops with relevant stakeholders is the main vehicle for developing a theory of change map Such an approach has been used in the program for improving mental health care (PRIME) [5], a multi-country complex intervention aimed at generating evidence on how to integrate mental health into primary care through the development, implementation and evaluation of district level mental health care plans for priority disorders [16]

Methods

Results

Discussion

Conclusion