Abstract

BackgroundThe Theory of Change (ToC) approach has been used to develop and evaluate complex health initiatives in a participatory way in high income countries. Little is known about its use to develop mental health care plans in low and middle income countries where mental health services remain inadequate.AimsToC workshops were held as part of formative phase of the Programme for Improving Mental Health Care (PRIME) in order 1) to develop a structured logical and evidence-based ToC map as a basis for a mental health care plan in each district; (2) to contextualise the plans; and (3) to obtain stakeholder buy-in in Ethiopia, India, Nepal, South Africa and Uganda. This study describes the structure and facilitator’s experiences of ToC workshops.MethodsThe facilitators of the ToC workshops were interviewed and the interviews were recorded, transcribed and analysed together with process documentation from the workshops using a framework analysis approach.ResultsThirteen workshops were held in the five PRIME countries at different levels of the health system. The ToC workshops achieved their stated goals with the contributions of different stakeholders. District health planners, mental health specialists, and researchers contributed the most to the development of the ToC while service providers provided detailed contextual information. Buy-in was achieved from all stakeholders but valued more from those in control of resources.ConclusionsToC workshops are a useful approach for developing ToCs as a basis for mental health care plans because they facilitate logical, evidence based and contextualised plans, while promoting stakeholder buy in. Because of the existing hierarchies within some health systems, strategies such as limiting the types of participants and stratifying the workshops can be used to ensure productive workshops.

Highlights

  • The Theory of Change (ToC) approach has been used to develop and evaluate complex health initiatives in a participatory way in high income countries

  • The ToC workshops achieved their stated goals with the contributions of different stakeholders

  • ToC workshops are a useful approach for developing ToCs as a basis for mental health care plans because they facilitate logical, evidence based and contextualised plans, while promoting stakeholder buy in

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Summary

Introduction

The Theory of Change (ToC) approach has been used to develop and evaluate complex health initiatives in a participatory way in high income countries. Little is known about its use to develop mental health care plans in low and middle income countries where mental health services remain inadequate. In order to expand and improve access, Theory of Change (ToC) is a participatory theory driven approach to programme design and evaluation whose underlying principle is to improve our understanding of how and why a programme works [7]. This is achieved through the development of a ToC, or programme theory, which describes the causal pathways through which a programme is hypothesised to have an effect. The ToC is often displayed visually as a ToC map [10]

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