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Planning and evaluating mental health services in low- and middle-income countries using theory of change

  • Erica Breuer (a1), Mary J. De Silva (a2), Rahul Shidaye (a3), Inge Petersen (a4), Juliet Nakku (a5), Mark J. D. Jordans (a6), Abebaw Fekadu (a7) and Crick Lund (a8)...
Abstract
Background

There is little practical guidance on how contextually relevant mental healthcare plans (MHCPs) can be developed in low-resource settings.

Aims

To describe how theory of change (ToC) was used to plan the development and evaluation of MHCPs as part of the PRogramme for Improving Mental health carE (PRIME).

Method

ToC development occurred in three stages: (a) development of a cross-country ToC by 15 PRIME consortium members; (b) development of country-specific ToCs in 13 workshops with a median of 15 (interquartile range 13–22) stakeholders per workshop; and (c) review and refinement of the cross-country ToC by 18 PRIME consortium members.

Results

One cross-country and five district ToCs were developed that outlined the steps required to improve outcomes for people with mental disorders in PRIME districts.

Conclusions

ToC is a valuable participatory method that can be used to develop MHCPs and plan their evaluation.

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Copyright
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
Corresponding author
Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa, Email: erica.breuer@uct.ac.za
Footnotes
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This paper was produced as part of the PRogramme for Improving Mental health carE (PRIME) funded by UK aid from the UK government. However, the views expressed do not necessarily reflect the UK government's official policies. M.J.D.S. is supported by a Wellcome Trust/London School of Hygiene and Tropical Medicine career fellowship.

Declaration of interest

None.

Footnotes
References
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1 Thara, R, John, S, Chatterjee, S. Community mental health teams in low- and middle-income countries. Epidemiol Psychiatr Sci 2014; 23: 119–22.
2 Saraceno, B, Van Ommeren, M, Batniji, R, Cohen, A, Gureje, O, Mahoney, J, et al. Barriers to improvement of mental health services in low-income and middle-income countries. Lancet 2007; 370: 1164–74.
3 World Health Organization. Mental Health Atlas 2011. WHO, 2011.
4 Kakuma, R, Minas, H, van Ginneken, N, Dal Poz, MR, Desiraju, K, Morris, JE, et al. Human resources for mental health care: current situation and strategies for action. Lancet 2011; 378: 1654–63.
5 World Health Organization. Mental Health Policy, Plans and Programmes. Mental Health Policy and Service Guidance Package. WHO, 2005.
6 Lund, C, Tomlinson, M, De Silva, M, Fekadu, A, Shidhaye, R, Jordans, M, et al. PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Med 2012; 9: e1001359.
7 Hanlon, C, Fekadu, A, Jordans, M, Kigozi, F, Petersen, I, Shidhaye, R, et al. District mental healthcare plans for five low- and middle-income countries: commonalities, variations and evidence gaps. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153767).
8 Connell, JP, Kubisch, AC. Applying a theory of change approach to the evaluation of comprehensive community initiatives: progress, prospects, and problems. In New Approaches to Evaluating Community Initiatives, Vol 2: Theory, Measurement, and Analysis (eds Fulbright-Anderson, K, Kubisch, AC, Connell, JP): 1544. The Aspen Institute, 1998.
9 Coryn, CLS, Noakes, LA, Westine, CD, Schroter, DC. A systematic review of theory-driven evaluation practice from 1990 to 2009. Am J Eval 2010; 32: 199226.
10 Cole, M. The health action zone initiative: lessons from Plymouth. Local Gov Stud 2003; 29: 99117.
11 Weitzman, BC, Mijanovich, T, Silver, D, Brecher, C. Finding the impact in a messy intervention: using an integrated design to evaluate a comprehensive citywide health initiative. Am J Eval 2009; 30: 495514.
12 Mason, P, Barnes, M. Constructing theories of change: methods and sources. Evaluation 2007; 13: 151–70.
13 Vogel, I. Review of the Use of ‘Theory of Change’ in International Development. Department for International Development, 2012.
14 Hernandez, M, Hodges, S. Applying a theory of change approach to interagency planning in child mental health. Am J Commun Psychol 2006; 38: 165–73.
15 Andersen, A. A Community Builder's Approach to Theory of Change: A Practical Guide to Theory Development. The Aspen Insitute, 2004.
16 Blamey, A, Mackenzie, M. Theories of change and realistic evaluation. Evaluation 2007; 13: 439–55.
17 World Health Organization. mhGAP Implementation Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings. WHO, 2010.
18 Barbui, C, Dua, T, van Ommeren, M, Yasamy, MT, Fleischmann, A, Clark, N, et al. Challenges in developing evidence-based recommendations using the GRADE approach: the case of mental, neurological, and substance use disorders. PLoS Med 2010; 7: e1000322.
19 Patel, V, Thornicroft, G. Packages of care for mental, neurological, and substance use disorders in low- and middle-income countries: PLoS Medicine series. PLoS Med 2009; 6: e1000160.
20 Hanlon, C, Luitel, NP, Kathree, T, Murhar, V, Shrivasta, S, Medhin, G, et al. Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries. PLoS One 2014; 9: e88437.
21 Jordans, MJ, Luitel, NP, Tomlinson, M, Komproe, IH. Setting priorities for mental health care in Nepal: a formative study. BMC Psychiatry 2013; 13: 332.
22 Fekadu, A, Hanlon, C, Medhin, G, Alem, A, Selamu, M, Giorgis, TW, et al. Development of a scalable mental healthcare plan for a rural district in Ethiopia. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153676).
23 Shidhaye, R, Shrivastava, S, Murhar, V, Samudre, S, Ahuja, S, Ramaswamy, R, et al. Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153700).
24 Jordans, MJD, Luitel, NP, Pokhrel, P, Patel, V. Development and pilot testing of a mental healthcare plan in Nepal. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153718).
25 Kigozi, NF, Kizza, D, Nakku, J, Ssebunnya, J, Ndyanabangi, S, Nakiganda, B, et al. Development of a district mental healthcare plan in Uganda. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153742).
26 Petersen, I, Fairall, L, Bhana, A, Kathree, T, Selohilwe, O, Brooke-Sumner, C, et al. Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153726).
27 Breuer, E, De Silva, M, Fekadu, A, Luitel, NP, Murhar, V, Nakku, J, et al. Using workshops to develop theories of change in five low and middle income countries: lessons from the Programme for Improving Mental Health Care (PRIME). Int J Ment Health Syst 2014; 8: 15.
28 De Silva, MJ, Rathod, SD, Hanlon, C, Breuer, E, Chisholm, D, Fekadu, A, et al. Evaluation of district mental healthcare plans: the PRIME consortium methodology. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153858).
29 World Health Organization. Monitoring and Evaluation of Mental Health Policies and Plans. WHO, 2007.
30 World Health Organization. Mental Health Gap Action Programme Scaling Up Care for Mental, Neurological, and Substance Use Disorders. WHO, 2008.
31 Jordans, MJD, Kohrt, BA, Luitel, NP, Komproe, IH, Lund, C. Accuracy of pro-active case finding for mental disorders by community informants in Nepal. Br J Psychiatry 2015, in press.
32 Shibre, T, Kebede, D, Alem, A, Negash, A, Kibreab, S, Fekadu, A, et al. An evaluation of two screening methods to identify cases with schizophrenia and affective disorders in a community survey in rural Ethiopia. Int J Soc Psychiatry 2002; 48: 200–8.
33 Patel, V, Simon, G, Chowdhary, N, Kaaya, S, Araya, R. Packages of care for depression in low-and middle-income countries. PLoS Med 2009; 6: e1000159.
34 De Silva, M, Breuer, E, Lee, L, Asher, L, Chowdhary, N, Lund, C, et al. Theory of change: a theory-driven approach to the MRC framework for complex interventions. Trials 2014; 15: 267.
35 Sullivan, H, Stewart, M. Who owns the theory of change? Evaluation 2006; 12: 179–99.
36 Hawe, P, Shiell, A, Riley, T, Gold, L. Methods for exploring implementation variation and local context within a cluster randomised community intervention trial. J Epidemiol Community Health 2004; 58: 788–93.
37 Funnell, SC, Rogers, PJ. Purposeful Program Theory: Effective Use of Theories of Change and Logic Models. Jossey-Bass, 2011.
38 Shiell, A, Hawe, P, Gold, L. Complex interventions or complex systems? Implications for health economic evaluation. BMJ 2008; 336: 1281–3.
39 Rogers, P. Using programme theory to evaluate complicated and complex aspects of interventions. Evaluation 2008; 14: 2948.
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Planning and evaluating mental health services in low- and middle-income countries using theory of change

  • Erica Breuer (a1), Mary J. De Silva (a2), Rahul Shidaye (a3), Inge Petersen (a4), Juliet Nakku (a5), Mark J. D. Jordans (a6), Abebaw Fekadu (a7) and Crick Lund (a8)...
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