Hostname: page-component-89b8bd64d-nlwjb Total loading time: 0 Render date: 2026-05-09T20:28:59.082Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2018

Erica Breuer ,
Mary J. De Silva ,
Rahul Shidaye ,
Inge Petersen ,
Juliet Nakku ,
Mark J. D. Jordans ,
Abebaw Fekadu  and
Crick Lund
Erica Breuer*
Affiliation:
Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Mary J. De Silva
Affiliation:
Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
Rahul Shidaye
Affiliation:
Public Health Foundation of India, Bhopal, Madhya Pradesh, India and Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
Inge Petersen
Affiliation:
School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, South Africa
Juliet Nakku
Affiliation:
Butabika National Mental Hospital, Kampala, Uganda
Mark J. D. Jordans
Affiliation:
HealthNet TPO, Amsterdam, The Netherlands and King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
Abebaw Fekadu
Affiliation:
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK and Addis Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
Crick Lund
Affiliation:
Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
*
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
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the 'Save PDF' action button.
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.

Information

Type
Papers
Information
The British Journal of Psychiatry , Volume 208 , Issue s56: Mental health plans in five low- and middle-income countries: PRogramme for Improving Mental health carE (PRIME) , January 2016 , pp. s55 - s62
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
Copyright
Copyright © Royal College of Psychiatrists, 2016

Footnotes

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.

References

1 Thara, R, John, S, Chatterjee, S. Community mental health teams in low- and middle-income countries. Epidemiol Psychiatr Sci 2014; 23: 119–22.Google Scholar
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.Google Scholar
3 World Health Organization. Mental Health Atlas 2011. WHO, 2011.Google Scholar
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.Google Scholar
5 World Health Organization. Mental Health Policy, Plans and Programmes. Mental Health Policy and Service Guidance Package. WHO, 2005.Google Scholar
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.CrossRefGoogle Scholar
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).CrossRefGoogle Scholar
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): 15–44. The Aspen Institute, 1998.Google Scholar
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: 199–226.Google Scholar
10 Cole, M. The health action zone initiative: lessons from Plymouth. Local Gov Stud 2003; 29: 99–117.CrossRefGoogle Scholar
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: 495–514.Google Scholar
12 Mason, P, Barnes, M. Constructing theories of change: methods and sources. Evaluation 2007; 13: 151–70.Google Scholar
13 Vogel, I. Review of the Use of ‘Theory of Change’ in International Development. Department for International Development, 2012.Google Scholar
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.CrossRefGoogle ScholarPubMed
15 Andersen, A. A Community Builder's Approach to Theory of Change: A Practical Guide to Theory Development. The Aspen Insitute, 2004.Google Scholar
16 Blamey, A, Mackenzie, M. Theories of change and realistic evaluation. Evaluation 2007; 13: 439–55.Google Scholar
17 World Health Organization. mhGAP Implementation Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings. WHO, 2010.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.CrossRefGoogle Scholar
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).Google Scholar
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).Google Scholar
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).Google Scholar
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).Google Scholar
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).Google Scholar
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.Google Scholar
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).Google Scholar
29 World Health Organization. Monitoring and Evaluation of Mental Health Policies and Plans. WHO, 2007.Google Scholar
30 World Health Organization. Mental Health Gap Action Programme Scaling Up Care for Mental, Neurological, and Substance Use Disorders. WHO, 2008.Google Scholar
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.Google Scholar
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.CrossRefGoogle Scholar
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.Google Scholar
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.Google Scholar
35 Sullivan, H, Stewart, M. Who owns the theory of change? Evaluation 2006; 12: 179–99.Google Scholar
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.Google Scholar
37 Funnell, SC, Rogers, PJ. Purposeful Program Theory: Effective Use of Theories of Change and Logic Models. Jossey-Bass, 2011.Google Scholar
38 Shiell, A, Hawe, P, Gold, L. Complex interventions or complex systems? Implications for health economic evaluation. BMJ 2008; 336: 1281–3.Google Scholar
39 Rogers, P. Using programme theory to evaluate complicated and complex aspects of interventions. Evaluation 2008; 14: 29–48.CrossRefGoogle Scholar
Supplementary material: PDF

Breuer et al. supplementary material

Supplementary Figure S1-S6

Download Breuer et al. supplementary material(PDF)
PDF 659.3 KB

This journal is not currently accepting new eletters.

eLetters

No eLetters have been published for this article.