Using a theory driven approach to develop and evaluate a complex mental health intervention: the friendship bench project in Zimbabwe.
Using a theory driven approach to develop and evaluate a complex mental health intervention: the friendship bench project in Zimbabwe.
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DOI：
10.1186/s13033-016-0050-1
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发表时间：
2016
影响因子：
3.6
通讯作者：
Lund C
中科院分区：
文献类型：
--
作者：
Chibanda D;Verhey R;Munetsi E;Cowan FM;Lund C
关于如何提供复杂的干预措施以缩小精神障碍治疗差距的数据很少，特别是在撒哈拉以南非洲。如果要在其他地方推广这种干预措施，就必须有文件完备的协议，明确说明方案和干预措施的制定和扩大情况。本文介绍了运用改变理论（Theory of Change，ToC）模型对常见精神障碍进行简易心理干预的方法，并通过在津巴布韦进行的一项整群随机对照试验进行了评价。在6个月的时间里，与一系列利益攸关方共举办了8次ToC研讨会，重点关注该计划的四个关键组成部分：形成工作、试点、评估和扩大规模。作为该过程的一部分，开发了ToC图，并确定了导致预期影响的因果途径。干预措施，指标，假设和理由的每一点沿着因果关系的途径进行了审议。利益攸关方的政治支持以及关键资源，包括人力、设施/基础设施、通信和监督，被确定为使用ToC方法的关键需求。具有具体指标、假设和原理的十（10）项关键干预措施构成了最终ToC地图的一部分，该地图以图形方式说明了导致心理干预措施开发和成功实施集群随机对照试验的因果路径。ToC研讨会可以通过一个迭代过程加强利益攸关方的参与，从而形成一个共同的愿景，可以改善复杂的心理健康干预措施的成果，特别是在需要扩大干预措施的情况下。
There 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. A 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. Political 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. ToC 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.