Using workshops to develop theories of change in five low and middle income countries: lessons from the programme for improving mental health care (PRIME)
Using workshops to develop theories of change in five low and middle income countries: lessons from the programme for improving mental health care (PRIME)
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DOI：
10.1186/1752-4458-8-15
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发表时间：
2014-04-30
影响因子：
3.6
通讯作者：
Lund, Crick
中科院分区：
文献类型：
--
作者：
Breuer, Erica;De Silva, Mary J.;Lund, Crick
背景：在高收入国家，变革理论（ToC）方法已被用于以参与式方式制定和评估复杂的卫生举措。在精神卫生服务仍然不足的低收入和中等收入国家，人们对其用于制定精神卫生保健计划知之甚少。目标：作为改善精神卫生保健方案形成阶段的一部分，举办了精神卫生保健讲习班，目的是(1)编制一份结构合理、以证据为基础的精神卫生保健地图，作为各区精神卫生保健计划的基础；(2)对计划进行背景分析；(3)在埃塞俄比亚、印度、尼泊尔、南非和乌干达获得利益相关者的支持。本研究描述了ToC工作坊的结构和推动者的经验。方法：采用框架分析方法，对ToC工作坊的主持人进行访谈，并将访谈内容与工作坊的流程文件一起进行记录、转录和分析。结果：在五个PRIME国家的各级卫生系统举办了13次讲习班。ToC研讨会在不同利益相关者的贡献下实现了既定目标。地区卫生规划人员、精神卫生专家和研究人员对ToC的发展贡献最大，而服务提供者提供了详细的背景信息。所有利益相关者都认同，但资源掌控者更看重这一点。结论：ToC讲习班是制定ToC作为精神卫生保健计划基础的一种有用方法，因为它们促进了合乎逻辑的、基于证据的和情境化的计划，同时促进利益攸关方的参与。由于一些卫生系统内现有的等级制度，可以使用诸如限制参与者类型和对讲习班进行分层等策略来确保讲习班富有成效。
Background: 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.Aims: ToC 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.Methods: The 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.Results: Thirteen 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.Conclusions: 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. 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.