Optimising implementation strategies of the scale-up of a primary care psychological intervention: The Friendship Bench

一项随机对照试验明确表明，友谊长凳（FB）是迄今为止在撒哈拉以南非洲测试的第一个有效的初级保健心理治疗方案。大约一年前，这一可喜的结果说服了政府将FB扩大到哈拉雷及其周边的72家诊所。计划在今年晚些时候进一步扩大规模。到目前为止，还没有对这一推广举措的结果进行评估。本研究旨在评估到目前为止的规模扩大，但最重要的是确定影响FB实施结果的因素，以期设计一种增强的促进干预措施，以改善在表现不佳的诊所的实施。我们将使用两个著名的实现科学框架（RE-AIM和CFIR）来指导我们的工作。RE-AIM将为我们提供一个结果框架，而CIFR将引导我们探索决定FB实施成败的“核心”因素。我们将首先利用迄今为止在扩大工作期间例行收集的所有数据，对迄今取得的成就进行评估。这将得到通过调查和其他定性方法获得的额外数据的补充。结果将使我们能够评估RE-AIM的结果，并根据其实施结果对诊所进行分类。随后，我们将与主要利益攸关方举行一次研讨会，讨论并商定用于第二阶段勘探的CFIR框架。第二阶段的主要目的是确定被认为是成功实施财务预算的关键预测因素的关键或核心变量。为了做到这一点，我们将重点比较低和高性能的诊所，以确定这些因素，可能会解释实施结果。在第二阶段，除了小型调查和收集额外的经济数据外，大部分研究将是定性的，通过焦点小组和半结构化访谈进行。我们将再次邀请主要利益相关者审查我们的结果和结论，并帮助我们确定加强的促进干预措施的组成部分，我们将在那些实施成果下降的诊所进行测试最低的四分之一。我们将进行一项混合3型研究，以确定与对照诊所相比，在这种促进发生后四个月，实施结果是否有所改善。本研究中产生的信息对于继续成功扩展FB和巩固目前正在进行的实施至关重要。此外，它还将为其他邻国提供使用执行科学方法的基本信息，并了解执行过程中的潜在问题以及改进其执行工作的可能办法。

A randomised controlled trial showed unequivocally that the Friendship Bench (FB) is the first effective psychological treatment programme in primary care to be tested so far in Sub-Saharan Africa. The auspicious results persuaded the government to scale-up the FB to 72 clinics in and around Harare about one year ago. Additional scaling-up has been planned for later this year. Up until now, there has not been an evaluation of the results of this scaling-up initiative. This study aims to evaluate the scaling-up so far but most importantly to identify the factors that have influenced the outcome of the implementation of the FB with a view to design an enhancedfacilitation intervention to improve the implementation in clinics that have not performed so well. We will use two well-known implementation science frameworks (RE-AIM and CFIR) to guide our work. Whilst RE-AIM will provide us with a framework for the outcomes, CIFR will guide us through the process of exploring the 'core' factors that determine the success or failure of the implementation of the FB. We will start with an evaluation of what has been achieved so far using all the data that has been routinely collected during the scale-up effort until now. This will be supplemented with additional data captured through a survey and other qualitative methods. The results will allow us to evaluate RE-AIM outcomes and classify clinics according to their implementation outcomes. Subsequently we will conduct a workshop with the main stakeholders to discuss and agree on the CFIR framework to use for the second phase of exploration. The main aim of the second phase is to identify key or core variables deemed to be key predictors of the successful implementation of the FB. In order to do this we will focus on comparing low and high performing clinics to identify those factors that might explain implementation outcomes. During the second phase, most research will be of a qualitative nature, through focus groups and semi-structured interviews, except for small surveys and the collection of additional economic data.At the end of this phase, we will invite main stakeholders again to review our results and conclusions and to help us identify the components of an enhanced facilitation intervention that we will test in those clinics whose implementation achievements fall into the lowest quartile. We will conduct a hybrid type 3 study to ascertain if implementation outcomes improve four months after thisfacilitation takes place in comparison with control clinics. The information generated in this study is vital to continue the successful expansion of the FB and to consolidate the implementation currently underway. Besides it will provide essential information for other neighbouring countries in terms of using implementation science methodology as well as learning about potential problems in the route to implementation as well as possible approaches to improve their implementation efforts.