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.
Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Int J Ment Health Syst. 2014 Apr 30;8:15. doi: 10.1186/1752-4458-8-15. eCollection 2014.
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.
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.
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.
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.
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.
变革理论（ToC）方法已被用于以参与式的方式在高收入国家开发和评估复杂的健康计划。在心理健康服务仍然不足的中低收入国家，关于其用于制定精神卫生保健计划的信息知之甚少。
ToC 研讨会是改善精神卫生保健计划（PRIME）形成阶段的一部分，旨在 1）制定一个结构化的逻辑和基于证据的 ToC 图，作为每个地区精神卫生保健计划的基础；2）使计划本土化；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认可。本研究描述了 ToC 研讨会的结构和协调员的经验。
对 ToC 研讨会的协调员进行了访谈，并记录了访谈内容，然后与研讨会的过程文件一起使用框架分析方法进行转录和分析。
在五个 PRIME 国家的不同卫生系统层面上举办了 13 次研讨会。ToC 研讨会通过不同利益相关者的贡献实现了既定目标。区域卫生规划人员、精神卫生专家和研究人员为 ToC 的制定做出了最大贡献，而服务提供者则提供了详细的背景信息。所有利益相关者都表示认可，但对控制资源的利益相关者的认可更为重要。
ToC 研讨会是制定 ToC 作为精神卫生保健计划基础的有用方法，因为它们促进了逻辑、基于证据和本土化的计划，同时促进了利益相关者的认可。由于一些卫生系统中存在等级制度，可以采用限制参与者类型和分层研讨会等策略，以确保研讨会富有成效。
