Chibanda Dixon, Verhey Ruth, Munetsi Epiphany, Cowan Frances M, Lund Crick
Department of Community medicine, Zimbabwe Aids Prevention Project-University of Zimbabwe, Harare, Zimbabwe.
Research Department of Infection and Population Health, University College London, London, UK ; Centre for Sexual Health and HIV AIDS Research Zimbabwe, Harare, Zimbabwe.
Int J Ment Health Syst. 2016 Feb 29;10:16. doi: 10.1186/s13033-016-0050-1. eCollection 2016.
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.
关于如何实施旨在缩小精神障碍治疗差距的复杂干预措施的数据匮乏，尤其是在撒哈拉以南非洲地区。如果要在其他地方复制此类干预措施，就需要有详细记录的方案，清晰描述项目和干预措施的开发及扩大规模情况。本文描述了如何运用变革理论（ToC）模型来开发针对常见精神障碍的简短心理干预措施，并通过在津巴布韦进行的整群随机对照试验对其进行评估。
在6个月的时间里，与一系列利益相关者共举办了8次ToC研讨会，重点关注该项目的四个关键组成部分：形成性工作、试点、评估和扩大规模。作为该过程的一部分，绘制了一张ToC图，其中定义了通向预期影响的因果路径。考虑了因果路径上每个点的干预措施、指标、假设和基本原理。
使用ToC方法确定，利益相关者的政治支持以及包括人力、设施/基础设施、沟通和监督在内的关键资源是关键需求。最终的ToC图包含十项（10项）具有特定指标、假设和基本原理的关键干预措施，以图形方式说明了导致心理干预措施开发以及整群随机对照试验成功实施的因果路径。
ToC研讨会可以通过一个迭代过程增强利益相关者的参与度，从而形成一个能够改善复杂心理健康干预措施结果的共同愿景，特别是在希望扩大干预规模的情况下。
