Fuhr Daniela C, Acarturk Ceren, Uygun Ersin, McGrath Michael, Ilkkursun Zeynep, Kaykha Sadaf, Sondorp Egbert, Sijbrandij Marit, Ventevogel Peter, Cuijpers Pim, Roberts Bayard
1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine; Public Health and Policy, 15-17 Tavistock Place, London, UK.
2Department of Psychology, Koc University Istanbul, Istanbul, Turkey.
Confl Health. 2020 May 4;14:22. doi: 10.1186/s13031-020-00278-w. eCollection 2020.
A considerable evidence base has been produced in recent years highlighting the effectiveness of brief scalable psychological interventions for people living in communities exposed to adversity. However, practical guidance on how to scale up these interventions to wider populations does not exist. In this paper we report on the use of Theory of Change (ToC) to plan the scale up of the World Health Organization's flagship low intensity psychological intervention "Problem Management Plus" (PM+) for Syrian refugees in Turkey.
We conducted a one-day ToC workshop in Istanbul. ToC is a participatory planning process used in the development, implementation and evaluation of projects. It is similar to driver diagrams or logic models in that it offers a tool to visually present the components needed to reach a desired long-term outcome or impact. The overall aim of ToC is to understand the change process of a complex intervention and to map out causal pathways through which an intervention or strategy has an effect.
Twenty-four stakeholders (including governmental officials, mental health providers, officials from international/national non-governmental organisations, conflict and health researchers) participated in the ToC workshop. A ToC map was produced identifying three key elements of scaling up (the resource team; the innovation and the health system; and the user organisation) which are represented in three distinct causal pathways. Context-specific barriers related to the health system and the political environment were identified, and possible strategies for overcoming these challenges were suggested.
ToC is a valuable methodology to develop an integrated framework for scaling up. The results highlight that the scaling up of PM+ for Syrian refugees in Turkey needs careful planning and investment from different stakeholders at the national level. Our paper provides a theoretical foundation of the scaling up of PM+, and exemplifies for the first time the use of ToC in planning the scaling up of an evidence-based psychological intervention in global mental health.
近年来已产生了大量证据，突显了针对身处逆境社区的人群开展简短可扩展心理干预措施的有效性。然而，目前尚无关于如何将这些干预措施推广至更广泛人群的实用指南。在本文中，我们报告了如何运用变革理论（ToC）来规划扩大世界卫生组织的旗舰低强度心理干预措施“问题管理强化版”（PM+），以惠及土耳其的叙利亚难民。
我们在伊斯坦布尔举办了为期一天的变革理论研讨会。变革理论是一种用于项目开发、实施和评估的参与式规划过程。它与驱动图或逻辑模型类似，提供了一种直观呈现实现预期长期成果或影响所需组件的工具。变革理论的总体目标是理解复杂干预措施的变化过程，并勾勒出干预措施或策略产生效果的因果路径。
24名利益相关者（包括政府官员、心理健康服务提供者、国际/国家非政府组织官员、冲突与健康研究人员）参加了变革理论研讨会。绘制了一张变革理论图，确定了扩大规模的三个关键要素（资源团队；创新与卫生系统；以及用户组织），它们体现在三条不同的因果路径中。识别出了与卫生系统和政治环境相关的特定背景障碍，并提出了克服这些挑战的可能策略。
变革理论是一种用于制定扩大规模综合框架的宝贵方法。结果表明，在土耳其扩大针对叙利亚难民的PM+需要国家层面不同利益相关者进行精心规划和投资。我们的论文为扩大PM+提供了理论基础，并首次例证了变革理论在规划全球心理健康领域循证心理干预措施扩大规模方面的应用。
