Browsing by Author "Cowan, Frances M"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Open Access
    Development and scaling up of a psychological intervention for common mental disorders among people living with HIV in Zimbabwe
    (2016) Chibanda, Dickson; Lund, Crick; Cowan, Frances M
    Common mental disorders (CMD) which primarily include depression, anxiety disorders and mixed anxiety depression are leading causes of disability in sub-Saharan Africa. They are particularly common in people living with HIV (PLWH) and may hasten HIV disease progression. This thesis consists of 5 articles which have been submitted for publication and provide evidence on the requirements for developing a psychological intervention to be delivered by lay health workers (LHW) and a strategy for scaling up this intervention to over 50 primary health care clinics in Harare, Zimbabwe. The thesis formed part of formative research leading to a cluster randomized controlled trial(RCT) of a psychological intervention and provides supplementary research to the RCT to support the scale up of the intervention. The first chapter describes the magnitude of the problem and the lack of resources to reduce the treatment gap for CMD. It highlights the growing evidence of using Lay Health Workers (LHW) to reduce this treatment gap.
  • Thumbnail Image
    Item
    Open Access
    Using a theory driven approach to develop and evaluate a complex mental health intervention: the friendship bench project in Zimbabwe
    (BioMed Central, 2016-02-29) Chibanda, Dixon; Verhey, Ruth; Munetsi, Epiphany; Cowan, Frances M; Lund, Crick
    Background: 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. Methods: 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. Results: 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. Conclusion: 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.