Developing a mental health care plan in a low resource setting: the theory of change approach

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dc.contributor.authorHailemariam, Maji
dc.contributor.authorFekadu, Abebaw
dc.contributor.authorSelamu, Medhin
dc.contributor.authorAlem, Atalay
dc.contributor.authorMedhin, Girmay
dc.contributor.authorGiorgis, Tedla W
dc.contributor.authorDeSilva, Mary
dc.contributor.authorBreuer, Erica
dc.date.accessioned2015-10-30T14:26:40Z
dc.date.available2015-10-30T14:26:40Z
dc.date.issued2015-09-28
dc.date.updated2015-10-26T17:22:07Z
dc.description.abstractAbstract Background Scaling up mental healthcare through integration into primary care remains the main strategy to address the extensive unmet mental health need in low-income countries. For integrated care to achieve its goal, a clear understanding of the organisational processes that can promote and hinder the integration and delivery of mental health care is essential. Theory of Change (ToC), a method employed in the planning, implementation and evaluation of complex community initiatives, is an innovative approach that has the potential to assist in the development of a comprehensive mental health care plan (MHCP), which can inform the delivery of integrated care. We used the ToC approach to develop a MHCP in a rural district in Ethiopia. The work was part of a cross-country study, the Programme for Improving Mental Health Care (PRIME) which focuses on developing evidence on the integration of mental health in to primary care. Methods An iterative ToC development process was undertaken involving multiple workshops with stakeholders from diverse backgrounds that included representatives from the community, faith and traditional healers, community associations, non-governmental organisations, Zonal, Regional and Federal level government offices, higher education institutions, social work and mental health specialists (psychiatrists and psychiatric nurses). The objective of this study is to report the process of implementing the ToC approach in developing mental health care plan. Results A total of 46 persons participated in four ToC workshops. Four critical path dimensions were identified: community, health facility, administrative and higher level care organisation. The ToC participants were actively engaged in the process and the ToC encouraged strong commitment among participants. Key opportunities and barriers to implementation and how to overcome these were suggested. During the workshops, a map incorporating the key agreed outcomes and outcome indicators was developed and finalized later. Conclusions The ToC approach was found to be an important component in the development of the MHCP and to encourage broad political support for the integration of mental health services into primary care. The method may have broader applicability in planning complex health interventions in low resource settings.
dc.identifier.apacitationHailemariam, M., Fekadu, A., Selamu, M., Alem, A., Medhin, G., Giorgis, T. W., ... Breuer, E. (2015). Developing a mental health care plan in a low resource setting: the theory of change approach. <i>BMC health services research</i>, http://hdl.handle.net/11427/14579en_ZA
dc.identifier.chicagocitationHailemariam, Maji, Abebaw Fekadu, Medhin Selamu, Atalay Alem, Girmay Medhin, Tedla W Giorgis, Mary DeSilva, and Erica Breuer "Developing a mental health care plan in a low resource setting: the theory of change approach." <i>BMC health services research</i> (2015) http://hdl.handle.net/11427/14579en_ZA
dc.identifier.citationBMC Health Services Research. 2015 Sep 28;15(1):429
dc.identifier.ris TY - Journal Article AU - Hailemariam, Maji AU - Fekadu, Abebaw AU - Selamu, Medhin AU - Alem, Atalay AU - Medhin, Girmay AU - Giorgis, Tedla W AU - DeSilva, Mary AU - Breuer, Erica AB - Abstract Background Scaling up mental healthcare through integration into primary care remains the main strategy to address the extensive unmet mental health need in low-income countries. For integrated care to achieve its goal, a clear understanding of the organisational processes that can promote and hinder the integration and delivery of mental health care is essential. Theory of Change (ToC), a method employed in the planning, implementation and evaluation of complex community initiatives, is an innovative approach that has the potential to assist in the development of a comprehensive mental health care plan (MHCP), which can inform the delivery of integrated care. We used the ToC approach to develop a MHCP in a rural district in Ethiopia. The work was part of a cross-country study, the Programme for Improving Mental Health Care (PRIME) which focuses on developing evidence on the integration of mental health in to primary care. Methods An iterative ToC development process was undertaken involving multiple workshops with stakeholders from diverse backgrounds that included representatives from the community, faith and traditional healers, community associations, non-governmental organisations, Zonal, Regional and Federal level government offices, higher education institutions, social work and mental health specialists (psychiatrists and psychiatric nurses). The objective of this study is to report the process of implementing the ToC approach in developing mental health care plan. Results A total of 46 persons participated in four ToC workshops. Four critical path dimensions were identified: community, health facility, administrative and higher level care organisation. The ToC participants were actively engaged in the process and the ToC encouraged strong commitment among participants. Key opportunities and barriers to implementation and how to overcome these were suggested. During the workshops, a map incorporating the key agreed outcomes and outcome indicators was developed and finalized later. Conclusions The ToC approach was found to be an important component in the development of the MHCP and to encourage broad political support for the integration of mental health services into primary care. The method may have broader applicability in planning complex health interventions in low resource settings. DA - 2015-09-28 DB - OpenUCT DO - 10.1186/s12913-015-1097-4 DP - University of Cape Town J1 - BMC health services research LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Developing a mental health care plan in a low resource setting: the theory of change approach TI - Developing a mental health care plan in a low resource setting: the theory of change approach UR - http://hdl.handle.net/11427/14579 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1186/s12913-015-1097-4
dc.identifier.urihttp://hdl.handle.net/11427/14579
dc.identifier.vancouvercitationHailemariam M, Fekadu A, Selamu M, Alem A, Medhin G, Giorgis TW, et al. Developing a mental health care plan in a low resource setting: the theory of change approach. BMC health services research. 2015; http://hdl.handle.net/11427/14579.en_ZA
dc.language.rfc3066en
dc.publisher.departmentCentre for Public Mental Healthen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rights.holderHailemariam et al.
dc.sourceBMC health services research
dc.source.urihttp://bmchealthservres.biomedcentral.com/
dc.titleDeveloping a mental health care plan in a low resource setting: the theory of change approach
dc.typeJournal Articleen_ZA
uct.subject.keywordsintegrated care
uct.subject.keywordscomplex intervention
uct.subject.keywordsEthiopia
uct.subject.keywordstheory of change
uct.subject.keywordsmental health care plan
uct.type.filetype
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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