Theory of change for complex mental health interventions: 10 lessons from the programme for improving mental healthcare

Breuer, Erica; Silva, Mary De; Lund, Crick

doi:10.1017/gmh.2018.13

Cited by 21 publications

(24 citation statements)

References 23 publications

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“…A core challenge in developing this consensus statement was that the evidence comes predominantly from high income countries, which have more health services compared with low and middle income countries41–43 where many athletes reside. There is debate concerning the range of ways in which mental health symptoms and disorders can be managed in culturally appropriate ways, drawing on resources from other health sectors and community carers, for example,44–46 with increasing evidence that intervening in ways that support existing community strengths may be of benefit to people with these conditions 47 48. It is important to consider this global context throughout this statement.…”

Section: General Approaches To Management Of Mental Health Symptoms Amentioning

confidence: 99%

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

et al. 2019

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Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

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Section: General Approaches To Management Of Mental Health Symptoms Amentioning

confidence: 99%

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

et al. 2019

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“…ToC is "a theory of how and why an initiative works", laying bare the causal pathway by which an initiative aims to achieve impact (18). Often a ToC is depicted visually as a diagram and developed in consultation with key stakeholders, with additional bene ts for consensus-building and communication (15,21). By assigning indicators to short-, mediumand long-term outcomes along the causal pathway, a ToC can be especially valuable as an evaluation framework.…”

Section: Methodsmentioning

confidence: 99%

“…Less attention has been paid to ensuring that funding made available for global mental health is used to maximum effect. Theory of Change (ToC), which in recent years has become a popular tool for the design and evaluation of complex interventions in global mental health (15), is increasingly attracting the interest of funders seeking to evaluate their own impact (16)(17)(18). This is the rst of four papers investigating Grand Challenges Canada's (GCC's) rst global mental health research funding portfolio, using a ToC-driven approach.…”

Section: Introductionmentioning

confidence: 99%

Lessons From a Theory of Change-driven Evaluation of a Global Mental Health Funding Portfolio

Esponda

Ryan

Estrin

et al. 2020

Preprint

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BackgroundGiven the underinvestment in global mental health to-date, it is important to consider how best to maximize the impact of existing investments. Theory of Change (ToC) is increasingly attracting the interest of funders seeking to evaluate their own impact. This is the first of four papers investigating Grand Challenges Canada’s (GCC’s) first global mental health research funding portfolio (2012-2016) using a ToC-driven approach.MethodsA portfolio-level ToC map was developed through a collaborative process involving GCC grantees and other key stakeholders. Proposed ToC indicators were harmonised with GCC’s pre-existing Results-based Management and Accountability Framework to produce a “Core Metrics Framework” of 23 indicators linked to 17 outcomes of the ToC map. For each indicator relevant to their project, the grantee was asked to set a target prior to the start of implementation, then report results at six-month intervals. We used the latest available dataset from all 56 projects in GCC’s global mental health funding portfolio to produce a descriptive analysis of projects’ characteristics and outcomes related to delivery. Results12,999 people were trained to provide services, the majority of whom were lay or other non-specialist health workers. Most projects exceeded their training targets for capacity-building, except for those training lay health workers. Of the 321,933 people screened by GCC-funded projects, 162,915 received treatment. Most projects focused on more than one disorder and exceeded all their targets for screening, diagnosis and treatment. Fewer people than intended were screened for common mental disorders and epilepsy (60% and 54%, respectively), but many more were diagnosed and treated than originally proposed (148% and 174%, respectively). In contrast, the three projects that focused on perinatal depression exceeded screening and diagnosis targets, but only treated 43% of their intended target. ConclusionsUnder- or over-achievement of targets may reflect operational challenges such as high staff turnover, or challenges in setting appropriate targets, for example due to insufficient epidemiological evidence. Differences in delivery outcomes when disaggregated by disorder suggest that these challenges are not universal. We caution implementers, funders and evaluators from taking a one-size-fits all approach and make several recommendations for how to facilitate more in-depth, multi-method evaluation of impact using portfolio-level ToC.

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“…The potential for effective communication and dissemination of research results to encourage sustained engagement and buy-in from policy makers points to a need for mechanisms of support for researchers to engage in iKT activities by engaging key decision-makers from the inception of research (30). Methods such as Theory of Change workshops (21) may facilitate engagement of policy makers and other stakeholders in program planning and priority setting from the outset (20). This also suggests a need for researchers to seek out capacity building opportunities and to invest time to learn skills that enable them to effectively participate in policy engagement and communications activities.…”

Section: Communication and Disseminationmentioning

confidence: 99%

“…Engagement with service users and community members, from the inception of research and implementation planning can promote an essential understanding of community concepts of mental health and the acceptability of planned interventions (12). Participatory and user-led research methodologies such as community-based participatory research (19) and Theory of Change (20) can help to engage service users throughout the research process and ensure they are actively involved in priority setting, knowledge creation and dissemination. SE is an essential component of GMH implementation, and the gap in literature points to a need for research in this area.…”

Section: Introductionmentioning

confidence: 99%

Barriers and Drivers to Stakeholder Engagement in Global Mental Health Projects

Murphy

Qureshi

Endale

et al. 2020

Preprint

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Background: Engagement with diverse stakeholders, including policy makers, care providers and end users, is essential for successful implementation of global mental health interventions. Despite being a fundamental factor in the implementation process, evidence about challenges and drivers to stakeholder engagement is limited in the global mental health literature. Methods: We conducted semi-structured qualitative interviews with n=29 recipients of global Grand Challenges Canada Global Mental Health funding to assess barriers and drivers to global mental health implementation across a portfolio of Grand Challenges Canada-funded projects. We used framework analysis to identify key themes related to implementation barriers and facilitators. This paper reports on barriers and facilitators to stakeholder engagement, with results related to capacity development and service delivery reported elsewhere in this volume. Results: Barriers and drivers to stakeholder engagement were identified across four themes: 1) Contextual Considerations, 2) Resources, 3) Participation, Uptake and Empowerment, and 3) Stigma. While complex contextual challenges create barriers, mechanisms such as formative research can facilitate a deeper contextual understanding that supports effective implementation planning. Limited financial and human resources and competing priorities can lead to substantial challenges. Investing in and leveraging existing local resources and expertise can help to mitigate these barriers. The challenge of achieving active participation from stakeholders and diverging expectations about the nature of participation were identified as barriers, while providing opportunities for meaningful participation and empowerment acted as facilitators. Stigma at the institutional and individual level was also identified as a substantial barrier to engagement. Conclusion: Stakeholder engagement is critical to successful implementation of global mental health interventions, particularly for promoting scale-up and sustainability. The findings of this study are relevant to implementors in global mental health. They also have implications for global mental health funding agencies and policy organizations, who can support improved stakeholder engagement in several ways. Investing in high-quality formative research, supporting capacity building in methods such as integrated knowledge translation and participatory priority-setting, investing in longer-term funding schemes to support sustainable partnerships and scale-up and supporting researchers to build skills in policy engagement would help to foster successful engagement and thus support effective implementation of global mental health innovations.

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Theory of change for complex mental health interventions: 10 lessons from the programme for improving mental healthcare

Cited by 21 publications

References 23 publications

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Lessons From a Theory of Change-driven Evaluation of a Global Mental Health Funding Portfolio

Barriers and Drivers to Stakeholder Engagement in Global Mental Health Projects

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