RT Journal Article
SR Electronic
T1 Using qualitative comparative analysis and theory of change to unravel the effects of a mental health intervention on service utilisation in Nepal
JF BMJ Global Health
FD BMJ Publishing Group Ltd
SP e001023
DO 10.1136/bmjgh-2018-001023
VO 3
IS 6
A1 Breuer, Erica
A1 Subba, Prasansa
A1 Luitel, Nagendra
A1 Jordans, Mark
A1 De Silva, Mary
A1 Marchal, Bruno
A1 Lund, Crick
YR 2018
UL http://gh.bmj.com/content/3/6/e001023.abstract
AB Background The integration of mental health services into primary care is essential to improve the coverage of mental health services in low resource settings, but the evaluation of this remains challenging. We used a programme’s Theory of Change (ToC) as a conceptual framework to determine what combination(s) of conditions at facility and community level influenced the mental health service utilisation as a result of a district mental healthcare plan (MHCP) implemented in Chitwan, Nepal. In addition, we show how qualitative comparative analysis can be used to provide an integrated analysis of data from a ToC.Methods We conducted a longitudinal case study of 10 health facilities where the MHCP was implemented. We collected data from all facilities at baseline (October to December 2013) and quarterly following the implementation of the intervention (March 2014 to November 2016). The data were analysed using pooled qualitative comparative analysis in fsQCA V.2.5.Results The following conditions were necessary for high mental health service utilisation: presence of basic and advanced psychosocial care, evidence-based identification and treatment guidelines (WHO mhGAP), referral to tertiary services and the presence of trained female community health volunteers . Two additional combinations of conditions were also identified as sufficient for a high mental health service utilisation: high medication supply, trained facility staff and either the use of a community informant detection tool or having a larger proportion of the community attend community awareness activities.Conclusions Both supply-side interventions (formalised approaches to health worker detection and treatment, training of health workers, supervision) and demand-side interventions (community awareness and case finding) are important to integrate mental health in primary care. ToC can be used to provide an integrated analysis of data from a ToC, therefore helping to shed light on the black box of complex multilevel interventions.