Optimising implementation strategies of the first scaleup of a primary care psychological intervention for common mental disorders in Sub-Saharan Africa: a mixed methods study protocol for the optimised Friendship Bench (OptFB)

Ruth Verhey; Charmaine Chitiyo; Sandra Ngonidzashe Mboweni; Ephraim Chiriseri; Dixon Chibanda; Andy Healey; Bradley Wagenaar; Ricardo Araya

doi:10.1136/bmjopen-2020-045481

Optimising implementation strategies of the first scaleup of a primary care psychological intervention for common mental disorders in Sub-Saharan Africa: a mixed methods study protocol for the optimised Friendship Bench (OptFB)

BMJ Open. 2021 Sep 13;11(9):e045481. doi: 10.1136/bmjopen-2020-045481.

Authors

Ruth Verhey^{1

2}, Charmaine Chitiyo^{1

2}, Sandra Ngonidzashe Mboweni^{1

2}, Ephraim Chiriseri², Dixon Chibanda^{1

2

3}, Andy Healey⁴, Bradley Wagenaar^{5

6}, Ricardo Araya^{7

8}

Affiliations

¹ Research Support Centre, University of Zimbabwe, Harare, Harare, Zimbabwe.
² Friendship Bench Zimbabwe, Harare, Zimbabwe.
³ Global Mental Health, London School of Hygiene and Tropical Medicine, LSHTM, London, UK.
⁴ IOPPN, King's College London, London, UK.
⁵ Department of Epidemiology, University of Washington, Seattle, Washington, USA.
⁶ Department of global health, University of Washington, Seattle, Washington, USA.
⁷ IOPPN, King's College London, London, UK ricardo.araya@kcl.ac.uk.
⁸ Centre for Global Mental Health and Primary Care Research, London, UK.

Abstract

Introduction: Common mental disorders (CMDs) are a leading cause of disability globally. CMDs are highly prevalent in Zimbabwe and have been addressed by an evidence-based, task-shifting psychological intervention called the Friendship Bench (FB). The task-shifted FB programme guides clients through problem-solving therapy. It was scaled up across 36 implementation sites in Zimbabwe in 2016.

Methods and analysis: This study will employ a mixed-method framework. It aims to: (1) use quantitative survey methodologies organised around the Reach, Effectiveness, Adoption and Implementation and Maintenance evaluation framework to assess the current scaleup of the FB intervention and classify 36 clinics according to levels of performance; (2) use qualitative focus group discussions and semistructured interviews organised around the Consolidated Framework for Implementation Research to analyse determinants of implementation success, as well as elucidate heterogeneity in implementation strategies through comparing high-performing and low-performing clinics; and (3) use the results from aims 1 and 2 to develop strategies to optimise the Friendship Bench intervention and apply this model in a cluster randomised controlled trial to evaluate potential improvements among low-performing clinics. The trial will be registered with the Pan African Clinical Trial Registry (www.pactr.org). The planned randomised controlled trial for the third research aim will be registered after completing aims one and two because the intervention is dependent on knowledge generated during these phases.

Ethics and dissemination: The research protocol received full authorisation from the Medical Research Council of Zimbabwe (MRCZ A/242). It is anticipated that changes in data collection tools and consent forms will take place at all three phases of the study and approval from MRCZ will be sought. All interview partners will be asked for informed consent. The research team will prioritise open-access publications to disseminate research results.

Keywords: mental health; primary care; public health; qualitative research.

Publication types

Clinical Trial Protocol
Research Support, Non-U.S. Gov't

MeSH terms

Africa South of the Sahara
Friends*
Humans
Mental Disorders*
Primary Health Care
Psychosocial Intervention
Randomized Controlled Trials as Topic

Grants and funding

MR/S004270/1/MRC_/Medical Research Council/United Kingdom