Top

Published in:

01-12-2022 | Care | Study protocol

Systems analysis and improvement approach to optimize outpatient mental health treatment cascades in Mozambique (SAIA-MH): study protocol for a cluster randomized trial

Authors: Vasco F. J. Cumbe, Alberto Gabriel Muanido, Morgan Turner, Isaias Ramiro, Kenneth Sherr, Bryan J. Weiner, Brian P. Flaherty, Monisha Sharma, Flávia Faduque, Ernesto Rodrigo Xerinda, Bradley H. Wagenaar

Published in: Implementation Science | Issue 1/2022

Abstract

Background

Significant investments are being made to close the mental health (MH) treatment gap, which often exceeds 90% in many low- and middle-income countries (LMICs). However, limited attention has been paid to patient quality of care in nascent and evolving LMIC MH systems. In system assessments across sub-Saharan Africa, MH loss-to-follow-up often exceeds 50% and sub-optimal medication adherence often exceeds 60%. This study aims to fill a gap of evidence-based implementation strategies targeting the optimization of MH treatment cascades in LMICs by testing a low-cost multicomponent implementation strategy integrated into routine government MH care in Mozambique.

Methods

Using a cluster-randomized trial design, 16 clinics (8 intervention and 8 control) providing primary MH care will be randomized to the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH) or an attentional placebo control. SAIA-MH is a multicomponent implementation strategy blending external facilitation, clinical consultation, and provider team meetings with system-engineering tools in an overall continuous quality improvement framework. Following a 6-month baseline period, intervention facilities will implement the SAIA-MH strategy for a 2-year intensive implementation period, followed by a 1-year sustainment phase. Primary outcomes will be the proportion of all patients diagnosed with a MH condition and receiving pharmaceutical-based treatment who achieve functional improvement, adherence to medication, and retention in MH care. The Consolidated Framework for Implementation Research (CFIR) will be used to assess determinants of implementation success. Specific Aim 1b will include the evaluation of mechanisms of the SAIA-MH strategy using longitudinal structural equation modeling as well as specific aim 2 estimating cost and cost-effectiveness of scaling-up SAIA-MH in Mozambique to provincial and national levels.

Discussion

This study is innovative in being the first, to our knowledge, to test a multicomponent implementation strategy for MH care cascade optimization in LMICs. By design, SAIA-MH is a low-cost strategy to generate contextually relevant solutions to barriers to effective primary MH care, and thus focuses on system improvements that can be sustained over the long term. Since SAIA-MH is integrated into routine government MH service delivery, this pragmatic trial has the potential to inform potential SAIA-MH scale-up in Mozambique and other similar LMICs.

Trial registration

ClinicalTrials.gov; NCT05103033; 11/2/2021.

Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualization: Mozambique. 2017.

Patel V, Marino M, Flisher A, De Silva M, Koschorke M. Reducing the treatment gap for mental disorders: a WPA survey. World Psychiatry. 2010;9(3):169–76 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed9&NEWS=N&AN=2011533889.CrossRef

Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet. 2007;370(9590):878–89. https://doi.org/10.1016/S0140-6736(07)61239-2.CrossRefPubMed

Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care health. Bull World Health Organ. 2004;82(11):858–66. https://doi.org/10.1590/S0042-96862004001100011.CrossRefPubMedPubMedCentral

Kakuma R, Minas H, van Ginneken N, et al. Human resources for mental health care: current situation and strategies for action. Lancet. 2011;378(9803):1654–63. https://doi.org/10.1016/S0140-6736(11)61093-3.CrossRefPubMed

World Health Organization. Task Shifting: Rational Redistribution of Tasks among Health Workforce Teams: Global Recommendations and Guidelines. 2008.

Petersen I, Lund C, Bhana A, Flisher AJ. A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings. Health Policy Plan. 2012;27(1):42–51. https://doi.org/10.1093/heapol/czr012.CrossRefPubMed

van Ginneken N, Tharayan P, Lwein S, et al. Non-specialist health worker interventions for the care of mental , neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database Syst Rev. 2013;(11):CD009149. https://doi.org/10.1002/14651858.CD009149.

Buttorff C, Hock RS, Weiss HA, et al. Economic evaluation of a task-shifting intervention for common mental disorders in India. Bull World Health Organ. 2012;90(11):813–21. https://doi.org/10.2471/BLT.12.104133.CrossRefPubMedPubMedCentral

10.

Patel V. The future of psychiatry in low- and middle-income countries. Psychol Med. 2009;39(11):1759. https://doi.org/10.1017/S0033291709005224.CrossRefPubMed

11.

Eaton J, McCay L, Semrau M, et al. Scale up of services for mental health in low-income and middle-income countries. Lancet. 2011;378(9802):1592–603. https://doi.org/10.1016/S0140-6736(11)60891-X.CrossRefPubMed

12.

Padmanathan P, De Silva MJ. The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review. Soc Sci Med. 2013;97:82–6. https://doi.org/10.1016/j.socscimed.2013.08.004.CrossRefPubMed

13.

World Health Organization. Mental Health Atlas 2014. 2014.

14.

Araya R, Rojas G, Fritsch R, et al. Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial. Lancet. 2003;361(9362):995–1000. https://doi.org/10.1016/S0140-6736(03)12825-5.CrossRefPubMed

15.

Bolton P, Bass J, Verdeli H, Clougherty KF, Ndogoni L. Group interpersonal psychotherapy for depression in rural Uganda. JAMA. 2003;289(23):3117–24.CrossRef

16.

Patel V, Chisholm D, Rabe-Hesketh S, Dias-Saxena F, Andrew G, Mann A. Efficacy and cost-effectiveness of drug and psychological treatments for common mental disorders in general health care in Goa, India: a randomised, controlled trial. Lancet. 2003;361(9351):33–9. https://doi.org/10.1016/S0140-6736(03)12119-8.CrossRefPubMed

17.

Patel V, Chisholm D, Dua T, Laxminarayan R, Medina-Mora ME. Disease control priorities, Third Edition (Volume 4): Mental, Neurological, and Substance Use Disorders; 2015. https://doi.org/10.1596/978-1-4648-0426-7.CrossRef

18.

Dos Santos PF, Wainberg ML, Caldas-de-Almeida JM, Saraceno B, Mari JDJ. Overview of the mental health system in Mozambique: addressing the treatment gap with a task-shifting strategy in primary care. Int J Ment Health Syst. 2016;10:1. https://doi.org/10.1186/s13033-015-0032-8.CrossRefPubMedPubMedCentral

19.

Fernandes QF, Wagenaar BH, Anselmi L, Pfeiffer J, Gloyd S, Sherr K. Effects of health-system strengthening on under-5, infant, and neonatal mortality: 11-year provincial-level time-series analyses in Mozambique. Lancet Glob Heal. 2014;2(8):e468–77. https://doi.org/10.1016/S2214-109X(14)70276-1.CrossRef

20.

Wagenaar BH, Cumbe V, Raunig-Berho M, et al. Health facility determinants and trends of ICD-10 outpatient psychiatric consultations across Sofala, Mozambique: time-series analyses from 2012 to 2014. BMC Psychiatry. 2015;15(1):227. https://doi.org/10.1186/s12888-015-0609-4.CrossRefPubMedPubMedCentral

21.

Sokhela NE, Uys LR. The integration of comprehensive psychiatric/mental health care into the primary health system: diagnosis and treatment. J Adv Nurs. 1999;30(1):229–37.CrossRef

22.

Petersen I, Bhana A, Campbell-Hall V, et al. Planning for district mental health services in South Africa: a situational analysis of a rural district site. Health Policy Plan. 2009;24(2):140–50. https://doi.org/10.1093/heapol/czn049.CrossRefPubMed

23.

Couper I, Wright A, van Deventer C. Evaluation of primary mental helath care in north west province. Final Report; 2006.

24.

Hanlon C, Wondimagegn D, Alem A. Lessons learned in developing community mental health care in Africa. World Psychiatry. 2010;9:185–9.CrossRef

25.

Fabian KE, Muanido A, Cumbe VFJ, et al. Optimizing treatment cascades for mental healthcare in Mozambique: preliminary effectiveness of the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH). Health Policy Plan. 2020. https://doi.org/10.1093/heapol/czaa114.

26.

Acharya B, Swar SB. The role of consultant psychiatrists in ensuring high quality mental health care provision from non-specialists. Psychiatr Serv. 2016. https://doi.org/10.1176/appi.ps.670701.

27.

Gimbel S, Rustagi AS, Robinson J, et al. Evaluation of a systems analysis and improvement approach to optimize prevention of mother-to-child transmission of HIV using the Consolidated Framework for Implementation Research. J Acquir Immune Defic Syndr. 2016;72(Suppl 2):S108–16. https://doi.org/10.1097/QAI.0000000000001055.CrossRefPubMedPubMedCentral

28.

Boaden R, Harvey G, Moxham C, Proudlove N. Quality Improvement: Theory and Practice in Healthcare; 2008.

29.

Sherr K, Gimbel S, Rustagi A, et al. Systems analysis and improvement to optimize pMTCT (SAIA): a cluster randomized trial. Implement Sci. 2014;9(1):55. https://doi.org/10.1186/1748-5908-9-55.CrossRefPubMedPubMedCentral

30.

Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1965;44(3):166–206.CrossRef

31.

Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015;10(1):1–14. https://doi.org/10.1186/s13012-015-0209-1.CrossRef

32.

Lau R, Stevenson F, Ong BN, et al. Achieving change in primary care-causes of the evidence to practice gap: Systematic reviews of reviews. Implement Sci. 2016;11(1). https://doi.org/10.1186/s13012-016-0396-4.

33.

Krause J, Van Lieshout J, Klomp R, et al. Identifying determinants of care for tailoring implementation in chronic diseases: An evaluation of different methods. Implement Sci. 2014;9(1):1–12. https://doi.org/10.1186/s13012-014-0102-3.CrossRef

34.

Flottorp SA, Oxman AD, Krause J, et al. A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implement Sci. 2013;8(1). https://doi.org/10.1186/1748-5908-8-35.

35.

Wagner AD, Crocker J, Liu S, et al. Making smarter decisions faster: systems engineering to improve the global public health response to HIV. Curr HIV/AIDS Rep. 2019;16(4):279–91. https://doi.org/10.1007/s11904-019-00449-2.CrossRefPubMedPubMedCentral

36.

Ritchie M, Dollar J, Miller C, et al. Implementation faciliation training manual: using implementation facilitation to improve care in the Veterans Health Administration. 2017.

37.

Wagenaar BH, Hirschhorn LR, Henley C, et al. Data-driven quality improvement in low-and middle-income country health systems: Lessons from seven years of implementation experience across Mozambique, Rwanda, and Zambia. BMC Health Serv Res. 2017;17. https://doi.org/10.1186/s12913-017-2661-x.

38.

Wagner AD, Gimbel S, Ásbjörnsdóttir KH, et al. Cascade analysis: an adaptable implementation strategy across HIV and non-HIV delivery platforms. J Acquir Immune Defic Syndr. 2019;82. https://doi.org/10.1097/QAI.0000000000002220.

39.

Gimbel S, Voss J, Mercer MA, et al. The prevention of mother-to-child transmission of HIV cascade analysis tool: supporting health managers to improve facility-level service delivery. BMC Res Notes. 2014;7:743. https://doi.org/10.1186/1756-0500-7-743.CrossRefPubMedPubMedCentral

40.

Aycock DM, Hayat MJ, Helvig A, Dunbar SB, Clark PC. Essential considerations in developing attention control groups in behavioral research. Res Nurs Health. 2018;41(3):320–8. https://doi.org/10.1002/nur.21870.CrossRefPubMed

41.

Shadish WRS, Cook TD, Campbell DT. Experimental and quasi-experimental designs for generalized causal inference. Boston: Houghton Mifflin Company; 2002.

42.

Wagenaar BH, Cumbe V, Raunig-Berhó M, et al. Outpatient mental health services in Mozambique: use and treatments. Psychiatr Serv. 2016. https://doi.org/10.1176/appi.ps.201500508.

43.

Wagenaar BH, Stergachis A, Rao D, et al. The availability of essential medicines for mental healthcare in Sofala, Mozambique. Glob Health Action. 2015;8(1). https://doi.org/10.3402/gha.v8.27942.

44.

Zhang Y, Augusto O, Ásbjörnsdóttir K, et al. Geographic distribution and determinants of mental health stigma in central Mozambique. Soc Psychiatry Psychiatr Epidemiol. 2019;(0123456789). https://doi.org/10.1007/s00127-019-01708-8.

45.

Sherr K, Cuembelo F, Michel C, et al. Strengthening integrated primary health care in Sofala, Mozambique. BMC Health Serv Res. 2013;13(Suppl 2):S4. https://doi.org/10.1186/1472-6963-13-S2-S4.CrossRefPubMedPubMedCentral

46.

Ustun TB, Kostanjsek N, Chatterji S, Rehm JT. Measuring health and disability, manual for WHO disability assessment schedule (WHODAS 2.0); 2010.

47.

Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil. 2017;39(23):2347–80. https://doi.org/10.1080/09638288.2016.1223177.CrossRefPubMed

48.

Habtamu K, Alem A, Medhin G, et al. Validation of the World Health Organization Disability Assessment Schedule in people with severe mental disorders in rural Ethiopia. Health Qual Life Outcomes. 2017;15(1):64. https://doi.org/10.1186/s12955-017-0647-3.CrossRefPubMedPubMedCentral

49.

Ustün TB, Chatterji S, Kostanjsek N, et al. Developing the World Health Organization Disability Assessment Schedule 2.0. Bull World Health Organ. 2010;88(11):815–23. https://doi.org/10.2471/BLT.09.067231.CrossRefPubMedPubMedCentral

50.

Walters CB, Schwalbach T, Sevene E, et al. Chronic pain and associated factors in Maputo, Mozambique: a pilot study. Br J Pain. 2019;13(1):43–53. https://doi.org/10.1177/2049463718777009.CrossRefPubMed

51.

McKibbin C, Patterson TL, Jeste DV. Assessing disability in older patients with schizophrenia: results from the WHODAS-II. J Nerv Ment Dis. 2004;192(6):405–13.CrossRef

52.

Guilera G, Gomez-Benito J, Pino O, et al. Utility of the World Health Organization Disability Assessment Schedule II in schizophrenia. Schizophr Res. 2012;138(2-3):240–7. https://doi.org/10.1016/j.schres.2012.03.031.CrossRefPubMed

53.

Hernandez-Orduna O, Robles-Garcia R, Martinez-Lopez N, et al. WHODAS and the evaluation of disability among people with mental disorders with and without psychotic symptomsd. Salud Ment. 2017;40(5):209–17.CrossRef

54.

Hanlon C, Medhin G, Selamu M, et al. Impact of integrated district level mental health care on clinical and social outcomes of people with severe mental illness in rural Ethiopia: an intervention cohort study. Epidemiol Psychiatr Sci. 2019;29:e45. https://doi.org/10.1017/S2045796019000398.CrossRefPubMedPubMedCentral

55.

Gureje O, Oladeji BD, Montgomery AA, et al. Effect of a stepped-care intervention delivered by lay health workers on major depressive disorder among primary care patients in Nigeria (STEPCARE): a cluster-randomised controlled trial. Lancet Glob Heal. 2019;7(7):e951–60. https://doi.org/10.1016/S2214-109X(19)30148-2.CrossRef

56.

Lund C, Schneider M, Garman EC, et al. Task-sharing of psychological treatment for antenatal depression in Khayelitsha, South Africa: effects on antenatal and postnatal outcomes in an individual randomised controlled trial. Behav Res Ther. 2019:103466. https://doi.org/10.1016/j.brat.2019.103466.

57.

Jordans MJD, Luitel NP, Garman E, et al. Effectiveness of psychological treatments for depression and alcohol use disorder delivered by community-based counsellors: two pragmatic randomised controlled trials within primary healthcare in Nepal. Br J Psychiatry. 2019;215(2):485–93. https://doi.org/10.1192/bjp.2018.300.CrossRefPubMedPubMedCentral

58.

Weobong B, Weiss H, McDaid D, et al. Sustained effectiveness and cost-effectiveness of the Healthy Activity Programme, a brief psychological treatment for depression delivered by lay counsellors in primary care: 12-month follow-up of a randomised controlled trial. PLoS Med. 2017;14(9 PG-e1002385):e1002385. https://doi.org/10.1371/journal.pmed.1002385.CrossRefPubMedPubMedCentral

59.

Petersen I, Bhana A, Folb N, et al. Collaborative care for the detection and management of depression among adults with hypertension in South Africa: study protocol for the PRIME-SA randomised controlled trial. Trials. 2018;19:192. https://doi.org/10.1186/s13063-018-2518-6.

60.

Lorenz E, Gabrysch S. Covariate-constrained randomization routine for achieving baseline balance in cluster-randomized trials. Stata J. 2017;17(2):503–10. https://doi.org/10.1177/1536867x1701700214.CrossRef

61.

Dimagi. Dimagi: CommCare App. 2021. Accessed 15 Nov 2021. https://www.dimagi.com/commcare/

62.

Tableau. Tableau Software. 2021. Accessed 15 Nov 2021. https://www.tableau.com/

63.

Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: A tutorial. Int J Epidemiol. 2017;46(1):348–55. https://doi.org/10.1093/ije/dyw098.CrossRefPubMed

64.

Xiao H, Augusto O, Wagenaar BH. Reflection on modern methods: a common error in the segmented regression parameterization of interrupted time-series analyses. Int J Epidemiol. 2021;50(3):1011–5. https://doi.org/10.1093/ije/dyaa148.CrossRefPubMed

65.

Jamtvedt G, Young JM, Kristoffersen DT, Thomson O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane database Syst Rev. 2003;(3):CD000259. https://doi.org/10.1002/14651858.CD000259.

66.

Hysong SJ. Meta-analysis: audit and feedback features impact effectiveness on care quality. Med Care. 2009;47(3):356–63. https://doi.org/10.1097/MLR.0b013e3181893f6b.CrossRefPubMedPubMedCentral

67.

Tuti T, Nzinga J, Njoroge M, et al. A systematic review of electronic audit and feedback: intervention effectiveness and use of behaviour change theory. Implement Sci. 2017;12(1):61. https://doi.org/10.1186/s13012-017-0590-z.CrossRefPubMedPubMedCentral

68.

Colquhoun HL, Brehaut JC, Sales A, et al. A systematic review of the use of theory in randomized controlled trials of audit and feedback. Implement Sci. 2013;8:66. https://doi.org/10.1186/1748-5908-8-66.CrossRefPubMedPubMedCentral

69.

Colquhoun HL, Carroll K, Eva KW, et al. Advancing the literature on designing audit and feedback interventions: identifying theory-informed hypotheses. Implement Sci. 2017;12(1):117. https://doi.org/10.1186/s13012-017-0646-0.CrossRefPubMedPubMedCentral

70.

Wells S, Tamir O, Gray J, Naidoo D, Bekhit M, Goldmann D. Are quality improvement collaboratives effective? A systematic review. BMJ Qual Saf. 2018;27(3):226–40. https://doi.org/10.1136/bmjqs-2017-006926.CrossRefPubMed

71.

Hargreaves S, Rustage K, Nellums LB, et al. Do quality improvement initiatives improve outcomes for patients in antiretroviral programs in low- and middle-income countries? A Systematic Review. J Acquir Immune Defic Syndr. 2019;81(5):487–96. https://doi.org/10.1097/QAI.0000000000002085.CrossRefPubMedPubMedCentral

72.

Boonyasai RT, Windish DM, Chakraborti C, Feldman LS, Rubin HR, Bass EB. Effectiveness of teaching quality improvement to clinicians: a systematic review. JAMA. 2007;298(9):1023–37. https://doi.org/10.1001/jama.298.9.1023.CrossRefPubMed

73.

Nadeem E, Olin SS, Hill LC, Hoagwood KE, Horwitz SM. Understanding the components of quality improvement collaboratives: a systematic literature review. Milbank Q. 2013;91(2):354–94. https://doi.org/10.1111/milq.12016.CrossRefPubMedPubMedCentral

74.

Hempel S, O’Hanlon C, Lim YW, Danz M, Larkin J, Rubenstein L. Spread tools: a systematic review of components, uptake, and effectiveness of quality improvement toolkits. Implement Sci. 2019;14(1):83. https://doi.org/10.1186/s13012-019-0929-8.CrossRefPubMedPubMedCentral

75.

Shojania KG, Grimshaw JM. Evidence-based quality improvement: the state of the science. Health Aff (Millwood). 2005;24(1):138–50. https://doi.org/10.1377/hlthaff.24.1.138.CrossRefPubMed

76.

Cranley LA, Cummings GG, Profetto-McGrath J, Toth F, Estabrooks CA. Facilitation roles and characteristics associated with research use by healthcare professionals: a scoping review. BMJ Open. 2017;7(8):e014384. https://doi.org/10.1136/bmjopen-2016-014384.CrossRefPubMedPubMedCentral

77.

Baskerville NB, Liddy C, Hogg W. Systematic review and meta-analysis of practice facilitation within primary care settings. Ann Fam Med. 2012;10(1):63–74. https://doi.org/10.1370/afm.1312.CrossRefPubMedPubMedCentral

78.

Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res. 2011;45(5):626–9. https://doi.org/10.1016/j.jpsychires.2010.10.008.The.CrossRefPubMed

79.

Lynn HS. Suppression and Confounding in Action. Am Stat. 2003;57(1):58–61. https://doi.org/10.1198/0003130031090.CrossRef

80.

Wagenaar BH, Gimbel S, Hoek R, et al. Wait and consult times for primary healthcare services in central Mozambique: a time-motion study. Glob Health Action. 2016;9(1):31980. https://doi.org/10.3402/gha.v9.31980.CrossRefPubMed

81.

Chisholm D, Sanderson K, Ayuso-Mateos JL, Saxena S. Reducing the global burden of depression: population-level analysis of intervention cost-effectiveness in 14 world regions. Br J Psychiatry. 2004;184:393–403. https://doi.org/10.1192/bjp.184.5.393.CrossRefPubMed

82.

Jack H, Wagner RG, Petersen I, et al. Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness. Glob Health Action. 2014;7:23431. https://doi.org/10.3402/gha.v7.23431.CrossRefPubMed

83.

Chisholm D. Cost-effectiveness of first-line antiepileptic drug treatments in the developing world: a population-level analysis. Epilepsia. 2005;46(5):751–9. https://doi.org/10.1111/j.1528-1167.2005.52704.x.CrossRefPubMed

84.

Chisholm D, van Ommeren M, Ayuso-Mateos J-L, Saxena S. Cost-effectiveness of clinical interventions for reducing the global burden of bipolar disorder. Br J Psychiatry. 2005;187:559–67. https://doi.org/10.1192/bjp.187.6.559.CrossRefPubMed

85.

Chisholm D, Gureje O, Saldivia S, et al. Schizophrenia treatment in the developing world: an interregional and multinational cost-effectiveness analysis. Bull World Health Organ. 2008;86(7):542–51. https://doi.org/10.2471/blt.07.045377.CrossRefPubMedPubMedCentral

86.

Siskind D, Baingana F, Kim J. Cost-effectiveness of group psychotherapy for depression in Uganda. J Ment Health Policy Econ. 2008;11(3):127–33.PubMed

87.

McBain RK, Salhi C, Hann K, Salomon JA, Kim JJ, Betancourt TS. Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial. Health Policy Plan. 2016;31(4):415–24. https://doi.org/10.1093/heapol/czv078.CrossRefPubMed

88.

Murray CJ. Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ. 1994;72(3):429–45.PubMedPubMedCentral

89.

GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England). 2018;392(10159):1789–858. https://doi.org/10.1016/S0140-6736(18)32279-7.CrossRef

90.

Powell BJ, Proctor EK, Glass JE. A systematic review of strategies for implementing empirically supported mental health interventions. Res Soc Work Pract. 2014;24(2):192–212. https://doi.org/10.1177/1049731513505778.CrossRefPubMed

91.

Lewis CC, Klasnja P, Powell BJ, et al. From classification to causality: advancing understanding of mechanisms of change in implementation science. Front Public Heal. 2018;6(May). https://doi.org/10.3389/fpubh.2018.00136.

92.

Williams NJ. Multilevel mechanisms of implementation strategies in mental health: integrating theory, research, and practice. Adm Policy Ment Heal Ment Heal Serv Res. 2016;43(5):783–98. https://doi.org/10.1007/s10488-015-0693-2.CrossRef

93.

Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629. https://doi.org/10.1111/j.0887-378X.2004.00325.x.CrossRefPubMedPubMedCentral

94.

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. https://doi.org/10.1186/1748-5908-4-50.CrossRefPubMedPubMedCentral

95.

Rustagi AS, Gimbel S, Nduati R, et al. Implementation and operational research: impact of a systems engineering intervention on PMTCT service delivery in Côte d’Ivoire, Kenya, Mozambique: a cluster randomized trial. J Acquir Immune Defic Syndr. 2016;72(3). https://doi.org/10.1097/QAI.0000000000001023.

Title: Systems analysis and improvement approach to optimize outpatient mental health treatment cascades in Mozambique (SAIA-MH): study protocol for a cluster randomized trial
Authors: Vasco F. J. Cumbe
Alberto Gabriel Muanido
Morgan Turner
Isaias Ramiro
Kenneth Sherr
Bryan J. Weiner
Brian P. Flaherty
Monisha Sharma
Flávia Faduque
Ernesto Rodrigo Xerinda
Bradley H. Wagenaar
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Care
Published in: Implementation Science / Issue 1/2022
Electronic ISSN: 1748-5908
DOI: https://doi.org/10.1186/s13012-022-01213-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Systems analysis and improvement approach to optimize outpatient mental health treatment cascades in Mozambique (SAIA-MH): study protocol for a cluster randomized trial

Abstract

Background

Methods

Discussion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Discussion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2022

Correction to: Implementation of innovative medical technologies in German inpatient care: patterns of utilization and evidence development

Trends in guideline implementation: an updated scoping review

Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research

Can clinician champions reduce potentially inappropriate medications in people living with dementia? Study protocol for a cluster randomized trial

Effect of the Growth Assessment Protocol on the DEtection of Small for GestatioNal age fetus: process evaluation from the DESiGN cluster randomised trial

Do providers use computerized clinical decision support systems? A systematic review and meta-regression of clinical decision support uptake