PMID- 29599820 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220410 IS - 1752-4458 (Print) IS - 1752-4458 (Electronic) IS - 1752-4458 (Linking) VI - 12 DP - 2018 TI - A structured approach to integrating mental health services into primary care: development of the Mental Health Scale Up Nigeria intervention (mhSUN). PG - 11 LID - 10.1186/s13033-018-0188-0 [doi] LID - 11 AB - BACKGROUND: The treatment gap for mental illness in Nigeria, as in other sub-Saharan countries, is estimated to be around 85%. There is need to prioritise mental health care in low and middle income countries by providing a strong body of evidence for effective services, particularly with a view to increasing international and government confidence in investment in scaling up appropriate services. This paper lays out the processes by which a programme to integrate evidence-based mental health care into primary care services in Nigeria was designed, including a research framework to provide evidence from a robust evaluation. METHODS: This paper forms the first step in the overall process evaluation of the mhSUN intervention, where standard research practice indicates that the intervention, and its development, is clearly documented prior to subsequent evaluation. The report covers the period of programme development and evaluation design, and study site and design was chosen to allow generalisability and practical conclusions to be drawn for service development in Nigeria. In order to design an intervention that was informed by evidence and took into account local context and input of stakeholders, a structured process was followed, including: (1) Engagement of relevant stakeholders for information gathering and buy-in; (2) Literature review and gathering of pertinent evidence; (3) Situation analysis at a national and local level; (4) Model development (using Theory of Change); (5) Ongoing consultation, recognising the iterative nature of Theory of Change, and need for ongoing refinement of complex interventions. RESULTS: The different sections of the structured approach resulted in outputs that built the necessary components (literature review, situation analysis) for informing the Theory of Change. A Theory of Change map is presented, which includes transparent documentation of the assumptions and logic behind the activities to drive the desired change. In addition, it documents the indicators necessary to measure fidelity and draw conclusions as to hypothesised effects of different mechanisms of action in subsequent evaluation. CONCLUSION: In addition to the details of ensuring robust evaluation design, there are a number of considerations that are particular to the context that must be taken into account in programme development, including the relationships between ultimate beneficiaries, implementers, host government and institutions, donors, and programme evaluators. Structured methods from existing frameworks can be drawn upon to use and collate relevant information to maximise the local applicability of a generic evidence base. Theory of Change, with its documented assumptions can form the basis of subsequent evaluation and iterative programme refinement, contributing to a more scientifically valid means of developing mental health programmes for scale up. FAU - Eaton, Julian AU - Eaton J AUID- ORCID: 0000-0003-2697-4965 AD - 1Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK. ISNI: 0000 0004 0425 469X. GRID: grid.8991.9 AD - 2CBM International, Bensheim, Germany. ISNI: 0000 0000 9041 9163. GRID: grid.468276.9 FAU - Gureje, Oye AU - Gureje O AD - 3Department of Psychiatry and WHO Collaborating Centre, University of Ibadan, Ibadan, Nigeria. ISNI: 0000 0004 1794 5983. GRID: grid.9582.6 FAU - De Silva, Mary AU - De Silva M AD - 4Wellcome Trust, London, UK. ISNI: 0000 0004 0427 7672. GRID: grid.52788.30 FAU - Sheikh, Taiwo Lateef AU - Sheikh TL AD - Federal Neuropsychiatric Hospital, Kaduna, Nigeria. FAU - Ekpe, Ekpe Esien AU - Ekpe EE AD - Federal Neuropsychiatric Hospital, Calabar, Nigeria. FAU - Abdulaziz, Mohammed AU - Abdulaziz M AD - Federal Neuropsychiatric Hospital, Kaduna, Nigeria. FAU - Muhammad, Asiya AU - Muhammad A AD - Federal Neuropsychiatric Hospital, Kaduna, Nigeria. FAU - Akande, Yusuf AU - Akande Y AD - Federal Neuropsychiatric Hospital, Kaduna, Nigeria. FAU - Onukogu, Uchechi AU - Onukogu U AD - Federal Neuropsychiatric Hospital, Calabar, Nigeria. FAU - Onyuku, Theo AU - Onyuku T AD - Federal Neuropsychiatric Hospital, Calabar, Nigeria. FAU - Abdulmalik, Jibril AU - Abdulmalik J AD - 3Department of Psychiatry and WHO Collaborating Centre, University of Ibadan, Ibadan, Nigeria. ISNI: 0000 0004 1794 5983. GRID: grid.9582.6 FAU - Fadahunsi, Woye AU - Fadahunsi W AD - 3Department of Psychiatry and WHO Collaborating Centre, University of Ibadan, Ibadan, Nigeria. ISNI: 0000 0004 1794 5983. GRID: grid.9582.6 FAU - Nwefoh, Emeka AU - Nwefoh E AD - 2CBM International, Bensheim, Germany. ISNI: 0000 0000 9041 9163. GRID: grid.468276.9 FAU - Cohen, Alex AU - Cohen A AD - 1Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK. ISNI: 0000 0004 0425 469X. GRID: grid.8991.9 LA - eng PT - Journal Article DEP - 20180327 PL - England TA - Int J Ment Health Syst JT - International journal of mental health systems JID - 101294224 PMC - PMC5870530 OTO - NOTNLM OT - Community mental health services OT - Integration OT - Low-and middle-income countries (LAMIC) OT - Mental health OT - Primary care OT - Scaling up EDAT- 2018/03/31 06:00 MHDA- 2018/03/31 06:01 PMCR- 2018/03/27 CRDT- 2018/03/31 06:00 PHST- 2018/01/02 00:00 [received] PHST- 2018/03/01 00:00 [accepted] PHST- 2018/03/31 06:00 [entrez] PHST- 2018/03/31 06:00 [pubmed] PHST- 2018/03/31 06:01 [medline] PHST- 2018/03/27 00:00 [pmc-release] AID - 188 [pii] AID - 10.1186/s13033-018-0188-0 [doi] PST - epublish SO - Int J Ment Health Syst. 2018 Mar 27;12:11. doi: 10.1186/s13033-018-0188-0. eCollection 2018.