ArticleBMJ global health2018
Using qualitative comparative analysis and theory of change to unravel the effects of a mental health intervention on service utilisation in Nepal.
Article in BMJ global health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The use of Qualitative Comparative Analysis (QCA) to address causality in complex systems: a systematic review of research on public health interventions.BMC public health · 2021Pooled it
- Implementation of peer support for people with severe mental health conditions in high-, middle- and low-income-countries: a theory of change approach.BMC health services research · 2024Trial
- Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South Africa.Global health action · 2021Trial
- Mental health service readiness in Nepal: Insights from the 2021 Nepal Health Facility Survey.PLOS mental health · 2025Article
- Feasibility and acceptability of community-based psychosocial interventions delivered by nonspecialists for perinatal common mental disorders: A systematic review using an implementation science framework.Global mental health (Cambridge, England) · 2025Review
- The Role of School Health Promotion in Students' Dietary Intake during School Hours: A Qualitative Comparative Analysis.Nutrients · 2024Article
- A qualitative study on the adaptation of community programmes for the promotion of early detection and health-seeking of perinatal depression in Nepal.BMC women's health · 2024Article
- Impact pathways of personality and psychosocial stress on depression among adult community residents in China: a fuzzy-set qualitative comparative analysis.Frontiers in psychology · 2024Article
- One-year impact of a multicomponent, street-level design intervention in Mexico City on pedestrian crashes: a quasi-experimental study.Journal of epidemiology and community health · 2023Article
- Identifying multilevel and multisectoral strategies to develop a Theory of Change for improving child and adolescent mental health services in a case-study district in South Africa.Child and adolescent psychiatry and mental health · 2022Article
- Influence of Workload, Personality, and Psychological Flexibility on Occupational Stress Among Medical Staff: A Fuzzy-Set Qualitative Comparative Analysis.Frontiers in public health · 2022Article
- WHO mental health gap action programme (mhGAP) intervention guide: updated systematic review on evidence and impact.Evidence-based mental health · 2021Review
- Lessons from a theory of change-driven evaluation of a global mental health funding portfolio.International journal of mental health systems · 2021Article
- Traditional and biomedical care pathways for mental well-being in rural Nepal.International journal of mental health systems · 2021Article
- Factors affecting utilization of mental health services from Primary Health Care (PHC) facilities of western hilly district of Nepal.PloS one · 2021Article
- Designs and methods for implementation research: Advancing the mission of the CTSA program.Journal of clinical and translational science · 2020Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe 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.
methodsWe 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.
resultsThe 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.
conclusionsBoth 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.
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