TY - JOUR
KW - Humans
KW - Mental Health Services
KW - Primary Health Care
KW - South Africa
KW - Integrated mental healthcare
KW - health systems
KW - low-to-middle income country
KW - primary healthcare
KW - qualitative comparative analysis
AU - Janse van Rensburg
AU - T. Kathree
AU - E. Breuer
AU - O. Selohilwe
AU - N. Mntambo
AU - R. Petrus
AU - A. Bhana
AU - C. Lund
AU - L. Fairall
AU - I. Petersen
A1 - 
AB - BACKGROUND: Integrating mental health services into primary healthcare platforms is an established health systems strategy in low-to-middle-income countries. In South Africa, this was pursued through the Programme for Improving Mental Health Care (PRIME), a multi-country initiative that relied on task-sharing as a principle implementation strategy. Towards better describing the implementation processes, qualitative comparative analysis was adopted to explore causal pathways in the intervention. OBJECTIVE: This study aimed to explore factors that could have influenced key outcomes of an integrated mental healthcare intervention in South Africa. METHODS: Drawing from an embedded multiple case study design, the analysis used qualitative comparative analysis. Focusing on nine PHC clinics in the Dr Kenneth Kaunda District as cases, with depression reduction scores set as outcome measures, trial data variables were modelled in a hypothetical causal process. A fuzzy-set qualitative comparative analysis was performed by 1) developing the research questions, 2) developing the fuzzy set, 3) testing necessity and 4) testing sufficiency. These steps were undertaken collaboratively among the research team. RESULTS: The data were calibrated during several meetings among team members to gain a degree of consensus. Necessity analyses suggested that none of the causal conditions exceeded the threshold of necessity and triviality, and confirmed the inclusion of relevant variables in line with the proposed models. Sufficiency analyses produced two configurations, which were subjected to standard and specific analyses. Ultimately, the results suggested that none of the causal conditions were necessary for a reduction in depression scores to occur, while programme fidelity was identified as a sufficient condition for a reduction in scores to occur. CONCLUSIONS: The study highlights the importance of understanding implementation pathways to enable better integration of mental health services within primary healthcare in low-to-middle-income settings. It underlines the importance of programme fidelity in achieving the goals of implementation.
AD - Centre for Rural Health, University of KwaZulu-Natal, School of Nursing and Public Health, Durban, South Africa.; Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.; Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa.; Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.; Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.; Department of Psychology, University of KwaZulu-Natal, Durban, South Africa.; Centre for Rural Health, University of KwaZulu-Natal & South African Medical Research Council, Durban, South Africa.; Alan J Flisher Centre for Public Mental Health, University of Cape Town & Centre for Global Mental Health, King's College London, Cape Town, South Africa.; Centre for Knowledge Translation, University of Cape Town, Cape Town, South Africa.; Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.
BT - Global health action
C5 - Education & Workforce
CP - 1
DO - 10.1080/16549716.2021.1940761
IS - 1
JF - Global health action
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Integrating mental health services into primary healthcare platforms is an established health systems strategy in low-to-middle-income countries. In South Africa, this was pursued through the Programme for Improving Mental Health Care (PRIME), a multi-country initiative that relied on task-sharing as a principle implementation strategy. Towards better describing the implementation processes, qualitative comparative analysis was adopted to explore causal pathways in the intervention. OBJECTIVE: This study aimed to explore factors that could have influenced key outcomes of an integrated mental healthcare intervention in South Africa. METHODS: Drawing from an embedded multiple case study design, the analysis used qualitative comparative analysis. Focusing on nine PHC clinics in the Dr Kenneth Kaunda District as cases, with depression reduction scores set as outcome measures, trial data variables were modelled in a hypothetical causal process. A fuzzy-set qualitative comparative analysis was performed by 1) developing the research questions, 2) developing the fuzzy set, 3) testing necessity and 4) testing sufficiency. These steps were undertaken collaboratively among the research team. RESULTS: The data were calibrated during several meetings among team members to gain a degree of consensus. Necessity analyses suggested that none of the causal conditions exceeded the threshold of necessity and triviality, and confirmed the inclusion of relevant variables in line with the proposed models. Sufficiency analyses produced two configurations, which were subjected to standard and specific analyses. Ultimately, the results suggested that none of the causal conditions were necessary for a reduction in depression scores to occur, while programme fidelity was identified as a sufficient condition for a reduction in scores to occur. CONCLUSIONS: The study highlights the importance of understanding implementation pathways to enable better integration of mental health services within primary healthcare in low-to-middle-income settings. It underlines the importance of programme fidelity in achieving the goals of implementation.
PY - 2021
SN - 1654-9880; 1654-9716; 1654-9880
SP - 1940761
T1 - Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South Africa
T2 - Global health action
TI - Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South Africa
U1 - Education & Workforce
U2 - 34402770
U3 - 10.1080/16549716.2021.1940761
VL - 14
VO - 1654-9880; 1654-9716; 1654-9880
Y1 - 2021
Y2 - Jan 1
ER -