Implementation outcomes of cognitive behavioural therapy delivered by non-specialists for common mental disorders and substance-use disorders in low- and middle-income countries: a systematic review

Verhey, Ibone; Ryan, Grace; Scherer, Nathaniel; Magidson, Jessica F.

doi:10.1186/s13033-020-00372-9

Cited by 39 publications

(33 citation statements)

References 39 publications

(209 reference statements)

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“…We found several similarities when comparing our results to previous systematic reviews on implementation outcomes. Similar to previous reviews on implementation outcomes in LMICs, acceptability, appropriateness, and feasibility were the most frequently reported implementation outcomes [ 41 – 43 ]. All six interventions in the review reported high intervention acceptability.…”

Section: Discussionsupporting

confidence: 67%

“…In addition, there was low reporting on intervention fidelity or descriptions on how the interventions are implemented which are crucial information for ensuring the successful replication or adoption of these interventions to maximize effectiveness and public health gains [ 55 ]. These gaps are in congruence with reviews of interventions in LMICs, which calls for more robust and consistent measurement of adoption [ 41 , 42 , 56 ] and fidelity [ 42 ]. Future reporting of mHealth interventions for young people in LMICs should consider providing detailed fidelity measures or information to provide structure for effective planning, implementation, and evaluation of interventions.…”

Section: Discussionmentioning

confidence: 55%

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Mobile health interventions for HIV/STI prevention among youth in low- and middle-income countries (LMICs): a systematic review of studies reporting implementation outcomes

Nwaozuru

Obiezu-Umeh

Shato

et al. 2021

Implement Sci Commun

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Background Advances and proliferation of technologies such as mobile phones may provide opportunities to improve access to HIV/STI services and reach young people with high risk for HIV and STI. However, the reach, uptake, and sustainability of mobile health (mHealth) HIV/STI interventions targeting young people aged 10–24 years in low- and middle-income countries (LMICs) are largely unknown. To address this gap and to inform implementation science research, a review was conducted to summarize what is known, and what we need to know about implementing mhealth interventions for HIV/STI prevention targeting young people in LMICs. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this review. Drawing upon Proctor’s eight implementation outcome measures, we evaluated the acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability of m-health HIV/STI interventions targeting young people in LMICs. The search was performed from September 2020–January 2021 and updated on March 1, 2021, in Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, SCOPUS, Global Health, and Web of Science. Eligible studies were required to include an HIV/STI prevention outcome, target young people aged 10–24 years, include a comparison/control group, and reporting of atleast one implementation outcome as outlined by Proctor. Results A total of 1386 articles were located, and their titles and abstracts were screened. Of these, 57 full-text articles were reviewed and subsequently, and 11 articles representing 6 unique interventions were included in the systematic review. Acceptability 6 (100%), appropriateness 6 (100%), and feasibility 5(83%) were the most frequently evaluated implementation outcomes. Adoption 2 (33%), fidelity 1 (17%), and cost 1 (17%) were rarely reported; penetration and sustainability were not reported. Conclusions This review contributes to implementation science literature by synthesizing key implementation outcomes of mHealth HIV/STI interventions targeting young people in LMICs. Future research is needed on m-health HIV/STI implementation outcomes, particularly the penetration, cost, and long-term sustainability of these interventions. Doing so will enhance the field’s understanding of the mechanisms by which these interventions lead or do not lead to changes in high HIV/STI risk and vulnerability among young people in LMICs.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 55%

Mobile health interventions for HIV/STI prevention among youth in low- and middle-income countries (LMICs): a systematic review of studies reporting implementation outcomes

Nwaozuru

Obiezu-Umeh

Shato

et al. 2021

Implement Sci Commun

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“…It is worth noting that every evaluation of effectiveness showed some treatment effect, typically with moderate to large effect sizes, for one or more CMDs [ 67 – 76 , 84 – 91 , 93 ]. Further, implementation research generally found lay-delivered talk therapies to be acceptable, appropriate and feasible to implement [ 77 – 89 , 92 , 93 ], echoing findings from a recent review of implementation outcomes of non-specialist-delivered CBT in LMICs (though the authors note the variable quality of this research) [ 106 ]. Several studies also demonstrated that with appropriate supervision systems in place, lay workers can deliver manualised talk therapies with a high degree of fidelity [ 84 – 88 ].…”

Section: Discussionmentioning

confidence: 80%

Lay-delivered talk therapies for adults affected by humanitarian crises in low- and middle-income countries

et al. 2021

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Background Published by the World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR) in 2015, the mental health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG) recommends brief versions of structured psychological interventions for people experiencing symptoms of common mental disorders (CMDs). mhGAP-HIG acknowledges a growing body of evidence suggesting these interventions can be delivered by lay workers to people affected by humanitarian crises in low- and middle-income countries (LMICs). However, there has not yet been a systematic review and synthesis of this evidence. This paper reports the results of a systematic review of qualitative, quantitative, and mixed-methods studies assessing the implementation and/or effectiveness of talk therapies for CMDs when provided by lay workers in LMICs to adults who have survived or are currently living in humanitarian situations. Methods Seven electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library, and ClinicalTrials.gov. We also hand-searched the contents pages of three academic journals, reference lists of 30 systematic reviews, and online resource directories of two mental health networks. A preliminary list of included studies was circulated to topical experts for review, and all included studies were backward and forward searched. All titles, abstracts, and full-texts were independently double-screened. Quality appraisal and data extraction were carried out by a single reviewer and checked by a second reviewer, using standardised tools. Any disagreements were discussed and referred to a third reviewer as needed. Results We identified 23 unique studies and carried out a narrative synthesis of patient and implementation outcome data. Every evaluation of the effectiveness of lay-delivered talk therapies for adults affected by humanitarian crises in LMICs showed some treatment effect for at least one CMD, and often multiple CMDs. Implementation research generally found these interventions to be acceptable, appropriate and feasible to implement, with good fidelity to manualised therapies. Conclusion Although results are promising, particularly for individually-delivered talk therapies based on cognitive behavioural therapy techniques, there is a high degree of heterogeneity in this literature. We make several recommendations on how to improve the quality and generalisability of research on this topic, to facilitate further evidence synthesis. Trial registration PROSPERO registration number: CRD42017058287.

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“…The implementation challenges for this cognitive-behavioral therapy group-based intervention are noteworthy. This intervention design, in consultation with the GHS, utilized peer mothers with low literacy in the local language and no formal health-care role to deliver the intervention as has been seen in other community-based mental health trials (Singla et al ., 2017; Verhey et al ., 2020). This strategy supported the potential sustainability of the intervention but came with literacy challenges for delivering the iMBC content with full fidelity.…”

Section: Discussionmentioning

confidence: 99%

Effect of a lay counselor-delivered integrated maternal mental health and early childhood development group-based intervention in Northern Ghana: a cluster-randomized controlled trial

et al. 2021

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Background Caregiver mental health is linked to early childhood development, yet more robust evidence of community-based interventions to prevent maternal depression and optimize socio-emotional development of young children is needed. Objectives of this cluster-randomized controlled trial (cRCT), based in Northern Ghana, are to assess the impact of the lay counselor-delivered, group-based Integrated Mothers and Babies Course and Early Childhood Development (iMBC/ECD) program on (1) the mental health of mothers of children under age 2; and (2) the socio-emotional development of their children. Methods This cRCT randomized 32 women's groups – 16 received iMBC/ECD content (intervention) and 16 received general health education content (control). Surveys were administered at baseline, immediate post-intervention, and 8-month post-intervention. The primary outcome was maternal depression [Patient Health Questionnaire (PHQ-9)], and the secondary outcome was child's socio-emotional development [Ages and Stages Questionnaire: Social Emotional (ASQ:SE-2)]. Qualitative interviews with 33 stakeholders were also conducted. Results In total, 374 participants were enrolled at baseline while pregnant with the index child, 19% endorsing moderate/severe depression. Of these, 266 (71.1%) completed the 8-month post-intervention survey (~19 months post-baseline). There were no significant effects of iMBC/ECD on PHQ-9 and ASQ:SE-2 scores. However, results favored the intervention arm in most cases. iMBC participants were highly satisfied with the program but qualitative feedback from stakeholders indicated some implementation challenges. Conclusions This real-world evaluation had null findings; however, post-intervention depression levels were very low in both arms (3%). Future research should examine the potential impact of women's groups on postpartum mental health more broadly with varying content.

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Implementation outcomes of cognitive behavioural therapy delivered by non-specialists for common mental disorders and substance-use disorders in low- and middle-income countries: a systematic review

Cited by 39 publications

References 39 publications

Mobile health interventions for HIV/STI prevention among youth in low- and middle-income countries (LMICs): a systematic review of studies reporting implementation outcomes

Mobile health interventions for HIV/STI prevention among youth in low- and middle-income countries (LMICs): a systematic review of studies reporting implementation outcomes

Lay-delivered talk therapies for adults affected by humanitarian crises in low- and middle-income countries

Effect of a lay counselor-delivered integrated maternal mental health and early childhood development group-based intervention in Northern Ghana: a cluster-randomized controlled trial

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