Evaluating the delivery of Problem Management Plus in primary care settings in rural Rwanda: a study protocol using a pragmatic randomised hybrid type 1 effectiveness-implementation design
Introduction Evidence-based low-intensity psychological interventions such as Problem Management Plus (PM+) have the potential to expand treatment access for depression and anxiety, yet these interventions are not yet effectively implemented in rural, public health systems in resource-limited settin...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/12/e054630.full |
| _version_ | 1826938754788491264 |
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| author | Christian Rusangwa Fredrick Kateera Stephanie L Smith Beatha Nyirandagijimana Janvier Hakizimana Roger P Levy Robert Bienvenu Anathalie Uwamwezi Octavien Hakizimfura Eugenie Uwimana Priya Kundu Egide Mpanumusingo Alphonse Nshimyiryo Hildegarde Mukasakindi Giuseppe Raviola |
| author_facet | Christian Rusangwa Fredrick Kateera Stephanie L Smith Beatha Nyirandagijimana Janvier Hakizimana Roger P Levy Robert Bienvenu Anathalie Uwamwezi Octavien Hakizimfura Eugenie Uwimana Priya Kundu Egide Mpanumusingo Alphonse Nshimyiryo Hildegarde Mukasakindi Giuseppe Raviola |
| author_sort | Christian Rusangwa |
| collection | DOAJ |
| description | Introduction Evidence-based low-intensity psychological interventions such as Problem Management Plus (PM+) have the potential to expand treatment access for depression and anxiety, yet these interventions are not yet effectively implemented in rural, public health systems in resource-limited settings. In 2017, Partners In Health adapted PM+ for delivery by primary care nurses in rural Rwanda and began integrating PM+ into health centres in collaboration with the Rwandan Ministry of Health, using established implementation strategies for mental health integration into primary care (Mentoring and Enhanced Supervision at Health Centers for Mental Health (MESH MH)). A gap in the evidence regarding whether low-intensity psychological interventions can be successfully integrated into real-world primary care settings and improve outcomes for common mental disorders remains. In this study, we will rigorously evaluate the delivery of PM+ by primary care nurses, supported by MESH MH, as it is scaled across one rural district in Rwanda.Methods and analysis We will conduct a hybrid type 1 effectiveness-implementation study to test the clinical outcomes of routinely delivered PM+ and to describe the implementation of PM+ at health centres. To study the clinical effectiveness of PM+, we will use a pragmatic, randomised multiple baseline design to determine whether participants experience improvement in depression symptoms (measured by the Patient Health Questionnaire-9) and functioning (measured by the WHO-Disability Assessment Scale Brief 2.0) after receiving PM+. We will employ quantitative and qualitative methods to describe and evaluate PM+ implementation outcomes using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, using routinely collected programme data and semistructured interviews.Ethics and dissemination This evaluation was approved by the Rwanda National Ethics Committee (Protocol #196/RNEC/2019) and deemed exempt by the Harvard University Institutional Review Board. The results from this evaluation will be useful for health systems planners and policy-makers working to translate the evidence base for low-intensity psychological interventions into practice. |
| first_indexed | 2024-12-20T13:24:43Z |
| format | Article |
| id | doaj.art-600269ce4a934bf9b88845efb9b0c6b3 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2025-02-17T19:02:24Z |
| publishDate | 2021-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-600269ce4a934bf9b88845efb9b0c6b32024-12-10T16:00:09ZengBMJ Publishing GroupBMJ Open2044-60552021-12-01111210.1136/bmjopen-2021-054630Evaluating the delivery of Problem Management Plus in primary care settings in rural Rwanda: a study protocol using a pragmatic randomised hybrid type 1 effectiveness-implementation designChristian Rusangwa0Fredrick Kateera1Stephanie L Smith2Beatha Nyirandagijimana3Janvier Hakizimana4Roger P Levy5Robert Bienvenu6Anathalie Uwamwezi7Octavien Hakizimfura8Eugenie Uwimana9Priya Kundu10Egide Mpanumusingo11Alphonse Nshimyiryo12Hildegarde Mukasakindi13Giuseppe Raviola14Inshuti Mu Buzima, Partners In Health – Rwanda, Rwinkwavu, RwandaResearch Department, Partners In Health/Inshuti Mu Buzima, Kigali, RwandaSchool of Public and International Affairs, Virginia Tech, Arlington, Virginia, USAPartners In Health, Kigali, RwandaPartners In Health, Kigali, RwandaDepartment of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USAPartners In Health, Kigali, RwandaPartners In Health, Kigali, RwandaMinistry of Health, Butaro, RwandaMinistry of Health, Butaro, RwandaPartners In Health, Kigali, RwandaClinical, Partners In Health/Inshuti Mu Buzima, Kigali, RwandaResearch and Training, Partners In Health/Inshuti Mu Buzima, Kigali, RwandaPartners In Health, Kigali, RwandaPartners In Health, Boston, Massachusetts, USAIntroduction Evidence-based low-intensity psychological interventions such as Problem Management Plus (PM+) have the potential to expand treatment access for depression and anxiety, yet these interventions are not yet effectively implemented in rural, public health systems in resource-limited settings. In 2017, Partners In Health adapted PM+ for delivery by primary care nurses in rural Rwanda and began integrating PM+ into health centres in collaboration with the Rwandan Ministry of Health, using established implementation strategies for mental health integration into primary care (Mentoring and Enhanced Supervision at Health Centers for Mental Health (MESH MH)). A gap in the evidence regarding whether low-intensity psychological interventions can be successfully integrated into real-world primary care settings and improve outcomes for common mental disorders remains. In this study, we will rigorously evaluate the delivery of PM+ by primary care nurses, supported by MESH MH, as it is scaled across one rural district in Rwanda.Methods and analysis We will conduct a hybrid type 1 effectiveness-implementation study to test the clinical outcomes of routinely delivered PM+ and to describe the implementation of PM+ at health centres. To study the clinical effectiveness of PM+, we will use a pragmatic, randomised multiple baseline design to determine whether participants experience improvement in depression symptoms (measured by the Patient Health Questionnaire-9) and functioning (measured by the WHO-Disability Assessment Scale Brief 2.0) after receiving PM+. We will employ quantitative and qualitative methods to describe and evaluate PM+ implementation outcomes using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, using routinely collected programme data and semistructured interviews.Ethics and dissemination This evaluation was approved by the Rwanda National Ethics Committee (Protocol #196/RNEC/2019) and deemed exempt by the Harvard University Institutional Review Board. The results from this evaluation will be useful for health systems planners and policy-makers working to translate the evidence base for low-intensity psychological interventions into practice.https://bmjopen.bmj.com/content/11/12/e054630.full |
| spellingShingle | Christian Rusangwa Fredrick Kateera Stephanie L Smith Beatha Nyirandagijimana Janvier Hakizimana Roger P Levy Robert Bienvenu Anathalie Uwamwezi Octavien Hakizimfura Eugenie Uwimana Priya Kundu Egide Mpanumusingo Alphonse Nshimyiryo Hildegarde Mukasakindi Giuseppe Raviola Evaluating the delivery of Problem Management Plus in primary care settings in rural Rwanda: a study protocol using a pragmatic randomised hybrid type 1 effectiveness-implementation design BMJ Open |
| title | Evaluating the delivery of Problem Management Plus in primary care settings in rural Rwanda: a study protocol using a pragmatic randomised hybrid type 1 effectiveness-implementation design |
| title_full | Evaluating the delivery of Problem Management Plus in primary care settings in rural Rwanda: a study protocol using a pragmatic randomised hybrid type 1 effectiveness-implementation design |
| title_fullStr | Evaluating the delivery of Problem Management Plus in primary care settings in rural Rwanda: a study protocol using a pragmatic randomised hybrid type 1 effectiveness-implementation design |
| title_full_unstemmed | Evaluating the delivery of Problem Management Plus in primary care settings in rural Rwanda: a study protocol using a pragmatic randomised hybrid type 1 effectiveness-implementation design |
| title_short | Evaluating the delivery of Problem Management Plus in primary care settings in rural Rwanda: a study protocol using a pragmatic randomised hybrid type 1 effectiveness-implementation design |
| title_sort | evaluating the delivery of problem management plus in primary care settings in rural rwanda a study protocol using a pragmatic randomised hybrid type 1 effectiveness implementation design |
| url | https://bmjopen.bmj.com/content/11/12/e054630.full |
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