Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South Africa
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 tas...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2021-01-01
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| Series: | Global Health Action |
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| Online Access: | http://dx.doi.org/10.1080/16549716.2021.1940761 |
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| author | André Janse van Rensburg Tasneem Kathree Erica Breuer One Selohilwe Ntokozo Mntambo Ruwayda Petrus Arvin Bhana Crick Lund Lara Fairall Inge Petersen |
| author_facet | André Janse van Rensburg Tasneem Kathree Erica Breuer One Selohilwe Ntokozo Mntambo Ruwayda Petrus Arvin Bhana Crick Lund Lara Fairall Inge Petersen |
| author_sort | André Janse van Rensburg |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-4f1526e8bd504a33bfe5c324dd2f16db |
| institution | Kabale University |
| issn | 1654-9880 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Global Health Action |
| spelling | doaj-art-4f1526e8bd504a33bfe5c324dd2f16db2025-08-20T04:03:21ZengTaylor & Francis GroupGlobal Health Action1654-98802021-01-0114110.1080/16549716.2021.19407611940761Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South AfricaAndré Janse van Rensburg0Tasneem Kathree1Erica Breuer2One Selohilwe3Ntokozo Mntambo4Ruwayda Petrus5Arvin Bhana6Crick Lund7Lara Fairall8Inge Petersen9University of KwaZulu-Natal, School of Nursing and Public HealthUniversity of KwaZulu-NatalUniversity of Cape TownUniversity of KwaZulu-NatalUniversity of KwaZulu-NatalUniversity of KwaZulu-NatalUniversity of KwaZulu-Natal & South African Medical Research CouncilUniversity of Cape Town & Centre for Global Mental Health, King’s College LondonUniversity of Cape TownUniversity of KwaZulu-NatalBackground 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.http://dx.doi.org/10.1080/16549716.2021.1940761integrated mental healthcarehealth systemsprimary healthcarequalitative comparative analysislow-to-middle income country |
| spellingShingle | André Janse van Rensburg Tasneem Kathree Erica Breuer One Selohilwe Ntokozo Mntambo Ruwayda Petrus Arvin Bhana Crick Lund Lara Fairall Inge Petersen Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South Africa Global Health Action integrated mental healthcare health systems primary healthcare qualitative comparative analysis low-to-middle income country |
| title | Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South Africa |
| title_full | Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South Africa |
| title_fullStr | Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South Africa |
| title_full_unstemmed | Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South Africa |
| title_short | Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South Africa |
| title_sort | fuzzy set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in south africa |
| topic | integrated mental healthcare health systems primary healthcare qualitative comparative analysis low-to-middle income country |
| url | http://dx.doi.org/10.1080/16549716.2021.1940761 |
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