Using the RE-AIM framework to evaluate the implementation of scaling-up the Friendship Bench in Zimbabwe - a quantitative observational study.

Journal: BMC health services research

Volume: 22

Issue: 1

Year of Publication: 2022

Affiliated Institutions:  Friendship Bench, Harare, Zimbabwe. ruth.verhey@zol.co.zw. Friendship Bench, Harare, Zimbabwe. Women's University in Africa (WUA), Harare, Zimbabwe. Centre for Global Mental Health, King's College, IOPPN, London, UK. Department of Global Health, University of Washington, Seattle, WA, USA.

Abstract summary 

This study aimed to evaluate the real-world implementation of the Friendship Bench (FB) - an evidence-based brief psychological intervention delivered by community health workers (CHWs) - three years after its implementation in three city health departments in Zimbabwe. Implementation sites were evaluated according to their current performance using the RE-AIM framework making this one of the first evaluations of a scaled-up evidence-based psychological intervention in sub-Saharan Africa (SSA).Using the RE-AIM guide ( www.re-aim.org ), the authors designed quantitative indicators based on existing FB implementation data. Thirty-six primary health care clinics (PHC) in Harare (n=28), Chitungwiza (n=4) and Gweru (n=4) were included. Among these clinics 20 were large comprehensive health care centers, 7 medium (mostly maternal and child healthcare) and 9 small clinics (basic medical care and acting as referral clinic). Existing data from these clinics, added to additionally collected data through interviews and field observations were used to investigate and compare the performance of the FB across clinics. The focus was on the RE-AIM domains of Reach, Adoption, and Implementation.Small clinics achieved 34% reach, compared to large (15%) and medium clinics (9%). Adoption was high in all clinic types, ranging from 59% to 71%. Small clinics led the implementation domain with 53%, followed by medium sized clinics 43% and large clinics 40%. Small clinics performed better in all indicators and differences in performance between small and large clinics were significant. Program activity and data quality depends on ongoing support for delivering agents and buy-in from health authorities.The Friendship Bench program was implemented over three years transitioning from a research-based implementation program to one led locally. The Reach domain showed the largest gap across clinics where larger clinics performed poorly relative to smaller clinics and should be a target for future implementation improvements. Program data needs to be integrated into existing health information systems. Future studies should seek to optimize scale-up and sustainment strategies to maintain effective task-shared psychological interventions in SSA.

Authors & Co-authors:  Verhey Ruth R Chitiyo Charmaine C Mboweni Sandra S Turner Jean J Murombo Gift G Healey Andy A Chibanda Dixon D Wagenaar Bradley H BH Araya Ricardo R

Study Outcome 

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Statistics
Citations :  Alonso J, Liu Z, Evans-Lacko S, Sadikova E, Sampson N, Chatterji S, et al. Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries. Depress Anxiety. 2018;35:195–208. doi: 10.1002/da.22711.
Authors :  9
Identifiers
Doi : 1392
SSN : 1472-6963
Study Population
Male,Female
Mesh Terms
Child
Other Terms
Friendship Bench;Low- and middle-income countries;Mental health;RE-AIM;common mental disorders (CMD);implementation evaluation;scale up;sub-Saharan Africa
Study Design
Study Approach
,Quantitative
Country of Study
Zimbabwe
Publication Country
England