Table 4 Research implementation steps and data gathering activities
Research Implementation steps and data gathering activities | Protocol development, pre-testing of tools and training; formation of technical and community advisory boards | Mixed qualitative methods inquiry on facilitators and barriers to uptake of evidence- based interventions for depression care in primary care settings for pregnant adolescents | Adaptation of mhGAP depression care guidelines and treatment intervention for pregnant adolescents | Observational notes for clinical workflow in primary care and training in integrated mhGAP and IPT-G for depression care | Adaptation of brief IPT-G | Test feasibility of implementation and estimate the size of effect on mental health for the adapted version of mhGAP-IG/ IPT-G. | Analyses, writing and dissemination |
Sample | Community advisory (17members), Technical advisory board (5 members) | 40 participants (8 FGDs with 5 members per group), | Utilizing community advisory and technical advisory boards for adaptation process; expert consultation as and where needed | 20 researchers and 16 providers | Utilizing community advisory and technical advisory boards for adaptation process; expert consultation as and where needed | 90 pregnant adolescents in a three-arm study: IPT-G Full and IPT-G Mini | Compiling all the information derived from all participants and consultations with mentors, experts and advisory board members |
Location of activity | In person and virtual meetings with study team members and mentors | Community and health facility based | Desk-based activity including expert consultation with partners from Department of Psychiatry University of Nairobi, Department of Mental Health MoH, WHO, UNFPA and Nairobi county | Community and health facility sample | Community and health facility sample | Community and health facility -based purposive sampling | Virtual, in-person one-on-one and group discussions and meetings with research team, advisory board members and mentors |
Training of health workers and capacity building activities | Train two-four career researchers, engage communities and build networks with Ministry of Health, mapping a referrals process for any medical or psychosocial issue arising during study | Train data collectors & RAs in two sites, train teams in psychological first aid, identify community health workers for linkages in case of any referrals for those with high depression or at risk for mental or physical | Collaborative work with the research team; three early career researchers and postgraduate students trained in mhGAP and IPT-G; technical and community advisory | Collaborative work with research team, trained researchers to train health facility workers and community health workers; capacity building of the health facility nurses in depression screening for adolescents especially peripartum | Collaborative work with the research team; trained health facility and community providers; technical and community advisory and mentors | Trained data collectors from Aim 1 would be re-engaged and additional trainings and capacity building on survey data collection will be carried out before the survey is collected. Quality assurance checks will be carried out after first 5 participant survey data per site and training repeated if there are discrepancies | Dissemination of findings to Ministry of Health and Nairobi County, Training programs for health facility workers with county and ministry of health using mhGAP |
Data collection method | Iteratively developed mixed methods inquiry with expert consultation, community advisory support | a. FGDs, KIIs b. Short survey for conjoint experiment | a. Stakeholder engagement through advisory board meetings and group discussions, b. Expert feedback | a. ethnographic- observational study, b. training workshops with the researchers, c. training workshops in the health facilities | a. Stakeholder engagement through advisory board meetings and group discussions, b. Expert feedback | feasibility trial with individual level randomization- Intervention will be delivered in groups at the health facility and data would be collected during each session and after session | Mixed methods analysis: psychometrics/multivariate analyses/ mixed qual methods |
Domains addressed /focal activities | Comprehensive community based participatory approach integrating strengths and needs of key partners from Ministry of Health, Nairobi County, WHO and UNFPA | Depression care needs from multiple stakeholders; depression care treatment preferences | Adaptations and modifications for WHO mhGAP depression treatment manual and IPT-G manual for peripartum adolescents | Integrated work-flow plan to address mental health needs of pregnant adolescents | Brief version of IPT-G which has been validated for use by technical and community advisory | Multilevel assessments from participants, providers and facility managers on acceptability, appropriateness, and usefulness of the adapted version and implementation process of the mhGAP-IG/ IPT-G service model; and adolescent self- report depression and functioning outcomes; | Several planned publications including: a. mhGAP/IPT-G adaptation for adolescent mothers with depression; b. Acceptability and Appropriateness of the Brief and Long versions of IPT-G intervention implemented by CHWs (results from a mixed method study), c. D&I context measures validation paper, d. Implementation Effectiveness Evaluation (using RCT implementation study data to study effectiveness for brief and long version of IPT-G) |
Outcome measure/s or final output | Finalized protocol with all IRB clearances and peer reviewed by a wide group of specialists | Multi-stakeholder appraisal of depression care treatment preferences | Integrated mhGAP depression care with modified IPT-G manual | New workflow plan to organize clinical services around mental health care for pregnant adolescents | Finalized version of the manual | Acceptable and useful integrated mhGAP depression care and modified IPT-G for adolescents, health facility and community health workers. Evidence of small to moderate size of intervention effect on adolescents. See Tables 1 and 2 | Peer reviewed publications, conference presentations, dissemination in the three communities through Ministry of Health and in the scientific community |