Browsing by Author "Nixdorf, Rebecca"

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    Implementation of peer support for people with severe mental health conditions in high-, middle- and low-income-countries: a theory of change approach
    (BioMed Central Ltd, 2024-04) Hiltensperger, Ramona; Ryan, Grace; Ben-Dor, Inbar Adler; Charles, Ashleigh; Epple, Ellen; Kalha, Jasmine; Korde, Palak; Kotera, Yasuhiro; Mpango, Richard; Moran, Galia; Mueller-Stierlin, Annabel Sandra; Nixdorf, Rebecca; Ramesh, Mary; Shamba, Donat; Slade, Mike; Puschner, Bernd; Nakku, Juliet
    Abstract Background Stakeholder engagement is essential to the design, implementation and evaluation of complex mental health interventions like peer support. Theory of Change (ToC) is commonly used in global health research to help structure and promote stakeholder engagement throughout the project cycle. Stakeholder insights are especially important in the context of a multi-site trial, in which an intervention may need to be adapted for implementation across very different settings while maintaining fidelity to a core model. This paper describes the development of a ToC for a peer support intervention to be delivered to people with severe mental health conditions in five countries as part of the UPSIDES trial. Methods One hundred thirty-four stakeholders from diverse backgrounds participated in a total of 17 workshops carried out at six UPSIDES implementing sites across high-, middle- and low-income settings (one site each in India, Israel, Uganda and Tanzania; two sites in Germany). The initial ToC maps created by stakeholders at each site were integrated into a cross-site ToC map, which was then revised to incorporate additional insights from the academic literature and updated iteratively through multiple rounds of feedback provided by the implementers. Results The final ToC map divides the implementation of the UPSIDES peer support intervention into three main stages: preparation, implementation, and sustainability. The map also identifies three levels of actors involved in peer support: individuals (service users and peer support workers), organisations (and their staff members), and the public. In the UPSIDES trial, the ToC map proved especially helpful in characterising and distinguishing between (a) common features of peer support, (b) shared approaches to implementation and (c) informing adaptations to peer support or implementation to account for contextual differences. Conclusions UPSIDES is the first project to develop a multi-national ToC for a mental health peer support intervention. Stakeholder engagement in the ToC process helped to improve the cultural and contextual appropriateness of a complex intervention and ensure equivalence across sites for the purposes of a multi-site trial. It may serve as a blueprint for implementing similar interventions with a focus on recovery and social inclusion among people with mental ill-health across diverse settings. Trial registration ISRCTN26008944 (Registration Date: 30/10/2019).
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    Mental health workers’ perspectives on the implementation of a peer support intervention in five countries: qualitative findings from the UPSIDES study
    (BMJ Publishing Group Ltd, 2024-05) Maria Hildegard Haun; Girit, Selina; Goldfarb, Yael; Kalha, Jasmine; Korde, Palak; Kwebiiha, Eric; Moran, Galia; Mtei, Rachel; Niwemuhwezi, Jackline; Nixdorf, Rebecca; Nugent, Lena; Puschner, Bernd; Ramesh, Mary; Ryan, Grace Kathryn; Slade, Mike; Ashleigh, Charles; Krumm, Silvia
    OBJECTIVEThe introduction of peer support in mental health teams creates opportunities and challenges for both peer and non-peer staff. However, the majority of research on mental health workers' (MHWs) experiences with peer support comes from high-income countries. Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) is an international multicentre study, which aims at scaling up peer support for people with severe mental illness in Europe, Asia and Africa. This study investigates MHWs experiences with UPSIDES peer support.DESIGNSix focus groups with MHWs were conducted approximately 18 months after the implementation of the UPSIDES peer support intervention. Transcripts were analysed with a descriptive approach using thematic content analysis.SETTINGQualitative data were collected in Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel) and Pune (India).PARTICIPANTS25 MHWs (19 females and 6 males) from UPSIDES study sites in the UPSIDES Trial (ISRCTN26008944) participated.FINDINGSFive overarching themes were identified in MHWs' discussions: MHWs valued peer support workers (PSWs) for sharing their lived experiences with service users (theme 1), gained trust in peer support over time (theme 2) and provided support to them (theme 3). Participants from lower-resource study sites reported additional benefits, including reduced workload. PSWs extending their roles beyond what MHWs perceived as appropriate was described as a challenge (theme 4). Perceptions about PSWs varied based on previous peer support experience, ranging from considering PSWs as equal team members to viewing them as service users (theme 5).CONCLUSIONSConsidering local context is essential in order to understand MHWs' views on the cooperation with PSWs. Especially in settings with less prior experience of peer support, implementers should make extra effort to promote interaction between MHWs and PSWs. In order to better understand the determinants of successful implementation of peer support in diverse settings, further research should investigate the impact of contextual factors (eg, resource availability and cultural values).TRIAL REGISTRATION NUMBERISRCTN26008944. MEDLINE - Academic