Using a Theory of Change to integrate digitalised lived experience stories into the Youth Friendship Bench, a psychological intervention for treating common mental disorders in young people in Zimbabwe

doi:10.21203/rs.3.rs-5283116/v1

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Research Article

Using a Theory of Change to integrate digitalised lived experience stories into the Youth Friendship Bench, a psychological intervention for treating common mental disorders in young people in Zimbabwe

https://doi.org/10.21203/rs.3.rs-5283116/v1

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Background

Advances in multimedia technologies' capabilities and accessibility have made it possible for stories to be digitally recorded, stored, and shared with a much wider audience. In mental health, digitalised lived experiences have been used to promote self-management and recovery during therapy, mental health awareness and literacy, and social relationships. In this paper, we describe the theory of change process we used to integrate The Human Aspect’s digitalised lived experiences (videos) into the Friendship Bench intervention.

Results

There was consensus from the stakeholders that digitalised lived experiences could be used as in-session and between-session resources for promoting the subjective psychological well-being of Friendship Bench clients. The stakeholders were of the same view that the digital videos be used as both an in-session and between-session intervention. Clients would be given the opportunity to choose the modality that works for them. It was agreed that the digitalised lived experiences stories could potentially be used to increase mental health awareness, improve mental health literacy, reduce mental health-related stigma and help facilitate recovery in Friendship Bench clients.

Conclusions

Theory of Change can be used to build consensus on how to integrate digitalised lived experiences into an existing evidence-based mental health intervention. There is now a need to evaluate the feasibility and acceptability of the integration as well as evaluate its effectiveness in reducing common mental disorders symptoms through an adequately powered study.

Lived Experiences

Digital Stories

Integration

Theory of Change

Advances in the capabilities and accessibility of multimedia technologies have now made it possible for stories to be digitally recorded stored and shared with a much wider audience (1). Digital storytelling involves using multimedia technology to capture and share stories through the internet. These stories come in different formats i.e. audio, video, graphics, and text (2). In mental health, digital stories have been used to promote self-management and recovery during therapy (3, 4), for promoting mental health awareness and literacy (1, 4, 5) and enhancing social relationships (4).

Therapeutic models that are based on digital storytelling include digital reminiscence therapy, narrative therapy, expressive remix therapy, and expressive arts therapy (4). Digital storytelling leverages the widespread use of social media and electronic devices as well as the traditional practice of storytelling to share ideas, promote learning and inspire behaviour change (5). The Self-Management And Recovery Technology (SMART) program made use of video-based lived experience stories alongside routine care for psychosis either in session or between sessions as therapeutic homework (6, 8). Literature shows that the use of digital lived experiences improved patient interaction with clinicians, reduced loneliness, promoted learning and inspired hope in patients that recovery is possible (8, 9). Evidence from a recent systematic review indicates that digital stories are effective at reducing depression and anxiety-related symptoms (4). Although there were few studies exploring the effect of digital storytelling using quantitative approaches, the authors did acknowledge that digital resources have an impact on mental health-related symptoms but was an area that needed further exploration. Moreover, the reach that digital stories have is said to facilitate conversations that question societal stereotypes that perpetuate the stigma and shame experienced by people living with a mental disorder(s) (1, 10). Through digital stories, people who are defined as “mentally ill” get a chance to present themselves as able and capable people contrary to what they are assumed to be (2, 11).

Recognizing the value of lived experiences and using modern technology, The Human Aspect (THA) Foundation created an online platform featuring lived experiences from over 800 individuals in a video format. THA is a non-profit organisation that conveys knowledge about mental health through in-depth interviews of individuals describing mental health challenges, coping strategies and recovery processes (12). These lived experiences are termed by THA as digitalised lived experiences due to their video format and are uploaded onto the dedicated THA website (13). Each story typically features an individual narrating i) their challenges with mental health, ii) how they overcame them, and iii) the lessons they learned along the way (12). Most of the stories are narrated in English and vernacular with subtitles. The videos range from 25 minutes to an hour in length. THA recently entered into a collaboration with Friendship Bench, a private voluntary organization that provides talk therapy to individuals suffering from mild to moderate common mental disorders (14, 15). The partnership entails finding ways to integrate the lived experience videos from the THA library into the Friendship Bench intervention. Henceforward, to avoid confusion and interchanging among different terms, the video from THA’s library will be referred to as Digitalised Lives Experiences (DLE).

The YouFB is an adaptation of the original Friendship Bench that focuses on young people (15–24 years). YouFB is delivered by trained university students (male and female) on industrial attachment for one year. YouFB counsellors provide problem-solving therapy to young people in primary care clinics and the community (16). They also deliver e-counselling via WhatsApp. On top of talk therapy, the counsellors also assist clients in setting up peer support groups known in Shona as Circle Kubatana Tose (CKT) which translates to ‘holding hands together’ (17). Through a randomised control trial that included young people between the ages of 18–24 the Friendship Bench intervention showed effectiveness in treating common mental disorders (CMDs) compared to routine care [13.7% v. 49.9%; adjusted risk ratio 0.28; 95% confidence interval 0.22–0.34] (15). To facilitate recovery the Friendship Bench interventions seek clients to achieve four things that can be understood through the following four indigenous concepts; i) kuvhura pfungwa (open the mind), ii) kusimudzira (uplift), iii) kusimbisa (strengthen) and iv) kusimbisisa (further strengthen) (18). Therefore, the integration of the DLEs is an attempt to further strengthen the existing Friendship Bench model by giving clients resources that will help open their minds, uplift their spirits, and strengthen their resolve to recover.

However, there is a paucity of data on interventions that combine DLE resources with CBT-based interventions particularly in low- and middle-income countries (LMICs) to learn from. Those available were developed in high-income settings (4, 6, 19) and may not be feasible and acceptable in our setting. This has left researchers with limited guidance on how to effectively integrate digital lived experiences with evidence-based interventions like Friendship Bench in a low-resource setting. Theory of Change (ToC) is a participatory method used for designing, implementing, and evaluating health interventions (20, 21). The value of creating a Theory of Change (TOC) lies in providing a clear roadmap for achieving long-term goals. Social intervention initiatives often overlook the specific early and intermediate steps needed for lasting change (24). TOC mitigates this by outlining how a given intervention, or set of interventions, are expected to lead to a desired change and spells out the underlying assumptions driving each expected outcome (20, 22). In this paper, we describe the theory of change process we used to integrate THA's digitalised lived experience content into the Friendship Bench counselling model. We sought to use ToC to build consensus among stakeholders on how to integrate digitalised lived experiences into the existing Friendship Bench counselling model.

Study Design

We conducted ToC workshops with key stakeholders to develop a pathway to integrating the digitalised lived experiences from The Human Aspect into the Friendship Bench intervention. ToC workshops helped us to analyse different scenarios about integrating DLEs from THA into the FB intervention, ensuring a road for planning and evaluation. It gave stakeholders a realistic view of what steps are necessary, what impact they can have, and whether their goals can be achieved within the available time and resources. We used the checklist for reporting ToC in public health intervention developed by Breuer (21) to guide the ToC process for this study.

Setting

The workshops were conducted at the Friendship Bench Hub in Harare. Another facilitator [MC] joined the workshops online via Microsoft Teams. Before the workshops, participants were requested to watch at least one THA video. This ensured that participants understood how the videos are structured for them to provide better-informed contributions during the ToC.

Workshop Participants

We invited 50 participants to attend the ToC workshop. Invitations together with the aim of each meeting were sent out to relevant stakeholders a week before the workshop via phone, email and WhatsApp. Participants were given links to videos to watch in advance before the workshop. In total 43 participants attended; persons with lived experience of mental disorder n = 10 and the following personnel from Friendship Bench: YouFB counsellors (n = 20) managers (n = 7) Clinicians (n = 4) and trainers (n = 2).

Theory of Change procedure

We conducted three ToC workshops over 3 months. We held different workshops for different groups to avoid power differentials [Workshop 1:Youth Friendship Bench Counsellors; Workshop 2: Friendship Bench Clients; Workshop 3: Friendship Bench Clients and managers, clinicians, and trainers]. We also invited some counsellors to attend workshops 2 and 3. The workshops were approximately 5–6 hours long. Each workshop began with an appointed lead facilitator with experience facilitating ToC workshops giving a brief overview of the project and the aim of the workshop. This was followed by a brainstorming session with the stakeholders on how the DLEs could be integrated into the existing Friendship Bench model. The workshops looked at the purposes the videos could be used for, expected outcomes of interests, indicators, and the resources that will be needed to successfully implement the project. During the discussion, the lead facilitator [TK] also co-created a ToC map with the stakeholders whilst a co-facilitator [SNM] took notes. After the workshop, a ToC map was refined and constructed, and a descriptive narrative of it was written.

In addition to the ToC workshops, we also conducted at least seven small group and one-on-one follow-up meetings with stakeholders after the workshops. These meetings were mostly with Friendship Bench counsellors and collaborating partners from THA. The purpose of these meetings was to clarify uncertain areas and make refinements to the ToC map and integration framework.

Overall synthesis

There was a consensus from the stakeholders that the digitalised lived experiences (DLEs) were a potential self-help tool that could be used to promote the subjective psychological well-being of Friendship Bench clients [figure 1]. It was agreed that DLEs could be used to increase mental health awareness and improve mental health literacy. The videos could also contribute to the reduction of stigma, particularly internalised or self-stigma in people with CMDs. Additionally, used alongside talk therapy the videos were seen as a resource that can be used to promote recovery in Friendship Bench clients with CMDs. Listening to the success stories of people who have gone through similar experiences could motivate and inspire hope in viewers that their recovery was possible too. These combined benefits could also potentially contribute to the reduction of CMD symptoms.

There was widespread agreement that the DLEs be used as both an in-session and between-session resource. Friendship Bench clients will be given the opportunity to choose the modality they are comfortable with. As a between-session intervention, the videos will be shared as homework. Friendship Bench clients attending the ToC pointed out that the interviews were engaging and were something they would consider watching on their own in their spare time. This move would make therapy more ubiquitous with the videos covering the space that exists between counselling session appointments. Moreover, it was proposed that the viewers also journal their thoughts and experiences on the video(s). The team at THA already has a set of generic reflection questions that prompt viewers to reflect on the different segments of the videos. The questions ask the viewer to (a) describe what they saw and heard in the video, (b) what content they identified with in the videos, and (c) the lessons drawn. A Portable Document Format file (PDF) [Supplementary File] containing the reflection questions was created to be used as a journal for reflections. The viewer can choose to or not to share these with their counsellor.

It was noted that some clients may need support when watching the videos as there is a risk of clients being retraumatized by the content they watch. Therefore, there is a need for an option where clients can watch videos with their counsellor. Hence, there was consensus among stakeholders that a video-watching session be introduced for those needing support from their counsellor when watching a video. However, this session would not include any counselling, but just video and the reflection questions that the client would go through with the counsellor if they preferred. The idea of a watching session was proposed as a way to maintain fidelity to how a Friendship Bench counselling session is delivered. The Friendship Bench is a manualized intervention that follows a defined set of steps better known as 'problem-solving therapy steps’. Thus, pausing the session mid-way to watch a video could potentially divert focus from the problem at hand thus defeating the purpose of helping the client find solutions to their problem(s). Moreover, having a counselling session and watching the video on the same occasion could also be overwhelming for both the client and the counsellor.

There was also widespread agreement that the integrated intervention was mostly suited for urban settings due to accessibility barriers associated with implementing a digital intervention in a rural setting, particularly in Zimbabwe. These primarily include limited access to the internet and electricity. These factors were considered major barriers to effective implementation as the intervention relies heavily on those for it to work as intended. Therefore, to obtain better outcomes it was agreed that for now the intervention be implemented in urban settings where connectivity barriers are not as severe as in rural areas.

Integration

A Friendship Bench counselling session aims to help clients come up with feasible solutions to the problem(s) they might be facing. Therefore, at the end of a counselling session it is expected that a client should come up with an ‘action plan’ they would implement towards solving their problem (25). When a client feels stuck and fails to come up with an action plan, they are given some time by the counsellor (usually a day or two) to think of some solutions and return with them to the counsellor for evaluation during their next session. It was proposed that the DLEs be used in two scenarios i.e. 1) for clients who successfully come up with an action plan and 2) for clients who are stuck and unable to do so [figure 2].

For clients who successfully develop an action plan, the videos will be assigned as a self-help resource they can use in their spare time as homework. The purpose of the videos would be to reinforce the positive gains they may have received from counselling by listening to the success stories of others. For clients who fail to develop an action plan, it was proposed that the videos be shared as a brainstorming aid during the time they would be thinking about potential solutions. It was hypothesized that watching the videos could help open up their mind and/or motivate them to come up with solutions. Some clients might have solutions but lack the confidence to say them out loud as such the videos could give them the confidence to open up as they see their peers speak. Therefore, watching the videos would function as the client’s tentative action plan to be reflected on during their next session with the counsellor.

For in-session use as highlighted above the client and counsellor would schedule a video-watching session. For the watching session, the two would watch the video on the counsellor's 11-inch mobile tablet. After the viewing, the counsellor and clients will go through the reflection questions together. As a between-session intervention, the counsellor would share an internet link that would take the viewer directly to the webpage where they will be able to watch the video [figure 3]. It was agreed that the counsellors would share links to three videos (to give clients variety) that relate to the problem that the client would be facing. It was emphasized that the counsellor needs to be familiar with the videos they share for them to better relate to the clients’ reflections on the videos during the follow-up session. The client would be expected to watch at least one video. The counsellor will also take care to show the clients how to access and watch the videos.

The follow-up session would begin with the counsellor eliciting feedback on the videos from the client [figure 4]. The feedback for clients who had an action plan in the earlier session would be centred around the clients’ experience watching the videos, what they found helpful, and whether they would consider watching more of the videos.

On the other hand, feedback from clients who did not have an action plan would focus on potential solutions they may have come up with through watching the videos or they may have thought of while they were away. The solutions would then be evaluated together with the counsellor and then the action plan they did not have in the previous session formulated.

Additional Friendship Bench Resources

Apart from counselling, Friendship Bench's social media platforms were identified as avenues where the videos could be applied in diverse ways. The media team was interested in exploring how the videos can be used to create social media reels/ shorts and short clips that can be shared on the Friendship Bench Facebook Twitter, Instagram, TikTok, and LinkedIn pages. Apart from raising awareness, reels and short clips can also be a marketing strategy for Friendship Bench services. The Friendship Bench website was also highlighted as another platform where videos can be hosted. At the time of writing this manuscript, this had been implemented and there are currently 15 Zimbabwean stories that can be found on the website (https://www.friendshipbenchzimbabwe.org/lived-experiences). The idea is for the website to host the lived experience of Friendship Bench clients who would like to share their stories.

When it came to using the DLEs in support groups the media team proposed a different approach, which they assume will have a greater impact for the groups. The flagship feature of Friendship Bench support groups is the income-generating component where clients come together and implement income-generating projects as a group. These groups are designed to raise both the mental health and livelihood of the Friendship Bench clients. To date, Friendship Bench has facilitated the formation of 700 support groups. The proposed idea was to move around the country filming mini-documentary series on various income-generating projects that Friendship Bench clients have set up since its inception. It was argued that this kind of content would be better suited for the support groups and serve as a window into what support groups are all about to would-be members. The mini-documentaries would also have the added advantage of being used by clients receiving individual therapy.

Perceived Barriers to Integration and Implementation

The ToC also explored potential barriers that could hinder the optimum integration and implementation of THA resources into the Friendship Bench model. These included content access costs and increased workload for counsellors. There was concern that some clients might not have smart devices from which to watch the videos and/ or the internet data to access them online. Thus, it was proposed that mobile tablets be procured for the counsellors to cater for clients who may not have devices. To mitigate the challenge of internet data stakeholders from THA proposed storing the video files directly in the counsellor’s tablet and sharing them with clients using Bluetooth or Shareit which do not require the internet. The introduction of digital stories into the Friendship Bench counselling model inadvertently increases the workload of the counsellor considering the video-watching sessions that have been introduced and the time spent looking for the ideal content to share. Despite this added work, the counsellors acknowledged that digital stories could be useful in opening up the minds of clients especially those who may not be making significant progress in therapy. To minimize the burden on counsellors it was agreed that counselling and video-watching be done on separate occasions.

This study aimed to employ the theory of change approach to integrate digitalised lived experiences (DLEs) from THA into Friendship Bench, a CBT-based psychological intervention. Using ToC, we aimed to develop a pathway for integrating DLEs through consensus building with key stakeholders. The ToC also defined the outcomes that can be expected from the introduction of DLEs into therapy. On integration, findings from the ToC indicated that the digital stories from THA could be best utilized as homework that can be shared with clients to watch in their spare time. It was agreed the videos could help increase mental health awareness, improve mental health literacy, and reduce mental health-related stigma. Moreover, by listening to the stories of others who have gone through similar struggles it was hypothesized that listeners could learn, be inspired, and gain a sense of hope which would positively contribute to their subjective psychological wellbeing.

To our knowledge, this is the first time the theory of change approach has been applied to integrate DLEs with an evidence-based psychological intervention for treating CMDs. However, it is not the first time a participatory method has been used to develop a psychological intervention that makes use of digital stories to promote recovery (6, 19). The SMART program was developed through participatory workshops with people with lived experiences of psychosis and mental health practitioners (6). Similar, to the current study, findings from the SMART program also showed that the digital videos could be used as homework commonly referred to in therapy as a between-session intervention (26). However, the SMART program also made use of the videos in-session where they watched the video together with a health worker. Research shows that between-session interventions make therapy ubiquitous beyond therapy sessions with the therapist thus reducing the potential for therapeutic drift between the patient and the counsellor (27). Participants from the SMART program reported that watching the videos alongside a counsellor provided them with more support and motivation to watch than they would have had they watched alone (9). In terms of intervention engagement, the SMART program reported moderate use of the videos between sessions compared to in-session [56.7% versus 76.7%] (6). The moderate use of the website between sessions was attributed to lower levels of use of digital technology and higher rates of disability among persons with severe mental illness which may act as a barrier to non-supported access and use of the online resources (6). To remedy this the authors recommended employing a blended approach of offering both the in-session and between-session options to clients as a way to boost engagement with the intervention similar to how our ToC proposes(6, 8).

Findings from the current study indicate that introducing DLEs to the Friendship Bench model can potentially promote mental health awareness and increase mental health literacy among Friendship Bench service users as they learn from others. This is largely premised on the social learning theory which states that people can learn from others through observation, socialising, modelling, and imitation (28). Qualitative findings from the SMART study on digital stories showed the same as participants from the study reported gaining knowledge from listening to others as well as solidifying the knowledge they already have (9). The acquisition of knowledge and skills was described in a scoping review as improving a person’s sense of connection to others, self-efficacy, confidence and sense of personal achievement, factors which are considered essential in recovery-oriented service provision (1). Findings from our ToC also hypothesise that improved mental health awareness and literacy could also contribute to the reduction of stigma as a corollary outcome, especially self-stigma. Self-stigma refers to negative stereotypes that an individual adopts and internalises about their mental illness (29). These stereotypes may include a sense of insufficiency to carry social roles, feeling fundamentally different from others, and expecting pessimistic long-term outcomes (3, 30). Contact with other people with CMDs has been reported to reduce negative stereotypes in those also experiencing CMDs (6, 31). Thomas et al (6) found that video-based lived experience narratives had a moderate to large effect on the alienation subscale of the Internalized Stigma of Mental Illness Scale (ISMI) that was statistically different [p-value 0.006; d 0.69]. However, the effect on other factors, such as negative stereotype endorsement was low (6).

Regarding treatment outcomes, the current ToC indicated that the digital stories from THA could contribute to the reduction of CMD-related symptoms albeit as a distal outcome improved mental health literacy and coping. However, current literature is still inconclusive as to whether the use of digital stories can contribute to treatment outcomes due to the small sample sizes that previous studies have used which limit the generalizability of the findings (4, 8). Pre- and post-intervention data on outcome measures for participants from the SMART project pilot showed no significant changes in the primary outcome measure of personal recovery [F_1,22=.140, p = .711, partial η² = .006] (8). The study did not find any effect on depression and anxiety. On the other hand, results from two studies reported in a recent systematic review indicate that digital stories had a significant impact on reducing depression symptoms. However, it is important to note the participants from the study were elderly people with dementia and Latina women (P < 0.001) thus making it hard to generalise the findings across other settings and populations (4). The study on Latina women also showed a significant decrease in anxiety levels from a mean of 13.9 to 9.5 (F_1,17=25.5, P < .001) at 1 week and 8.6 (F_1,27=23, P < .001) at 6 weeks. However, this study lacked a control group to compare means with (4).

Qualitative data, however, indicates that listening to digital lived experiences could facilitate recovery in people with CMDs (1, 6, 8, 9). Listening to the stories of others was reported to improve client-counsellor interactions as using the videos enabled clients to express things they had not been able to before (6, 8). Other participants reported feeling connected to their peers in the videos and inspired by their recovery stories thus making them believe that their recovery was possible and strengthening their resolve (9). Participants also reported watching the videos of others made them feel less alone. Similarly, quantitative findings from the SMART pilot study showed significant reductions in loneliness with a large effect size [F_1,22=5.878, p = .024, partial η² = .211] (8). Substantial evidence supports the correlation between loneliness and common mental disorders (32, 33) and how loneliness is a common occurrence in people with CMDs (34). However, a major strength of the current ToC is that the integration is happening with an evidence-based intervention (i.e. Friendship Bench) that has proven effective in treating mild to moderate CMDs like depression (adjusted mean difference, − 6.36; 95% CI, − 6.45 to − 5.27; P < .001) and anxiety (adjusted mean difference, − 5.73; 95% CI, − 6.61 to − 4.85; P < .001) (15). Therefore, the counselling component of the intervention would focus on the CMD therapeutic outcomes and the digital stories on outcomes related to mental health literacy, stigma and the therapeutic relationship with the counsellor. However, as part of future research, it would be worthwhile to investigate the added benefit of the videos in reducing CMD symptoms through a randomised control trial that is powered enough to determine the effects of the videos conclusively.

Our ToC also noted some potential barriers that could get in the way of optimal integration however the one that stood out the most was the costs associated with accessing online content. A survey by Afrobarometer showed that whilst most Zimbabweans have cell phones 43% are said to have internet access capabilities. Around 25% were reported to be using the internet regularly while 62% reported never using the internet (35). Moreover, rural areas were found to be disproportionately affected compared to the urban areas with regards to the number of devices that have internet access capabilities [64%, vs. 28%] and this was attributed to the lack of internet infrastructure in rural areas (35, 36). Limited access to the internet would affect the uptake of the DLEs as they can only be accessed via the internet at the moment. Efforts are underway to mitigate the perceived accessibility challenges, and these include procuring mobile tablets for counsellors to share with those without devices and storing the video files directly in the counsellor tablets to share via applications like Bluetooth. For the long term, there are plans to develop a THA application that has the capability of accessing content offline like the YouTube application. Moreover, given that rural Zimbabwe is disproportionately affected by limited access to the internet and has fewer smart devices compared to urban it was agreed that in the meantime the intervention be implemented in urban settings and then scaled up as internet accessibility and use improve in Zimbabwe’s rural settings.

Limitations

A limitation of our ToC is that the integration framework did not go through feasibility testing as recommended by Breuer et al., (21) to evaluate the integration strategies that were developed during the ToC workshops. However, as highlighted in the ToC map [figure 1] that shall be the focus of our future research. As part of the study, we will evaluate the intervention's feasibility and acceptability. In the feasibility study, the current ToC shall be used to guide the evaluation of the intervention strategies and hypotheses related to the predicted outcomes and impact of the blended intervention. The findings will be used to improve the quality of the proposed ToC. Finally with existing literature being inconclusive on the impact of digital stories on CMD symptoms, it would be worthwhile to conduct clinical trials in the future that are powered enough to draw significant conclusions from and finally set the matter to rest. The research could further explore the method of delivery that yields the most benefits between in-session and between-session, and thus make a conscious effort to spread and scale up the desired mechanism of delivery.

The development of a ToC for the integration of DLEs into the Friendship Bench intervention helped map out the core elements of the integration and how it will be done. Using this participatory approach, stakeholders and the research team worked to find a common approach to implementing the intervention while also determining local specifics and challenges that necessitate careful adaptation to the local setting. Successful local implementation while maintaining fidelity to some core elements is an essential precondition for a multi-site evaluation to be able to draw meaningful conclusions. Finally, we believe the ToC we mapped can serve to inform and guide other research initiatives looking to blend CBT counselling interventions with digital content.

ToC

theory of change

THA

The Human Aspect

CKT

Circle Kubatana Tose

PST

problem-solving therapy

LMIC = low

and middle-income countries

CBT

cognitive behavioural therapy

CMD

common mental disorders.

Acknowledgements

This research was funded by the Inner Foundation. The views expressed in this publication are those of the author(s) and not necessarily those of the Inner Foundation.

Methods

Methods used in the study were carried out in accordance with the ethical regulations and guidelines stipulated by the Medical Research Council of Zimbabwe (MRCZ).

Authors' contributions

TTK- facilitation, development of ToC maps & study conceptualization; LTS- facilitation & development of ToC maps; MC, SNM, MWM- facilitation & review of the manuscript; IDB, JD, PJ, TLK, KP, KM, VL LZ- review of the manuscript; JW, DC overview of ToC workshop & review of the manuscript. All authors reviewed the manuscript.

Funding

This study was funded by the Inner Foundation

Availability of data and material

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

Ethics approval and consent to participate

The study was approved by the Medical Research Council of Zimbabwe (MRCZ) Ethics Committee- reference number MRCZ/A/3126. All study participants provided informed verbal consent before participating in the workshops. Written consent was waived as the research presented no more than minimal risk to the participants and involved no procedures for which written consent is normally required outside the research context.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

De Vecchi N, Kenny A, Dickson-Swift V, Kidd S. How digital storytelling is used in mental health: A scoping review. Int J Ment Health Nurs. 2016;25(3):183–93.
De Vecchi N, Kenny A, Dickson-Swift V, Kidd S. Exploring the Process of Digital Storytelling in Mental Health Research: A Process Evaluation of Consumer and Clinician Experiences. Int J Qual Methods. 2017;16(1):1609406917729291.
Thomas N, Farhall J, Foley F, Rossell SL, Castle D, Ladd E, et al. Randomised controlled trial of a digitally assisted low intensity intervention to promote personal recovery in persisting psychosis: SMART-Therapy study protocol. BMC Psychiatry. 2016;16(1):312.
Ogbeiwi O, Khan W, Stott K, Zaluczkowska A, Doyle M. A systematic review of digital storytelling as psychotherapy for people with mental health needs. J Psychother Integr. 2024;34(2):115–32.
Sawyer C, Willis J. Introducing Digital Storytelling to Influence the Behavior of Children and Adolescents. J Creat Ment Health. 2011;6:274–83.
Thomas N, Farhall J, Foley F, Leitan ND, Villagonzalo KA, Ladd E, et al. Promoting Personal Recovery in People with Persisting Psychotic Disorders: Development and Pilot Study of a Novel Digital Intervention. Front Psychiatry. 2016;7:196.
Brooks SP, Zimmermann GL, Lang M, Scott SD, Thomson D, Wilkes G, et al. A framework to guide storytelling as a knowledge translation intervention for health-promoting behaviour change. Implement Sci Commun. 2022;3(1):35.
Farhall J, Castle D, Constantine E, Foley F, Kyrios M, Rossell S, et al. Using a digital personal recovery resource in routine mental health practice: feasibility, acceptability and outcomes. J Ment Health. 2023;32(3):567–74.
Williams A, Fossey E, Farhall J, Foley F, Thomas N. Recovery After Psychosis: Qualitative Study of Service User Experiences of Lived Experience Videos on a Recovery-Oriented Website. JMIR Ment Health. 2018;5(2):e37.
Matthews N, Sunderland N. Digital Life-Story Narratives as Data for Policy Makers and Practitioners: Thinking Through Methodologies for Large-Scale Multimedia Qualitative Datasets. J Broadcast Electron Media. 2013;57(1):97–114.
Ferrari M, Rice C, McKenzie K. ACE Pathways Project: Therapeutic Catharsis in Digital Storytelling. Psychiatr Serv. 2015;66(5):556–556.
Mental Health Innovation Network. Mental Health Innovation Network. [cited 2024 Aug 14]. The Human Aspect. Available from: https://www.mhinnovation.net/organisations/human-aspect
Harbø K, Chrisikopoulou M, Andresen A. Evaluation of the Use of Digitalised Lived Experience in an undergraduate psychology course - A qualitative approach [Manuscript submitted for publication]. 2023.
Chibanda D, Verhey R, Munetsi E, Cowan FM, Lund C. Using a theory driven approach to develop and evaluate a complex mental health intervention: the friendship bench project in Zimbabwe. Int J Ment Health Syst. 2016;10(1):16.
Chibanda D, Weiss HA, Verhey R, Simms V, Munjoma R, Rusakaniko S, et al. Effect of a Primary Care–Based Psychological Intervention on Symptoms of Common Mental Disorders in Zimbabwe: A Randomized Clinical Trial. JAMA. 2016;316(24):2618.
Broström S, Johansson BA, Verhey R, Landgren K. “Seeing a Brighter Future” - Experiences of Adolescents with Common Mental Disorders Receiving the Problem-Solving Therapy “Youth Friendship Bench” in Zimbabwe. Issues Ment Health Nurs. 2021;42(11):1019–29.
Friendship Bench. Friendship Bench. [cited 2024 Aug 28]. CIRCLE KUBATANA TOSE. Available from: https://www.friendshipbenchzimbabwe.org/ckt
Fernando S, Brown T, Datta K, Chidhanguro D, Tavengwa NV, Chandna J, et al. The Friendship Bench as a brief psychological intervention with peer support in rural Zimbabwean women: a mixed methods pilot evaluation. Glob Ment Health. 2021;8:e31.
Peck CE, Lim MH, Purkiss M, Foley F, Hopkins L, Thomas N. Development of a Lived Experience-Based Digital Resource for a Digitally-Assisted Peer Support Program for Young People Experiencing Psychosis. Front Psychiatry. 2020;11:635.
De Silva MJ, Breuer E, Lee L, Asher L, Chowdhary N, Lund C, et al. Theory of Change: a theory-driven approach to enhance the Medical Research Council’s framework for complex interventions. Trials. 2014;15:267.
Breuer E, Lee L, De Silva M, Lund C. Using theory of change to design and evaluate public health interventions: a systematic review. Implement Sci. 2015;11(1):63.
Vogel I. Review of the Use of ‘Theory of Change’ in International Development. UK: UK Department of International Development; 2012 Jan.
Kamvura TT, Turner J, Chiriseri E, Dambi J, Verhey R, Chibanda D. Using a theory of change to develop an integrated intervention for depression, diabetes and hypertension in Zimbabwe: lessons from the Friendship Bench project. BMC Health Serv Res. 2021;21(1):928.
United Nations Development Group. THEORY OF CHANGE: UNDAF COMPANION GUIDANCE. United Nations; nd.
Friendship Bench. Friendship Bench Training Manual for Lay Health Workers [Internet]. Friendship Bench; 2015 [cited 2024 Aug 1]. Available from: https://www.mhinnovation.net/resources/friendship-bench-training-manual
Cronin T, Lawrence K, Taylor K, Norton P, Kazantzis N. Integrating Between-Session Interventions (Homework) in Therapy: The Importance of the Therapeutic Relationship and Cognitive Case Conceptualization. J Clin Psychol. 2015;71.
Cerga-Pashoja A, Doukani A, Gega L, Walke J, Araya R. Added value or added burden? A qualitative investigation of blending internet self-help with face-to-face cognitive behaviour therapy for depression. Psychother Res J Soc Psychother Res. 2020;30(8):998–1010.
Firmansyah D, Saepuloh D. Social Learning Theory: Cognitive and Behavioral Approaches. 2022;1:297–324.
Corrigan PW, Rao D. On the self-stigma of mental illness: stages, disclosure, and strategies for change. Can J Psychiatry Rev Can Psychiatr. 2012;57(8):464–9.
Hinshaw SP, Stier A. Stigma as related to mental disorders. Annu Rev Clin Psychol. 2008;4:367–93.
Naslund JA, Grande SW, Aschbrenner KA, Elwyn G. Naturally Occurring Peer Support through Social Media: The Experiences of Individuals with Severe Mental Illness Using YouTube. De Haan L, editor. PLoS ONE. 2014;9(10):e110171.
Erzen E, Çikrikci Ö. The effect of loneliness on depression: A meta-analysis. Int J Soc Psychiatry. 2018;64(5):427–35.
Kraav SL, Lehto SM, Junttila N, Ruusunen A, Kauhanen J, Hantunen S, et al. Depression and loneliness may have a direct connection without mediating factors. Nord J Psychiatry. 2021;75(7):553–7.
Caple V, Maude P, Walter R, Ross A. An exploration of loneliness experienced by people living with mental illness and the impact on their recovery journey: An integrative review. J Psychiatr Ment Health Nurs. 2023;30(6):1170–91.
Moyo-Nyede S, Ndoma S. Limited Internet access in Zimbabwe a major hurdle for remote learning during pandemic [Internet]. Zimbabwe: Afrobarometer; 2020 [cited 2024 Aug 28] p. 11. Report No.: Afrobarometer Dispatch No. 371. Available from: https://www.afrobarometer.org/wp-content/uploads/2022/02/ab_r7_dispatchno371_hurdles_for_remote_learning_during_pandemic_in_zimbabwe.pdf
Media Institute for Southern Africa Zimbabwe. MISA Zimbabwe. 2021 [cited 2024 Aug 28]. Internet access and affordability in Zimbabwe. Available from: https://zimbabwe.misa.org/2021/07/28/internet-access-and-affordability-in-zimbabwe/

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Using a Theory of Change to integrate digitalised lived experience stories into the Youth Friendship Bench, a psychological intervention for treating common mental disorders in young people in Zimbabwe

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