A realist process evaluation of the INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) randomized controlled trial in India.

• Type of Material: Article
• Authors: Leslie Johnson, Emory University; Nancy Thompson, Emory University; Mohammed Ali, Emory University; Kirk Elifson, Emory University; Lydia Chwastiak, University of Washington; Viswanathan Mohan, Madras Diabetes Research Foundation; Ranjit Mohan Anjana, Madras Diabetes Research Foundation; Subramani Poongothai, Madras Diabetes Research Foundation; Nikhil Tandon, All India Institute of Medical Sciences
• Language: English
• Date: 2022-12
• Publisher: Elsevier BV
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 The Author(s). Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ajmo.2022.100015
• Title of Journal or Parent Work: Am J Med Open
• Volume: 8
• Start Page: 100015
• End Page: 100015
• Grant/Funding Information: This study was supported by the National Institutes of Health through the Fogarty Global Health Fellows and Scholars Program (VECD Consortium, D43 TW009337) and the National Institute for Mental Health. The funders had no involvement in the study design; collection, analysis and interpretation of data; writing of the report; and the decision to submit the article for publication.
• Keywords: Implementation science; Collaborative care; Qualitative

Abstract

AIMS: We aimed to determine what key resources, mechanisms, and contextual factors are necessary to integrate depression and diabetes treatment into low-resource settings. METHODS: A realist evaluation framework was employed to conduct a comparative case study. Data were collected through document review, key informant interviews (n = 4), activity logs, and interviews with implementing health care providers (n = 11) to test and refine program theories for collaborative care. RESULTS: Efforts to enhance patient care coordination (i.e., adapting clinics' patient flow and resources, on-going trainings, and on-site support for care coordinators) improved implementation of depression treatment by usual care diabetes physicians. Clinician's avoidance of the term depression was identified as a barrier to mental health counseling and treatment. CONCLUSIONS: The variations in organizational features and processes linked to implementation activities across two clinics provided an opportunity to examine how and why different contextual factors help or hinder the implementation process. Findings from this study demonstrate that successful implementation of an integrated depression and diabetes care model is feasible in a low-resource setting, while the revised program theories provide an explanatory framework of coordinated care implementation processes that can inform future efforts to disseminate and scale this care model.