Aligning Facility Leadership and Climate to Advance Mental Health Services Integration in Malawi

NCT ID: NCT06399991

Last Updated: 2025-05-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

1080 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-04-08

Study Completion Date

2027-09-30

Brief Summary

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The main objective of the proposed study is to evaluate the impact of the combined leadership alignment + champion implementation strategy compared to a champion strategy alone, on integration of an evidence-based mental health treatment model into multiple medical care settings.

Detailed Description

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Task-shared mental health interventions are effective in low- and middle-income countries (LMICs), yet they remain underutilized, and the mental health treatment gap remains substantial. Innovative implementation strategies are needed to successfully integrate evidence-based mental health treatments into medical care in LMICs.

A common component of many implementation efforts is a "champion" strategy which identifies and empowers an on-the-ground staff member as the implementation champion, in charge of focusing their colleagues' efforts on implementation of the evidence-based treatment model. Yet a growing body of research, including our own work in Malawi and elsewhere, highlights that the champion's success is strongly influenced by the strength of support from their line manager and other up-the-chain organization leaders, who are critical in aligning the organization's climate and priorities in support of the implementation effort.

Approaches to influencing leadership engagement to change organizational climate and align priorities has been developed over decades in the field of organizational and industrial psychology but only relatively recently applied to implementation science health research and primarily to implementation in high-income countries. The Leadership and Organizational Change for Implementation (LOCI) is a recently developed multi-level leadership coaching implementation strategy that has demonstrated effectiveness in changing organizational climate, aligning priorities, and enhancing mental health treatment model integration in the US and Norway, but has not been adapted to or tested in low-income country settings. LOCI has significant potential to address the gaps identified in our current research by aligning leadership priorities to support champions in advancing mental health integration.

The overall aim of the proposed study is to evaluate the impact of the combined leadership alignment + champion implementation strategy compared to a champion strategy alone, on integration of an evidence-based mental health treatment model into multiple medical care settings via a cluster-randomized randomized control trial(RCT).

Leadership alignment strategies are an understudied but essential ingredient for successful mental health integration efforts. This project will make a major contribution to our understanding of the role of leadership alignment in advancing evidence-based mental health integration in LMICs.

Conditions

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Anxiety Depression

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Adapted LOCI leadership and climate alignment strategy plus champion strategy

Implementation of LOCI strategy (adapted for the Malawian context) plus the champion strategy (enhanced usual care- usual outpatient care enhanced with use of trained champions).

Group Type EXPERIMENTAL

Adapted LOCI leadership and climate alignment strategy plus champion strategy

Intervention Type BEHAVIORAL

The LOCI strategy involves engaging with district health leadership through data and feedback, leadership development trainings, coaching, and alignment strategy activities to align leadership and climate in support of implementing the evidence-based mental health package. The champion strategy involves identifying champions within each district who are trained and supported as change agents through training and supervision.

Champion strategy

Enhanced usual care. Continue with usual outpatient care, enhanced with use of trained champions.

Group Type ACTIVE_COMPARATOR

Champion strategy

Intervention Type BEHAVIORAL

The champion strategy involves identifying champions within each district who are trained and supported as change agents through training and supervision.

Interventions

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Champion strategy

The champion strategy involves identifying champions within each district who are trained and supported as change agents through training and supervision.

Intervention Type BEHAVIORAL

Adapted LOCI leadership and climate alignment strategy plus champion strategy

The LOCI strategy involves engaging with district health leadership through data and feedback, leadership development trainings, coaching, and alignment strategy activities to align leadership and climate in support of implementing the evidence-based mental health package. The champion strategy involves identifying champions within each district who are trained and supported as change agents through training and supervision.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* 18 years old or older
* Patient receiving medical care in participating district who screened positive for elevated common mental disorder symptoms that day or in the preceding month.

Exclusion Criteria

* \<18 years old
* Not currently a patient receiving medical care in participating district who screened positive for elevated common mental disorder symptoms that day or in the preceding month.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

University of North Carolina, Chapel Hill

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Brian Pence

Role: PRINCIPAL_INVESTIGATOR

University of North Carolina, Chapel Hill

Locations

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Chiradzulu District Hospital

Chiradzulu, , Malawi

Site Status RECRUITING

Dedza District Hospital

Dedza, , Malawi

Site Status RECRUITING

Kasungu District Hospital

Kasungu, , Malawi

Site Status RECRUITING

Machinga District Hospital

Machinga, , Malawi

Site Status RECRUITING

Mangochi District Hospital

Mangochi, , Malawi

Site Status RECRUITING

Mchinji District Hospital

Mchinji, , Malawi

Site Status RECRUITING

Mulanje District Hospital

Mulanje, , Malawi

Site Status RECRUITING

Mzimba South District Hospital

Mzimba, , Malawi

Site Status RECRUITING

Nkhata Bay District Hospital

Nkhata Bay, , Malawi

Site Status RECRUITING

Ntcheu District Hospital

Ntcheu, , Malawi

Site Status RECRUITING

Phalombe District Hospital

Phalombe, , Malawi

Site Status RECRUITING

Salima District Hospital

Salima, , Malawi

Site Status RECRUITING

Countries

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Malawi

Central Contacts

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Brian Pence, PhD, MPH

Role: CONTACT

1-919-966-7446

Kazione Kulisewa, MBBS MMed

Role: CONTACT

+265-997-210-381

Facility Contacts

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Kelvin Maziya

Role: primary

Kelvin Maziya

Role: primary

Kelvin Maziya

Role: primary

Kelvin Maziya

Role: primary

Kelvin Maziya

Role: primary

Kelvin Maziya

Role: primary

Kelvin Maziya

Role: primary

Kelvin Maziya

Role: primary

Kelvin Maziya

Role: primary

Kelvin Maziya

Role: primary

Kelvin Maziya

Role: primary

Kelvin Maziya

Role: primary

Other Identifiers

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R01MH133028

Identifier Type: NIH

Identifier Source: secondary_id

View Link

23-2722

Identifier Type: -

Identifier Source: org_study_id

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