Using Theory of Change to Select Implementation Strategies for Intersectoral Mental Health Care for Violence Victims
1
School of Nursing, University of São Paulo (USP), São Paulo - SP, Brazil
2
Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas - SP, Brazil
3
Center of Health Sciences, Federal University of Recôncavo da Bahia (UFRB), Santo Antônio de Jesus - Bahia, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A2605
ABSTRACT
BACKGROUND:
Providing intersectoral integrated mental health care for violence victims is critical, yet achieving this integration remains challenging1. Implementation science offers guidance for addressing this gap, particularly through implementation strategies—actions designed to enhance adoption, implementation, and sustainment of innovations2. Participatory methods are known to improve the usefulness and sustainability of technology implementation3, and Theory of Change (ToC) models are recognized as effective approaches for engaging stakeholders and promoting participation4. The aim of this study was to select through consensus with stakeholders implementation strategies for intersectoral mental health care for violence victims in a district of a large Brazilian city.
METHODS:
Twenty professionals from primary health care and social services participated in co-designing the implementation process. ToC was selected as the methodology and included: (I) three workshops for stakeholder input; (II) synthesis of each workshop results with group validation at the end of each workshop; (III) development of a draft ToC based on workshop findings; and (IV) a refinement and validation workshop.
RESULTS:
The ToC workshops facilitated consensus-building among stakeholders regarding necessary changes for intervention success. To achieve these changes, twelve implementation strategies were selected and classified using the Expert Recommendations for Implementing Change (ERIC) compilation2: five as "Use evaluative and iterative strategies", three as "Develop stakeholder interrelationships", two as "Engage service users", one as "Change infrastructure", and one as "Train and educate stakeholders." Notably, strategies involving interaction among different types of implementation actors predominated.
CONCLUSIONS:
The ToC methodology proved to be a powerful tool for promoting stakeholder participation in selecting implementation strategies, this may enhance the likelihood of successful adoption and implementation. These findings demonstrate the value of participatory methods in implementation science.
Providing intersectoral integrated mental health care for violence victims is critical, yet achieving this integration remains challenging1. Implementation science offers guidance for addressing this gap, particularly through implementation strategies—actions designed to enhance adoption, implementation, and sustainment of innovations2. Participatory methods are known to improve the usefulness and sustainability of technology implementation3, and Theory of Change (ToC) models are recognized as effective approaches for engaging stakeholders and promoting participation4. The aim of this study was to select through consensus with stakeholders implementation strategies for intersectoral mental health care for violence victims in a district of a large Brazilian city.
METHODS:
Twenty professionals from primary health care and social services participated in co-designing the implementation process. ToC was selected as the methodology and included: (I) three workshops for stakeholder input; (II) synthesis of each workshop results with group validation at the end of each workshop; (III) development of a draft ToC based on workshop findings; and (IV) a refinement and validation workshop.
RESULTS:
The ToC workshops facilitated consensus-building among stakeholders regarding necessary changes for intervention success. To achieve these changes, twelve implementation strategies were selected and classified using the Expert Recommendations for Implementing Change (ERIC) compilation2: five as "Use evaluative and iterative strategies", three as "Develop stakeholder interrelationships", two as "Engage service users", one as "Change infrastructure", and one as "Train and educate stakeholders." Notably, strategies involving interaction among different types of implementation actors predominated.
CONCLUSIONS:
The ToC methodology proved to be a powerful tool for promoting stakeholder participation in selecting implementation strategies, this may enhance the likelihood of successful adoption and implementation. These findings demonstrate the value of participatory methods in implementation science.
| eISSN: | 2654-1459 |
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