Pathways towards scaling up Problem Management plus in Turkey: A theory of change workshop

Daniela C. Fuhr*, Ceren Acarturk, Ersin Uygun, Michael McGrath, Zeynep Ilkkursun, Sadaf Kaykha, Egbert Sondorp, Marit Sijbrandij, Peter Ventevogel, Pim Cuijpers, Bayard Roberts

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Background: A considerable evidence base has been produced in recent years highlighting the effectiveness of brief scalable psychological interventions for people living in communities exposed to adversity. However, practical guidance on how to scale up these interventions to wider populations does not exist. In this paper we report on the use of Theory of Change (ToC) to plan the scale up of the World Health Organization's flagship low intensity psychological intervention "Problem Management Plus" (PM+) for Syrian refugees in Turkey. Methods: We conducted a one-day ToC workshop in Istanbul. ToC is a participatory planning process used in the development, implementation and evaluation of projects. It is similar to driver diagrams or logic models in that it offers a tool to visually present the components needed to reach a desired long-term outcome or impact. The overall aim of ToC is to understand the change process of a complex intervention and to map out causal pathways through which an intervention or strategy has an effect. Results: Twenty-four stakeholders (including governmental officials, mental health providers, officials from international/national non-governmental organisations, conflict and health researchers) participated in the ToC workshop. A ToC map was produced identifying three key elements of scaling up (the resource team; the innovation and the health system; and the user organisation) which are represented in three distinct causal pathways. Context-specific barriers related to the health system and the political environment were identified, and possible strategies for overcoming these challenges were suggested. Conclusion: ToC is a valuable methodology to develop an integrated framework for scaling up. The results highlight that the scaling up of PM+ for Syrian refugees in Turkey needs careful planning and investment from different stakeholders at the national level. Our paper provides a theoretical foundation of the scaling up of PM+, and exemplifies for the first time the use of ToC in planning the scaling up of an evidence-based psychological intervention in global mental health.

Original languageEnglish
Article number22
Pages (from-to)1-9
Number of pages9
JournalConflict and Health
Issue number1
Publication statusPublished - 4 May 2020


This study was funded through the STRENGTHS (Syrian REfuGees MeNTal HealTH Care Systems) project. The STRENGTHS project is funded under Horizon 2020 – the Framework Programme for Research and Innovation (2014–2020). The content of this article reflects only the authors’ views and the European Community is not liable for any use that may be made of the information contained therein.

FundersFunder number
Horizon 2020 Framework Programme733337


    • Low-intensity psychological intervention
    • Mental health
    • Refugees
    • Scaling up
    • Theory of change


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