# Practice facilitation and supervision to strengthen depression treatment in primary care in Zimbabwe

> **NIH NIH K23** · UNIVERSITY OF WASHINGTON · 2024 · $184,012

## Abstract

PROJECT SUMMARY
Background: Worldwide, the majority of people with depression receive no treatment, despite the existence of
evidence-based, low-cost treatments. In Zimbabwe, at least a third of people presenting to primary care screen
positive for depression, but most cases go unrecognized and untreated. Research strategy: This study
includes the development and pilot testing of an implementation strategy to improve uptake of clinical
guidelines for depression diagnosis and treatment in primary care. It has three phases: 1) Assessment of
current practice: In a sample of patients presenting to routine primary care (n=200), determine what percent of
patients with probable depression are recognized by primary care nurses and offered treatment, 2) Adaptation
of an implementation strategy: Using a human-centered design (HCD) approach, conduct qualitative interviews
and hold focus groups with nurses to iteratively adapt a implementation strategy that combines in-person
practice facilitation with mobile phone-based clinical supervision, 3) Pilot trial of the implementation strategy: In
order to evaluate whether the implementation strategy is feasible and acceptable and to inform a future cluster
randomized trial of the strategy, pilot test the strategy in two clinics (n=12 nurses, n=30 patients), comparing
outcomes to two control clinics (n=12 nurses, n=30 patients). Outcomes include a) feasibility and acceptability
of the implementation strategy (qualitative interviews, surveys, and program data), b) exploratory
implementation outcomes (e.g. depression screening, recognition, treatment receipt), c) exploratory clinical
outcomes: PHQ-9 score of patients at 6 and 12 weeks after initial visit, and d) feasibility of data collection
strategy. Training plan: To conduct the proposed research and transition to being an independent
investigator, Dr. Jack will receive mentorship and training in the following areas: 1) foundational understanding
of methods for the design and analysis of clustered clinical trials, 2) implementation science with a focus on
mixed methods, and 3) human-centered design. Mentorship: Dr. Jack’s primary mentor (Rao) brings expertise
in implementation science and global mental health in primary care, which is complemented by her co-mentors
who are experts in depression research in Zimbabwe (Chibanda) and mental health treatment guidelines and
clinical trials in low and middle income-countries (Thornicroft). She also has a scientific advisory team (Dorsey,
Hallgren, and Lyon) who will support her training and research in implementation science, clustered trial
design, and HCD, respectively. Candidate: Dr. Jack combines clinical training in Internal Medicine with a
research background that has focused on global mental health and the integration of behavioral health into
primary care (42 publications, 15 as first author). This K23 builds on her eight years of prior research in
Zimbabwe and will allow her the dedicated time for research and ...

## Key facts

- **NIH application ID:** 10903818
- **Project number:** 5K23MH129420-03
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Helen Elizabeth Jack
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $184,012
- **Award type:** 5
- **Project period:** 2022-09-15 → 2027-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10903818

## Citation

> US National Institutes of Health, RePORTER application 10903818, Practice facilitation and supervision to strengthen depression treatment in primary care in Zimbabwe (5K23MH129420-03). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10903818. Licensed CC0.

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