Table 4 Key steps for contextualization of evidence-based psychological interventions in low-resource health systems according to the Replicating Effective Programs (REP) framework

1. Pre-conditions

1.1. Establish need for psychological treatments (identify and characterize target population and condition)

1.2. Use systematic, scoping, or desk reviews to identify psychological treatments with an evidence base for target condition in similar cultural settings and health systems context (e.g., what treatments have been successfully delivered in the country or region? What treatments have been successfully delivered in similar low-resource health systems?)

1.3. Review national and local health policies and guidelines to determine human resources in health system, levels of training of different health worker cadres, existing supervision systems, and cadres with greatest engagement with target population (e.g., What health worker cadres in the government health system can most feasibly deliver the intervention and what is their current supervision pathway?)

1.4 Review existing training approaches for the target health worker cadre with regard to their literacy level, costs and compensation for training, types of trainers, etc. (e.g., How long could the training feasibly be? Who could deliver it? How and what materials need to be adapted?) and develop an implementation research manual

2. Pre-implementation

2.1 Conduct formative research to identify cultural beliefs and practices including coping and health seeking behavior of target beneficiaries

2.2 Identify health system attributes and other contextual factors that may facilitate and/or obstruct access to psychological treatments in the government health system

2.3 Partner with local administration and health system to form community advisory boards, working groups, and stakeholder groups

2.4 Establish process for community working groups and stakeholder groups to collaboratively develop and modify implementation plan within public health system, as well as select appropriate site(s) for pilot implementation

3. Implementation

3.1 Conduct training within government health system for both supervisors and implementers of the psychological treatment

3.2 Build technical and support supervision into government health system, while addressing potential barriers related to power differentials and hierarchies, burden of work and limited compensation, low literacy and knowledge among supervisors, and issues regarding technology use, reporting, and internal dissemination

3.3 Use hybrid implementation trial designs to evaluate implementation and effectiveness outcomes

3.4 Organize stakeholder feedback and dissemination meetings during and post-piloting to inform refining of intervention package and next steps

3.5 Revise manual and materials for treatment delivery based on implementation and effectiveness outcomes

4. Maintenance and evolution

4.1 Work with government and international stakeholders (e.g., World Health Organization) to plan expansion throughout the government health system.

4.2 Establish process for national and local quality monitoring and improvement, including ongoing evaluation of health and economic outcomes