Co-production using Theory of Change in the development of the SUCCEED Africa community-based rehabilitation intervention for people living with psychosis in West and Southeast Africa

Psychosis and other severe mental health conditions cause substantial disability and reduced functioning across a number of domains. Services in low- and middle-income settings are often weak, and predominantly biomedical. Community-Based Rehabilitation (CBR) offers a comprehensive and person-centred approach that is aligned to effective case management models. The Support, Comprehensive Care and Empowerment for People with Psychosocial Disabilities (SUCCEED) programme was co-produced with people living with psychosis in four sub-Saharan countries, with a view to improving quality of life, mental health outcomes, and community participation. This paper described the intervention development process, using multiple iterations of Theory of Change (ToC), incorporating situation analysis, formative research and piloting. We present these iterations as results, using the GUIDED framework for intervention development, and the intervention is described using the TIDieR framework. We conclude that ToC can promote participatory processes of intervention co-development, as well as generate research questions. Interventions must remain flexible, and be open to revision, even if having core active ingredients.