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Developing a theory of change for implementing cognitive interventions in low-resource settings: The CognIFiEd study
Abiodun O Adewuya1,2, Azizat Lebimoyo3, Olabisi E Oladipoi3
1Behavioural Medicine, Lagos State University College of Medicine, Nigeria.
Global Mental Health (Cambridge, England)
|July 17, 2026
Summary
Cognitive rehabilitation for young adults with first-episode psychosis (FEP) is scarce in sub-Saharan Africa. This study developed a Theory of Change for a task-shifted Compensatory Cognitive Training intervention, addressing implementation gaps in Nigeria.
Area of Science:
- Implementation Science
- Global Mental Health
- Psychiatry
Background:
- Cognitive impairment is prevalent in over 75% of young people with first-episode psychosis (FEP).
- Cognitive rehabilitation services are critically underrepresented in sub-Saharan Africa's public mental health systems.
- This gap stems from limited intervention availability and inadequate planning for local contexts.
Purpose of the Study:
- To describe the participatory development of a Theory of Change (ToC) for the CognIFiEd study.
- To outline a task-shifted Compensatory Cognitive Training intervention for young adults with FEP in Nigeria.
- To address implementation challenges within low- and middle-income countries (LMICs).
Main Methods:
- A Theory of Change (ToC) approach was employed, guided by WHO ExpandNet and RE-AIM frameworks.
- Co-production and validation involved 25 diverse stakeholders across five workshops.
- An implementation logic model was developed, identifying core inputs, activities, outputs, and outcomes.
Main Results:
- The ToC identified key inputs: trained non-specialist facilitators, adapted manuals, low-tech reinforcement (SMS/print), and stakeholder engagement.
- Intervention components include group sessions, psychoeducation, digital reinforcement, supervision, and outpatient integration.
- Anticipated outputs and proximal outcomes encompass cognitive strategy use, retention, social reintegration, neurocognition, functional capacity, and caregiver support.
Conclusions:
- The developed ToC provides a roadmap for implementing cognitive rehabilitation for FEP in LMICs.
- It addresses specific barriers and outlines mitigation strategies for sustainable service delivery.
- The model facilitates distinguishing pilot results from long-term system impacts.
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