Study design

We conducted a case design with three embedded levels of analysis [60, 61], the case being the organization of a mental health training program based on the mhGAP-IG, offered to PCPs working in the Greater Tunis area. Three factors influenced this design. Firstly, the case study method is suggested when conducting Type III implementation analysis [33]. Secondly, the single case design was chosen because our case is a common case [60]. More specifically, the Greater Tunis area is often where interventions are piloted, given the setting’s diversity (i.e., urban, rural, semi-urban, and semi-rural), which is representative of other areas of Tunisia. Therefore, lessons learned from the in-depth exploration of factors perceived to interact with the implemented training to prevent the attainment of its expected outcomes may help shed light on such factors in other areas of Tunisia [60, 62]. Lastly, the case study has embedded levels of analysis [60] because our aim was to identify contextual factors interacting with the implemented training to influence its expected outcomes according to a multi-factor framework [57]. While Chaudoir and colleagues (2013) [57] identify five levels in their framework, these may be regrouped into three levels of explanation [60]: structural (i.e., the health system in the Greater Tunis area), organizational (i.e., primary healthcare clinics’ organizational context), and individual (i.e., provider, patient, and innovation factors, (i.e., provider, patient, and innovation factors).