Community Mental Health Service Lay Counsellor Supervision Density and Suicide Risk Detection in Ugandan Primary Care: A Stepped-Wedge Cluster Estimation of Supervision Exposure
Year: 2026
Type: article
Abstract: Lay counsellors increasingly carry suicide risk detection in Ugandan primary care, yet the supervision intensity required to sustain detection quality remains unquantified. the present analysis characterises the operating characteristics of a stepped-wedge cluster design for estimating the effect of supervision density on suicide risk detection, using a before-after-control-impact estimator under a declared variance structure (between-cluster SD = 6.0, residual SD = 4.5, intraclass correlation = 0.64). Power was estimated across 2000 replications per design cell for cluster counts of 8, 16, 24 and 32 and effect sizes of 3, 5 and 8 percentage points.54 clusters are required to detect a 5-percentage-point effect at 80% power, and that minimum detectable effects decline steeply as cluster counts rise from 8 to 32. The intraclass correlation of 0.64 dominates the design's sensitivity, compressing effective information and making supervision density a cluster-level rather than counsellor-level exposure.
Institution: Makerere University
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7223222514