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Embleton L, Shah P, Apondi E, Ayuku D, Braitstein P. "If they had a place to live, they would be taking medication": a qualitative study identifying strategies for engaging street-connected young people in the HIV prevention-care continuum in Kenya. J Int AIDS Soc 2023; 26:e26023. [PMID: 37267115 DOI: 10.1002/jia2.26023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/15/2022] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Street-connected young people (SCY) experience structural and social barriers to engaging in the HIV prevention-care continuum. We sought to elicit recommendations for interventions that may improve SCY's engagement along the HIV prevention-care continuum from healthcare providers, policymakers, community members and SCY in Kenya. METHODS This qualitative study was conducted in Uasin Gishu, Trans Nzoia, Bungoma, Nakuru and Kitale counties in Kenya between May 2017 and September 2018 to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY. This secondary analysis focuses on a subset of data interviews that investigated SCY's healthcare needs in relation to HIV prevention and care. We conducted 41 in-depth interviews and seven focus group discussions with 100 participants, of which 43 were SCY. In total, 48 participants were women and 52 men. RESULTS Our analysis resulted in four major themes corresponding to stages in the HIV prevention-care continuum for key populations. We identified the need for an array of strategies to engage SCY in HIV prevention and testing services that are patient-centred and responsive to the diversity of their circumstances. The use of pre-exposure prophylaxis was a biomedical prevention strategy that SCY and healthcare providers alike stressed the need to raise awareness around and access to for SCY. Several healthcare providers suggested peer-based approaches for engaging SCY throughout the continuum. However, SCY heavily debated the appropriateness of using peer-based methods. Structural interventions, such as the provision of food and housing, were suggested as strategies to improve antiretroviral therapy adherence. CONCLUSIONS This study identified contextually relevant interventions that should be adapted and piloted for use with SCY. Education and sensitization of SCY and healthcare providers alike were identified as possible strategies, along with affordable housing and anti-poverty strategies as cash transfers and provision of food. Peer-based interventions are a clear option but require SCY-specific adaptation to be implemented effectively.
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Affiliation(s)
- Lonnie Embleton
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Pooja Shah
- London School of Hygiene & Tropical Medicine, London, UK
| | - Edith Apondi
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - David Ayuku
- Department of Mental Health and Behavioural Science, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
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Khan M, MacEntee K, Kiptui R, Van Berkum A, Oudshoorn A, Ayuku DO, Apondi E, Lee EOJ, Abramovich A, MacDonald SA, Braitstein P. Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and Kenya. BMC Public Health 2022; 22:1901. [PMID: 36224566 PMCID: PMC9555255 DOI: 10.1186/s12889-022-14290-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of peer navigators to increase access to HIV services. Methods Semi-structured interviews, focus group discussions (FGD), and theatre testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM). Results Across the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services. Conclusion Intersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14290-7.
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Affiliation(s)
- Momina Khan
- Division of Social and Behavioral Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Katie MacEntee
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Reuben Kiptui
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Amy Van Berkum
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | - David O Ayuku
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Alex Abramovich
- Division of Social and Behavioral Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Division of Child and Youth Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Paula Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, ON, Canada. .,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. .,Department of Epidemiology and Medical Statistics, School of Public Health, College of Health Sciences, Eldoret, Kenya.
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Myers C, Apondi E, Toromo JJ, Omollo M, Bakari S, Aluoch J, Sang F, Njoroge T, Morris Z, Kantor R, Braitstein P, Nyandiko WM, Wools-Kaloustian K, Elul B, Vreeman RC, Enane LA. "Who am I going to stay with? Who will accept me?": family-level domains influencing HIV care engagement among disengaged adolescents in Kenya. J Int AIDS Soc 2022; 25:e25890. [PMID: 35192747 PMCID: PMC8863355 DOI: 10.1002/jia2.25890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/01/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV (ALHIV, ages 10-19) have developmentally specific needs in care, and have lower retention compared to other age groups. Family-level contexts may be critical to adolescent HIV outcomes, but have often been overlooked. We investigated family-level factors underlying disengagement and supporting re-engagement among adolescents disengaged from HIV care. METHODS Semi-structured interviews were performed with 42 disengaged ALHIV, 32 of their caregivers and 28 healthcare workers (HCW) in the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya, from 2018 to 2020. Disengaged ALHIV had ≥1 visit within the 18 months prior to data collection at one of two sites and nonattendance ≥60 days following their last scheduled appointment. HCW were recruited from 10 clinics. Transcripts were analysed through thematic analysis. A conceptual model for family-level domains influencing adolescent HIV care engagement was developed from these themes. RESULTS Family-level factors emerged as central to disengagement. ALHIV-particularly those orphaned by the loss of one or both parents-experienced challenges when new caregivers or unstable living situations limited support for HIV care. These challenges were compounded by anticipated stigma; resultant non-disclosure of HIV status to household members; enacted stigma in the household, with overwhelming effects on adolescents; or experiences of multiple forms of trauma, which undermined HIV care engagement. Some caregivers lacked finances or social support to facilitate care. Others did not feel equipped to support adolescent engagement or adherence. Regarding facilitators to re-engagement, participants described roles for household disclosure; and solidarity from caregivers, especially those also living with HIV. Family-level domains influencing HIV care engagement were conceptualized as follows: (1) adolescent living situation and contexts; (2) household material resources or poverty; (3) caregiver capacities and skills to support adolescent HIV care; and (4) HIV stigma or solidarity at the household level. CONCLUSIONS Family-level factors are integral to retention in care for ALHIV. The conceptual model developed in this study for family-level influences on care engagement may inform holistic approaches to promote healthy outcomes for ALHIV. Developmentally appropriate interventions targeting household relationships, disclosure, HIV stigma reduction, HIV care skills and resources, and economic empowerment may promote adolescent engagement in HIV care.
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Affiliation(s)
- Courtney Myers
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Judith J Toromo
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mark Omollo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Salim Bakari
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Festus Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tabitha Njoroge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Zariel Morris
- Indiana University-Purdue University-Indianapolis, Indiana University, Indianapolis, Indiana, USA
| | - Rami Kantor
- Division of Infectious Diseases, Department of Medicine, Brown University Apert Medical School, Providence, Rhode Island, USA
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Epidemiology, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Winstone M Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Indiana University Center for Global Health, Indianapolis, Indiana, USA
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Rachel C Vreeman
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.,Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Arnhold Institute for Global Health, New York, New York, USA
| | - Leslie A Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Indiana University Center for Global Health, Indianapolis, Indiana, USA
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Beksinska A, Jama Z, Kabuti R, Kungu M, Babu H, Nyariki E, Shah P, Nyabuto C, Okumu M, Mahero A, Ngurukiri P, Irungu E, Adhiambo W, Muthoga P, Kaul R, Seeley J, Beattie TS, Weiss HA, Kimani J. Prevalence and correlates of common mental health problems and recent suicidal thoughts and behaviours among female sex workers in Nairobi, Kenya. BMC Psychiatry 2021; 21:503. [PMID: 34649544 PMCID: PMC8518166 DOI: 10.1186/s12888-021-03515-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/29/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs), poverty, violence and harmful alcohol/substance use are associated with poor mental health outcomes, but few studies have examined these risks among Female Sex Workers (FSWs). We examine the prevalence and correlates of common mental health problems including suicidal thoughts and behaviours among FSWs in Kenya. METHODS Maisha Fiti is a longitudinal study among FSWs randomly selected from Sex Worker Outreach Programme (SWOP) clinics across Nairobi. Baseline behavioural-biological survey (n = 1003) data were collected June-December 2019. Mental health problems were assessed using the Patient Health Questionnaire (PHQ-9) for depression, the Generalised Anxiety Disorder tool (GAD-7) for anxiety, the Harvard Trauma Questionnaire (HTQ-17) for Post-Traumatic Stress Disorder (PTSD) and a two-item tool to measure recent suicidal thoughts/behaviours. Other measurement tools included the WHO Adverse Childhood Experiences (ACE) score, WHO Violence Against Women questionnaire, and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Descriptive statistics and multivariable logistic regression were conducted using a hierarchical modelling approach. RESULTS Of 1039 eligible FSWs, 1003 FSWs participated in the study (response rate: 96%) with mean age 33.7 years. The prevalence of moderate/severe depression was 23.2%, moderate/severe anxiety 11.0%, PTSD 14.0% and recent suicidal thoughts/behaviours 10.2% (2.6% suicide attempt, 10.0% suicidal thoughts). Depression, anxiety, PTSD and recent suicidal thoughts/behaviours were all independently associated with higher ACE scores, recent hunger (missed a meal in last week due to financial difficulties), recent sexual/physical violence and increased harmful alcohol/substance. PTSD was additionally associated with increased chlamydia prevalence and recent suicidal thoughts/behaviours with low education and low socio-economic status. Mental health problems were less prevalent among women reporting social support. CONCLUSIONS The high burden of mental health problems indicates a need for accessible services tailored for FSWs alongside structural interventions addressing poverty, harmful alcohol/substance use and violence. Given the high rates of ACEs, early childhood and family interventions should be considered to prevent poor mental health outcomes.
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Affiliation(s)
- Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Zaina Jama
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Rhoda Kabuti
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Mary Kungu
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Hellen Babu
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Emily Nyariki
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Pooja Shah
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Chrispo Nyabuto
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Monica Okumu
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Anne Mahero
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Pauline Ngurukiri
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Erastus Irungu
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Wendy Adhiambo
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Peter Muthoga
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Rupert Kaul
- grid.17063.330000 0001 2157 2938University of Toronto, Toronto, Canada
| | - Janet Seeley
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Tara S. Beattie
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A. Weiss
- grid.8991.90000 0004 0425 469XMRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Joshua Kimani
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
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Braitstein P, DeLong A, Ayuku D, Ott M, Atwoli L, Galárraga O, Sang E, Hogan J. Association of Care Environment With HIV Incidence and Death Among Orphaned, Separated, and Street-Connected Children and Adolescents in Western Kenya. JAMA Netw Open 2021; 4:e2125365. [PMID: 34529063 PMCID: PMC8446813 DOI: 10.1001/jamanetworkopen.2021.25365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE In 2015, there were nearly 140 million orphaned children globally, particularly in low- and middle-income regions, and millions more for whom the street is central to their everyday lives. A total of 16.6 million children were orphaned because of deaths associated with HIV/AIDS, of whom 90% live in sub-Saharan Africa. Although most orphaned and separated children and adolescents in this region are cared for by extended family, the large number of children requiring care has produced a proliferation of institutional care. Few studies have investigated the association between care environment and physical health among orphaned and separated youths in sub-Saharan Africa. OBJECTIVE To examine the association of care environment with incident HIV and death among orphaned and separated children and adolescents who were living in charitable children's institutions, family-based settings, and street settings in western Kenya over almost 10 years. DESIGN, SETTING, AND PARTICIPANTS The Orphaned and Separated Children's Assessments Related to Their Health and Well-Being (OSCAR) project was an observational prospective cohort study conducted in Uasin Gishu County, Kenya. The cohort comprised 2551 orphaned, separated, and street-connected children from communities within 8 administrative locations, which included 300 randomly selected households (family-based settings) caring for children who were orphaned from all causes, 19 charitable children's institutions (institutional settings), and a convenience sample of 100 children who were practicing self-care on the streets (street settings). Participants were enrolled from May 31, 2010, to April 24, 2013, and were followed up until November 30, 2019. EXPOSURES Care environment (family-based, institutional, or street setting). MAIN OUTCOMES AND MEASURES Survival regression models were used to investigate the association between care environment and incident HIV, death, and time to incident HIV or death. RESULTS Among 2551 participants, 1230 youths were living in family-based settings, 1230 were living in institutional settings, and 91 were living in street settings. Overall, 1321 participants (51.8%) were male, with a mean (SD) age at baseline of 10.4 (4.8) years. Most participants who were living in institutional (1047 of 1230 youths [85.1%]) or street (71 of 91 youths [78.0%]) settings were double orphaned (ie, both parents had died). A total of 59 participants acquired HIV infection or died during the study period. After adjusting for sex, age, and baseline HIV status, living in a charitable children's institution was not associated with death (adjusted hazard ratio [AHR], 0.26; 95% CI, 0.07-1.02) or incident HIV (AHR, 1.49; 95% CI, 0.46-4.83). Compared with living in a family-based setting, living in a street setting was associated with death (AHR, 5.46; 95% CI, 2.30-12.94), incident HIV (AHR, 17.31; 95% CI, 5.85-51.25), and time to incident HIV or death (AHR, 7.82; 95% CI, 3.48-17.55). CONCLUSIONS AND RELEVANCE In this study, after adjusting for potential confounders, no association was found between care environment and HIV incidence or death among youths living in institutional vs family-based settings. However, living in a street setting vs a family-based setting was associated with both HIV incidence and death. This study's findings suggest that strengthening of child protection systems and greater investment in evidence-based family support systems that improve child and adolescent health and prevent youth migration to the street are needed for safe and beneficial deinstitutionalization to be implemented at scale.
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Affiliation(s)
- Paula Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Epidemiology and Medical Statistics, School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH) Program, Eldoret, Kenya
| | - Allison DeLong
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - David Ayuku
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Mary Ott
- Department of Pediatrics, Faculty of Medicine, Indiana University, Indianapolis
| | - Lukoye Atwoli
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- Dean’s Office, Aga Khan University Medical College, East Africa, Nairobi, Kenya
| | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Edwin Sang
- Academic Model Providing Access to Healthcare (AMPATH) Program, Eldoret, Kenya
| | - Joseph Hogan
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
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Murphy K, Embleton L, Lachman JM, Owino E, Kirwa S, Makori D, Braitstein P. "From Analog to Digital": The Feasibility, Acceptability, and Preliminary Outcomes of a Positive Parenting Program for Street-Connected Mothers in Kenya. CHILDREN AND YOUTH SERVICES REVIEW 2021; 127:106077. [PMID: 34421160 PMCID: PMC8372834 DOI: 10.1016/j.childyouth.2021.106077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Children of street-connected women in Kenya are at risk of child maltreatment. There have been increasing calls for positive parenting programs for parents experiencing homelessness, however never has one been implemented with this population. We therefore adapted the evidence-based Parenting for Lifelong Health for Young Children program using participatory methods, and piloted the adapted program with street-connected mothers in Kenya. OBJECTIVES To (a) determine if the adapted program was feasible and acceptable with street-connected mothers, and (b) assess indicative effects on child maltreatment, positive parenting, and parental stress. PARTICIPANTS AND SETTING Two groups of 15 mothers (ages 19+, and 20- ) participated between June-July 2018 in Eldoret, Kenya. Participants were eligible if they (a) were the mother of at least one child and (b) self-identified as street-connected. METHODS Feasibility was measured via enrollment, attendance, drop-out rates, and engagement in take-away activities. Focus groups explored program acceptability and program outcomes. Self-report surveys assessed pre-post changes in child maltreatment, parental stress, parental sense of inefficacy, and positive parenting practices. RESULTS 70% of participants attended ≥3/4 of sessions, 10% dropped out, and >50% of take-away activities were completed. Participants reported high acceptability and requested its continuation for themselves and other parents. There was an increase in supporting good behaviour (t(21)=8.15, p < .000) and setting limits (t(18) = 10.03, p < .000); a reduction in physical abuse (t(23) = -2.15, p = .042) and parental stress (t(22) = -7.08, p < .000); results for parental inefficacy were not statistically significant (t(22) = 0.15, p = .882). CONCLUSIONS The adapted program is feasible and acceptable to street-connected mothers, and may reduce child maltreatment and parental stress, and increase positive parenting. Further research should test program effectiveness.
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Affiliation(s)
- Kathleen Murphy
- Dalhousie University, Halifax, Canada, 6420 Coburg Rd., Halifax, Nova Scotia, B3H 4R2, Canada
| | - Lonnie Embleton
- University of Toronto, Dalla Lana School of Public Health, Toronto, Canada, 155 College St, Toronto, Ontario, M5T 3M7, Canada
| | - Jamie M. Lachman
- Department of Social Policy and Intervention, University of Oxford, UK; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK, 32 Wellington Square, Oxford, United Kingdom, OX1 2ER
| | - Eucabeth Owino
- Beruham, Eldoret, Kenya, P.O. Box 3950 Eldoret, 30100 Kenya
| | - Sheila Kirwa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya, P.O. Box 4606, Eldoret, Kenya, 30100
| | - Dominic Makori
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya, P.O. Box 4606, Eldoret, Kenya, 30100
| | - Paula Braitstein
- University of Toronto, Dalla Lana School of Public Health, Division of Epidemiology, Toronto, Canada, Moi University, College of Health Sciences, School of Public Health, Department of Epidemiology and Medical Statistics, Eldoret, Kenya, 155 College Street, Toronto, ON Canada M5T 3M7
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