Short-Term Impact of "Amaka Amasanyufu" Multiple Family Group Intervention on Mental Health Functioning of Children With Disruptive Behavior Disorders in Uganda

Exploring mediators of the Amaka Amasanyufu Multiple Family Group Intervention (2016-2022) on parenting stress reduction among caregivers of children with disruptive behavior disorders in Uganda

Residing in poverty-impacted Ugandan communities and raising children with disruptive behavior disorders (DBDs) is associated with above heightened parenting stress. An evidence-based intervention designed to help parents tailor their parenting style to effectively manage children with DBDs was implemented in Uganda between 2017 and 2023. At the end of the intervention, caregivers displayed lower levels of parenting stress than controls, however the mechanisms by which stress reduction occurred is unknown. We investigated whether the intervention's effect on parenting stress was mediated by parenting practices, family cohesion, or mental health. Mediation was assessed using Mitchell and Maxwell's cross-lagged auto-regressive approach. Each mediation model regressed the outcome parenting stress score at each time point onto intervention group assignment (0 = Control; 1 = Multiple Family Group (MFG) intervention) and parenting stress score at the preceding time point. Each mediator was investigated one at a time and regressed onto intervention group assignment and the mediator score at the preceding time point. Parenting stress score was also regressed onto the preceding time point mediator score. The residuals for mediators and parenting stress were allowed to correlate at each time point. We included regression pathways from each covariate to the mediators and outcomes at subsequent waves and were included in the model as random variables. The findings show that the intervention had a significant direct effect on parenting stress at 16 weeks post intervention initiation and was partially mediated by parenting practices, caregiver mental health, and parenting stress at 8 weeks, but we found no evidence it was mediated by family cohesion, supporting two of our hypotheses. Equipping caregivers with parenting skills and strategies to improve mental health can go a long way in reducing overall parenting stress among caregivers with DBDs. Our findings could be leveraged to enhance stress reduction among caregivers of children with DBDs in the long-term.

"I decided to participate….because I saw it as benefiting our community and families": a qualitative study of lay providers' experiences with delivering an evidence-based mental health intervention for families in Uganda

BACKGROUND

Children and adolescents who live in resource-limited communities in sub-Saharan Africa (SSA) experience significant mental health problems, including behavioral problems. In SSA, one of the most significant impediments to expanding services is a scarcity of mental health specialists. Task-shifting can effectively solve the mental health care gap in low-resource settings, yet it is underutilized in child and adolescent mental health. Moreover, the experiences of lay providers are understudied in global mental health, despite their potential impact on intervention effectiveness. In this study, we examined the experiences of community health workers and parent peers with the task-shifting of an evidence-based family strengthening intervention in Uganda.

METHODS

As part of a larger randomized clinical trial, semi-structured in-depth interviews were conducted with 24 facilitators selected using stratified purposive sampling. Interviews explored their decision to participate in the program; experiences with the training; and experiences with intervention delivery. All interviews were conducted in Luganda (local language) and audio recorded. They were transcribed verbatim and translated into English. Thematic analysis was used to analyze the data.

RESULTS

Despite concerns around lack of previous experience and time commitment, facilitators reported high relevance of the intervention to the families in their communities as well as their own as a motivation to participate. They also identified financial incentives as a motivating factor. These two factors also ensured their attendance at the training. They were satisfied with the content and skills provided during the training and felt prepared to deliver the intervention. During intervention delivery, they enjoyed seeing the families engaged and participating actively in the sessions as well as observing positive changes in the families. Some challenges with family attendance and engagement were noted. The facilitators reported an increased sense of self-efficacy and competence over time; and expressed high satisfaction with supervision.

CONCLUSION

Facilitators' positive experiences point to the high acceptability and appropriateness of task-shifting this intervention in low-resource settings. As the global mental health field continues to be interested in task-shifting interventions to lay providers, successful examples should be studied so that evidence-based models can be put in place to support them through the process.