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Johnson SL, Rieder AD, Rasmussen JM, Mansoor M, Quick KN, Proeschold-Bell RJ, Boone WJ, Puffer ES. A Pilot Study of the Coping Together Virtual Family Intervention: Exploring Changes in Family Functioning and Individual Well-Being. Res Child Adolesc Psychopathol 2024; 52:1-16. [PMID: 38498230 DOI: 10.1007/s10802-024-01183-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
In this pilot study, we tested a virtual family strengthening and mental health promotion intervention, Coping Together (CT), during the COVID-19 pandemic. We explored changes at the family and individual levels, as well as mechanisms of change. Participants included 18 families (24 caregivers, 24 youth) with children aged 7 to 18 years. Community health workers delivered the 8-session CT intervention using videoconferencing software. We used qualitative semi-structured interviews with 14 of the families to explore changes and mechanisms of change using a thematic content analysis approach. We also administered pre-post surveys with the 18 families to explore the direction of changes, using only descriptive statistics in this small sample. Qualitative findings supported positive changes across family and individual level outcomes including family functioning, relationship quality, and individual psychosocial well-being. Results also confirmed several hypothesized mechanisms of change with improved communication providing the foundation for increased hope and improved problem solving and coping. Pre-post survey results were mixed, showing positive, but very small, changes in family closeness, caregiver-child communication, and levels of hope; almost no change was observed on measures of caregiver and child mental health. Families reported few problems at baseline quantitatively despite qualitative descriptions of pre-intervention difficulties. Results provide preliminary support for benefits of CT with the most consistent improvements seen across family relationships. Findings were mixed related to individual-level mental health benefits. Results have implications for revising content on mental health coping strategies and suggest the need to revise the quantitative measurement strategy for this non-clinical sample.
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Affiliation(s)
- Savannah L Johnson
- Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA.
- Duke Global Health Institute, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA.
| | - Amber D Rieder
- Duke Global Health Institute, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA
| | - Justin M Rasmussen
- Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA
- Duke Global Health Institute, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA
| | - Mahgul Mansoor
- Duke Global Health Institute, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA
| | - Kaitlin N Quick
- Duke Global Health Institute, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA
| | | | | | - Eve S Puffer
- Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA
- Duke Global Health Institute, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA
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Byansi W, Sensoy Bahar O, Small L, Namatovu P, Nabayinda J, Kiyingi J, Mwebembezi A, Nakigozi G, Hoagwood K, McKay MM, Ssewamala FM. The longitudinal impact of an evidence-based multiple family group intervention (Amaka Amasanyufu) on family cohesion among children in Uganda: Analysis of the cluster randomized SMART Africa-Uganda scale-up study (2016-2022). FAMILY PROCESS 2024. [PMID: 38761066 DOI: 10.1111/famp.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/29/2023] [Accepted: 04/22/2024] [Indexed: 05/20/2024]
Abstract
Family functioning plays a critical role in childhood disruptive behavior disorders (The Family Journal, 2003, 11(1), 33-41; Research in Nursing and Health, 2016, 39(4), 229-243). Yet, there is limited research on the impact of evidence-based family strengthening interventions on improving family cohesion as a protective factor among children experiencing behavioral challenges. To address this gap, we analyzed data (N = 636) from the SMART Africa-Uganda study (2016-2022), a cluster randomized clinical trial testing an evidence-based family-strengthening intervention called Amaka Amasanyufu (translated as "Happy Families" in the local language). Children aged 8-13 and their caregivers were recruited from 26 public primary schools that were randomized to: (1) control condition receiving generalized psychosocial literature (10 schools), (2) intervention delivered via parent peers (eight schools), and (3) intervention delivered via community healthcare workers (eight schools). Children completed the family cohesion questionnaire at baseline, 8 weeks, 16 weeks, and 6 months post-intervention completion. The intervention effectiveness was evaluated via a three-level logistic mixed effects model with pairwise comparisons across study conditions within each time point. Participants in the parent-peer intervention group had greater odds of being in the higher family cohesion group than participants in the control group at 8 weeks (OR = 3.24), 16 weeks (OR = 1.88) and 6 months (OR = 2.07). At 8 weeks, 16 weeks, and 6 months, participants in the community health worker group had 3.98, 2.08, and 1.79 times greater odds of being in the higher family cohesion group than participants in the control group, respectively. Our findings strengthen the evidence base for Amaka Amansayufu as an effective intervention that can be utilized in SSA to improve family cohesion in families with children experiencing behavioral challenges.
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Affiliation(s)
- William Byansi
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Latoya Small
- Luskin School of Public Affairs, University of California at Los Angeles, Los Angeles, California, USA
| | - Phionah Namatovu
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | | | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | | | - Kimberly Hoagwood
- Grossman School of Medicine, New York University, New York City, New York, USA
| | - Mary M McKay
- Vice Provost Office, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
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Greene Barker T, O'Higgins A, Fonagy P, Gardner F. A systematic review and meta-analysis of the effectiveness of co-designed, in-person, mental health interventions for reducing anxiety and depression symptoms. J Affect Disord 2024; 350:955-973. [PMID: 38199405 DOI: 10.1016/j.jad.2023.12.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/02/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Co-design is recommended in mental health fields and has been associated with improved intervention efficacy. Despite its growing popularity, syntheses of evidence on the effectiveness of co-designed interventions are scarce, and little is known about their impact on anxiety and depression. METHODS The purpose of this systematic review and meta-analysis was to consolidate evidence on the effectiveness of in-person, co-designed mental health interventions for reducing anxiety and depression symptoms. An exhaustive search was conducted across six electronic databases (PubMed, PsycINFO, Embase, CINAHL, CENTRAL, and ProQuest) and grey literature. Criteria for inclusion comprised studies utilizing randomized or quasi-randomized methods, implementing non-digital/in-person, co-designed interventions for mental health enhancement, and assessing anxiety and/or depression. Intervention impacts were evaluated using random-effects meta-analyses. RESULTS The review identified 20 studies, with only three using the term 'co-design'. Other terminologies included 'co-developed' (n = 2), 'co-produced' (n = 2), and 'CBPR' (n = 11). Seventeen studies exhibited moderate risk of bias, while three demonstrated high risk. Meta-analyses demonstrated a moderate non-significant effect size of 0.5 (95 % CI: -0.8, 1.08; p = 0.08) on depression outcomes, and a small non-significant effect size of 0.12 (95 % CI: -0.1, 0.33; p = 0.23) on anxiety outcomes. LIMITATIONS The majority of studies lacked sufficient statistical power to detect between-group differences. Following GRADE criteria, confidence in estimates was low. CONCLUSIONS Notwithstanding widespread enthusiasm for co-design, the current evidence base is inadequate to confirm the impact of in-person, co-designed mental health interventions on anxiety and depression. More full-scale evaluation trials of higher quality are urgently needed, along with uniform terminology and measurement.
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Affiliation(s)
- Tamsin Greene Barker
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, UK; Research Department of Clinical, Educational and Health Psychology, University College London, UK.
| | - Aoife O'Higgins
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, UK; Foundations What Works Centre for Children & Families, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Frances Gardner
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, UK
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Puffer ES, Johnson SL, Quick KN, Rieder AD, Mansoor M, Proeschold-Bell RJ, Jones S, Moore-Lawrence S, Rasmussen JD, Cucuzzella C, Burwell F, Dowdy L, Moore F, Rosales N, Sanyal A, Ramachandran P, Duerr E, Tice L, Ayuku D, Boone WJ. Family Strengthening in the Context of COVID-19: Adapting a Community-Based Intervention from Kenya to the United States. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:267-278. [PMID: 36040621 PMCID: PMC9425799 DOI: 10.1007/s11121-022-01418-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 10/26/2022]
Abstract
COVID-19 led to widespread disruption of services that promote family well-being. Families impacted most were those already experiencing disparities due to structural and systemic barriers. Existing support systems faded into the background as families became more isolated. New approaches were needed to deliver evidence-based, low-cost interventions to reach families within communities. We adapted a family strengthening intervention developed in Kenya ("Tuko Pamoja") for the United States. We tested a three-phase participatory adaptation process. In phase 1, we conducted community focus groups including 11 organizations to identify needs and a community partner. In phase 2, the academic-community partner team collaboratively adapted the intervention. We held a development workshop and trained community health workers to deliver the program using an accelerated process combining training, feedback, and iterative revisions. In phase 3, we piloted Coping Together with 18 families, collecting feedback through session-specific surveys and participant focus groups. Community focus groups confirmed that concepts from Tuko Pamoja were relevant, and adaptation resulted in a contextualized intervention-"Coping Together"-an 8-session virtual program for multiple families. As in Tuko Pamoja, communication skills are central and applied for developing family values, visions, and goals. Problem-solving and coping skills then equip families to reach goals, while positive emotion-focused activities promote openness to change. Sessions are interactive, emphasizing skills practice. Participants reported high acceptability and appropriateness, and focus groups suggested that most content was understood and applied in ways consistent with the theory of change. The accelerated reciprocal adaptation process and intervention could apply across resource-constrained settings.
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Affiliation(s)
- Eve S Puffer
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Savannah L Johnson
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kaitlin N Quick
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Amber D Rieder
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Mahgul Mansoor
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Sierra Jones
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | | | - Justin D Rasmussen
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Cameron Cucuzzella
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | | | | | | | | | - Ameya Sanyal
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Emmy Duerr
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Logan Tice
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - David Ayuku
- Department of Behavioral Sciences, Moi University, Eldoret, Kenya
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Purgato M, Prina E, Ceccarelli C, Cadorin C, Abdulmalik JO, Amaddeo F, Arcari L, Churchill R, Jordans MJ, Lund C, Papola D, Uphoff E, van Ginneken N, Tol WA, Barbui C. Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries. Cochrane Database Syst Rev 2023; 10:CD014722. [PMID: 37873968 PMCID: PMC10594594 DOI: 10.1002/14651858.cd014722.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma. OBJECTIVES To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021. SELECTION CRITERIA Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs. DATA COLLECTION AND ANALYSIS Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2. MAIN RESULTS Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants). AUTHORS' CONCLUSIONS The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.
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Affiliation(s)
- Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy
| | | | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Rachel Churchill
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Jd Jordans
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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Mthiyane N, Rapulana AM, Harling G, Copas A, Shahmanesh M. Effect of multi-level interventions on mental health outcomes among adolescents in sub-Saharan Africa: a systematic review. BMJ Open 2023; 13:e066586. [PMID: 37788931 PMCID: PMC10551963 DOI: 10.1136/bmjopen-2022-066586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/09/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVE In sub-Saharan Africa (SSA), multiple factors contribute to the considerable burden of mental health disorders among adolescents, highlighting the need for interventions that address underlying risks at multiple levels. We reviewed evidence of the effectiveness of community or family-level interventions, with and without individual level interventions, on mental health disorders among adolescents in SSA. DESIGN Systematic review using the Grades of Recommendation, Assessment, Development and Evaluation approach. DATA SOURCES A systematic search was conducted on Cochrane Library, MEDLINE, EMBASE, PSYCINFO and Web of Science up to 31 March 2021. ELIGIBILITY CRITERIA Studies were eligible for inclusion in the review if they were randomised controlled trials (RCTs) or controlled quasi-experimental studies conducted in sub-Saharan African countries and measured the effect of an intervention on common mental disorders in adolescents aged 10-24 years. DATA EXTRACTION AND SYNTHESIS We included studies that assessed the effect of interventions on depression, anxiety, post-traumatic stress disorder and substance abuse. Substance abuse was only considered if it was measured alongside mental health disorders. The findings were summarised using synthesis without meta-analysis, where studies were grouped according to the type of intervention (multi-level, community-level) and participants. RESULTS Of 1197 studies that were identified, 30 studies (17 RCTs and 3 quasi-experimental studies) were included in the review of which 10 delivered multi-level interventions and 20 delivered community-level interventions. Synthesised findings suggest that multi-level interventions comprise economic empowerment, peer-support, cognitive behavioural therapy were effective in improving mental health among vulnerable adolescents. Majority of studies that delivered interventions to community groups reported significant positive changes in mental health outcomes. CONCLUSIONS The evidence from this review suggests that multi-level interventions can reduce mental health disorders in adolescents. Further research is needed to understand the reliability and sustainability of these promising interventions in different African contexts. PROSPERO REGISTRATION NUMBER CRD42021258826.
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Affiliation(s)
- Nondumiso Mthiyane
- Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
| | - Antony M Rapulana
- Africa Health Research Institute, Durban, South Africa
- School of Laboratory Medicine and Medical Science, University of KwaZulu-Natal, Durban, South Africa
| | - Guy Harling
- Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology & Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
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7
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Klein EK, Bond L, McLean KE, Feika M, Bah AJ, Betancourt TS. Navigating the Tension between Fatherhood Ideals and Realities of a Post-Conflict Setting: A Phenomenological Study of Former Child Soldiers in Sierra Leone. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100227. [PMID: 38107407 PMCID: PMC10722571 DOI: 10.1016/j.ssmqr.2023.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
The concept of "fatherhood" in many African countries has traditionally been understood in terms of instrumental support to one's family, most notably, financial provision. However, in Sierra Leone and elsewhere, this narrow understanding of fatherhood is changing as a result of shifting demographic trends and responses to recent crises such as the Ebola pandemic and the aftermath of a civil war. Very little is understood about how male former children associated with armed forces and armed groups (CAAFAG) are navigating fatherhood and understanding their roles as fathers, particularly as many have grown up without fathers or parents themselves and experienced violence. Our study builds upon previous ethnographic research in Sierra Leone, and uses a phenomenological approach to understand 1) the meaning and importance of fatherhood to former child soldiers in Sierra Leone, 2) what fatherhood looks like normatively and ideally, with attention to norms about nurturing care as well as violence, and 3) how ideals of fatherhood may or may not be in tension with socioeconomic circumstances. We find that CAAFAG fathers in Sierra Leone are committed to providing emotional support, encouragement, and a loving upbringing in addition to striving to provide financially. CAAFAG fathers experienced the greatest tension between their ideals of fatherhood and their socio-economic circumstances in terms of financial support, such as paying school fees. In other words, fathers felt inhibited in becoming the types of fathers they hoped to be due to their experiences in a post-conflict, resource-constrained environment.
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Affiliation(s)
- Elizabeth K Klein
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
| | - Laura Bond
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
| | - Kristen E McLean
- International Studies Program, College of Charleston, 66 George Street, Charleston, SC, 29424, USA
| | - Mahmoud Feika
- Caritas Freetown, 19 Savage Street, Freetown, Sierra Leone
| | - Abdulai Jawo Bah
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Musselburgh, Musselburgh, EH21 6UU, UK
| | - Theresa S Betancourt
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
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8
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Musindo O, Jafry S, Nyamiobo J, Becker KD, Gellatly R, Maloy C, Lozano-Ruiz A, Romero-Gonzalez B, Kola L, Merali Z, Chorpita BF, Kumar M. Mental health and psychosocial interventions integrating sexual and reproductive rights and health, and HIV care and prevention for adolescents and young people (10-24 years) in sub-Saharan Africa: a systematic scoping review. EClinicalMedicine 2023; 57:101835. [PMID: 36874395 PMCID: PMC9981905 DOI: 10.1016/j.eclinm.2023.101835] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 12/14/2022] [Accepted: 01/09/2023] [Indexed: 02/24/2023] Open
Abstract
Background Interventions targeting combined sexual and reproductive health, Human Immunodeficiency Virus (HIV) management and mental health care in sub-Saharan Africa (SSA) are few. There is a need to address common determinants of poor mental, psychosocial and sexual and reproductive health and rights (SRHR) through multimodal and multipronged interventions for adolescents. The main objective of this study was to identify whether and how interventions targeting adolescent SRHR and HIV with a focus on pregnant and parenting adolescents in SSA include mental health components and how these components and their outcomes have been reported in the literature. Methods We carried out a two process scoping review approach between 01.04.2021 and 23.08.2022. In the first stage, we searched the PubMed database to identify studies focusing on adolescents and young people aged 10 to 24 from 2001 to 2021. We identified studies focusing on HIV and SRHR that had mental health and psychosocial aspects to the interventions. Our search yielded 7025 studies. Of these 38 were eligible based on our screening criteria that covered interventions, and on further scrutiny, using PracticeWise, an established coding system, we identified select problems and practices to provide a more granular assessment of how interventions developed for this context mapped on to specific problems. At this second stage process, we selected 27 studies for inclusion as actual interventional designs for further systematic scoping of their findings and we used the Joanna Briggs Quality Appraisal checklist to rate these studies. This review was registered within the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42021234627. Findings Our first set of findings is that when coding problems and solutions, mental health concerns were the least common category of problems targeted in these SRHR/HIV interventions; nevertheless, psychoeducation and cognitive behavioral strategies such as improved communication, assertiveness training, and informational support were offered widely. Of the 27 interventional studies included in the final review, 17 RCTs, 7 open trials, and 3 mixed designs, represented nine countries of the 46 countries in SSA. Intervention types included peer, community, family, digital, and mixed modality interventions. Eight interventions focused on caregivers and youth. Social or community ecology associated problems (being an orphan, sexual abuse, homelessness, negative cultural norms) were the most common risk factors and were more frequent than medical issues associated with HIV exposure. Our findings highlight the relevance and centrality of social issues related to adolescent mental and physical health along with the need to strengthen multimodal interventions along the lines of problems we have identified in our review. Interpretation Combined interventions jointly addressing adolescent SRHR, HIV, and mental health have been relatively understudied, despite evidence that adverse social and community factors are rampant in this population. Funding MK was funded by Fogarty International CenterK43 TW010716-05 and lead the initiative.
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Affiliation(s)
- Otsetswe Musindo
- Department of Clinical, Neuro- & Developmental Psychology, Vrije University, Amsterdam, Netherlands
| | - Sheharbano Jafry
- Department of Global Health, University of Washington Seattle, USA
| | - Joseph Nyamiobo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Kimberly D. Becker
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Resham Gellatly
- Department of Psychology, University of California, Los Angeles, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Caitlin Maloy
- Health Sciences Library, University of Washington Seattle, USA
| | - Alvaro Lozano-Ruiz
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Borja Romero-Gonzalez
- Department of Psychology, Faculty of Education, University of Valladolid, Valladolid, Spain
| | - Lola Kola
- Department of Psychiatry, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Zul Merali
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Bruce F. Chorpita
- Department of Psychology, University of California, Los Angeles, USA
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
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Bose DL, Hundal A, Singh S, Singh S, Seth K, Hadi SU, Saran A, Joseph J, Goyal K, Salve S. Evidence and gap map report: Social and Behavior Change Communication (SBCC) interventions for strengthening HIV prevention and research among adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs). CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1297. [PMID: 36911864 PMCID: PMC9831290 DOI: 10.1002/cl2.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Adolescent girls and young women (AGYW), aged 15-24 years, are disproportionately affected by HIV and other sexual and reproductive health (SRH) risks due to varying social, cultural, and economic factors that affect their choices and shape their knowledge, understanding, and practices with regard to their health. Socio-Behavioral Change Communication (SBCC) interventions targeted at strengthening the capabilities of individuals and their networks have supported the demand and uptake of prevention services and participation in biomedical research. However, despite growing global recognition of the domain, high-quality evidence on the effectiveness of SBCC remains scattered. This evidence and gap map (EGM) report characterizes the evidence base on SBCC interventions for strengthening HIV Prevention and Research among AGYW in low- and middle-income countries (LMICs), identifying evidence gaps and outlining the scope of future research and program design. Objectives The objectives of the proposed EGM are to: (a) identify and map existing EGMs in the use of diverse SBCC strategies to strengthen the adoption of HIV prevention measures and participation in research among AGYW in LMICs and (b) identify areas where more interventions and evidence are needed to inform the design of future SBCC strategies and programs for AGYW engagement in HIV prevention and research. Methods This EGM is based on a comprehensive search of systematic reviews and impact evaluations corresponding to a range of interventions and outcomes-aimed at engaging AGYW in HIV prevention and research - that were published in LMICs from January 2000 to April 2021. Based on guidance for producing a Campbell Collaboration EGM, the intervention and outcome framework was designed in consultation with a group of experts. These interventions were categorized across four broad intervention themes: mass-media, community-based, interpersonal, and Information Communication and Technology (ICT)/Digital Media-based interventions. They were further sub-categorized into 15 intervention categories. Included studies looked at 23 unique behavioral and health outcomes such as knowledge attitude and skills, relationship dynamics, household dynamics, health care services, and health outcomes and research engagement. The EGM is presented as a matrix in which the rows are intervention categories/sub-categories, and the columns are outcome domains/subdomains. Each cell is mapped to an intervention targeted at outcomes. Additional filters like region, country, study design, age group, funding agency, influencers, population group, publication status, study confidence, setting, and year of publication have been added. Selection Criteria To be eligible, studies must have tested the effectiveness of SBCC interventions at engaging AGYW in LMICs in HIV prevention and research. The study sample must have consisted of AGYW between the ages of 15-24, as defined by UNAIDS. Both experimental (random assignment) and quasi-experimental studies that included a comparison group were eligible. Relevant outcomes included those at the individual, influencer, and institutional levels, along with those targeting research engagement and prevention-related outcomes. Results This EGM comprises 415 impact evaluations and 43 systematic reviews. Interventions like peer-led interactions, counseling, and community dialogues were the most dominant intervention sub-types. Despite increased digital penetration use of media and technology-driven interventions are relatively less studied. Most of the interventions were delivered by peers, health care providers, and educators, largely in school-based settings, and in many cases are part of sex-education curricula. Evidence across geographies was mostly concentrated in Sub-Saharan Africa (70%). Most measured outcomes focused on disease-related knowledge dissemination and enhancing awareness of available prevention options/strategies. These included messaging around consistent condom use, limiting sexual partners, routine testing, and awareness. Very few studies were able to include psychographic, social, and contextual factors influencing AGYW health behaviors and decisions, especially those measuring the impact of social and gender norms, relationship dynamics, and household dynamics-related outcomes. Outcomes related to engagement in the research were least studied. Conclusion This EGM highlights that evidence is heavily concentrated within the awareness-intent spectrum of behavior change and gets lean for outcomes situated within the intent-action and the action-habit formation spectrum of the behavior change continuum. Most of the evidence was concentrated on increasing awareness, knowledge, and building risk perception around SRH domains, however, fewer studies focused on strengthening the agency and self-efficacy of individuals. Similarly, evidence on extrinsic factors-such as strengthening social and community norms, relationships, and household dynamics-that determine individual thought and action such as negotiation and life skills were also found to be less populated. Few studies explore the effectiveness of these interventions across diverse AGYW identities, like pregnant women and new mothers, sex workers, and people living with HIV, leading to limited understanding of the use of these interventions across multiple user segments including key influencers such as young men, partners, families, religious leaders, and community elders was relatively low. There is a need for better quality evidence that accounts for the diversity of experiences within these populations to understand what interventions work, for whom, and toward what outcome. Further, the evidence for use of digital and mass-media tools remains poorly populated. Given the increasing penetration of these tools and growing media literacy on one end, with widening gender-based gaps on the other, it is imperative to gather more high-quality evidence on their effectiveness. Timely evidence generation can help leverage these platforms appropriately and enable intervention designs that are responsive to changing communication ecologies of AGYW. SBCC can play a critical role in helping researchers meaningfully engage and collaborate with communities as equal stakeholders, however, this remains poorly evidenced and calls for investigation and investment. A full list of abbreviations and acronyms are available in Supporting Information: Appendix F.
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Yamin A, Suryani S, Rahayu SY, Juniarti N. The potential of intervention-based community development programs in reducing multiple health risk behaviors among adolescent: A scoping review of the latest RCTs. Health Promot Perspect 2022; 12:163-168. [PMID: 36276413 PMCID: PMC9508396 DOI: 10.34172/hpp.2022.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/08/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Adolescents are more likely than adults to engage in risky health behaviors such as smoking, drinking, and sexual activity. Community development plays a role in reducing adolescents’ personal, cognitive, and social skill deficits. A review of the effectiveness of community-development interventions is required to advance our understanding of how the intervention reduce health risk behaviors. This study analyze type and effectiveness of adolescents’ community development programs reduce multiple health risk behaviors among adolescents. Methods: This scoping review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). With a date range of 2015–2021, searches were conducted in PubMed, EBSCO, and ProQuest using keywords (((Life skill education) OR (community development)) AND ((health risk behavior) OR (risk behavior)) AND ((adolescent) OR (adolescence) OR (teenagers) OR (teens) OR (youth))). After title and abstract checking, full-text retrieval, and data extraction, data were synthesized based on the main objectives. The most important data were tabulated. Results: Most studies showed that community development–based interventions effectively reduce adolescents’ health risk behaviors, including risky sexual behaviors, drug and alcohol use. Interventions were carried out in schools, places of worship, and communities, involving adolescents, educational institutions, health professionals, religious leaders, and families. Conclusion: This review can assist community health nurses, policymakers, researchers, and teachers in developing and implementing effective community-development programs that ensure knowledge, attitudes, and skills transfer to reduce health risk behaviors.
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Affiliation(s)
- Ahmad Yamin
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
| | - Suryani Suryani
- Department of Mental Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
| | - Siti Yuyun Rahayu
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia; Bandung
| | - Neti Juniarti
- Department of Community Health Nursing, and Continuity of Care Research Center, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
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Hoekstra RA. Serving the underserved: How can we reach autism families who systemically miss out on support? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1315-1319. [PMID: 35757982 DOI: 10.1177/13623613221105389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Puffer ES, Ayuku D. A Community-Embedded Implementation Model for Mental-Health Interventions: Reaching the Hardest to Reach. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2022; 17:1276-1290. [PMID: 35486821 DOI: 10.1177/17456916211049362] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The mental-health-care treatment gap remains very large in low-resource communities, both within high-income countries and globally in low- and middle-income countries. Existing approaches for disseminating psychological interventions within health systems are not working well enough, and hard-to-reach, high-risk populations are often going unreached. Alternative implementation models are needed to expand access and to address the burden of mental-health disorders and risk factors at the family and community levels. In this article, we present empirically supported implementation strategies and propose an implementation model-the community-embedded model (CEM)-that integrates these approaches and situates them within social settings. Key elements of the model include (a) embedding in an existing, community-based social setting; (b) delivering prevention and treatment in tandem; (c) using multiproblem interventions; (d) delivering through lay providers within the social setting; and (e) facilitating relationships between community settings and external systems of care. We propose integrating these elements to maximize the benefits of each to improve clinical outcomes and sustainment of interventions. A case study illustrates the application of the CEM to the delivery of a family-based prevention and treatment intervention within the social setting of religious congregations in Kenya. The discussion highlights challenges and opportunities for applying the CEM across contexts and interventions.
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Affiliation(s)
- Eve S Puffer
- Department of Psychology & Neuroscience, Duke University.,Duke Global Health Institute, Duke University
| | - David Ayuku
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University
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Memiah P, Wagner FA, Kimathi R, Anyango NI, Kiogora S, Waruinge S, Kiruthi F, Mwavua S, Kithinji C, Agache JO, Mangwana W, Merci NM, Ayuma L, Muhula S, Opanga Y, Nyambura M, Ikahu A, Otiso L. Voices from the Youth in Kenya Addressing Mental Health Gaps and Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5366. [PMID: 35564760 PMCID: PMC9104498 DOI: 10.3390/ijerph19095366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/24/2022] [Accepted: 04/14/2022] [Indexed: 11/16/2022]
Abstract
Studies including adolescents and young people (AYP) enhance the relevance of research results, benefit stakeholders, and inform future research. There exists a mental health gap in services for AYP living in low and middle-income countries. This study aims to identify mental health challenges faced by adolescents and young people in Kenya, develop practical recommendations to mitigate these issues, and reduce the mental health burden among this population. We convened an AYP-led meeting that involved 41 participants. The meeting objectives were to (1) identify efforts to support existing national and regional strategic priorities and review goals for addressing mental health needs among AYPs, (2) develop immediate action plans for strengthened mental health services, (3) review and strengthen country-level coordination mechanisms, and (4) identify how participating county experiences can inform mental health services in Kenya. Ministry of Health (MoH) officials from national and county levels, academic experts, and implementing partner agencies involved in mental health services participated in the meeting. The team, including AYP representatives, identified various mental health challenges among the AYA and recommended interventions aimed towards improving their mental health situation in the country. The challenges were clustered into three themes and comprehensively reviewed to establish the precipitating factors to mental health outcomes among AYPs in Kenya and provide recommendations. The themes included (1) legislative, (2) service provider/Ministry of Health, and (3) adolescent/individual-level factors. To bridge the mental health gap in the country and scale up mental health outcomes, the stakeholders recommended interventions within the context of the three clusters. The key suggestions included an increase in insurance financing, acceleration of community health interventions, the establishment of adolescent-friendly spaces, the training of adolescent youth champions, interactive service provision models, implementation of the existing mental health policies and structures, the development of comprehensive assessment tools, well equipped mental health departments in health facilities, the enhancement of telehealth services and digital villages, the mobilization of a functional mental health response team, and the development of a mental health database.
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Affiliation(s)
- Peter Memiah
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Fernando A. Wagner
- School of Social Work, University of Maryland Baltimore, Baltimore, MD 21201, USA;
| | - Robert Kimathi
- LVCT Health, Nairobi P.O. Box 19835-00202, Kenya; (R.K.); (A.I.); (L.O.)
| | - Naomi Idah Anyango
- Ministry of Health Kenya, Nairobi P.O. Box 30016-00100, Kenya; (N.I.A.); (S.K.); (M.N.)
| | - Samuel Kiogora
- Ministry of Health Kenya, Nairobi P.O. Box 30016-00100, Kenya; (N.I.A.); (S.K.); (M.N.)
| | - Stella Waruinge
- Nairobi Metropolitan Services, Nairobi P.O. Box 30430-00100, Kenya; (S.W.); (F.K.); (S.M.)
| | - Faith Kiruthi
- Nairobi Metropolitan Services, Nairobi P.O. Box 30430-00100, Kenya; (S.W.); (F.K.); (S.M.)
| | - Shillah Mwavua
- Nairobi Metropolitan Services, Nairobi P.O. Box 30430-00100, Kenya; (S.W.); (F.K.); (S.M.)
| | - Celina Kithinji
- Mombasa County Department of Health, Mombasa P.O. Box 81599-80100, Kenya;
| | | | - Wincolyne Mangwana
- Youth Advisory Champions for Health, Nairobi Youth Advisory Council, Mombasa P.O. Box 81599-80100, Kenya; (W.M.); (N.M.M.); (L.A.)
| | - Niyibeshaho Marie Merci
- Youth Advisory Champions for Health, Nairobi Youth Advisory Council, Mombasa P.O. Box 81599-80100, Kenya; (W.M.); (N.M.M.); (L.A.)
| | - Leonidah Ayuma
- Youth Advisory Champions for Health, Nairobi Youth Advisory Council, Mombasa P.O. Box 81599-80100, Kenya; (W.M.); (N.M.M.); (L.A.)
| | - Samuel Muhula
- Amref Health Africa in Kenya, Nairobi P.O. Box 30125-00100, Kenya; (S.M.); (Y.O.)
| | - Yvonne Opanga
- Amref Health Africa in Kenya, Nairobi P.O. Box 30125-00100, Kenya; (S.M.); (Y.O.)
| | - Maureen Nyambura
- Ministry of Health Kenya, Nairobi P.O. Box 30016-00100, Kenya; (N.I.A.); (S.K.); (M.N.)
| | - Annrita Ikahu
- LVCT Health, Nairobi P.O. Box 19835-00202, Kenya; (R.K.); (A.I.); (L.O.)
| | - Lillian Otiso
- LVCT Health, Nairobi P.O. Box 19835-00202, Kenya; (R.K.); (A.I.); (L.O.)
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Defining culturally compelling mental health interventions: A qualitative study of perspectives on adolescent depression in Lagos, Nigeria. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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15
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Jurinsky J, Perkins JM, Kakuhikire B, Nyakato VN, Baguma C, Rasmussen JD, Satinsky EN, Ahereza P, Kananura J, Audet CM, Bangsberg DR, Tsai AC. Ease of marital communication and depressive symptom severity among men and women in rural Uganda: cross-sectional, whole-population study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:343-352. [PMID: 34355265 PMCID: PMC8792190 DOI: 10.1007/s00127-021-02135-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/22/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Depression is a major contributor to the global burden of disease. The extent to which marital communication may influence depression in contexts with little mental health support is unknown. METHODS We conducted a whole-population study of married adult residents of eight villages in a rural region of southwestern Uganda. Depression symptom severity was measured using a modified version of the Hopkins Symptom Checklist for Depression, with > 1.75 classified as a positive screen for probable depression. Respondents were asked to report about ease of marital communication ('never easy', 'easy once in a while', 'easy most of the time' or 'always easy'). Sex-stratified, multivariable Poisson regression models were fit to estimate the association between depression symptom severity and marital communication. RESULTS Among 492 female and 447 male participants (response rate = 96%), 23 women and 5 men reported communication as 'never easy' and 154 women and 72 men reported it as 'easy once in a while'. Reporting communication as 'never easy' was associated with an increased risk of probable depression among women (adjusted relative risk [ARR], 2.06; 95% confidence interval [CI], 1.08-3.93, p = 0.028) and among men (ARR, 7.10; 95% CI 1.70-29.56, p = 0.007). CONCLUSION In this whole-population study of married adults in rural Uganda, difficulty of marital communication was associated with depression symptom severity. Additional research is needed to assess whether communication training facilitated by local leaders or incorporated into couples-based services might be a novel pathway to address mental health burden.
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Affiliation(s)
| | - Jessica M. Perkins
- Peabody College, Vanderbilt University, Nashville, TN, USA,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA,Corresponding author: Dr. Jessica M. Perkins, , Phone: (615) 875-3289, Fax: 615-343-2661
| | | | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Emily N. Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
| | - Phionah Ahereza
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Justus Kananura
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Carolyn M. Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA,University of Witwatersrand, Johannesburg, South Africa
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda,Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda,Center for Global Health, Massachusetts General Hospital, Boston MA USA,Harvard Medical School, Boston, MA, USA,Mongan Institute, Massachusetts General Hospital, Boston MA USA
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Mabrouk A, Mbithi G, Chongwo E, Too E, Sarki A, Namuguzi M, Atukwatse J, Ssewanyana D, Abubakar A. Mental health interventions for adolescents in sub-Saharan Africa: A scoping review. Front Psychiatry 2022; 13:937723. [PMID: 36061286 PMCID: PMC9429610 DOI: 10.3389/fpsyt.2022.937723] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/11/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Globally, adolescents are vulnerable to mental health problems, particularly those from sub-Saharan Africa (SSA) due to impoverished living conditions and a higher prevalence of chronic conditions such as HIV/AIDS in the region. The COVID-19 pandemic has further exacerbated this risk. This calls for an urgent need for evidence-based adolescent mental health interventions to reduce the risk and burden of mental health problems in SSA. The review aims to identify and characterize existing adolescent mental health interventions in SSA, as well as to evaluate their implementation strategies and effectiveness. METHODS We systematically searched PubMed, African Index Medicus, PsycINFO, Web of Science, and CINAHL databases for relevant articles. Furthermore, we searched gray literature databases, including Think Tank search, open gray, NGO search engine, and IGO search engine for additional relevant articles. The scoping review was conducted to identify original research articles on mental health interventions among adolescents in sub-Saharan Africa published from database inception to 31 December 2021. We carried out a narrative synthesis to report our findings. RESULTS Our literature search generated 4,750 studies, of which 1,141 were duplicates, 3,545 were excluded after screening, and 64 articles met the inclusion criteria. The 64 studies describe a total of 57 unique mental health interventions comprising 40,072 adolescents. The nature of these interventions was diverse, encompassing various implementation strategies such as economic-based, family strengthening, psychoeducation, interpersonal psychotherapy, Cognitive Behavioral Therapy, and resilience training, among others. Most of the interventions were selective interventions that targeted adolescents at high risk of developing mental health problems including adolescents living with HIV, war-affected adolescents, orphans, adolescents from poorer backgrounds, and survivors of sexual violence. Half of the interventions were delivered by lay persons. Sixty-two of the eligible studies examined the effectiveness of the mental health interventions, of which 55 of them reported a positive significant impact on various mental health outcomes. CONCLUSIONS The review findings show that there exist several diverse interventions that promote mental health among adolescents in sub-Saharan Africa. These interventions can be implemented in diverse settings including schools, communities, health facilities, and camps, and can be delivered by lay persons.
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Affiliation(s)
- Adam Mabrouk
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Gideon Mbithi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Esther Chongwo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Ezra Too
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Ahmed Sarki
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda.,Family and Youth Health Initiative (FAYOHI), Dutse, Jigawa State, Nigeria
| | - Mary Namuguzi
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Joseph Atukwatse
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Derrick Ssewanyana
- Alliance for Human Development, Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya.,Neurosciences Group, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
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Puffer ES, Giusto A, Rieder AD, Friis-Healy E, Ayuku D, Green EP. Development of the Family Togetherness Scale: A Mixed-Methods Validation Study in Kenya. Front Psychol 2021; 12:662991. [PMID: 34168594 PMCID: PMC8217654 DOI: 10.3389/fpsyg.2021.662991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
Family functioning is an important target of clinical intervention and research given its close ties with mental health outcomes of both children and adults. However, we lack family functioning measures validated for use in many low- and middle-income country (LMIC) settings. In this mixed-methods prospective diagnostic accuracy study, we first used formative qualitative data to develop an extensive battery of screening items to measure family functioning in Kenya. We then recruited 30 Kenyan families (N = 44 adults; 30 youth aged 8-17 years) to complete the questionnaires and participate in clinical interviews conducted by local interviewers. Quantitative and qualitative analyses were then conducted to select a subset of screening items that balanced conceptual understanding of family distress with diagnostic efficiency and accuracy to yield a brief but valid scale. The final index test consisting of 30 items correctly identified distressed families in 89% of cases according to adult-report and 76% of cases according to child-report. The optimal cutoffs are associated with estimates of sensitivity/specificity of 0.88/0.90 and 0.75/0.77 for adult-report and child-report measures, respectively. The final measure-the Family Togetherness Scale (FTS)-assesses global family functioning, including items related to family organization, emotional closeness, and communication/problem-solving. In addition to general items, the scale also includes items explicitly assessing family responses to stressors common in LMIC settings. Results establish a strong rationale for larger-scale validation studies.
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Affiliation(s)
- Eve S. Puffer
- Department of Psychology and Neuroscience, Trinity College of Arts and Sciences, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Ali Giusto
- Department of Psychology and Neuroscience, Trinity College of Arts and Sciences, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Amber D. Rieder
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Elsa Friis-Healy
- Department of Psychology and Neuroscience, Trinity College of Arts and Sciences, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - David Ayuku
- Department of Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Eric P. Green
- Duke Global Health Institute, Duke University, Durham, NC, United States
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Collins PY, Velloza J, Concepcion T, Oseso L, Chwastiak L, Kemp CG, Simoni J, Wagenaar BH. Intervening for HIV prevention and mental health: a review of global literature. J Int AIDS Soc 2021; 24 Suppl 2:e25710. [PMID: 34164934 PMCID: PMC8222838 DOI: 10.1002/jia2.25710] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Numerous effective HIV prevention options exist, including behaviour change interventions, condom promotion and biomedical interventions, like voluntary medical male circumcision and pre-exposure prophylaxis. However, populations at risk of HIV also face overlapping vulnerabilities to common mental disorders and severe mental illness. Mental health status can affect engagement in HIV risk behaviours and HIV prevention programmes. We conducted a narrative review of the literature on HIV prevention among key populations and other groups vulnerable to HIV infection to understand the relationship between mental health conditions and HIV prevention outcomes and summarize existing evidence on integrated approaches to HIV prevention and mental healthcare. METHODS We searched five databases for studies published from January 2015 to August 2020, focused on HIV prevention and mental health conditions among key populations and individuals with serious mental illness. Studies were included if they evaluated an HIV prevention intervention or assessed correlates of HIV risk reduction and included assessment of mental health conditions or a mental health intervention. RESULTS AND DISCUSSION We identified 50 studies meeting our inclusion criteria, of which 26 were randomized controlled trials or other experimental designs of an HIV prevention intervention with or without a mental health component. Behaviour change interventions were the most common HIV prevention approach. A majority of studies recruited men who have sex with men and adolescents. Two studies provided distinct approaches to integrated HIV prevention and mental health service delivery. Overall, a majority of included studies showed that symptoms of mental disorder or distress are associated with HIV prevention outcomes (e.g. increased risky sexual behaviour, poor engagement in HIV prevention behaviours). In addition, several studies conducted among groups at high risk of poor mental health found that integrating a mental health component into a behaviour change intervention or linking mental health services to combination prevention activities significantly reduced risk behaviour and mental distress and improved access to mental healthcare. CONCLUSIONS Evidence suggests that mental health conditions are associated with poorer HIV prevention outcomes, and tailored integrated approaches are urgently needed to address overlapping vulnerabilities among key populations and other individuals at risk.
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Affiliation(s)
- Pamela Y Collins
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWAUSA
| | | | | | - Linda Oseso
- HIV Vaccine Trials Network, Vaccine and Infectious Disease DivisionFred HutchSeattleWAUSA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWAUSA
| | | | - Jane Simoni
- Department of PsychologyUniversity of WashingtonSeattleWAUSA
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Bhana A, Kreniske P, Pather A, Abas MA, Mellins CA. Interventions to address the mental health of adolescents and young adults living with or affected by HIV: state of the evidence. J Int AIDS Soc 2021; 24 Suppl 2:e25713. [PMID: 34164939 PMCID: PMC8222850 DOI: 10.1002/jia2.25713] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/26/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Adolescents and young adults (AYA) remain vulnerable to HIV-infection and significant co-morbid mental health challenges that are barriers to treatment and prevention efforts. Globally millions of AYA are living with HIV (AYALH) and/or have been affected by HIV in their families (AYAAH), with studies highlighting the need for mental health programmes. With no current guidelines for delivering mental health interventions for AYALH or AYAAH, a scoping review was undertaken to explore current evidence-based mental health interventions for AYALH and AYAAH to inform future work. METHODS The review, targeting work between 2014 and 2020, initially included studies of evidence-based mental health interventions for AYALH and AYAAH, ages 10 to 24 years, that used traditional mental health treatments. Given the few studies identified, we expanded our search to include psychosocial interventions that had mental health study outcomes. RESULTS AND DISCUSSION We identified 13 studies, seven focused on AYALH, five on AYAAH, and one on both. Most studies took place in sub-Saharan Africa. Depression was targeted in eight studies with the remainder focused on a range of emotional and behavioural symptoms. Few studies used evidence-based approaches such as Cognitive Behaviour Therapy; psychosocial approaches included mental health treatments, group-based and family strengthening interventions, economic empowerment combined with family strengthening, group-based mindfulness and community interventions. Eleven studies were randomized control trials with four pilot studies. There was variation in sample size, treatment delivery mode (individual focus, group-based, family focus), and measures of effectiveness across studies. Most used trained lay counsellors as facilitators, with few using trained mental health professionals. Eleven studies reported positive intervention effects on mental health. CONCLUSIONS Despite the need for mental health interventions for AYALH and AYAAH, we know surprisingly little about mental health treatment for this vulnerable population. There are some promising approaches, but more work is needed to identify evidence-based approaches and corresponding mechanisms of change. Given limited resources, integrating mental health treatment into healthcare settings and using digital health approaches may support more standardized and scalable treatments. Greater emphasis on implementation science frameworks is needed to create sustainable mental health treatment for AYALH and AYAAH globally.
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Affiliation(s)
- Arvin Bhana
- Health Systems Research UnitSouth African Medical Research CouncilDurbanSouth Africa
- Centre for Rural HealthCollege of Health SciencesUniversity of KwaZulu‐NatalSouth Africa
| | - Philip Kreniske
- HIV Center for Clinical and Behavioral StudiesDepartment of PsychiatryNew York State Psychiatric Institute and Columbia UniversityNew YorkNYUSA
| | - Ariana Pather
- HIV Center for Clinical and Behavioral StudiesDepartment of PsychiatryNew York State Psychiatric Institute and Columbia UniversityNew YorkNYUSA
| | - Melanie Amna Abas
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral StudiesDepartment of PsychiatryNew York State Psychiatric Institute and Columbia UniversityNew YorkNYUSA
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Schultz K, Farmer S, Harrell S, Hostetter C. Closing the Gap: Increasing Community Mental Health Services in Rural Indiana. Community Ment Health J 2021; 57:684-700. [PMID: 33385268 PMCID: PMC7775639 DOI: 10.1007/s10597-020-00737-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/26/2020] [Indexed: 11/12/2022]
Abstract
Due to the significant need for mental health services in rural Martin County, IN and lack of providers, this study examined the current strengths of the community as well as the barriers preventing mental health service delivery. The goal of the study was to propose community-specific solutions to overcoming the barriers. Using a strengths-based approach (Saleeby in The strengths perspective in social work practice, Longman, White Plains, NY, 1992), the authors first sought to understand Martin County residents' current experiences with mental health services. Second, the authors sought to understand Martin County residents' opinions about church/mental health partnerships. As a result of this analysis, the authors comprised a list of feasible and sustainable recommendations for Martin County and similar rural areas that incorporate the strengths in the community, address their identified challenges, and thus created a model for mental health service provision that can be replicated in other rural communities with similar strengths as well as similar challenges.
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Affiliation(s)
- Kristi Schultz
- School of Medicine, Indiana University, 39 E 9th Street, Apt 504, Indianapolis, IN, 46204, USA.
| | - Sara Farmer
- CCB Counseling, Catholic Charities, 803 N. Monroe St., Bloomington, IN, 47404, USA
| | - Sam Harrell
- School of Social Work, Portland State University, PO Box 751, Portland, OR, 97207, USA
| | - Carol Hostetter
- School of Social Work, Indiana University, 1127 E. Atwater Avenue, Bloomington, IN, 47401, USA
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Lahijani AY, King AR, Gullatte MM, Hennink M, Bednarczyk RA. HPV Vaccine Promotion: The church as an agent of change. Soc Sci Med 2020; 268:113375. [PMID: 32979772 DOI: 10.1016/j.socscimed.2020.113375] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
Vaccination to prevent human papillomavirus (HPV) infections and associated cancers has been recommended for use in the US since 2006; however, vaccine uptake remains suboptimal. Many sociodemographic factors have been evaluated with regard to HPV vaccine uptake but there has been less focus on the role of religion and religiosity. Our qualitative case study aimed to identify community perceptions of HPV and HPV vaccination via seven focus group discussions (FGDs) with leaders and members of an African Methodist Episcopal (AME) church in metro-Atlanta, Georgia from April 2018 to July 2018. A Social and Behavior Change Communication (SBCC) conceptual framework was used to identify potential avenues to strengthen communication and health promotion strategies in the church community. Results showed diverse perceptions about HPV vaccine amongst the church community, ranging from viewing the HPV vaccine as essential to unnecessary for adolescents. Two key barriers to the HPV vaccine that may be addressed through the SBCC strategies were identified: 1) general mistrust in the healthcare system and 2) the expectation of abstinence among adolescents. For future HPV prevention opportunities, congregants highlighted they would be more receptive to receiving HPV vaccine promotion messages from pre-established trustworthy sources. Church leaders hold the trust of their congregation, therefore implementation of a church-based intervention utilizing the SBCC strategies has considerable potential to transform perceptions of the HPV vaccine and increase vaccination uptake. These findings may be implemented in future HPV vaccine promotion strategies within faith-based communities to promote safe and open dialogue for health communication messages to be disseminated in a familiar and trusted setting.
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Affiliation(s)
- Ariana Y Lahijani
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Adrian R King
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Mary M Gullatte
- Winship Cancer Institute, Emory University, 1365 Clifton Rd, Atlanta, GA, 30322, USA; Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, USA; Emory Healthcare, 235 Peachtree Street, NE, Atlanta, GA, 30303, USA
| | - Monique Hennink
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA; Winship Cancer Institute, Emory University, 1365 Clifton Rd, Atlanta, GA, 30322, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA; Emory Vaccine Center, Emory University, 954 Gatewood Road, Atlanta, GA, 30329, USA.
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22
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Bhana A, Abas MA, Kelly J, van Pinxteren M, Mudekunye LA, Pantelic M. Mental health interventions for adolescents living with HIV or affected by HIV in low- and middle-income countries: systematic review. BJPsych Open 2020; 6:e104. [PMID: 32886056 PMCID: PMC7488323 DOI: 10.1192/bjo.2020.67] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mental health difficulties and mental disorders are common in adolescents living with HIV or who are affected by HIV because of living in HIV-affected households in low- and middle-income (LMICs) countries, but little is known about the interventions that target these individuals and whether they are effective. AIMS This systematic review aims to address these gaps by examining what has worked and what has not worked to support the mental health of adolescents living with HIV or affected by HIV in low- and middle-income contexts (PROSPERO Number: CRD42018103269). METHOD A systematic literature review of online databases from the year 2000 to 2018, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, included English-language publications of quantitative evaluations of psychosocial interventions aiming to improve mental health among adolescents living with HIV and adolescents from HIV-affected households (aged 10-24 years) in LMICs. RESULTS Out of 2956 articles, 16 studies from 8 LMICs met the inclusion criteria. Thirteen studies focused on adolescents affected by HIV and only three studies on adolescents living with HIV. Only five studies included were from Sub-Saharan Africa. Interventions most often used a family-strengthening approach strengthening caregiver-adolescent relationships and communication and some problem-solving in groups or individually. Five studies reported statistically significant changes in adolescent and caregiver mental health or mental well-being, five among adolescents only and two among caregivers only. CONCLUSIONS Research on what works to improve mental health in adolescents living with HIV in LMIC is in its nascent stages. Family-based interventions and economic strengthening show promise.
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Affiliation(s)
- Arvin Bhana
- Health Systems Research Unit, South African Medical Research Council, South Africa; and Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Melanie Amna Abas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Jane Kelly
- Policy and Research Directorate, Department of Community Safety, Western Cape Government, South Africa
| | - Myrna van Pinxteren
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | | | - Marija Pantelic
- Department of Social Policy and Intervention, Oxford University, UK; Frontline AIDS, UK; and Department of Medical Education, Brighton and Sussex Medical School, UK
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Penner F, Sharp C, Marais L, Shohet C, Givon D, Boivin M. Community‐Based Caregiver and Family Interventions to Support the Mental Health of Orphans and Vulnerable Children: Review and Future Directions. New Dir Child Adolesc Dev 2020; 2020:77-105. [DOI: 10.1002/cad.20352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Carla Sharp
- University of Houston Houston TX 77004 United States
- Centre for Development SupportUniversity of the Free State Bloemfontein 9301 South Africa
| | - Lochner Marais
- Centre for Development SupportUniversity of the Free State Bloemfontein 9301 South Africa
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Marcus R, Rivett J, Kruja K. How far do parenting programmes help change norms underpinning violence against adolescents? Evidence from low and middle-income countries. Glob Public Health 2020; 16:820-841. [PMID: 32515279 DOI: 10.1080/17441692.2020.1776364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Recent years have seen an upsurge in parent education programmes in low and middle-income countries (LMICs) that aim to help reduce violence against children. This article draws on a narrative review that examined the impact of 42 programmes working with parents of adolescents in LMICs. Here we focus on 17 initiatives that aimed to reduce neglect of, or physical, emotional or sexual violence against adolescents, or to reduce child marriage. Programmes aiming to prevent sexual violence or child marriage generally focused more strongly on understanding and challenging prevailing norms, while those oriented to preventing physical and emotional violence emphasised sharing information and practising new communication skills. We argue that key elements of programme design (group-based participatory sessions, formative research that enabled sensitive framing and adaptation of content) have strong potential to help shift norms that underpin violence against adolescents. To fulfil their potential to change norms underpinning violence against adolescents, programmes should expand their reach, with a particular focus on embedding initiatives within institutions that can take them to scale, promoting male engagement, and support participants to maintain changes over the long-term.
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Affiliation(s)
- Rachel Marcus
- Overseas Development Institute, London, United Kingdom of Great Britain and Northern Ireland
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25
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Desrosiers A, Betancourt T, Kergoat Y, Servilli C, Say L, Kobeissi L. A systematic review of sexual and reproductive health interventions for young people in humanitarian and lower-and-middle-income country settings. BMC Public Health 2020; 20:666. [PMID: 32398129 PMCID: PMC7216726 DOI: 10.1186/s12889-020-08818-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/30/2020] [Indexed: 11/21/2022] Open
Abstract
Background Accessibility of sexual and reproductive health (SRH) services in many lower-and-middle-income countries (LMICs) and humanitarian settings remains limited, particularly for young people. Young people facing humanitarian crises are also at higher risk for mental health problems, which can further exacerbate poor SRH outcomes. This review aimed to explore, describe and evaluate SRH interventions for young people in LMIC and humanitarian settings to better understand both SRH and psychosocial components of interventions that demonstrate effectiveness for improving SRH outcomes. Methods We conducted a systematic review of studies examining interventions to improve SRH in young people in LMIC and humanitarian settings following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards for systematic reviews. Peer-reviewed journals and grey literature from January 1, 2000 to December 31, 2018 were included. Two authors performed title, abstract and full-text screening independently. Data was extracted and analyzed using a narrative synthesis approach and the practice-wise clinical coding system. Results The search yielded 813 results, of which 55 met inclusion criteria for full-text screening and thematic analysis. Primary SRH outcomes of effective interventions included: contraception and condom use skills, HIV/STI prevention/education, SRH knowledge/education, gender-based violence education and sexual self-efficacy. Common psychosocial intervention components included: assertiveness training, communication skills, and problem-solving. Conclusions Findings suggest that several evidence-based SRH interventions may be effective for young people in humanitarian and LMIC settings. Studies that use double blind designs, include fidelity monitoring, and focus on implementation and sustainability are needed to further contribute to this evidence-base.
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Affiliation(s)
- Alethea Desrosiers
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Theresa Betancourt
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Yasmine Kergoat
- Department of Sexual and Reproductive Health Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | - Chiara Servilli
- Department of Sexual and Reproductive Health Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | - Lale Say
- Department of Sexual and Reproductive Health Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | - Loulou Kobeissi
- Department of Sexual and Reproductive Health Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
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Goin DE, Pearson RM, Craske MG, Stein A, Pettifor A, Lippman SA, Kahn K, Neilands TB, Hamilton EL, Selin A, MacPhail C, Wagner RG, Gomez-Olive FX, Twine R, Hughes JP, Agyei Y, Laeyendecker O, Tollman S, Ahern J. Depression and Incident HIV in Adolescent Girls and Young Women in HIV Prevention Trials Network 068: Targets for Prevention and Mediating Factors. Am J Epidemiol 2020; 189:422-432. [PMID: 31667490 PMCID: PMC7306677 DOI: 10.1093/aje/kwz238] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 12/31/2022] Open
Abstract
The human immunodeficiency virus (HIV) epidemic among adolescent girls and young women (AGYW) in sub-Saharan Africa is a critical public health problem. We assessed whether depressive symptoms in AGYW were longitudinally associated with incident HIV, and identified potential social and behavioral mediators. Data came from a randomized trial of a cash transfer conditional on school attendance among AGYW (ages 13-21 years) in rural Mpumalanga Province, South Africa, during 2011-2017. We estimated the relationship between depressive symptoms and cumulative HIV incidence using a linear probability model, and we assessed mediation using inverse odds ratio weighting. Inference was calculated using the nonparametric bootstrap. AGYW with depressive symptoms had higher cumulative incidence of HIV compared with those without (risk difference = 3.5, 95% confidence interval (CI): 0.1, 7.0). The strongest individual mediators of this association were parental monitoring and involvement (indirect effect = 1.6, 95% CI: 0.0, 3.3) and reporting a partner would hit her if she asked him to wear a condom (indirect effect = 1.5, 95% CI: -0.3, 3.3). All mediators jointly explained two-thirds (indirect effect = 2.4, 95% CI: 0.2, 4.5) of the association between depressive symptoms and HIV incidence. Interventions addressing mental health might reduce risk of acquiring HIV among AGYW.
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Affiliation(s)
- Dana E Goin
- Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Rebecca M Pearson
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, United Kingdom
- Bristol Biomedical Research Centre, National Institute for Health Research, Bristol, United Kingdom
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Alan Stein
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Audrey Pettifor
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheri A Lippman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Erica L Hamilton
- HIV Prevention Trials Network Leadership and Operations Center, Science Facilitation Department, FHI 360, Durham, North Carolina
| | - Amanda Selin
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Carolina Population Center, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Catherine MacPhail
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ryan G Wagner
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gomez-Olive
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - James P Hughes
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Yaw Agyei
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Oliver Laeyendecker
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer Ahern
- Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
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Palinkas LA. Commentary: Equity and Exchange in Global Research-Practice Partnerships. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2019; 6:209-213. [PMID: 31828003 PMCID: PMC6905463 DOI: 10.1007/s40609-018-0118-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Lawrence A Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California
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García-Carrión R, Villarejo-Carballido B, Villardón-Gallego L. Children and Adolescents Mental Health: A Systematic Review of Interaction-Based Interventions in Schools and Communities. Front Psychol 2019; 10:918. [PMID: 31068881 PMCID: PMC6491840 DOI: 10.3389/fpsyg.2019.00918] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 04/05/2019] [Indexed: 11/13/2022] Open
Abstract
Background: There is growing evidence and awareness regarding the magnitude of mental health issues across the globe, starting half of those before the age of 14 and have lifelong effects on individuals and society. Despite the multidimensional nature of this global challenge, which necessarily require comprehensive approaches, many interventions persist in seeking solutions that only tackle the individual level. The aim of this paper is to provide a systematic review of evidence for positive effects in children and adolescents' mental health resulting from interventions conducted in schools and communities in which interaction among different agents is an integral component. Methods: An extensive search in electronic databases (Web of Knowledge, SCOPUS, ERIC, and PsycINFO) was conducted to identify interventions in which interactions between peers, teachers, families or other community members or professionals played a role. Their effects on children and adolescents' mental health were also reviewed. We carried out a systematic review of papers published from 2007 to 2017. Eleven studies out of 384 met the inclusion criteria. Seven of the articles reviewed focus on interventions conducted in schools and promote supportive interactions involving students, teachers, families and mental health professionals. Four of the articles develop interventions that engage community members in dialogic interactions with children and adolescents. Results: Interventions in schools and communities implement strategies that foster supportive interactions among diverse actors including teachers, parents, community members, and other professionals. The effects of the mental health interventions reported on children and adolescents' problems include a decrease in disruptive behaviors and affective symptoms such as depression and anxiety, together with an increase in social skills, as well as an improvement in personal well-being. Conclusions: There is evidence of a positive effect on the mental health of children and adolescents, both in decreasing symptoms of mental disorder and in promoting emotional well-being. Whereas, interactions among different actors seem to be a relevant aspect across the interventions, more research is needed to conclude its effect on the outcomes of the studies reviewed.
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Affiliation(s)
- Rocío García-Carrión
- Faculty of Education, Psychology and Social Work, Universitat de Lleida, Lleida, Spain
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Neary J, Wagner AD, Mugo C, Mutiti PM, Bukusi D, John-Stewart GC, Wamalwa DC, Kohler PK, Slyker JA. Influence and involvement of support people in adolescent and young adult HIV testing. AIDS Care 2018; 31:105-112. [PMID: 30261747 DOI: 10.1080/09540121.2018.1524563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
HIV incidence and mortality are high among adolescents and young adults (AYA) in sub-Saharan Africa, but testing rates are low. Understanding how support people (SP), such as peers, partners, or parents, influence AYA may improve HIV testing uptake. AYA aged 14-24 seeking HIV testing at a referral hospital in Nairobi, Kenya completed a post-test survey assessing the role of SP. Among 1062 AYA, median age was 21. Overall, 12% reported their decision to test was influenced by a parent, 20% by a partner, and 22% by a peer. Young adults (20-24 years old) were more likely than adolescents (14-19 years old) to be influenced to test by partners (23% vs. 12%, p < .001), and less likely by parents (6.6% vs. 27%, p < .001), healthcare workers (11% vs. 16%, p < .05), or counselors (9.4% vs. 19%, p < .001). Half of AYA were accompanied for testing (9.9% with parent, 10% partner, 23% peer, 4.3% others, and 2.1% multiple types). Young adults were more likely than adolescents to present alone (58% vs. 32%, p < .001) or with a partner (12% vs. 6.7%, p < .05), and less likely with a parent (1.6% vs. 31%, p < .001). Similar proportions of adolescents and young adults came with a peer or in a group. Correlates of presenting with SP included: younger age (aRR = 1.55 [95%CI = 1.30-1.85]), female sex (aRR = 1.45 [95%CI = 1.21-1.73]), and school enrollment (aRR = 1.41 [95%CI = 1.05-1.88]). SP play an important role in AYAs' HIV testing and varies with age. Leveraging SP may promote uptake of HIV testing and subsequent linkage care for AYA.
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Affiliation(s)
- Jillian Neary
- a Department of Epidemiology , University of Washington , Seattle , WA , USA.,b Department of Global Health , University of Washington , Seattle , WA , USA
| | - Anjuli D Wagner
- b Department of Global Health , University of Washington , Seattle , WA , USA
| | - Cyrus Mugo
- c Department of Paediatrics and Child Health , University of Nairobi , Nairobi , Kenya
| | - Peter M Mutiti
- d VCT and HIV Prevention Unit/Youth Centre , Kenyatta National Hospital , Nairobi , Kenya
| | - David Bukusi
- d VCT and HIV Prevention Unit/Youth Centre , Kenyatta National Hospital , Nairobi , Kenya
| | - Grace C John-Stewart
- a Department of Epidemiology , University of Washington , Seattle , WA , USA.,b Department of Global Health , University of Washington , Seattle , WA , USA.,e School of Medicine , University of Washington , Seattle , WA , USA.,f Department of Pediatrics , University of Washington , Seattle , WA , USA
| | - Dalton C Wamalwa
- c Department of Paediatrics and Child Health , University of Nairobi , Nairobi , Kenya
| | - Pamela K Kohler
- b Department of Global Health , University of Washington , Seattle , WA , USA.,g Department of Psychosocial and Community Health , University of Washington , Seattle , WA , USA.,h International Training and Education Center for Health , University of Washington , Seattle , WA , USA
| | - Jennifer A Slyker
- a Department of Epidemiology , University of Washington , Seattle , WA , USA.,b Department of Global Health , University of Washington , Seattle , WA , USA
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Improving Mental Health Outcomes of Burmese Migrant and Displaced Children in Thailand: a Community-Based Randomized Controlled Trial of a Parenting and Family Skills Intervention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 18:793-803. [PMID: 27858282 DOI: 10.1007/s11121-016-0728-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The negative effects of displacement and poverty on child mental health are well-known, yet research on prevention interventions in low- and middle-income countries, especially fragile states, remains limited. We examined the effectiveness of a parenting skills intervention on mental health outcomes among Burmese migrant and displaced children living in 20 communities in Thailand. Participants were primary caregivers and children aged 7 to 15 years (n = 479 families). Families were randomly assigned to receive an adapted version of the Strengthening Families Program (n = 240) or a wait-list control condition (n = 239). Assessments were conducted at baseline and 1-month post-intervention for both conditions and at 6 months for treatment group only. One month after the program, children in the treatment condition showed significant reductions in externalizing problems (caregiver effect size (ES) -0.22, p = 0.02; child report ES -0.11, p = 0.02) and child attention problems compared with controls (caregiver report ES -0.23, p = 0.03). There was no significant treatment effect on children's internalizing problems (ES -0.06; p = 0.31). Children reported a significant increase in prosocial protective factors relative to controls (ES 0.20, p < 0.01). Results suggest that an evidence-based parenting skills intervention adapted for a displaced and migrant Burmese population facing high levels of adversity can have positive effects on children's externalizing symptoms and protective psychosocial factors. TRIAL REGISTRATION Clinicaltrials.gov: https://clinicaltrials.gov/show/NCT01829815.
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Healy EA, Kaiser BN, Puffer ES. Family-based youth mental health interventions delivered by nonspecialist providers in low- and middle-income countries: A systematic review. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2018; 36:182-197. [PMID: 29902035 PMCID: PMC6742429 DOI: 10.1037/fsh0000334] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Youth in low- and middle-income countries (LMICs) are at increased risk for poor mental health due to economic and social disadvantage. Interventions that strengthen families may equip children and adolescents with the supports and resources to fulfill their potential and buffer them from future stressors and adversity. Due to human resource constraints, task-sharing-delivery of interventions by nonspecialists-may be an effective strategy to facilitate the dissemination of mental health interventions in low resource contexts. To this end, we conducted a systematic review of the literature on family-based interventions delivered in LMICs by nonspecialist providers (NSPs) targeting youth mental health and family related outcomes. METHOD Cochrane and PRISMA procedures guided this review. Searches were conducted in PsychInfo, PubMed, and Web of Science, with additional articles pulled from reference lists. RESULTS This search yielded 10 studies. Four studies were developed specifically for the delivery context using formative qualitative research; the remaining interventions underwent adaptation for use in the context. All interventions employed a period of structured training; nine studies additionally provided ongoing supervision to counselors. Interventions noted widespread acceptance of program material and delivery by NSPs. They also noted the need for ongoing supervision of NSPs to increase treatment fidelity. DISCUSSION Usage of NSPs is quite consistently proving feasible, acceptable, and efficacious and is almost certainly a valuable component within approaches to scaling up mental health programs. A clear next step is to establish and evaluate sustainable models of training and supervision to further inform scalability. (PsycINFO Database Record
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Thurman TR, Nice J, Luckett B, Visser M. Can family-centered programing mitigate HIV risk factors among orphaned and vulnerable adolescents? Results from a pilot study in South Africa. AIDS Care 2018; 30:1135-1143. [PMID: 29606017 DOI: 10.1080/09540121.2018.1455957] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Let's Talk is a structured, family-centered adolescent HIV prevention program developed for use in South Africa using key components adapted from programs successfully implemented in the US and South Africa. It is designed to address individual HIV transmission risk factors common among orphaned and vulnerable adolescents, including elevated risk for poor psychological health and sexual risk behavior. These efforts are accentuated through parallel programing to support caregivers' mental health and parenting skills. Twelve Let's Talk groups, each serving approximately 10 families, were piloted by two local community-based organizations in Gauteng and Kwa-Zulu Natal provinces, South Africa. Face-to-face interviews were conducted among participating caregivers and adolescents at baseline and three months post-intervention to explore the potential effects of the program on intermediate outcomes that may support HIV preventive behavior. Specifically, generalized estimation equations were used to estimate average change on HIV prevention knowledge and self-efficacy, caregiver and adolescent mental health, and family dynamics. Among the 105 adolescents and their 95 caregivers who participated in Let's Talk and completed both surveys, statistically significant improvements were found for adolescents' HIV and condom use knowledge as well as condom negotiation self-efficacy, but not sexual refusal self-efficacy. Both caregivers and adolescents demonstrated significantly better mental health at post-test. Adolescent/caregiver connection and communication about healthy sexuality also improved. These preliminary results highlight the potential of HIV prevention interventions that engage caregivers alongside the vulnerable adolescents in their care to mitigate adolescent HIV risk factors. A more rigorous evaluation is warranted to substantiate these effects and identify their impact on adolescents' risk behavior and HIV incidence.
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Affiliation(s)
- Tonya Renee Thurman
- a Highly Vulnerable Children Research Center , Tulane University School of Social Work , New Orleans , LA , USA
| | - Johanna Nice
- a Highly Vulnerable Children Research Center , Tulane University School of Social Work , New Orleans , LA , USA
| | - Brian Luckett
- a Highly Vulnerable Children Research Center , Tulane University School of Social Work , New Orleans , LA , USA
| | - Maretha Visser
- b Department of Psychology , University of Pretoria , Pretoria , South Africa
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Giambrone CA, Cook-Cottone CP, Klein JE. The Africa Yoga Project and Well-Being: A Concept Map of Students' Perceptions. Appl Psychol Health Well Being 2018; 10:149-170. [PMID: 29498237 DOI: 10.1111/aphw.12124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Concept mapping methodology was used to explore the perceived impact of practicing yoga with the Africa Yoga Project (AYP)-an organisation created to increase health and well-being by providing community-based yoga classes throughout Kenya. AYP's mission fit with theoretical models of well-being is discussed. Anecdotal evidence and initial qualitative research suggested the AYP meaningfully impacted adult students. METHODS Of the hundreds of AYP's adult students, 56 and 82 students participated in Phases I and II, respectively. Phase I brainstorming resulted in 94 student-generated statements about their perceived change. Phase II participants sorted and rated statements in terms of importance. Multidimensional scaling and hierarchical cluster analysis of sort data was utilised to map and group statements into clusters. RESULTS Based on statistical and interpretive criteria, a five-cluster solution with the following concepts was identified as the best model of students' change: Personal Growth; Interpersonal Effectiveness (lowest importance); Physical and Social Benefits; Emotional Resiliency; and Improved Self-Concept (highest importance). CONCLUSIONS Overall, students reported positive perceptions of the AYP. Additional research is needed to quantify students' change, and to compare the AYP outcomes to those of other programs aimed at poverty-related stress reduction and well-being.
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Hoosen N, Davids EL, de Vries PJ, Shung-King M. The Strengths and Difficulties Questionnaire (SDQ) in Africa: a scoping review of its application and validation. Child Adolesc Psychiatry Ment Health 2018; 12:6. [PMID: 29344084 PMCID: PMC5765647 DOI: 10.1186/s13034-017-0212-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/23/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Child and adolescent mental health in Africa remains largely neglected. Quick and cost-effective ways for early detection may aid early intervention. The Strengths and Difficulties Questionnaire (SDQ) is globally used to screen for mental health problems, but little is known about its use in Africa. We set out to perform a scoping review to examine existing studies that have used the SDQ in Africa. METHODS A comprehensive scoping review methodology was used to identify all peer-reviewed studies ever published that have used the SDQ in Africa. Data were extracted and analysed to assess the countries, languages and SDQ versions used, the purpose of the SDQ studies, psychometric properties of the SDQ, and to consider knowledge gaps for future in-country and cross-country studies. RESULTS Fifty-four studies from 12 African countries were identified, most from South Africa. Many different languages were used, but authorized SDQs in those languages were not always available on the SDQinfo website. Authors frequently commented on challenges in the translation and backtranslation of mental health terminology in African languages. The SDQ was typically used to investigate internalisation/externalization disorders in different clinical populations, and was most frequently used in the evaluation of children and adolescents affected by HIV/AIDS. Sixteen studies (29.6%) administered the SDQ to participants outside the intended age range, only 4 (7.4%) used triangulation of all versions to generate assessments, and eight studies (14.8%) used only subscales of the SDQ. Only one study conducted thorough psychometric validation of the SDQ, including examination of internal consistency and factor analysis. Where 'caseness' was defined in studies, UK cut-off scores were used in all but one of the studies. CONCLUSIONS The SDQ may be a very useful tool in an African setting, but the scoping review suggested that, where it was used in Africa researchers did not always follow instrument guidelines, and highlighted that very little is known about the psychometric properties of the SDQ in Africa. We recommend comprehensive evaluation of the psychometric properties of the SDQ in various African languages, including internal consistency, factor structure, need for local cut-off values and ensuring cultural equivalence of the instrument.
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Affiliation(s)
- Nikhat Hoosen
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
- Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
| | - Eugene Lee Davids
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Petrus J. de Vries
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Maylene Shung-King
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
- Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
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Social Support as a Key Protective Factor against Depression in HIV-Infected Patients: Report from large HIV clinics in Hanoi, Vietnam. Sci Rep 2017; 7:15489. [PMID: 29138432 PMCID: PMC5686163 DOI: 10.1038/s41598-017-15768-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/02/2017] [Indexed: 12/16/2022] Open
Abstract
Depression is the most common mental health issue among people living with HIV/AIDS (PLWHA). This study explored how different types and sources of social support are associated with depression among HIV-infected patients in Vietnam. We carried out a cross-sectional survey on 1,503 HIV-infected patients receiving antiretroviral therapy at two HIV clinics in Hanoi in 2016. Depression was prevalent in 26.2% of participants. Higher score of social support, especially emotional/informational support and positive social interaction, showed significant association with lower depression rate. Although family was primary source of all types of social support, receiving emotional/informational support not only from family but also from outside of family correlated with a lower proportion of depression. In countries with constrained social resources and/or with family-oriented social structures, as in Vietnam, expanding social networks between HIV populations and society is a potentially important option for reducing depression.
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Giusto AM, Green EP, Puffer ES. Associations Between Fathers' and Sons' Sexual Risk in Rural Kenya: The Potential for Intergenerational Transmission. J Adolesc Health 2017; 61:219-225. [PMID: 28391964 DOI: 10.1016/j.jadohealth.2017.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Despite high rates of HIV in areas of Sub-Saharan Africa and men's role in driving the epidemic, little is known about whether or how sexual risk-both behaviors and beliefs-may be passed down through generations of males. This study examined associations between sexual risk behaviors and sex-related beliefs of adolescent males and those of their male caregivers in Kenya, as well as the potential moderating effects of parenting characteristics and father-son relationship quality. METHODS Cross-sectional linear regression analysis was applied to baseline data from a trial of a family- and church-based intervention for families in rural Kenya that followed a stepped-wedge cluster randomized design. Our subsample consisted of 79 male caregiver and son (aged 10-16 years) dyads. RESULTS Results demonstrated a direct relationship between fathers' and sons' sex-related beliefs that was not moderated by parenting or quality of father-son relationship. Parenting/relationship characteristics did moderate the relationship between fathers' and sons' sexual behavior; if fathers did not engage in high-risk sex and exhibited more positive parenting/higher relationship quality, their sons were less likely to be sexually active. Among fathers having high-risk sex, parenting was unrelated to sons' behavior except at very high levels of positive parenting/relationship quality; at these levels, sons were actually more likely to have had sex. CONCLUSIONS Findings support recommendations to include male caregivers in youth HIV prevention efforts, potentially by targeting fathers' parenting strategies and their individual risk.
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Affiliation(s)
- Ali M Giusto
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina.
| | - Eric P Green
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Eve S Puffer
- Department of Psychology and Neuroscience, Duke Global Health Institute, Duke University, Durham, North Carolina
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