Towards school mental health programmes in Nigeria: systematic review revealed the need for contextualised and culturally-nuanced research

Developing ACASI questionnaires in Borno State, Nigeria during COVID-19: Using data-informed processes to address complexity, sensitivity, and functionality of family functioning and wellbeing measures

Audio Computer-Assisted Self-Interview (ACASI) has become increasingly popular for collecting data on sensitive topics among populations with lower levels of literacy. However, the development of an ACASI tool is an involved process that can be further complicated when working in humanitarian contexts during the COVID-19 pandemic. This study describes the development of an ACASI tool to be used in a family-focused intervention evaluation. Participants included adolescent girls aged 10-14, adolescent boys aged 15-19, and caregivers in Borno State, Nigeria.  Data to inform the tool's development were collected using cognitive interviews, ACASI demonstrations, and post-demonstration assessments with adolescent girls, adolescent boys, and caregivers, as well as a focus group discussion with enumerators. Data found high levels of acceptance for the tool and helped identify appropriate visual representations for various answer options to maximize usability. The survey was found to be too long to administer solely through ACASI; the final tool employs a combination of ACASI and computer-assisted personal interview formats. Findings highlight the importance of repeatedly piloting and testing these types of tools to ensure content and language resonate with intended users. However, the steps employed demonstrate that researchers can maintain a commitment to developing high-quality, community-grounded research tools despite challenges germane to humanitarian settings.

If we build it, they will come: Caregiver decision to use an accessible outpatient psychiatric service for children and adolescents in Nigeria

OBJECTIVE

If child and adolescent psychiatric (CAP) services were accessible in lower-middle-income countries (LMIC) such as Nigeria, what individual and socio-cultural factors would influence caregivers' willingness to use these services when they are needed?

METHODS

To address this question, we conducted structured interviews with a stratified random sampling of 442 adult caregivers of children aged 5 to 19-years who lived within 10 km of an established CAP outpatient service in Ibadan, Nigeria.

RESULTS

Based on structural equation modeling, our cross-sectional findings indicated that caregivers were generally willing to use the accessible outpatient CAP service for a narrow range of overtly disruptive and developmentally atypical child behavior. However, their decisions were not influenced by their recognition of child and adolescent mental health (CAMH) conditions, competing life stressors, caregiver wellness, nor stigma as we had initially hypothesized. Rather caregivers pragmatically considered a range of approaches to address CAMH concerns. Post-hoc hypotheses confirmed that caregivers' beliefs about etiology and treatment effectiveness for CAMH conditions shaped their help-seeking decisions and stigmatization of CAP services. Specifically, caregivers who attributed CAMH conditions to physical causes regarded biomedical interventions as the most effective treatment while spiritual interventions were deemed to be the least effective.

CONCLUSIONS

Taken together our results suggested that caregivers were receptive and willing to use outpatient psychiatric services for their children. However, their beliefs about the etiology and treatment effectiveness of CAMH conditions shaped how they intended to engage the services. These findings underscored the importance of scaling up a broader spectrum of accessible complementary CAMH intervention and prevention services in Nigeria that extend beyond indigenous or biomedical models. In doing so caregivers will come.

A proposed one-stop-shop approach for the delivery of integrated oral, mental, sexual and reproductive healthcare to adolescents in Nigeria

The interconnectedness of oral, mental, sexual, and reproductive health (OMSRH) in adolescents prompts exploration of novel approaches to facilitate comprehensive access of this population to the relevant health services. This paper proposes an integrated one-stop-shop approach to increasing adolescents' access to OMSRH care by leveraging on dental clinics as a template for integration, using a non-stigmatized platform to deliver stigmatized healthcare. Novel healthcare delivery models are needed to enhance adolescents' access to the comprehensive prevention and treatment services that they critically need. Effective, integrated health care for this population is lacking, especially across various health areas. This is a proposal for leveraging dental clinics for integrated OMSRH care, using facility-based services, to adolescents. Emphasis will be placed on reducing stigma as a barrier to service accessibility, acceptability, equitability and appropriateness. Empirical studies will be required to test the feasibility, validity and effectiveness of this proposed model.