Substance use literacy: Implications for HIV medication adherence and addiction severity among substance users

This cross sectional study examined the relationship between substance use literacy and HIV medication adherence and whether severity of addiction modified this relationship. 179 HIV infected substance users completed the Questionnaire Assessment of Literacy in Mental Health, Addiction Severity Test, and Morisky Medication Adherence Scale. Most respondents wrongly identified the alcohol use vignette problem as stress (50.3%). Not recognizing that there was a problem was significantly correlated with moderate adherence (P = 0.003). Preference was given to informal sources of help such as a close friend (83.2%, P = 0.050), as well as psychosocial forms of management like physical exercise (79.9%, P = 0.007) rather than professionals such as psychiatrists (58.1%) which was associated with moderate adherence and low addiction severity. Substance use literacy was found to be a significant variable in increasing HIV medication adherence and decreasing addiction severity.Keywords: Substance use literacy, Substance use, HIV medication adherence, Addiction severity modifie

Social Networks and Students’ Performance in Secondary Schools: Lessons from an Open Learning Centre, Kenya

Given the known positive and negative effects of uncontrolled social networking among secondary school students worldwide, it is necessary to establish the relationship between social network sites and academic performances among secondary school students. This study, therefore, aimed at establishing the relationship between secondary school students’ access to and use of social network sites at an Open Learning Centre in Kenya. The centre was located about 30km South West of Nairobi, the capital city. This site was selected because information technology was the designed mode of delivery of the courses at the school, hence, high exposure of the students to quantitative social networking among the young, knowledge and information-thirsty population. The study sought opinions of key informants, parents, teachers and policy-makers in Kenya at the school compound. In addition, it investigated the behaviour of the students to generate both quantitative and qualitative data. Findings in this study showed that secondary school students in Kenya were much more vulnerable to the adverse effects of social networks in a manner consistently and concurrently similar to that found elsewhere in the worldwide. This included conversion of academic into recreational sessions and subsequent poor academic performances among the majority of the secondary school students in Kenya. It is, therefore, necessary for the schools to vet, supervise, monitor, control, censor and restrict secondary school students’ access to available information on the SNS in Kenya to enable the students to concentrate on academic excellence. The government, on the other hand, should develop a learner-friendly policy to curb the downward spiraling of academic performances in secondary schools in Kenya attributable to uncensored access to social network sites. Key words: Social networks, secondary  students’, academic performance, social network site

Improving psychotherapies offered in public hospitals in Nairobi, Kenya: extending practice-based research model for LMICs

BackgroundPsychotherapy and mental health services in Nairobis public hospitals are increasing. Rather than prematurely imposing psychotherapy protocols developed in Western countries to Kenya, we argue that first studying psychological interventions as they are practiced may generate understanding of which psychological problems are common, what interventions therapists use, and what seems to be effective in reducing psychiatric problems in a lower and middle income country like Kenya.MethodWe present preliminary findings from a process-outcome study involving 345 patients from two public institutions, Kenyatta National and Mathare National Hospitals. We asked our patients to fill out a brief personal information questionnaire, Clinical Outcomes in Routine Evaluation-Outcome Measure (Evans et al. in Br J Psychiatry 180:51-60, 2002, and the Session Alliance Inventory (Falkenstrom et al. in Psychol Assess 27:169-183, 2015) after each session. We present descriptives for CORE-OM, patient-therapist concordance on the SAI, and using longitudinal mixed-effects model, test change in CORE-OM over time with various therapy and patient factors as predictors in regression analyses.ResultsThe majority of patients who attended the outpatient care clinics were young males. Our regression analysis suggested that patients with depression reported higher initial distress levels (2.75 CORE-OM scores, se=1.11, z=2.48, p=0.013, 95% CI 0.57-4.93) than patients with addictions, anxiety, or psychosis. Older clients improved slower (0.08 CORE-OM scores slower improvement per session per year older age; se=0.03, z=3.02 p=0.003, 95% CI 0.03, 0.14). Female patients reported higher initial distress than men (2.62 CORE-OM scores, se=1.00, z=2.61, p=0.009, 95% CI 0.65, 4.58). However, interns had patients who reported significantly higher initial distress (3.24 CORE-OM points, se=0.90, z=3.60, pamp;lt;0.001, 95% CI 1.48, 5.00), and improved more over time (-1.20 CORE-OM scores per session, se=0.51, z=-2.35, p=0.019, 95% CI -2.20, -0.20) than patients seeing mental health practitioners. The results showed that at average alliance, CORE-OM decreased by 1.74 points per session (se=0.21, pamp;lt;0.001). For each point higher on the SAI at session 2, the CORE-OM decreased by an additional 0.58 points per session (se=0.25, p=0.02).DiscussionOur objective was to study psychotherapies as they are practiced in naturalistic settings. The overall significant finding is that our participants report improvement in their functioning mental health condition and distress reduced as psychotherapy progressed. There were many more male than female participants in our sample; younger patients improved more than older ones; and while interns had patients with higher distress, their patients improved better than those patients attended by professionals.ConclusionsThese are preliminary observations to consider for a larger sample follow-up study. Before changing practices, evaluating the existing practices by mapping clinical outcomes is a helpful route.Funding Agencies|Center for Clinical Research Sormland; US National Institutes of Health [1R24TW008889]</p

Attributions and private theories of mental illness among young adults seeking psychiatric treatment in Nairobi: an interpretive phenomenological analysis

Background: Mental illness affects every segment of population including young adults. The beliefs held by young patients regarding the causes of mental illness impact their treatment-seeking behaviour. It is pertinent to know the commonly held attributions around mental illness so as to effectively provide psychological care, especially in a resource constrained context such as Kenya. This helps in targeting services around issues such as stigma and extending youth-friendly services. Methods: Guided by the private theories interview (PTI-P) and attributional framework, individual semi-structured interviews were carried out with ten young adults of ages 18-25 years about their mental health condition for which they were undergoing treatment. Each interview took 30-45 min. We mapped four attributions (locus of control, stability, controllability and stigma) on PTI-P questions. Data was transcribed verbatim to produce transcripts coded using interpretive phenomenological analysis. These codes were then broken down into categories that could be used to understand various attributions. Results: We found PTI-P to be a useful tool and it elicited three key themes: (a) psychosocial triggers of distress (with themes of negative thoughts, emotions around mental health stigma and negative childhood experiences, parents separation or divorce, death of a loved one etc.), (b) biological conditions and psychopathologies limiting intervention, and (c) preferences and views on treatment. Mapping these themes on our attributional framework, PTI-P themes presented as causal attributions explaining stigma, locus of control dimensions and stability. External factors were mainly ascribed to be the cause of unstable and uncontrollable attributions including persistent negative emotions and thoughts further exacerbating psychological distress. Nine out of the ten participants expressed the need for more intense and supportive therapy. Conclusion: Our study has provided some experiential evidence in understanding how stigma, internal vs external locus of control, stability vs instability attributions play a role in shaping attitudes young people have towards their mental health. Our study points to psychosocial challenges such as stigma, poverty and lack of social support that continue to undermine mental well-being of Kenyan youth. These factors need to be considered when addressing mental health needs of young people in Kenya.Funding Agencies|NIMH; NIH [1R24TW008889]</p