Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study

Introduction: There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Children’s Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents. Materials and methods: Using a qualitative approach, we explored adolescent participants’ views on cultural acceptability, comprehensibility, relevance, and completeness of specific items in these tools through an adolescent-centered approach to understand their psychosocial needs, focusing on gender and age-differentiated nuances around expression of distress. Forty-two adolescents and 20 caregivers participated in the study carried out in two primary care centers where we conducted cognitive interviews and focused group discussions assessing mental health knowledge, literacy, access to services, community, and family-level stigma. Results: We reflect on process and findings of adaptations of the tools, including systematic identification of words adolescents did not understand in English and Kiswahili translations of these scales. Some translated words could not be understood and were not used in routine conversations. Response options were changed to increase comprehensibility; some statements were qualified by adding extra words to avoid ambiguity. Participants suggested alternative words that replaced difficult ones and arrived at culturally adapted tools. Discussion: Study noted difficult words, phrases, dynamics in understanding words translated from one language to another, and differences in comprehension in adolescents ages 10–19 years. There is a critical need to consider cultural adaptation of depression and anxiety tools for adolescents. Conclusion: Results informed a set of culturally adapted scales. The process was community-driven and adhered to the principles of cultural adaptation for assessment tools

Perceived impacts as narrated by service users and providers on practice, policy and mental health system following the implementation of the mhGAP-IG using the TEAM model in a rural setting in Makueni County, Kenya: a qualitative approach

Background A team approach is key to reduction of the mental health treatment gap. It requires collaborative effort of all formal and informal community based service providers and the consumers of the services. Qualitative evaluations of such an approach add value to the quantitative evaluations. Methods A qualitative study was conducted among 205 participants. These were grouped into a total of 19 focus group discussions for community health workers (CHW), traditional healers (TH), faith healers (FH) and patients. For nurses and clinical officers we held 10 key informant interviews and three key informant discussions. We aimed to document personal perceptions as expressed in narratives on mental health following a community based application of the WHO mental health treatment Gap-intervention guideline (mhGAP-IG) using the TEAM model. We also aimed to document how the narratives corroborated key findings on the quantitative wing of the TEAM model. Results There were three categories of perceptions: (i) patient-related, (ii) health provider-related and, (iii) health system related. The patient related narratives were linked to improvement in their mental and physical health, increased mental health awareness, change in lifestyle and behavior, enhanced social functioning and an increase in family productivity. Health provider perceptions were related to job satisfaction, capacity building and increased interest in mental health training. Mental health system related narratives included effectiveness and efficiency in service delivery and increase in number of referrals at the primary health care facilities. Conclusion The TEAM is a feasible model for the implementation of the mhGAP-IG. It led to positive perceptions and narratives by service provides and service consumers. The qualitative findings corroborated the quantitative findings of TEAM

Integration of Traditional Birth Attendants into Mental Healthcare: A Multistakeholder Qualitative Study Exploration

Background. A significant number of people with common mental disorders are undiagnosed or undetected at primary healthcare facilities. The experience of traditional birth attendants (TBAs) in reassuring perinatal mothers could be utilized in maternal mental healthcare. The aim of this study was to gain insight into the feasibility of integrating TBAs into maternal mental healthcare using multiple stakeholder views. Methods. We conducted an exploratory qualitative study in September 2017 using focus group discussions (FGDs) and in depth interviews in Makueni County, Kenya. A total of 246 participants (TBAs, community health volunteers (CHVs), healthcare workers (HCWs), antenatal and postnatal mothers seeking care from TBAs and those seeking both hospital and TBA services, mothers in law and/or husbands of perinatal mothers, and opinion leaders based in the county) were purposively selected to participate in the discussions. Transcribed data was analyzed using NVivo version 10. Results. Four major themes emerged from the qualitative data and were identified as follows; (a) involving TBAs in perinatal mental healthcare by assigning them roles, (b) utilizing TBAs' patient rapport and counseling experience, (c) recognition and appreciation of TBAs by the healthcare system, and (d) training and collaboration of TBAs with healthcare workers. Discussion. The findings of this study reveal that although TBAs informally provide psychosocial interventions to pregnant mothers, their roles in mental health are not clearly defined. The importance of TBAs sharing their experience and being recognized as important stakeholders in mental healthcare for perinatal mothers was highlighted. Inclusion of TBAs in dialogue and training them to offer evidence-based mental healthcare were identified as important steps towards improving the mental wellbeing of mothers and the future generation

Suicidal behavior risks during adolescent pregnancy in a low-resource setting: A qualitative study

Background: Suicide is one of the most common causes of death among female adolescents. A greater risk is seen among adolescent mothers who become pregnant outside marriage and consider suicide as the solution to unresolved problems. We aimed to investigate the factors associated with suicidal behavior among adolescent pregnant mothers in Kenya. Methods: A total of 27 Focus Group Discussions (FGDs) and 8 Key Informant Interviews (KIIs) were conducted in a rural setting (Makueni County) in Kenya. The study participants consisted of formal health care workers and informal health care providers (traditional birth attendants and community health workers), adolescent and adult pregnant and post-natal (up to six weeks post-delivery) women including first-time adolescent mothers, and caregivers (husbands and/or mothers-in-law of pregnant women) and local key opinion leaders. The qualitative data was analyzed using Qualitative Solution for Research (QSR) NVivo version 10. Results: Five themes associated with suicidal behavior risk among adolescent mothers emerged from this study. These included: (i) poverty, (ii) intimate partner violence (IPV), (iii) family rejection, (iv) social isolation and stigma from the community, and (v) chronic physical illnesses. Low economic status was associated with hopelessness and suicidal ideation. IPV was related to drug abuse (especially alcohol) by the male partner, predisposing the adolescent mothers to suicidal ideation. Rejection by parents and isolation by peers at school; and diagnosis of a chronic illness such as HIV/AIDS were other contributing factors to suicidal behavior in adolescent mothers. Conclusion: Improved social relations, economic and health circumstances of adolescent mothers can lead to reduction of suicidal behaviour. Therefore, concerted efforts by stakeholders including family members, community leaders, health care workers and policy makers should explore ways of addressing IPV, economic empowerment and access to youth friendly health care centers for chronic physical illnesses. Prevention strategies should include monitoring for suicidal behavior risks during pregnancy in both community and health care settings. Additionally, utilizing lay workers in conducting dialogue discussions and early screening could address some of the risk factors and reduce pregnancy- related suicide mortality in LMICs

Diverse policy maker perspectives on the mental health of pregnant and parenting adolescent girls in Kenya: Considerations for comprehensive, adolescent-centered policies and programs.

The pregnancy rate in Kenya among adolescent girls is among the highest in the world. Adolescent girls experience increased risk of anxiety and depression during pregnancy and postpartum which can result in poor health outcomes for both mother and baby, and negatively influence their life course. Mental health is often given low priority in health policy planning, particularly in Sub-Saharan Africa (SSA). There is an urgent need to address the treatment gap and provide timely mental health promotion and preventative services, there is a need to focus on the shifting demographic of SSA-the young people. To understand perspectives on policymakers on the mental health prevention and promotion needs of pregnant and parenting adolescent girls, we carried out a series of interviews as part of UNICEF funded helping pregnant and parenting adolescents thrive project in Kenya. We interviewed 13 diverse health and social policy makers in Kenya to understand their perspectives on the mental health experiences of pregnant and parenting adolescent girls and their ideas for optimizing mental health promotion. Six principal themes emerged including the mental health situation for adolescent girls, risk factors for poor mental health and barriers to accessing services for adolescent girls, health seeking behavior effect on maternal and child health outcomes, mental health promotion, protective factors for good mental health, and policy level issues. Examination of existing policies is required to determine how they can fully and effectively be implemented to support the mental health of pregnant and parenting adolescent girls

Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study.

INTRODUCTION: There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Childrens Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents. MATERIALS AND METHODS: Using a qualitative approach, we explored adolescent participants views on cultural acceptability, comprehensibility, relevance, and completeness of specific items in these tools through an adolescent-centered approach to understand their psychosocial needs, focusing on gender and age-differentiated nuances around expression of distress. Forty-two adolescents and 20 caregivers participated in the study carried out in two primary care centers where we conducted cognitive interviews and focused group discussions assessing mental health knowledge, literacy, access to services, community, and family-level stigma. RESULTS: We reflect on process and findings of adaptations of the tools, including systematic identification of words adolescents did not understand in English and Kiswahili translations of these scales. Some translated words could not be understood and were not used in routine conversations. Response options were changed to increase comprehensibility; some statements were qualified by adding extra words to avoid ambiguity. Participants suggested alternative words that replaced difficult ones and arrived at culturally adapted tools. DISCUSSION: Study noted difficult words, phrases, dynamics in understanding words translated from one language to another, and differences in comprehension in adolescents ages 10-19 years. There is a critical need to consider cultural adaptation of depression and anxiety tools for adolescents. CONCLUSION: Results informed a set of culturally adapted scales. The process was community-driven and adhered to the principles of cultural adaptation for assessment tools

Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study

INTRODUCTION: There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Children\u27s Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents. MATERIALS AND METHODS: Using a qualitative approach, we explored adolescent participants\u27 views on cultural acceptability, comprehensibility, relevance, and completeness of specific items in these tools through an adolescent-centered approach to understand their psychosocial needs, focusing on gender and age-differentiated nuances around expression of distress. Forty-two adolescents and 20 caregivers participated in the study carried out in two primary care centers where we conducted cognitive interviews and focused group discussions assessing mental health knowledge, literacy, access to services, community, and family-level stigma. RESULTS: We reflect on process and findings of adaptations of the tools, including systematic identification of words adolescents did not understand in English and Kiswahili translations of these scales. Some translated words could not be understood and were not used in routine conversations. Response options were changed to increase comprehensibility; some statements were qualified by adding extra words to avoid ambiguity. Participants suggested alternative words that replaced difficult ones and arrived at culturally adapted tools. DISCUSSION: Study noted difficult words, phrases, dynamics in understanding words translated from one language to another, and differences in comprehension in adolescents ages 10-19 years. There is a critical need to consider cultural adaptation of depression and anxiety tools for adolescents. CONCLUSION: Results informed a set of culturally adapted scales. The process was community-driven and adhered to the principles of cultural adaptation for assessment tools

Cultural and contextual adaptation of mental health measures in Kenya : An adolescent-centered transcultural adaptation of measures study

Introduction: There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Children’s Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents. Materials and methods: Using a qualitative approach, we explored adolescent participants’ views on cultural acceptability, comprehensibility, relevance, and completeness of specific items in these tools through an adolescent-centered approach to understand their psychosocial needs, focusing on gender and age-differentiated nuances around expression of distress. Forty-two adolescents and 20 caregivers participated in the study carried out in two primary care centers where we conducted cognitive interviews and focused group discussions assessing mental health knowledge, literacy, access to services, community, and family-level stigma. Results: We reflect on process and findings of adaptations of the tools, including systematic identification of words adolescents did not understand in English and Kiswahili translations of these scales. Some translated words could not be understood and were not used in routine conversations. Response options were changed to increase comprehensibility; some statements were qualified by adding extra words to avoid ambiguity. Participants suggested alternative words that replaced difficult ones and arrived at culturally adapted tools. Discussion: Study noted difficult words, phrases, dynamics in understanding words translated from one language to another, and differences in comprehension in adolescents ages 10–19 years. There is a critical need to consider cultural adaptation of depression and anxiety tools for adolescents. Conclusion: Results informed a set of culturally adapted scales. The process was community-driven and adhered to the principles of cultural adaptation for assessment tools

Summary of FGD participants.

Summary of FGD participants.</p

Item adjustment annex.

(DOCX)</p