What about lay counselors' experiences of task-shifting mental health interventions? Example from a family-based intervention in Kenya.

Background:A key focus of health systems strengthening in low- and middle-income countries is increasing reach and access through task-shifting. As such models become more common, it is critical to understand the experiences of lay providers because they are on the forefront for delivering care services. A greater understanding would improve lay provider support and help them provide high-quality care. This is especially the case for those providing mental health services, as providing psychological care may pose unique stressors. We sought to understand experiences of lay counselors, focusing on identity, motivation, self-efficacy, stress, and burnout. The goal was to understand how taking on a new provider role influences their lives beyond simply assuming a new task, which would in turn help identify actionable steps to improve interventions with task-shifting components. Methods:Semi-structured interviews (n = 20) and focus group discussions (n = 3) were conducted with three lay counselor groups with varying levels of experience delivering a community-based family therapy intervention in Eldoret, Kenya. Thematic analysis was conducted, including intercoder reliability checks. A Stress Map was created to visualize stress profiles using free-listing and pile-sorting data collected during interviews and focus group discussions. Results:Counselors described high intrinsic motivation to become counselors and high self-efficacy after training. They reported positive experiences in the counselor role, with new skills improving their counseling and personal lives. As challenges arose, including client engagement difficulties and balancing many responsibilities, stress and burnout increased, dampening motivation and self-efficacy. In response, counselors described coping strategies, including seeking peer and supervisor support, that restored their motivation to persevere. At case completion, they again experienced high self-efficacy and a desire to continue. Conclusions:Findings informed suggestions for ways to incorporate support for lay providers into task-shifting interventions at initiation, during training, and throughout implementation. These include acknowledging and preparing counselors for challenges during training, increasing explicit attention to counselor stress in supervision, fostering peer support among lay providers, and ensuring a fair balance between workload and compensation. Improving and building an evidence base around practices for supporting lay providers will improve the effectiveness and sustainability of lay provider-delivered interventions

Women's perceptions of effects of war on intimate partner violence and gender roles in two post-conflict West African Countries: Consequences and unexpected opportunities

Background The aim of this paper is to explore women's perceptions of the causes of intimate partner violence (IPV) in West Africa, and the ways in which they understand these causes to interact with the experiences of war. Methods The study was conducted in two locations in Sierra Leone and two in Liberia, using focus group discussions (N groups =14) and individual interviews (N-=-20). Results Women perceive the causes of IPV to be linked with other difficulties faced by women in these settings, including their financial dependence on men, traditional gender expectations and social changes that took place during and after the wars in those countries. According to respondents, the wars increased the use of violence by some men, as violence became for them a normal way of responding to frustrations and challenges. However, the war also resulted in women becoming economically active, which was said by some to have decreased IPV, as the pressure on men to provide for their families reduced. Economic independence, together with services provided by NGOs, also gave women the option of leaving a violent relationship. Conclusions IPV was found to be a significant problem for women in Sierra Leone and Liberia. The interactions between war experiences and financial and cultural issues are multi-faceted and not uniformly positive or negative.sch_iih8 [12]pub3561pu

Mapping complex systems: Responses to intimate partner violence against women in three refugee camps

From Frontiers via Jisc Publications RouterHistory: received 2020-10-03, collection 2021, accepted 2021-01-05, epub 2021-02-05Publication status: PublishedArmed conflict and forced migration are associated with an increase in intimate partner violence (IPV) against women. Yet as risks of IPV intensify, familiar options for seeking help dissipate as families and communities disperse and seek refuge in a foreign country. The reconfiguration of family and community systems, coupled with the presence of local and international humanitarian actors, introduces significant changes to IPV response pathways. Drawing from intensive fieldwork, this article examines response options available to women seeking help for IPV in refugee camps against the backdrop of efforts to localize humanitarian assistance. This study employed a qualitative approach to study responses to IPV in three refugee camps: Ajuong Thok (South Sudan), Dadaab (Kenya), and Domiz (Iraqi Kurdistan). In each location, data collection activities were conducted with women survivors of IPV, members of the general refugee community, refugee leaders, and service providers. The sample included 284 individuals. Employing visual mapping techniques, analysis of data from these varied sources described help seeking and response pathways in the three camps, and the ways in which women engaged with various systems. The analysis revealed distinct pathways for seeking help in the camps, with several similarities across contexts. Women in all three locations often “persevered” in an abusive partnership for extended periods before seeking help. When women did seek help, it was predominantly with family members initially, and then community-based mechanisms. Across camps, participants typically viewed engaging formal IPV responses as a last resort. Differences between camp settings highlighted the importance of understanding complex informal systems, and the availability of organizational responses, which influenced the sequence and speed with which formal systems were engaged. The findings indicate that key factors in bridging formal and community-based systems in responding to IPV in refugee camps include listening to women and understanding their priorities, recognizing the importance of women in camps maintaining life-sustaining connections with their families and communities, engaging communities in transformative change, and shifting power and resources to local women-led organizations.The research was funded by the U.S. Department of State’s Bureau of Population, Refugees and Migration (S-PRMCO-13-CA-1209).3pubpu

Drivers of intimate partner violence against women in three refugee camps

This qualitative study examined the drivers- of intimate partner violence (IPV) against women in displacement to identify protective factors and patterns of risk. Qualitative data were collected in three refugee camps in South Sudan, Kenya, and Iraq (N = 284). Findings revealed interrelated factors that triggered and perpetuated IPV: gendered social norms and roles, destabilization of gender norms and roles, men's substance use, women's separation from family, and rapid remarriages and forced marriages. These factors paint a picture of individual, family, community and societal processes that exacerbate women's risk of IPV in extreme conditions created by displacement. Implications for policy and practice are indicated.sch_iih24pub4838pub

'I don't need an eye for an eye': Women's responses to intimate partner violence in Sierra Leone and Liberia

This paper explores the possibilities for agency in intimate partner violence (IPV) situations from the perspective of women in Sierra Leone and Liberia using focus group discussions (N groups = 14, N participants = 110) and individual interviews (N = 20). Findings identify multiple interrelated factors influencing the decisionmaking of women experiencing IPV. At the individual level, emotional factors and women's knowledge of their rights and options influence their decision-making. At the relational level, the role of neighbours, family and friends is crucial, both for emotional support and practical assistance. At the community level, more formal structures play a role, such as chiefs and women's groups, though their effectiveness varies. At the structural level are barriers to effective responses, including a poorly functioning criminal justice system and a social system in which children often stay with fathers following separation or divorce. Strong cultural beliefs operate to keep women in abusive relationships. We identify implications for prevention and response services and make practice recommendations. Since the desire of most women experiencing IPV was to live in peace with their husbands, interventions should respect women's priorities by focusing more on prevention and interventions to end the violence, rather than solely assisting women to leave violent relationships.sch_iih11pub3966pub1-

The ecology of resilience: Predictors of psychological health in youth in Lebanon

Protective processes across levels of an individual’s life influence the likelihood of positive adaptation following adversity. Indicators of resilience are attributes and resources of an individual and the environment that predict positive adjustment. The purpose of this study was to examine the presence of resilience indicators across three ecological levels (individual, familial, environmental) among disadvantaged youth living in Lebanon and to examine whether indicators were associated with psychological well-being and psychological distress. A sample of 187 adolescents ages 15 to 23 completed surveys, and hierarchical multiple linear regressions were conducted to identify variables associated with psychological outcomes. Higher self-efficacy, curiosity, social support, and the availability/involvement with spiritual, cultural, and educational opportunities were related to greater psychological wellbeing. Low self-efficacy was the only indicator that was associated with psychological distress independently above and beyond demographic characteristics. Results support the potential importance of considering resilience indicators across ecological levels for interventions seeking to promote positive psychological outcomes for adolescents in highly stressful contexts

The impact of a family skills training intervention among Burmese migrant families in Thailand: A randomized controlled trial

Objective: To conduct a randomized controlled trial assessing the impact of a family-based intervention delivered to Burmese migrant families displaced in Thailand on parenting and family functioning. Participants and procedures Participants included 479 Burmese migrant families from 20 communities in Thailand. Families, including 513 caregivers and 479 children aged 7 to 15 years, were randomized to treatment and waitlist control groups. The treatment group received a 12-session family-based intervention delivered to groups of families by lay facilitators. Adapted standardized and locally derived measures were administered before and after the intervention to assess parent-child relationship quality, discipline practices, and family functioning. Results: Compared with controls, intervention families demonstrated improved quality of parent-child interactions on scales of parental warmth and affection (Effect size (ES) = 0.25 caregivers; 0.26 children, both p < 0.05) and negative relationship quality (ES = -0.37, p < 0.001 caregivers; -0.22 children, p < 0.05). Both children and caregivers also reported an effect on relationship quality based on a locally derived measure (ES = 0.40 caregivers, p < .001; 0.43 children, p < .05). Family functioning was improved, including family cohesion (ES = 0.46 caregivers; 0.36 children; both p < 0.001) and decreased negative interactions (ES = -0.30 caregivers, p < 0.01; -0.24 children, p < 0.05). Family communication also improved according to children only (ES = 0.29, p < 0.01). Caregivers, but not children, reported decreased harsh discipline (ES = -0.39, p < 0.001), and no effects were observed on use of positive discipline strategies. Treatment attendance was high, with participants attending a mean of 9.7 out of 12 sessions. Conclusion: The intervention increased protective aspects of family well-being for migrant children and caregivers in a middle-income country. The strongest effects were on parent-child relationship quality and family functioning, while results were mixed on changes in discipline practices. Results suggest that a behavioral family-based approach implemented by lay providers in community settings is a promising intervention approach for strengthening families in highly stressed contexts. Trial registration Clinicaltrials.gov: NCT0166899

Is social-ecological risk associated with individual HIV risk beliefs and behaviours?: An analysis of Kenyan adolescents’ local communities and activity spaces

The places where adolescents live, learn, and play are thought to influence behaviours and health, but we have limited tools for measuring environmental risk on a hyperlocal (e.g. neighbourhood) level. Working with 218 adolescents and their parents/guardians in rural western Kenya, we combined participatory mapping activities with satellite imagery to identify adolescent activity spaces and create a novel measure of social-ecological risks. We then examined the associations between social-ecological risk and individual HIV risk beliefs and behaviours. We found support for the conjecture that social-ecological risks may be associated with individual beliefs and behaviours. As social-ecological risk increased for a sample of Kenyan adolescents, so did their reports of riskier sex beliefs and behaviours, as well as unsupervised outings at night. This study reinforces calls for disease prevention approaches that go beyond emphasising individual behaviour change

Validating mental health assessment in Kenya using an innovative gold standard.

With the growing burden of mental health disorders worldwide, alongside efforts to expand availability of evidence-based interventions, strategies are needed to ensure accurate identification of individuals suffering from mental disorders. Efforts to locally validate mental health assessments are of particular value, yet gold-standard clinical validation is costly, time-intensive, and reliant on available professionals. This study aimed to validate assessment items for mental distress in Kenya, using an innovative gold standard and a combination of culturally adapted and locally developed items. The mixed-method study drew on surveys and semi-structured interviews, conducted by lay interviewers, with 48 caregivers. Interviews were used to designate mental health "cases" or "non-cases" based on emotional health problems, identified through a collaborative clinical rating process with local input. Individual mental health survey items were evaluated for their ability to discriminate between cases and non-cases. Discriminant survey items included 23 items adapted from existing mental health assessment tools, as well as 6 new items developed for the specific cultural context. When items were combined into a scale, results showed good psychometric properties. The use of clinically rated semi-structured interviews provides a promising alternative gold standard that can help address the challenges of conducting diagnostic clinical validation in low-resource settings

Problematic alcohol use among fathers in Kenya: Poverty, people, and practices as barriers and facilitators to help acceptance

BackgroundIn Kenya, the prevalence of alcohol use disorder (AUD) is close to 6%, but a notable treatment gap persists. AUD is especially pronounced among men, leading to negative consequences at both individual and family levels. This study examines the experiences of problem-drinking fathers in Kenya regarding previous treatment-seeking related to alcohol use. Experiences and dynamics of the family are also explored as they pertain to treatment-seeking experiences.MethodsIn Eldoret, Kenya, semi-structured qualitative interviews were conducted with 11 families with a male exhibiting problem drinking, his spouse, and one child. Thematic content analysis was used to examine themes related to barriers and facilitators to treatment.ResultsParticipants only reported informal help received from family and community members; they exhibited little awareness of available formal treatments. Families were both deeply affected by alcohol use and actively involved in help-seeking. Indeed, fathers' experiences are described as help-accepting rather than help-seeking. Three overarching themes emerged from the results: poverty, people, and practices. Poverty could be a motivator to accept help to support one's family financially, but stress from lack of work also drove drinking behaviours. People were also crucial as both barriers and facilitators of help-accepting. Negative help strategies or peer influence deterred fathers from accepting help to quit. Positive motivation, social support, and stigma against drinking were motivators. Practices that were culturally salient, such as religiosity and gender roles, facilitated help acceptance. Overall, most help efforts were short-term and only lead to very short-term behaviour change.ConclusionFamilies and communities are active in help provision for problem-drinking men in Kenya, though results confirm remaining need for effective interventions. Future interventions could benefit from recognizing the role of family to aid in treatment-engagement and attending to the importance of poverty, people, and practices in designing treatment strategies