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Background There is mounting evidence supporting the effectiveness of task-shifted mental health interventions in low- and middle-income countries (LMIC). However, there has been limited systematic scale-up or sustainability of these programs, indicating a need to study implementation. One barrier to progress is a lack of locally relevant and valid implementation measures. We adapted an existing brief dissemination and implementation (D&I) measure which includes scales for acceptability, appropriateness, feasibility and accessibility for local use and studied its validity and reliability among a sample of consumers in Ukraine. Methods Local qualitative data informed adaptation of the measure and development of vignettes to test the reliability and validity. Participants were veterans and internally displaced persons (IDPs) recruited as part of a separate validity study of adapted mental health instruments. We examined internal consistency reliability, test-retest reliability, and construct and criterion validity for each scale on the measure. We randomly assigned half the participants to respond to a vignette depicting existing local psychiatric services which we knew were not well regarded, while the other half was randomized to a vignette describing a potentially more well-implemented mental health service. Criterion validity was assessed by comparing scores on each scale by vignette and by overall summary ratings of the programs described in the vignettes. Results N = 169 participated in the qualitative study and N = 153 participated in the validity study. Qualitative findings suggested the addition of several items to the measure and indicated the importance of addressing professionalism/competency of providers in both the scales and the vignettes. Internal consistency reliabilities ranged from α = 0.85 for feasibility to α = 0.91 for appropriateness . Test-rest reliabilities were acceptable to good for all scales ( rho: 0.61–0.79). All scales demonstrated substantial and significant differences in average scores by vignette assignment ( ORs: 2.21–5.6) and overall ratings ( ORs: 5.1–14.47), supporting criterion validity. Conclusions This study represents an innovative mixed-methods approach to testing an implementation science measure in contexts outside the United States. Results support the reliability and validity of most scales for consumers in Ukraine. Challenges included large amounts of missing data due to participants’ difficulties responding to questions about a hypothetical program. Electronic supplementary material The online version of this article (10.1186/s12913-019-4097-y) contains supplementary material, which is available to authorized...

Bullying is one of the most common forms of aggression experienced by school-aged youth, yet research is sparse in low- and middle-income countries (LMIC) where cultural and contextual factors may influence victimization dynamics. We aimed to examine correlates of victimization and the prevalence of specific victimizing behaviors among youth in four LMIC. Data were included from 3,536 youth collected as part of the ongoing Young Lives Study cohorts in Ethiopia, India (Andhra Pradesh), Peru, and Vietnam who reported frequency of past-year exposure to nine bullying behaviors at age 15. We calculated both total victimization scores and subtype victimization scores (physical, verbal, relational, and property) by summing the frequencies of experiencing each behavior and used hurdle modeling to examine, separately by country, associations between three demographic correlates (sex, urban/rural setting, and school enrollment) and both total and subtype victimization scores, adjusting for clustered sampling. Mean past-year victimization scores were 11.1 in Ethiopia, 13.4 in India, 14.9 in Peru, and 12.0 in Vietnam, indicating that the average youth in Ethiopia reported two victimization experiences in the past year, up to nearly six in Peru. With the exception of Peru, direct victimization was higher among boys compared with girls, whereas relational victimization was not associated with sex. Physical bullying was less common than other forms of bullying in Ethiopia, Peru, and Vietnam but had a similar frequency as other forms in India. The different patterns in victimization experiences across the samples suggest that culture and/or context may influence victimization dynamics and highlights the need to better understand patterns and variation of bullying victimization in LMIC.

BackgroundSelf-report measurement instruments are commonly used to screen for mental health disorders in Low and Middle-Income Countries (LMIC). The Western origins of most depression instruments may constitute a bias when used globally. Western measures based on the DSM, do not fully capture the expression of depression globally. We developed a self-report scale design to address this limitation, the International Depression Symptom Scale-General version (IDSS-G), based on empirical evidence of the signs and symptoms of depression reported across cultures. This paper describes the rationale and process of its development and the results of an initial test among a non-Western population.MethodsWe evaluated internal consistency reliability, test–retest reliability and inter-rater reliability of the IDSS-G in a sample N = 147 male and female attendees of primary health clinics in Yangon, Myanmar. For criterion validity, IDSS-G scores were compared with diagnosis by local psychiatrists using the Structured Clinical Interview for DSM (SCID). Construct validity was evaluated by investigating associations between the IDSS-G and the Patient Health Questionnaire (PHQ), impaired function, and suicidal ideation.ResultsThe IDSS-G showed high internal consistency reliability (α = 0.92), test–retest reliability (r = 0.87), and inter-rater reliability (ICC = 0.90). Strong correlations between the IDSS-G and PHQ-9, functioning, and suicidal ideation supported construct validity. Criterion validity was supported for use of the IDSS-G to identify people with a SCID diagnosed depressive disorder (major depression/dysthymia). The IDSS-G also demonstrated incremental validity by predicting functional impairment beyond that predicted by the PHQ-9. Results suggest that the IDSS-G accurately assesses depression in this population. Future testing in other populations will follow.

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BackgroundIn Kachin State, Myanmar, collapse of a ceasefire in 2011 has resulted in widespread exposure to conflict and ongoing internal displacement. Such exposures are known risk factors for mental health and psychosocial (MHPS) problems, yet mental health services for children and youth are typically scarce in such circumstances. Following evaluation of a mental health treatment for adult trauma survivors on the Thailand-Myanmar border, our study team received requests to support the development of a similar intervention for displaced children in Kachin State. To inform this work, we conducted a brief qualitative needs assessment to explore priority MHPS problems among this population.MethodsData were collected in internally displaced persons camps in Kachin State during July and August, 2016. Free list interviews with a convenience sample of 28 adolescents and 12 adults produced a list of problems affecting children and adolescents in this area. Four problems were further explored in key informant interviews with a convenience sample of 26 adolescents and 4 adults. Data analysis was conducted by the local interview team.ResultsPriority problems included: behavior problems, substance use, effects of war, and feeling sad/depressed/hopeless. Descriptions emphasized the interconnectedness between the problems. Overall, most problems were related to specific events that suggest that the symptoms themselves are responses to unusual situations; however, the problems were also linked to current psychosocial stressors such as poverty, poor nutrition, and discrimination. Effects of war were described primarily as a constellation of social and economic problems rather than a list of mental health symptoms, although descriptions of these problems did include post-traumatic stress symptoms.ConclusionsFindings fit well within explanatory models of distress that include both direct trauma exposure and exacerbation of daily stressors. Results of this study have been used to inform intervention adaptation and evaluation, but also contribute to the literature on the needs of young people in situations of protracted conflict.

School climate is an important construct for guiding violence prevention efforts in U.S. schools, but there has been less consideration of this concept in its neighboring country Mexico, which has a higher prevalence of violence. The U.S. Department of Education outlined a three-domain conceptualization of school climate (i.e., safe and supportive schools model) that includes engagement, safety, and the school environment. To examine the applicability of this school climate model in Mexico, the present study tested its measurement invariance across middle school students in the United States (n = 15,099) and Mexico (n = 2,211). Findings supported full invariance for engagement and modified-safety scales indicating that factor loadings and intercepts contributed almost equally to factor means, and scale scores were comparable across groups. Partial invariance was found for the environment scales. Results of a multigroup confirmatory factor analysis (MGCFA) consisting of all 13 school climate scales indicated significantly positive associations among all scales in the U.S. sample and among most scales in the Mexico sample. Implications of these findings are discussed.