Conducting global mental health research: lessons learned from Kenya

Wasil, Akash R.; Osborn, Tom L.; Venturo‐Conerly, Katherine E.; Wasanga, Christine; Weisz, John R.

doi:10.1017/gmh.2021.7

Cited by 11 publications

(7 citation statements)

References 22 publications

(24 reference statements)

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“…To address these challenges, we will leverage existing partnerships through the Shamiri Institute ( https://www.shamiri.institute/ ) and apply best practices we have learnt through our previous work in Kenya. 30 31 …”

Section: Discussionmentioning

confidence: 99%

Online single-session interventions for Kenyan adolescents: study protocol for a comparative effectiveness randomised controlled trial

et al. 2021

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BackgroundMental health problems are the leading cause of disability among adolescents worldwide, yet access to treatment is limited. Brief digital interventions have been shown to improve youth mental health, but little is known about which digital interventions are most effective.AimsTo evaluate the effectiveness of two digital single-session interventions (Shamiri-Digital and Digital-CBT (cognitive-behavioural therapy)) among Kenyan adolescents.MethodsWe will perform a school-based comparative effectiveness randomised controlled trial. Approximately 926 Kenyan adolescents will be randomly assigned to one of three conditions: Shamiri-Digital (focused on gratitude, growth mindsets and values), Digital-CBT (focused on behavioural activation, cognitive restructuring and problem solving) or a study-skills control condition (focused on note-taking and essay writing skills). The primary outcomes include depressive symptoms (measured by the Patient Health Questionnaire-8), anxiety symptoms (Generalized Anxiety Disorder Screener-7) and subjective well-being (Short Warwick-Edinburgh Mental Well-being Scale). The secondary outcomes include acceptability, appropriateness, primary control and secondary control. Acceptability and appropriateness will be measured immediately post-intervention; other outcomes will be measured 2 weeks, 4 weeks and 12 weeks post-intervention.ResultsWe hypothesise that adolescents assigned to Shamiri-Digital and adolescents assigned to Digital-CBT will experience greater improvements (assessed via hierarchical linear models) than those assigned to the control group. We will also compare Shamiri-Digital with Digital-CBT, although we do not have a preplanned hypothesis.ConclusionsOur findings will help us evaluate two digital single-session interventions with different theoretical foundations. If effective, such interventions could be disseminated to reduce the public health burden of common mental health problems.Trial registration numberPACTR202011691886690.

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Section: Discussionmentioning

confidence: 99%

Online single-session interventions for Kenyan adolescents: study protocol for a comparative effectiveness randomised controlled trial

et al. 2021

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“…However, limited access to mental health care in these regions hinders young people's ability to lead healthy and ful lling lives (5). The scarcity of trained mental healthcare providers, lack of mental health resources, societal stigma, and lack of culturally appropriate interventions are barriers young people in SSA face to accessing mental health services (7)(8)(9)(10). Therefore, there is a need to develop and evaluate scalable and low-cost mental health interventions.…”

Section: Introduction Background and Rationale {6a}mentioning

confidence: 99%

Testing Pathways to Scale: Study Protocol for a Three-arm Randomized Controlled Trial of a Centralized and a Decentralized (“Train the Trainers”) Dissemination of a Mental Health Program for Kenyan Adolescents

Ochuku,

Osborn,

Nerima

et al. 2023

Preprint

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Background Providing mental health care in Kenya to all youth in need is difficult because of a shortage of professional providers and societal stigma. Previous trials of the Anansi model, which involves delivering low-touch mental health interventions through a tiered caregiving model (including lay-providers, supervisors, and clinical experts), have shown its effectiveness for reducing depression and anxiety symptoms in school-going Kenyan adolescents. In this trial, we aim to assess two different scale-up strategies by comparing centralized implementation (i.e., by the organization that designed the Anansi model) against implementation through an implementing partner. Methods In this three-arm trial, 1600 adolescents aged 13 to 20 years will be randomized to receive the Shamiri intervention from either the Shamiri Institute or an implementation partner, or to be placed in the treatment as usual (TAU) control group. The implementation partner will be trained and supplied with protocols to ensure that the same procedures are followed by both implementors. Implementation activities will run concurrently for both implementors. The Shamiri intervention will be delivered by trained lay providers to groups of 10–15 adolescents over four weekly sessions which will take place in secondary schools in Machakos and Makueni counties in Kenya. The TAU group will receive the usual care offered by their respective schools. Outcomes will be assessed at baseline, midpoint (two weeks), endpoint (four weeks), and one month follow-up. The analysis will be based on an intent-to-treat approach. Mixed effects models will be used to assess trajectories over time of the primary outcomes (anxiety and depressive symptoms, mental well-being, perceived social support, and academic performance) and secondary outcomes for the intervention groups and the control group. Effect sizes will be computed for the mean differences of the intervention and control arms at midpoint, endpoint, and follow-up. Discussion This trial will provide insight into the comparative effectiveness of different strategies for scaling a school-based mental health care model. Findings will also indicate areas for improved efficiency of the model to enhance its replicability by other implementors. Trial registration Pan African Clinical Trials Registry (PACTR) (ID: PACTR202305589854478, Approved: 02/05/2023).

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“…Task-sharing has been implemented in many LMICs, including Kenya, and has been shown as an effective approach for delivering mental health services and increasing access to treatment (Atif et al, 2019 ; Chibanda et al, 2015 ; Devassy et al, 2022 ; Giusto et al, 2021 ; Spedding et al, 2020 ). Task-sharing has the potential to reduce the mental health treatment gap for youth in Kenya (Wasil et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Peer-delivered Problem-solving Therapy for Adolescent Mental Health in Kenya: Adaptation for Context and Training of Peer-counselors

Giusto,

Vander Missen,

Kosgei

et al. 2023

Res Child Adolesc Psychopathol

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Peer-delivered interventions for adolescent mental health can help address poor access to mental health interventions. Questions remain about how interventions can be adapted for peer delivery and whether peers can be trained. In this study, we adapted problem solving therapy (PST) for peer-delivery with adolescents in Kenya and explored whether peer counselors can be trained in PST. We adapted treatment prior to and during training using the Cultural Adaptation and Contextualization for Implementation framework. Nine peer counselors (Ages 20–24) were selected and trained over 10 days. Peer competencies and knowledge were measured pre-post using a written exam, a written case study, and role plays rated using a standardized competency measure. We chose a version of PST used in India with secondary school adolescents originally delivered by teachers. All materials were translated into Kiswahili. Language and format were adapted to Kenyan adolescents as well as for delivery by peers with a focus on understandability and relevance (e.g., noting shared experience). Metaphors, examples, and visual materials were adapted for the context to reflect the culture and vernacular of Kenyan youth. Peer counselors were able to be trained in PST. Pre-post competencies and understanding of content showed improvements with peers minimally meeting patient needs (pre) on average to moderate/fully meeting patient needs (post). Post-training written exam score showed an average 90% correct. There is an adapted version of PST for Kenyan adolescents and peer delivery. Peer counselors can be trained to deliver a 5-session PST in a community context.

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Conducting global mental health research: lessons learned from Kenya

Cited by 11 publications

References 22 publications

Online single-session interventions for Kenyan adolescents: study protocol for a comparative effectiveness randomised controlled trial

Online single-session interventions for Kenyan adolescents: study protocol for a comparative effectiveness randomised controlled trial

Testing Pathways to Scale: Study Protocol for a Three-arm Randomized Controlled Trial of a Centralized and a Decentralized (“Train the Trainers”) Dissemination of a Mental Health Program for Kenyan Adolescents

Peer-delivered Problem-solving Therapy for Adolescent Mental Health in Kenya: Adaptation for Context and Training of Peer-counselors

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