Congregation leader and member discussions in a church-based family strengthening, mental health promotion and HIV prevention trial: Intervention

Abstract

Collaboration with African religious congregations can promote psychosocial well-being with greater accessibility. Effective collaboration requires studying congregations as unique intervention contexts. This study explored how an intervention in western Kenya fit within and altered congregational discussion patterns. We conducted a cluster-randomized trial of a church-based intervention to improve family relationships, mental health and sexual health. For each intervention topic covered, we describe baseline and post-intervention changes in church leaders' beliefs and communication as well as discussion frequency between leaders and members and among members. Mixed-effects logistic regression assessed pre-post change in member-reported discussion frequency. At baseline, members and leaders reported already discussing family, parenting, and emotions frequently and sexuality and finances less frequently. Leaders generally felt they should discuss all topics but were less comfortable and knowledgeable about sexuality and finances than other topics. After the intervention, leader comfort and knowledge increased and discussion frequency increased for nearly all topics, especially those discussed less initially. Good fit between the desires and activities of church members and leaders suggests the potential for further collaboration, especially on mental health and family wellbeing. Increased discussion of sensitive topics underscores the potential of community-level interventions to affect social norms. Impact statementThis article makes three unique contributions:1. It contributes novel findings to the study of collaborative intervention with African religious congregations, an important but underrepresented community setting in the global mental health research literature. 2. It demonstrates survey and analysis methods for using process data to understand contextual influences in community intervention. 3. It outlines future directions for studying congregational settings as unique contexts for mental health and family health intervention, particularly in African countries.