Transportability of an Evidence-Based Early Childhood Intervention in a Low-Income African Country: Results of a Cluster Randomized Controlled Study

Abstract

Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs. Despite the successes of numerous school-based interventions for promoting child mental health, most evidence-based interventions (EBIs) are not available in SSA. This study investigated the implementation quality and effectiveness of one component of an EBI from a developed country (United States) to a SSA country (Uganda). The EBI component, Professional Development, was provided by trained Ugandan mental health workers to Ugandan primary school teachers. It included large group experiential training and small group coaching to introduce and support a range of evidence-based practices (EBPs) to create nurturing and predictable classroom experiences. The study was guided by the Consolidated Framework for Implementation Research, the Teacher Training Implementation Model and the RE-AIM evaluation framework. Effectiveness outcomes were studied using a cluster randomized design, in which 10 schools were randomized to intervention and wait-list control conditions. A total of 79 early childhood teachers participated. Teacher knowledge and use of evidence-based practices (EBPs) were assessed at baseline and immediately post-intervention (4–5 months later). A sample of 154 parents was randomly selected to report on child behavior at baseline and post-intervention. Linear mixed effect modeling was applied to examine effectiveness outcomes. Findings support the feasibility of training Ugandan mental health professionals to provide Professional Development for Ugandan teachers. Professional Development was delivered with high levels of fidelity and resulted in improved teacher EBP knowledge and use of EBPs in the classroom, and child social competence.

Use of Technology to Promote Child Behavioral Health in the Context of Pediatric Care: A Scoping Review and Applications to Low- and Middle-Income Countries

“…Second, in designing eHealth that fits LMIC contexts, two lessons can be drawn from the review: i) given limited web/internet availability in LMICs, the design of eHealth strategies should use mixed approaches by combining offline video-based psychoeducational learning/training (individual or group-based) with mHealth or/and face-to-face support strategies. This might be a feasible model given evidence that either web-based or offline, video-based education approaches can result in promising positive outcomes (61), and that the combination of mHealth and in-person support strategies (in group or individual formats) can be useful and highly acceptable for users with different levels of family risk or child mental health problems (42, 49, 56); ii) given that evidence has shown similarity in human behavioral change mechanisms across ethnic groups and high- and LMIC populations (14, 77), lessons learned from high-income country-based literature in user-centered design and user-engagement strategies (described in Table 2 ) are likely to be relevant and applicable to populations in LMICs. However, eHealth design and strategies may need to be tailored to local contexts and to be more thoroughly evaluated.…”

“…From a services perspective, children and parents from LMICs are far less likely than families from high-income countries to have access to parenting information, preventive or promotive mental health services, or participate in evidence-based early interventions because of the lack of child mental health resources and systems networks. Therefore, to effectively address children’s behavioral and mental health needs, and minimize disparities in LMICs, solutions that focus on a wide range of individual, family, systems, and service determinants - as well as prioritizing early prevention and intervention - are needed (12–14).…”

Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review

“…Common qualitative methods utilized across the studies included focus group discussions and key informant interviews. Mixed methods studies used review of financial records [15], routine facility, or surveillance indicators [13,17,22,28,43], health worker questionnaires or other quantitative study process indicators [10,20,23,28,29], or validated surveys to calculate measures such as organizational readiness and provider burnout [24] in conjunction with qualitative research. CFIR constructs can be scored quantitatively and compared across cases according to strength and valence [44].…”

Implementing combined WHO mhGAP and adapted group interpersonal psychotherapy to address depression and mental health needs of pregnant adolescents in Kenyan primary health care settings (INSPIRE): a study protocol for pilot feasibility trial of the integrated intervention in LMIC settings

“…Quality and impacts of training will be assessed through attendance tracking, after training satisfaction evaluation, pre- to post-training knowledge/competence assessment with trainees. The measures will be developed during the study period, and adapted from the research teams’ previous D&I studies [ 57 ].…”