A step-wise community engagement and capacity building model prior to implementation of mhGAP-IG in a low- and middle-income country: a case study of Makueni County, Kenya

Mutiso, Victoria; Gitonga, Isaiah; Musau, Abednego; Musyimi, Christine; Nandoya, Eric S.; Rebello, Tahilia J.; Pike, Kathleen M.; Ndetei, David M.

doi:10.1186/s13033-018-0234-y

Cited by 28 publications

(16 citation statements)

References 47 publications

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“…Unfortunately, mental health services are often quite difficult to access in informal settlements. There are approximately 100 psychiatrists serving a population of 45 million in Kenya, and the majority of these, while located in urban areas, work in private practice [78]-charging fees well above those affordable to the majority of households in informal settlements. Consequently, despite high levels of IPV in informal settlements, services for survivors are minimal [79].…”

Section: Plos Onementioning

confidence: 99%

Intimate partner violence: A key correlate of women’s physical and mental health in informal settlements in Nairobi, Kenya

2020

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Globally, one billion people live in informal settlements, and that number is expected to triple by 2050. Studies suggests that health in informal settlements is a serious and growing concern, yet there is a paucity of research focused on health outcomes and the correlates of health in these settlements. Studies cite individual, environmental and social correlates to health in informal settlements, but they often lack empirical evidence. In particular, research suggests that high rates of violence against women (VAW) in informal settlements may be associated with detrimental effects on women's health, but few studies have investigated this link. The purpose of this study was to fill this gap by empirically exploring associations between women's experiences of intimate partner violence (IPV) and their physical and mental health. Data for this study were collected in August 2018 in Mathare Valley Informal Settlement in Nairobi, Kenya. A total of 550 randomly-selected women participated in surveys; however, analyses for this study were run on a subpopulation of the women (n = 361). Multivariate logistic regressions were used to investigate the link between psychological, sexual, and emotional IPV and women's mental and physical health. Results suggest that while some socioeconomic, demographic, and environmental variables were significantly associated with women's mental and physical health outcomes, all types of IPV emerged key correlates in this context. In particular, women's experiences of IPV were associated with lower odds of normal-high physical health component scores (based on SF-36); higher odds of gynecological and reproductive health issues, psychological distress (based on K-10), depression, suicidality, and substance use. Findings from this study suggest that policies and interventions focused on prevention and response to VAW in informal settlements may make critical contributions to improving health for women in these rapidly growing settlements.

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Section: Plos Onementioning

confidence: 99%

Intimate partner violence: A key correlate of women’s physical and mental health in informal settlements in Nairobi, Kenya

2020

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“…We decided to conduct a baseline study in the existing health system in Makueni County as an entry point for dialogue with the Government of Makueni County and the various stakeholders as a preliminary step towards the implementation of the mhGAP-IG. The process of implementing that program has been documented [24] and some of the outcomes have been published [25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Using the WHO-AIMS to inform development of mental health systems: the case study of Makueni County, Kenya

Mutiso

Musyimi

Gitonga

et al. 2020

BMC Health Serv Res

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Background: In order to develop a context appropriate in mental health system, there is a need to document relevant existing resources and practices with a view of identifying existing gaps, challenges and opportunities at baseline for purposes of future monitoring and evaluation of emerging systems. The World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) was developed as a suitable tool for this purpose. Our overall objective of this study, around which research questions and specific aims were formulated, was to establish a baseline on mental health system as at the time of the study, at Makueni County in Kenya, using the WHO-AIMS. Methods: To achieve our overall objective, answer our research questions and achieve specific aims, we conducted a mixed methods approach in which we did an audit of DHIS records and county official records, and conducted qualitative interviews with the various officers to establish the fidelity of the data according to their views. The records data was processed via the prescribed WHO-Aims 2.2 excel spreadsheet while the qualitative data was analyzed thematically. This was guided by the six domains stipulated in the WHO AIMS. Results: We found that at the time point of the study, there were no operational governance, policy or administrative structures specific to mental health, despite recognition by the County Government of the importance of mental health. The identified interviewees and policy makers were cooperative and participatory in identifying the gaps, barriers and potential solutions to those barriers. The main barriers and gaps were human and financial resources and low prioritization of mental health in comparison to physical conditions. The solutions lay in bridging of the gaps and addressing the barriers. Conclusion: There is a need to address the identified gaps and barriers and follow up on solutions suggested at the time of the study, if a functional mental health system is to be achieved at Makueni County.

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“…Research suggests the mhGAP programme may require further consultation with local stakeholders, particularly service users, to ensure it is culturally appropriate [9]. Some research studies on its implementation have illustrated and reflected on adaptations made, for example on the change of content to better fit the epidemiology of the setting or on translation and rearrangement of the chapter flow [10,11]. In all settings the input from local practitioners and stakeholders is considered essential to the process of adaptation to ensure best fit with local expressions of mental distress, cultural practices, and most frequently encountered issues in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Challenges and lessons learned in re-filming the WHO mhGAP training videos for Sri Lankan context - a qualitative study

Doherty

Dass

Edward³

et al. 2020

Confl Health

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Background: Understanding and addressing the unmet mental health needs burden in the Northern Province of Sri Lanka is the subject of the COMGAP-S two-phase study. Phase Two involves the implementation of the World Health Organization's mental health Gap Action Programme (mhGAP) in primary healthcare settings. As part of the contextual adaptation of mhGAP, eleven of the videos provided in the mhGAP training package have been refilmed by a local team. We investigated the challenges, barriers and good practices of this adaptation effort from the point of view of team participants. Methods: Twelve persons from the adaptation team, including students of medicine and drama, doctors, drama lecturers and professionals, consented to in-depth individual interviews following an open-ended topic guide with a member of the COMGAP-S study team. Interviews were recorded, transcribed, translated as necessary, and subjected to thematic analysis. Results: The majority of participants perceived the process positively and had pride in their involvement. Expectations, opportunities, and exposure were discussed as stemming from the video production. The main challenges derived from the analysis were lack of discussion around budgeting, logistical difficulties, struggles with team cooperation, and creative differences. Issues around exact translation into the local Tamil dialect and modelling around mental health were emphasised by the majority of participants. Potential uses for the videos were identified beyond the current study and recommendations included setting out clear guidance around available funding and role allocation, and increasing the flexibility in adapting the material. Conclusions: This study illustrated details of the adaptation of existing video materials to facilitate locally-based training for non-specialists on mhGAP curricula. With this, we have added to the knowledge base on conducting cultural and language adaptations and our findings indicate participants felt adapting the mhGAP films to local context was vital to ensuring training materials were culturally appropriate and valid.

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A step-wise community engagement and capacity building model prior to implementation of mhGAP-IG in a low- and middle-income country: a case study of Makueni County, Kenya

Cited by 28 publications

References 47 publications

Intimate partner violence: A key correlate of women’s physical and mental health in informal settlements in Nairobi, Kenya

Intimate partner violence: A key correlate of women’s physical and mental health in informal settlements in Nairobi, Kenya

Using the WHO-AIMS to inform development of mental health systems: the case study of Makueni County, Kenya

Challenges and lessons learned in re-filming the WHO mhGAP training videos for Sri Lankan context - a qualitative study

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