A systematic review of interventions targeting men's alcohol use and family relationships in low- and middle-income countries

Abstract

Background.Problem drinking accounts for 9.6% of disability-adjusted life years worldwide. It disproportionally affects men and has disabling physical, psychological, and behavioral consequences. These can lead to a cascade of negative effects on men's families, with documented ties to intimate partner violence (IPV) and child maltreatment. These multi-level problems are often exacerbated where poverty rates are high, including low and middle-income countries (LMICs). In contexts where strong patriarchal norms place men in positions of power, family-level consequences are often even more pronounced.Methods.We conducted a systematic review of the literature on interventions in LMICs targeting men's problem drinking and any family-related outcomes. Cochrane and PRISMA procedures guided the review. The search was conducted in PsychInfo, PubMed, and Web of Science.Results.The search yielded 1357 publications. Nine studies from four different countries met inclusion criteria. Of those, only one had the primary goal of simultaneously improving drinking and a related family-level outcome (IPV). Six of the studies documented modest improvements on both drinking and couples or family outcomes. Strategies common to these included cognitive-behavioral techniques, communication skills training, narrative therapy, and participatory learning. Gender-transformative approaches were associated with reduced IPV and more equitable gender norms, and motivational interviewing and behavioral approaches were beneficial for reducing alcohol use.Conclusions.Findings highlight the scarcity of interventions addressing men's drinking and its effects on families, particularly for parent-child outcomes. However, results point to strategies that, combined with other evidence-based family interventions can guide the development and rigorous evaluation of integrated programs.

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.…”

Learn, Engage, Act, Dedicate (LEAD): development and feasibility testing of a task-shifted intervention to improve alcohol use, depression and family engagement for fathers

“…Next, we aimed to identify evidence-based treatment (EBT) approaches that would form the foundation of the intervention. To do this, we conducted a systematic review of interventions targeting this cluster in LMICs, as well as a review of other evidence-based strategies targeting these outcomes globally [ 16 ]. The literature was then evaluated alongside qualitative results to assess the fit of treatment strategies with local needs, context, and amenability to lay provider use.…”

“…In LMICs, effective, evidence-based interventions for problem drinking (e.g., Motivational Interviewing (MI; [ 41 , 45 ]), depression (e.g., behavioral activation; PATEL), and family problems exist [ 6 , 9 , 26 , 34 , 48 ]. However, treatments addressing these commonly occurring problems simultaneously are scarce [ 16 ]. As such, there is a need for parsimonious treatments, conducive to LMIC delivery, that are tailored to engage men and target these interrelated problems together.…”

Interpersonal violence and mental health: a social justice framework to advance research and practice

“…1). Giusto and Puffer (2018) conducted a systematic review to identify evaluations of interventions focused on male alcohol misuse, to understand the impact of these interventions on family outcomes, including IPV. Overall, a scarcity of interventions have studied this topic rigorously (Giusto and Puffer, 2018).…”

“…Giusto and Puffer (2018) conducted a systematic review to identify evaluations of interventions focused on male alcohol misuse, to understand the impact of these interventions on family outcomes, including IPV. Overall, a scarcity of interventions have studied this topic rigorously (Giusto and Puffer, 2018). Given the current lack of studies, the RCT protocol aiming to understand the impacts of CETA with couples in Zambia on violence against women and girls in families is a welcome effort to improve knowledge in this area (Kane et al ., 2017).…”