From “4Rs and 2Ss” to “Amaka Amasanyufu” (Happy Families): Adapting a U.S.‐based Evidence‐Based Intervention to the Uganda Context

Abstract

In Uganda, one in five children presents mental health challenges, including disruptive behavior disorders (DBDs). DBDs can persist through adulthood and result in negative outcomes. Effective interventions for DBDs have been developed and tested in high-poverty communities in developed countries. Yet, most African countries, such as Uganda, lack such interventions. This paper describes the adaptation process of an evidence-based intervention of U.S. origin to optimize fit to context with intervention fidelity, as part of a randomized trial conducted with youth that exhibit behavioral challenges and their caregivers in 30 schools in Uganda. The process involved: initial meetings with headteachers and teachers to introduce the study and the main concepts of the intervention; initial manual review focusing on 4Rs and 2Ss content by the Uganda team; engagement of community stakeholders for additional feedback on content and cultural relevance; final revision of the manual; and collection of children's drawings for the illustration of the manual. This paper describes both similarities and differences between the original and adapted intervention content and methods of delivery. The findings also highlight the importance of involving community stakeholders in the adaptation process.

Design and Implementation of the Irie Homes Toolbox: A Violence Prevention, Early Childhood, Parenting Program

“…The development and/or adaptation of interventions for use in LMICs often entail formative research (14,(57)(58)(59)(60). Lachman et al (36) developed a parenting program to address child maltreatment in South Africa by combining formative research with a theory driven approach that included identifying empirically-derived core components from the literature.…”

Suubi4StrongerFamilies: A study protocol for a clustered randomized clinical trial addressing child behavioral health by strengthening financial stability and parenting among families in Uganda

“…There is robust evidence that shows that the economic empowerment intervention proposed in this study significantly improves the social circumstances of families in Uganda and has been associated with positive outcomes for youth, including some mental health outcomes (e.g., depression and hopelessness), particularly those made vulnerable by HIV/AIDS ( 18 , 22 , 23 , 25 , 74 , 125 ). The family strengthening intervention has successfully improved the familial circumstances and the behavioral health of children in South Africa and Uganda ( 27 , 28 , 81 , 170 ). To date, many approaches to child health and mental health in SSA communities have primarily been “transported” from outside the region, mainly from the global north ( 28 , 34 , 35 , 73 , 82 , 186 ).…”

“…Thus, culturally and contextually adapted family strengthening interventions that bolster SSA-specific family processes and parenting specific to SSA are needed to effectively address childhood DBDs. The group-delivered family strengthening interventions are specifically designed to target DBDs for youth whose families struggle with poverty and stress in the US and in SSA ( 27 , 28 , 81 – 83 ).…”

The longitudinal impact of an evidence‐based multiple family group intervention (Amaka Amasanyufu) on oppositional defiant disorder and impaired functioning among children in Uganda: analysis of a cluster randomized trial from the SMART Africa‐Uganda scale‐up study (2016–2022)

“…The Amaka Amansanyufu intervention was culturally adapted from an evidence‐based multiple family group (MFG) intervention titled “ 4Rs and 2Rs ” that was designed to strengthen families with children with DBDs including ODDs in the United States (McKay et al., 2004). Core components of the original intervention were preserved in the adapted version, entitled Amaka Amasanyufu (see Sensoy Bahar et al., 2020 and Appendix for details on the content and structure of the curriculum and adaptation for the Ugandan context).…”

“…The evidence‐based MFG intervention was designed specifically for children with Disruptive Behavior Disorders, including ODDs (Franco, Dean‐Assael, & McKay, 2008; McKay et al., 2011; Ssewamala et al., 2018). However, given the high level of stigma toward mental health problems in Uganda (Molodynski, Cusack, & Nixon, 2017; Ssebunnya, Kigozi, Lund, Kizza, & Okello, 2009), the team deliberately included families with children in the same age range who did not screen positive for DBDs in the intervention to avoid any discrimination (Sensoy Bahar et al., 2020). All the participants were blinded.…”