Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities

Abstract

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed.

Early intervention for obsessive compulsive disorder: An expert consensus statement

“…It is therefore unclear how data from HIC samples apply to subjects from LMIC. Finally, the amount of resources that can be dedicated to early intervention for mental health problems (including OCRDs) is both lower than those from HIC and more likely to be affected by problems such as political instability, economic crisis, or even war, among others (Parra-Cardona et al, 2018). However, the concept of LMIC is also heterogeneous.…”

Delivering evidence based services for all vulnerable families

“… Despite Latinos constituting the largest ethnic minority group in the United States the cultural adaptation and dissemination of evidence-based parenting intervention to Latino culture remains rare (Parra Cardona et al, 2012 [170])  A first adapted version of the intervention (CAPAS) focused on adapting materials for appropriateness and relevance to Latino culture. Adaptations were also made to ensure relevance to the contextual challenges faced by Latino communities.…”

Commentary on the Culture of Prevention

“…("How are you?) that address health-risk behaviors in Albania (Sentell et al 2018), or through the dissemination of parenting programs aimed at reducing child maltreatment and improving parental and child mental health in low-and middle-income countries (Parra-Cardona et al 2018). The successful implementation of these programs is part of building a culture of prevention from the ground up-a way of creating a demand for these effective strategies that depend on prevention science.…”

“…Indeed, a system such as that outlined has the potential to promote a culture of prevention. To sustain such a system requires a bottom-up as well as a top-down communication system to be fully effective (Bollmann et al 2020;Parra-Cardona et al 2018).…”