Congregation leader and member discussions in a church-based family strengthening, mental health promotion and HIV prevention trial: Intervention.

Collaboration with African religious congregations can promote psychosocial well-being with greater accessibility. Effective collaboration requires studying congregations as unique intervention contexts. This study explored how an intervention in western Kenya fit within and altered congregational discussion patterns. We conducted a cluster-randomized trial of a church-based intervention to improve family relationships, mental health and sexual health. For each intervention topic covered, we describe baseline and post-intervention changes in church leaders' beliefs and communication as well as discussion frequency between leaders and members and among members. Mixed-effects logistic regression assessed pre-post change in member-reported discussion frequency. At baseline, members and leaders reported already discussing family, parenting, and emotions frequently and sexuality and finances less frequently. Leaders generally felt they should discuss all topics but were less comfortable and knowledgeable about sexuality and finances than other topics. After the intervention, leader comfort and knowledge increased and discussion frequency increased for nearly all topics, especially those discussed less initially. Good fit between the desires and activities of church members and leaders suggests the potential for further collaboration, especially on mental health and family well-being. Increased discussion of sensitive topics underscores the potential of community-level interventions to affect social norms.

A Pilot Study of the Coping Together Virtual Family Intervention: Exploring Changes in Family Functioning and Individual Well-Being.

In this pilot study, we tested a virtual family strengthening and mental health promotion intervention, Coping Together (CT), during the COVID-19 pandemic. We explored changes at the family and individual levels, as well as mechanisms of change. Participants included 18 families (24 caregivers, 24 youth) with children aged 7 to 18 years. Community health workers delivered the 8-session CT intervention using videoconferencing software. We used qualitative semi-structured interviews with 14 of the families to explore changes and mechanisms of change using a thematic content analysis approach. We also administered pre-post surveys with the 18 families to explore the direction of changes, using only descriptive statistics in this small sample. Qualitative findings supported positive changes across family and individual level outcomes including family functioning, relationship quality, and individual psychosocial well-being. Results also confirmed several hypothesized mechanisms of change with improved communication providing the foundation for increased hope and improved problem solving and coping. Pre-post survey results were mixed, showing positive, but very small, changes in family closeness, caregiver-child communication, and levels of hope; almost no change was observed on measures of caregiver and child mental health. Families reported few problems at baseline quantitatively despite qualitative descriptions of pre-intervention difficulties. Results provide preliminary support for benefits of CT with the most consistent improvements seen across family relationships. Findings were mixed related to individual-level mental health benefits. Results have implications for revising content on mental health coping strategies and suggest the need to revise the quantitative measurement strategy for this non-clinical sample.

Correlates of Intimate Partner Violence Victimization and Perpetration in Adolescents and Young Adults in Sub-Saharan Africa: A Systematic Review.

Intimate partner violence (IPV) is a global public health crisis with long-term adverse consequences for both victims and perpetrators. Patterns of violence often begin during adolescence, yet most interventions target adult relationships. A systematic review was conducted to identify correlates of IPV victimization and perpetration among adolescents and young adults in sub-Saharan Africa (SSA). Eligible studies included participants 10 to 24 years old, took place in SSA, and tested a statistical association between a correlate and an IPV outcome. Correlates were defined as any condition or characteristic associated with statistically significant increased or decreased risk of IPV victimization or perpetration. PsycInfo, PubMed, Embase, and African Index Medicus were searched and included studies published between January 1, 2000 and February 4, 2022. The search resulted in 3,384 original studies, of which 55 met inclusion criteria and were analyzed. Correlates were first qualitatively synthesized by developmental period (e.g., early adolescence, older adolescence, and young adulthood) and then organized in a conceptual framework by correlate type (e.g., socio-demographic; health, behavior, and attitudes; relational; or contextual). Over two decades of literature reveals variability in evidence by developmental period but also substantial overlap in the correlates of victimization and perpetration. This review identifies multiple points for intervention and results suggest the urgent need for earlier, developmentally appropriate prevention efforts among younger adolescents as well as combined approaches that target both victimization and perpetration of IPV.

Parenting in a conflict-affected setting: Discipline practices, parent-child interactions, and parenting stress in Liberia.

Children in conflict-affected settings are at increased risk for exposure to violence, placing particular importance on caregiving environments. This study first describes parenting in urban Liberia by evaluating parent-child interactions, the use and acceptance of harsh and nonharsh discipline, discipline preferences, and the co-occurrence of positive interactions and harsh discipline. The relationship between parenting stress and harsh discipline attitudes and behaviors is then tested. Participants included 813 parents with a child aged 3 or 4 years old. A quantitative survey battery assessed parent-child interactions; discipline practices, preferences, and attitudes; and parenting stress. Parents reported frequent use and high acceptance of nonharsh discipline, as well as frequent positive interactions with their child. Though parents reported less frequent use and low acceptance of harsh discipline, preference for harsh discipline-based on hypothetical situations rather than self-report-was common. There was co-occurrence of frequent positive interactions and frequent harsh discipline, with one third reporting high frequency of both. Regression analysis revealed greater parenting stress (ß = .15, t = 4.49, p < .001) and stronger acceptance of harsh discipline (ß = .47, t = 15.49, p < .001) were associated with more frequent harsh discipline. Acceptance of harsh discipline interacted with parenting stress to predict the use of harsh discipline (ß = -.09, t = -3.09, p < .01). Among parents with lowest average acceptance of harsh practices, stress predicted more frequent harsh discipline, but acceptance did not moderate the association for those who are most accepting of harsh practices. Building on existing parenting strengths and addressing parenting stress could promote nurturing caregiving in conflict-affected settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Family Strengthening in the Context of COVID-19: Adapting a Community-Based Intervention from Kenya to the United States.

COVID-19 led to widespread disruption of services that promote family well-being. Families impacted most were those already experiencing disparities due to structural and systemic barriers. Existing support systems faded into the background as families became more isolated. New approaches were needed to deliver evidence-based, low-cost interventions to reach families within communities. We adapted a family strengthening intervention developed in Kenya ("Tuko Pamoja") for the United States. We tested a three-phase participatory adaptation process. In phase 1, we conducted community focus groups including 11 organizations to identify needs and a community partner. In phase 2, the academic-community partner team collaboratively adapted the intervention. We held a development workshop and trained community health workers to deliver the program using an accelerated process combining training, feedback, and iterative revisions. In phase 3, we piloted Coping Together with 18 families, collecting feedback through session-specific surveys and participant focus groups. Community focus groups confirmed that concepts from Tuko Pamoja were relevant, and adaptation resulted in a contextualized intervention-"Coping Together"-an 8-session virtual program for multiple families. As in Tuko Pamoja, communication skills are central and applied for developing family values, visions, and goals. Problem-solving and coping skills then equip families to reach goals, while positive emotion-focused activities promote openness to change. Sessions are interactive, emphasizing skills practice. Participants reported high acceptability and appropriateness, and focus groups suggested that most content was understood and applied in ways consistent with the theory of change. The accelerated reciprocal adaptation process and intervention could apply across resource-constrained settings.

Building community-based helping practices by training peer-father counselors: A novel intervention to reduce drinking and depressive symptoms among fathers through an expanded masculinity lens.

BACKGROUND: Problem drinking and co-occurring depression symptoms affect men at high rates and are associated with increased risk of family violence. In low- and middle-income countries, there is a large treatment gap for services due to a lack of human resources. Moreover, masculine norms are a barrier to men seeking treatment for drinking and depression in healthcare settings. We examined an approach for engaging peer-fathers to deliver an intervention to reduce alcohol use, improve depressive symptoms, and increase family involvement among fathers in Kenya with problem drinking. The intervention-LEAD (Learn, Engage, Act, Dedicate)-combines motivational interviewing, behavioral activation, and masculinity discussion strategies. METHODS: Community and religious leaders nominated fathers with no mental health training to serve as counselors (N=12); clients were recruited through community referrals. Nominated fathers completed a 10-day training beginning with treatment principles followed by manualized content. Three counselors were selected after training based on quantitative and qualitative assessments of communication skills, intervention knowledge, willingness to learn, ability to use feedback, and empathy. Supervision was tiered with local supervisors and clinical psychologist consultation. During LEAD delivery, counselor fidelity, delivery quality, and general and intervention-specific competencies were assessed. To evaluate acceptability, qualitative interviews were conducted with lay-counselors and clients (N=11). Descriptive statistics were calculated for quantitative outcomes; interviews were analyzed using thematic analysis. RESULTS: Peer-father lay counselors treated nine clients, with eight completing treatment. Counselors reached high rates of fidelity (93.8%) and high to optimal ratings on quality of delivery, clinical competency, and intervention-specific competencies. Qualitative results suggested high acceptability, with counselors expressing satisfaction and empowerment in their roles. Clients likewise described positive experiences with counselors. CONCLUSIONS: Findings provide initial support for the acceptability and feasibility of recruitment, selection, and training processes for peer-father lay counselors to deliver LEAD through a lens of masculinity that aligned with clients help-acceptance practices.