Mechanisms of change for a family intervention in Kenya: An Integrated Clinical and Implementation Mapping approach.
Family therapy
Global mental health
Implementation science
Mechanisms
Mixed methods
Journal
Behaviour research and therapy
ISSN: 1873-622X
Titre abrégé: Behav Res Ther
Pays: England
ID NLM: 0372477
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
received:
30
09
2021
revised:
02
10
2022
accepted:
14
10
2022
pubmed:
26
10
2022
medline:
7
12
2022
entrez:
25
10
2022
Statut:
ppublish
Résumé
To increase cultural relevance and maximize access for historically underserved populations, there is a need to explore mechanisms underlying treatment outcomes during piloting. We developed a mixed-method approach, Integrated Clinical and Implementation Mapping (ICIM), to explore clinical and implementation mechanisms to inform improvements in content and delivery. We applied ICIM in a pilot of Tuko Pamoja, a lay counselor-delivered family intervention in Kenya (10 families with adolescents ages 12-17). ICIM is a 3-phase process to triangulate data sources to analyze how and why change occurs within individual cases and across cases. We synthesized data from session and supervision transcripts, fidelity and clinical skills ratings, surveys, and interviews. Outputs included a comprehensive narrative and visual map depicting how content and implementation factors influenced change. For Tuko Pamoja, ICIM results showed common presenting problems, including financial strain and caregivers' distress, triggering negative interactions and adolescent distress. ICIM demonstrated that active treatment ingredients included communication skills and facilitated, prescribed time together. Families improved communication, empathy, and hope, facilitated improved family functioning and mental health. Key implementation mechanisms included provider clinical competencies, alliance-building, treatment-aligned adaptations, and consistent attendance. Results guided manual and training refinements and generated hypotheses about mechanisms to test in larger trials.
Identifiants
pubmed: 36283239
pii: S0005-7967(22)00190-5
doi: 10.1016/j.brat.2022.104219
pmc: PMC10155602
mid: NIHMS1891158
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
104219Subventions
Organisme : NIMH NIH HHS
ID : F32 MH113288
Pays : United States
Organisme : NIMH NIH HHS
ID : K23 MH128742
Pays : United States
Organisme : NIMH NIH HHS
ID : T32 MH096724
Pays : United States
Informations de copyright
Copyright © 2022 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest None.
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