Top

The Journal of Behavioral Health Services & Research

25-09-2024

Exploring Nonspecialist Preparedness to Deliver an Evidence-Based, Family Strengthening Intervention in Rwanda: A Qualitative Study

Authors: Laura Bond, PhD, Faith Cheonga, William Byansi, PhD, MSW, Eve Puffer, PhD, Theresa S. Betancourt, ScD, MA

Published in: The Journal of Behavioral Health Services & Research

Abstract

Families in low- and middle-income countries (LMICs) face significant mental health and psychosocial care gaps. In recent years, researchers and practitioners have addressed these gaps by task-sharing evidence-based mental health and psychosocial support (MHPSS) interventions to nonspecialist community providers. Supervision and training approaches are intended to prepare nonspecialists to deliver evidence-based interventions with quality. However, there is still little research exploring nonspecialist experiences with training and supervision and how, if at all, their training and supervision experiences result in fidelity and competence in delivering the intervention. This qualitative study uses data from a cluster-randomized trial of a family strengthening and violence prevention program in Rwanda, known as Sugira Muryango. In semi-structured interviews, the nonspecialists provided examples of using skills such as rapport-building, empathy, and active listening to deliver Sugira Muryango effectively. Because nonspecialists were serving in their own communities, they found that it was easier to earn trust with friends and neighbors, and this facilitated effective delivery of Sugira Muryango. Nonspecialists discussed how training, monthly supervision, in-person monitoring visits, and the use of the manual and audio recorders equipped them to deliver Sugira Muryango with quality. Nonspecialists also provided examples of barriers to quality of delivery, including supervisor lack of availability, delayed compensation, and technology issues. Preparedness was consistent across gender; however, nonspecialists serving in a better-resourced district had previous experiences delivering evidence-based interventions and felt more prepared at the beginning of Sugira Muryango.

Jack HE, Myers B, Regenauer KS, et al. Mutual capacity building to reduce the behavioral health treatment gap globally. Administration and Policy in Mental Health and Mental Health Services Research. 2020;47(4):497–500. Available at https://doi.org/10.1007/s10488-019-00999-y. Accessed 3 September, 2024.

World Health Organization, President’s Emergency Plan for AIDS Relief, United Nations AIDS. Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. 2007. Available at https://iris.who.int/handle/10665/43821. Accessed 3 September, 2024.

World Health Organization, United Nations High Commissioner for Refugees. mhGAP Humanitarian Intervention Guide (mhGAP-HIG): clinical management of mental, neurological and substance use conditions in humanitarian emergencies. World Health Organization. 2015. Available at https://www.who.int/publications/i/item/9789241548922. Accessed 3 September, 2024.

Singla DR, Kohrt BA, Murray LK, et al. Psychological treatments for the world: Lessons from low- and middle-income countries. Annual Review of Clinical Psychology. 2017;13:149–181. Available at https://doi.org/10.1146/annurev-clinpsy-032816-045217. Accessed 3 September 2024.

Murray LK, Dorsey S, Bolton P, et al. Building capacity in mental health interventions in low resource countries: An apprenticeship model for training local providers. International Journal of Mental Health Systems. 2011;5(1):30. Available at https://doi.org/10.1186/1752-4458-5-30. Accessed 3 September 2024.

Keynejad RC, Dua T, Barbui C, et al. WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: A systematic review of evidence from low and middle-income countries. Evidence-Based Mental Health. 2018;21(1):30–34. Available at https://doi.org/10.1136/eb-2017-102750. Accessed 3 September 2024.

Cherewick M, Daniel C, Shrestha CC, et al. Psychosocial interventions for autistic children and adolescents delivered by non-specialists in low- and middle-income countries: A scoping review. Frontiers in Psychology. 2023;14:1181976. Available at https://doi.org/10.3389/fpsyg.2023.1181976. Accessed 3 September 2024.

Healy EA, Kaiser BN, Puffer ES. Family-based youth mental health interventions delivered by nonspecialist providers in low- and middle-income countries: A systematic review. Families, Systems, and Health. 2018;36(2):182–197. Available at https://doi.org/10.1037/fsh0000334. Accessed 3 September 2024.

Perry H, Zulliger R. How effective are community health workers. An overview of current evidence with recommendations for strengthening community health worker programs to accelerate progress in achieving the health-related Millennium Development Goals. Baltimore: Johns Hopkins Bloomberg School of Public Health. 2012. Available at https://chwcentral.org/wp-content/uploads/2013/07/How-effective-are-community-health-workers-Johns-Hopkins-University_0.pdf. Accessed 3 September 2024.

10.

Patel V, Weobong B, Weiss HA, et al. The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial. Lancet. 2017;389(10065):176–185. Available at https://doi.org/10.1016/S0140-6736(16)31589-6. Accessed 3 September 2024.

11.

Kohrt BA, Asher L, Bhardwaj A, et al. The role of communities in mental health care in low- and middle-income countries: A meta-review of components and competencies. International Journal of Environmental Research and Public Health. 2018;15(6):1279. Available at https://doi.org/10.3390/ijerph15061279. Accessed 3 September 2024.

12.

Joshi R, Alim M, Kengne AP, et al. Task shifting for non-communicable disease management in low and middle income countries: A systematic review. PLoS One. 2014;9(8):e103754. Available at https://doi.org/10.1371/journal.pone.0103754. Accessed 3 September 2024.

13.

Freeman M. Global mental health in low and middle income, especially African countries. Epidemiology and Psychiatric Sciences. 2016;25(6): 503–505. Available at https://doi.org/10.1017/S2045796016000482. Accessed 3 September 2024.

14.

O’Shea O, McCormick R, Bradley JM, et al. Fidelity review: a scoping review of the methods used to evaluate treatment fidelity in behavioural change interventions. Physical Therapy Reviews. 2016 Nov 1;21(3–6):207–14. Available at https://doi.org/10.1080/10833196.2016.1261237. Accessed 3 September 2024.

15.

Rocha TIU, Aschar SCAL, Hidalgo-Padilla L, et al. Recruitment, training and supervision of nurses and nurse assistants for a task-shifting depression intervention in two RCTs in Brazil and Peru. Human Resources and Health. 2021;19(1):16. Available at https://doi.org/10.1186/s12960-021-00556-5. Accessed 3 September 2024.

16.

Munga MA, Kilima SP, Mutalemwa PP, et al. Experiences, opportunities and challenges of implementing task shifting in underserved remote settings: the case of Kongwa district, central Tanzania. BMC International Health and Human Rights. 2012;12:27. Available at https://doi.org/10.1186/1472-698X-12-27. Accessed 3 September 2024.

17.

McQuillin SD, Lyons MD, Becker KD, et al. Strengthening and expanding child services in low resource communities: the role of task-shifting and just-in-time training. American Journal of Community Psychology. 2019;63(3–4):355–365. Available at https://doi.org/10.1002/ajcp.12314. Accessed 3 September 2024.

18.

Leocata AM, Kaiser BN, Puffer ES. Flexible protocols and paused audio recorders: The limitations and possibilities for technologies of care in two global mental health interventions. Social Science and Medicine: Mental Health. 2021;1:100036. Available at https://doi.org/10.1016/j.ssmmh.2021.100036. Accessed 3 September 2024.

19.

Singla DR, Ratjen C, Krishna RN, et al. Peer supervision for assuring the quality of non-specialist provider delivered psychological intervention: Lessons from a trial for perinatal depression in Goa, India. Behavioral Research and Therapy. 2020;130:103533. Available at https://doi.org/10.1016/j.brat.2019.103533. Accessed 3 September 2024.

20.

Kemp CG, Petersen I, Bhana A, et al. Supervision of task-shared mental health care in low-resource settings: A commentary on programmatic experience. Global Health Science and Practice. 2019;7(2):150–159. Available at https://doi.org/10.9745/GHSP-D-18-00337. Accessed 3 September 2024.

21.

Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services. 2011;38(2):65–76. Available at https://doi.org/10.1007/s10488-010-0319-7. Accessed 3 September 2024.

22.

Kohrt BA, Jordans MJ, Rai S, et al. Therapist competence in global mental health: Development of the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale. Behavior Research and Therapy. 2015;69:11–21. Available at https://doi.org/10.1016/j.brat.2015.03.009. Accessed 3 September 2024.

23.

Ottman KE, Kohrt BA, Pedersen GA, et al. Use of role plays to assess therapist competency and its association with client outcomes in psychological interventions: A scoping review and competency research agenda. Behavior Research and Therapy. 2020;130:103531. Available at https://doi.org/10.1016/j.brat.2019.103531. Accessed 3 September 2024.

24.

Barber JP, Sharpless BA, Klostermann S, et al. Assessing intervention competence and its relation to therapy outcome: A selected review derived from the outcome literature. Professional Psychology: Research and Practice. 2007;38(5):493. Available at https://doi.org/10.1037/0735-7028.38.5.493. Accessed 3 September 2024.

25.

Collier S, Meyen R, Smith SL, et al. Enhancing quality supervision for the delivery of mental health care through nonspecialist clinicians in resource-limited settings. Harvard Review of Psychiatry. 2021;29(6):390–400. Available at https://doi.org/10.1097/HRP.0000000000000313. Accessed 3 September 2024.

26.

Naslund JA, Shidhaye R, Patel V. Digital technology for building capacity of nonspecialist health workers for task sharing and scaling up mental health care globally. Harvard Review of Psychiatry. 2019;27(3):181–192. Available at https://doi.org/10.1097/HRP.0000000000000217. Accessed 3 September 2024.

27.

Brown FL, Taha K, Steen F, et al. Feasibility randomised controlled trial of the Early Adolescent Skills for Emotions psychological intervention with young adolescents in Lebanon. BMC Psychiatry. 2023;23(1):131. Available at https://doi.org/10.1186/s12888-023-04571-9. Accessed 3 September 2024.

28.

Barnett ML, Klein CC, Gonzalez JC, et al. How do lay health worker engage caregivers? A qualitative study to enhance equity in evidence-based parenting programs. Evidence-Based Practice and Child Adolescent Mental Health. 2023;8(2):221–235. Available at https://doi.org/10.1080/23794925.2021.1993111. Accessed 3 September 2024.

29.

Barnett ML, Puffer ES, Ng LC, et al. Effective training practices for non-specialist providers to promote high-quality mental health intervention delivery: A narrative review with four case studies from Kenya, Ethiopia, and the United States. Global Mental Health. 2023;10:e26. Available at https://doi.org/10.1017/gmh.2023.19. Accessed 3 September 2024.

30.

Barnett ML, Lau AS, Miranda J. Lay health worker involvement in evidence-based treatment delivery: A conceptual model to address disparities in care. Annual Review of Clinical Psychology. 2018;14:185–208. Available at https://doi.org/10.1146/annurev-clinpsy-050817-084825. Accessed 3 September 2024.

31.

Caulfield A, Vatansever D, Lambert G, et al. WHO guidance on mental health training: a systematic review of the progress for non-specialist health workers. BMJ Open. 2019;9(1):e024059. Available at https://doi.org/10.1136/bmjopen-2018-024059. Accessed 3 September 2024.

32.

Seegan PL, Miller L, Young AS, et al. Enhancing Quality of Care Through Evidence-Based Practice: Training and Supervision Experiences. American Journal of Psychotherapy. 2023;76(3):100–106. Available at https://doi.org/10.1176/appi.psychotherapy.20220015. Accessed 3 September 2024.

33.

Yang LH, Bass JK, Le PD, et al. A Case Study of the Development of a Valid and Pragmatic Implementation Science Measure: The Barriers and Facilitators in Implementation of Task-Sharing Mental Health Interventions (BeFITS-MH) Measure. Preprint. Res Sq. 2024;rs.3.rs-3877031. Available at https://doi.org/10.21203/rs.3.rs-3877031/v1. Accessed 3 September 2024.

34.

Rugema L, Krantz G, Mogren I, et al. “A constant struggle to receive mental health care”: health care professionals' acquired experience of barriers to mental health care services in Rwanda. BMC Psychiatry. 2015;15:314. Available at https://doi.org/10.1186/s12888-015-0699-z. Accessed 3 September 2024.

35.

Kayiteshonga Y, Sezibera V, Mugabo L, et al. Prevalence of mental disorders, associated co-morbidities, health care knowledge and service utilization in Rwanda - towards a blueprint for promoting mental health care services in low- and middle-income countries? BMC Public Health. 2022;22(1):1858. Available at https://doi.org/10.1186/s12889-022-14165-x. Accessed 3 September 2024.

36.

Betancourt TS, Jensen SKG, Barnhart DA, et al. Promoting parent-child relationships and preventing violence via home-visiting: a pre-post cluster-randomised trial among Rwandan families linked to social protection programmes. BMC Public Health. 2020;20(1):621. Available at https://doi.org/10.1186/s12889-020-08693-7. Accessed 3 September 2024.

37.

Barnhart DA, Farrar J, Murray SM, et al. Lay-worker delivered home visiting promotes early childhood development and reduces violence in Rwanda: a randomized pilot. Journal of Child and Family Studies. 2020;29:1804–17. Available at https://doi.org/10.1136/bmjgh-2020-003508. Accessed 3 September 2024.

38.

Jensen SK, Placencio-Castro M, Murray SM, et al. Effect of a home-visiting parenting program to promote early childhood development and prevent violence: a cluster-randomized trial in Rwanda. BMJ Global Health. 2021;6(1):e003508. Available at https://doi.org/10.1136/bmjgh-2020-003508. Accessed 3 September 2024.

39.

Betancourt TS, Ng LC, Kirk CM, et al. Family-based promotion of mental health in children affected by HIV: a pilot randomized controlled trial. Journal of Child Psychology and Psychiatry. 2017;58(8):922–930. Available at https://doi.org/10.1111/jcpp.12729. Accessed 3 September 2024.

40.

Chaudhury S, Brown FL, Kirk CM, et al. Exploring the potential of a family-based prevention intervention to reduce alcohol use and violence within HIV-affected families in Rwanda. AIDS Care. 2016;28 Suppl 2(sup2):118–129. Available at https://doi.org/10.1080/09540121.2016.1176686. Accessed 3 September 2024.

41.

Anderson R. Thematic content analysis (TCA). Descriptive presentation of qualitative data. 2007;3:1–4. Available at http://rosemarieanderson.com/wp-content/uploads/2014/08/ThematicContentAnalysis.pdf. Accessed 3 September 2024.

42.

Boyatzis RE. Transforming qualitative information: Thematic analysis and code development. Sage; 1998 Apr 16.

43.

Bond L, Placencio-Castro M, Byansi W et al. Factors Associated with Nonspecialist Quality of Delivery within a Family Strengthening Intervention in Rwanda: A Parallel Latent Growth Model. Manuscript under review.

44.

Atif N, Bibi A, Nisar A, et al. Delivering maternal mental health through peer volunteers: a 5-year report. International Journal of Mental Health Systems. 2019;13:62. Published 2019 Sep 17. Available at https://doi.org/10.1186/s13033-019-0318-3. Accessed 3 September 2024.

45.

Puffer ES, Friis-Healy EA, Giusto A, et al. Development and implementation of a family therapy intervention in Kenya: A community-embedded lay provider model. Global Social Welfare. 2021;8:11–28. Available at https://doi.org/10.1007/s40609-019-00151-6. Accessed 3 September 2024.

46.

Rahman A, Akhtar P, Hamdani SU, et al. Using technology to scale-up training and supervision of community health workers in the psychosocial management of perinatal depression: a non-inferiority, randomized controlled trial. Global Mental Health (Cambridge). 2019;6:e8. Available at https://doi.org/10.1017/gmh.2019.7. Accessed 3 September 2024.

47.

Freeman JA, Farrar JC, Placencio-Castro M, et al. Integrating the Youth Readiness Intervention and entrepreneurship in Sierra Leone: A hybrid type II cluster randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry. 2024;63(7):708–719. Available at https://doi.org/10.1016/j.jaac.2023.09.552. Accessed 3 September 2024.

48.

Dorsey S, Pullmann MD, Kerns SEU, et al. The juggling act of supervision in community mental health: Implications for supporting evidence-based treatment. Administration and Policy in Mental Health and Mental Health Services Research. 2017;44(6):838–852. Available at https://doi.org/10.1007/s10488-017-0796-z. Accessed 3 September 2024.

49.

Bond L, Simmons E, Sabbath EL. Measurement and assessment of fidelity and competence in nonspecialist-delivered, evidence-based behavioral and mental health interventions: A systematic review. Social Science and Medicine- Population Health. 2022;19:101249. Available at https://doi.org/10.1016/j.ssmph.2022.101249. Accessed 3 September 2024.

50.

Desrosiers A, Freeman J, Mitra R, et al. Alternative delivery platforms for expanding evidence-based mental health interventions for youth in Sierra Leone: A pilot study. Vulnerable Children and Youth Studies. 2023;18(1):131–142. Available at https://doi.org/10.1080/17450128.2022.2094518. Accessed 3 September 2024.

51.

Rose D, Kalathil J. Power, privilege and knowledge: The untenable promise of co-production in mental “health”. Frontiers in Sociology. 2019;4:57. Available at https://doi.org/10.1111/1467-9566.13517. Accessed 3 September 2024.

52.

Fricchione GL, Borba CP, Alem A, Shibre T, Carney JR, Henderson DC. Capacity building in global mental health: professional training. Harvard Review of Psychiatry. 2012;20(1):47–57. Available at https://doi.org/10.3109/10673229.2012.655211. Accessed 3 September 2024.

53.

Singla DR, Raviola G, Patel V. Scaling up psychological treatments for common mental disorders: a call to action. World Psychiatry. 2018;17(2):226–227. Available at https://doi.org/10.1002/wps.20532. Accessed 3 September 2024.

54.

World Health Organization. EQUIP – Ensuring Quality in Psychological Support. 2022. Available at https://www.who.int/teams/mental-health-and-substance-use/treatment-care/equip-ensuring-quality-in-psychological-support. Accessed 3 September 2024.

55.

The President and Fellows of Harvard College (2022). EMPOWER: Building the Mental Health Workforce. Harvard Medical School. 2022. Available at https://mentalhealthforalllab.hms.harvard.edu/empower. Accessed 3 September 2024.

Title: Exploring Nonspecialist Preparedness to Deliver an Evidence-Based, Family Strengthening Intervention in Rwanda: A Qualitative Study
Authors: Laura Bond, PhD
Faith Cheonga
William Byansi, PhD, MSW
Eve Puffer, PhD
Theresa S. Betancourt, ScD, MA
Publication date: 25-09-2024
Publisher: Springer US
Published in: The Journal of Behavioral Health Services & Research
Print ISSN: 1094-3412
Electronic ISSN: 1556-3308
DOI: https://doi.org/10.1007/s11414-024-09913-3

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Exploring Nonspecialist Preparedness to Deliver an Evidence-Based, Family Strengthening Intervention in Rwanda: A Qualitative Study

Abstract

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Please log in to get access to this content