Strengthening mental health and research training in Sub-Saharan Africa (SMART Africa): Uganda study protocol

Fred M Ssewamala, Ozge Sensoy Bahar, Mary M McKay, Kimberly Hoagwood, Keng-Yen Huang, Beverly Pringle, Fred M Ssewamala, Ozge Sensoy Bahar, Mary M McKay, Kimberly Hoagwood, Keng-Yen Huang, Beverly Pringle

Abstract

Background: Children in Sub-Saharan Africa (SSA) comprise half of the total regional population, yet existing mental health services are severely under-equipped to meet their needs. Although effective interventions for the treatment of disruptive behavioral disorders (DBDs) in youth have been tested in high-poverty and high-stress communities in developed countries, and are relevant for widespread dissemination in low- and middle-income countries (LMICs), most of these evidence-based practices (EBPs) have not been utilized in SSA, a region heavily impacted by poverty, diseases including HIV/AIDS, and violence. Thus, this paper presents a protocol for a scale-up longitudinal experimental study that uses a mixed-methods, hybrid type II, effectiveness implementation design to test the effectiveness of an EBP, called Multiple Family Group (MFG) aimed at improving child behavioral challenges in Uganda while concurrently examining the multi-level factors that influence uptake, implementation, sustainment, and youth outcomes.

Methods: The MFG intervention will be implemented and tested via a longitudinal experimental study conducted across 30 public primary schools located in both semi-urban and rural communities. The schools will be randomly assigned to three study conditions (n = 10 per study condition): (1) MFG delivered by trained family peers; (2) MFG delivered by community health workers; or; (3) comparison: usual care comprising mental health care support materials, bolstered with school support materials. A total of 3000 children (ages 8 to 13 years; grades 2 to 7) and their caregivers (N = 3000 dyads); 60 parent peers, and 60 community health workers will be recruited. Each study condition will comprise of 1000 child-caregiver dyads. Data will be collected at baseline, 8 and 16 weeks, and 6-month follow-up.

Discussion: This project is the first to test the effectiveness of the MFG intervention while concurrently examining multi-level factors that influence overall implementation of a family-based intervention provided in schools and aimed at reaching the large child population with mental health service needs in Uganda. Moreover, the study draws upon an EBP that has already been tested for delivery by parent peers and community facilitators, and hence will take advantage of the advancing science behind task-shifting. If successful, the project has great potential to address global child mental health needs.

Trial registration: ClinicalTrials.gov, ID: NCT03081195 . Registered on 16 March 2017.

Keywords: Child mental health services; Evidence-based practice; Implementation science; Multiple family group interventions.

Conflict of interest statement

Ethics approval and consent to participate

All study procedures were approved by the Washington University in St. Louis Review Board (#2016011088) and the in-country local IRBs in Uganda: Uganda Virus Institute (UVRI – GC/127/16/05/555), and the Uganda National Council of Science and Technology (UNCST – SS4090). The study procedures were also approved by the Data Safety and Monitoring Board at the National Institute of Mental Health. Informed consent/assent will be obtained from all study participants. Any protocol modifications will be submitted to Washington University in St. Louis Review Board, in-country local IRBs, as well as the Data Safety and Monitoring Board for approval.

Consent for publication

Any results that will be published in academic journals or conferences will adhere to IRB guidelines.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Multi-level influences on Multiple Family Group (MFG) implementation and child outcomes
Fig. 2
Fig. 2
Standard Protocol Items; Recommendations for Interventional Trials (SPIRIT) schedule of enrollment, interventions, and assessments

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Source: PubMed

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