Understanding Community-Sourced Practices Used by Lay Counselors in a Family Therapy Intervention in Eldoret, Kenya

The large global burden of mental health disorders calls for the development and implementation of contextually-appropriate mental health interventions that improve the wellbeing of children and families in low-resource settings. Tuko Pamoja is a family therapy intervention designed for delivery by lay providers in low-resource settings and pilot tested in Eldoret, Kenya. Improving the effectiveness of evidence-based interventions like Tuko Pamoja requires cultural and contextual sensitivity in implementation. One important step towards contextual sensitivity is gaining an understanding of the community-sourced practices used in interventions. Community-sourced practices refer to the ways in which counselors draw upon their own local understandings and norms to discuss and incorporate different supports, lessons, and explanatory models into the intervention. This paper identifies and describes the community-sourced practices utilized by lay counselors delivering Tuko Pamoja. Results include six primary community-sourced practices used by lay counselors: 1) providing metaphors and proverbs, 2) incorporating religion, 3) self-disclosure, 4) using examples and role models, 5) discussing interpersonal relationships outside of the family, and 6) referring to community dynamics and resources. The community-sourced practices described in this thesis can be used to inform and develop context-specific implementation guidelines and a comprehensive implementation model for scale up, improving the intervention’s effectiveness in positively impacting child and family outcomes.