Development and Piloting of an Intervention to Reduce Alcohol Use and Improve Family Engagement Among Fathers in Kenya

Abstract

Problem drinking accounts for 9.6% of disability-adjusted life years worldwide, and disproportionally affects men with disabling physical, psychological, and behavioral consequences. These can lead to a cascade of negative effects on men’s families, with documented ties to intimate partner violence (IPV) and child maltreatment. These problems are often exacerbated where poverty rates are high, including low and middle-income countries (LMICs). To begin to address intersecting risks, two studies were completed. Study 1 aimed to develop an alcohol reduction and family engagement intervention for fathers with problem drinking in Kenya using a mixed-method, multi-step process, as well as evaluate its feasibility and acceptability among fathers and lay counselors using process data from the pilot trial. Study 2 aimed to pilot and examine the initial impact of the intervention on alcohol use and related problems in the family using a non-concurrent multiple baseline single case series design. Study 1 resulted in a 5-session family-focused intervention rooted in behavioral activation (BA), motivational interviewing (MI), and gender transformative strategies (GTS) modified for context-specific goal and streamlined for lay providers. Results indicated the treatment was feasible and acceptable to fathers with high attendance, high satisfaction, acceptance of implementation strategies, and perceived program helpfulness. Counselors with no prior formal training in mental health were able to recruited and trained as counselors and demonstrated reached high rates of intervention fidelity implemented with good quality and high general counselor competency. In Study 2, quantitative and qualitative findings demonstrated promising findings. Fathers who completed treatment (n=8) showed significant reductions in alcohol use during treatment and follow-up periods in comparison to the time prior to treatment. Improvements were also seen in alcohol-related conflict, drinking-related problems, father involvement, and missed family time due to drinking from the perspective of multiple reporters, as well as in secondary outcomes of individual mental health, couple relationship quality, and father-child relationship quality. Indicators of family violence did not show significant improvements, but trended in the expected direction. Results suggest that the developed treatment may be helpful for reducing men’s alcohol use and family outcomes.