A mixed-methods study to validate a measure of and explore influences on child mental health in Eldoret, Kenya

Abstract

Background: In Kenya, approximately 14.5% of children and youth meet criteria for a mental disorder. Despite this high burden, research is very limited related to mental health problems this population. Research is needed on the measurement of child mental health problems and on the risk and protective factors associated with these conditions.Objectives: (1) Evaluate a set of survey items, chosen from both standardized measures and locally developed items, to identify those that that best differentiate between children with and without mental health problems. (2) Identify and explore important individual- and family-level influences on child mental health. Methods: Individual surveys and semi-structured interviews were administered to members (1-2 caregivers, 1 child age 8-17) of 22 families living in Eldoret, Kenya. We evaluated differences in survey item endorsement between children with and without mental health problems to identify the best performing items. We used mixed-methods analysis of semi-structured interview transcripts and associated rating scores to explore differences between children with and without mental health problems on a variety of family-level variables.Results: Following an extensive cultural adaptation process, fourteen of 26 survey items were successful in differentiating between children with and without mental health problems. Successful survey items were all drawn from standardized measures; no locally developed items were successful. All family-level variables (e.g., overall family functioning, couples’ relationship quality, parent-child relationship quality, and caregiver mental health) were strongly associated with child mental health outcomes, evidenced by large effect sizes ranging from 0.86 to 4.16. Subsequent qualitative analysis identified specific components of these variables likely contributing to the large numerical differences in scores.Conclusions: The results of this study both suggest that standardized measures are appropriate for use in this population and highlight the importance of cultural adaptation before implementing standardized assessment tools. Additionally, the results indicate that the family environment is a promising target for interventions aiming to reduce mental health problems in Kenyan children.