“It must be in the thoughts”: A mixed-methods study to validate a mental health assessment and to identify family influences on mental health of Kenyan caregivers

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Puffer, Eve S

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Background: With the increasing burden of mental health disorders worldwide, strategies are needed to identify salient issues related to mental health and to locally validate mental health screening measures in order to ultimately inform and improve mental illness prevention and treatment. This is particularly the case in regions such as Sub-Saharan Africa, where the burden of illness caused by mental health and substance use disorders is putting increased pressure on an already severely under-resourced healthcare system with few mental health professionals. This study had two aims: (1) to validate items assessing general mental health distress in a Kenyan sample and (2) to identify salient family-level influences on caregiver mental health in Kenyan families.

Methods: This study used a mixed-methods approach with cross-sectional data collected from a sample of 33 caregivers from two communities in Kenya. Each caregiver participated in a survey and a semi-structured interview. Based on the interview data, presence of emotional problems in each study participant was determined such that each participant was designated a mental health “case” or “non-case.” For Aim 1, individual mental health survey items were evaluated for their ability to discriminate between mental health case status groups. For Aim 2, a mixed-methods approach was used to examine relationships between family functioning domains and individual mental health using survey and interview data.

Results: Survey items found to discriminate between individuals with and without emotional problems included 23 items adapted from existing measures of mental health, as well as 5 new items developed for the cultural context. Positively-worded items tended to have poor discrimination between individuals with and without emotional problems. Through examination of quantitative and qualitative data, both family functioning and couple functioning were found to be associated with individual mental health. Satisfaction with roles in terms of provision for family needs was a particularly salient issue affecting individual mental health, as corroborated by the qualitative data. Religiosity was also found to be an important factor in the population, with generally high religiosity among all participants and some differences in use of religion for coping with stressors between individuals with and without emotional problems.

Conclusions: Integration of both adapted and locally-developed mental health screening items should be considered to fully capture the construct of mental health in a given setting, and both content and structure of questions should be considered when developing measures. Both family functioning and couple functioning domains were found to be important, with implications for areas of focus for future research and interventions. Future contextually-sensitive research is needed to comprehensively validate measures of mental health and to further identify predictors of individual mental health in the Kenyan setting.






Watson, Leah Katarina (2017). “It must be in the thoughts”: A mixed-methods study to validate a mental health assessment and to identify family influences on mental health of Kenyan caregivers. Master's thesis, Duke University. Retrieved from https://hdl.handle.net/10161/15275.


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