Voices of Families: Evaluating the Implementation of Tuko Pamoja, a Two-Tiered Family Therapy Intervention, through Participant Perspectives in Western Kenya..

AbstractBackground: Mental health significantly affects overall well-being, with childhood identified as a critical period for intervention. The family unit plays a pivotal role in shaping children's mental health, serving as both a source of support and, potentially, stress. In low and middle-income countries (LMICs) like Kenya, where access to mental health services is limited, the impact of family dynamics on children's mental health underscores the need for effective, culturally tailored interventions. The Tuko Pamoja program in Kenya offers a novel approach by integrating community-based prevention with targeted family counseling, addressing the gap in family-based mental health interventions within a community-embedded framework. Objective: This study aims to explore the factors influencing family participation in the Tuko Pamoja program, examining the experiences of families who engaged with the program and those who did not. It seeks to understand the interplay between the program's two components –group-based prevention (Tuko Pamoja Family Days) and individual family counseling (Tuko Pamoja Home) and participants' perceptions of their collective influence on family dynamics and mental health. Methods: Employing a qualitative research design, this study included in-depth interviews with 14 caregivers from families identified within the community with high levels of family distress. Thematic content analysis was conducted to identify themes related to participation decisions, program impact, and recommendations for improvement. Results: Findings reveal that non-attenders had positive perceptions of the program but were still unable to attend due to logistical barriers. Among attenders, effective recruitment strategies, clear communication, and logistical support facilitated participation in both tiers of the program. Attenders expressed that participation in TP Family Days played a crucial role in reducing stigma and encouraging participation in the more intensive TP Home counseling tier. Participants who engaged with both tiers reported significant improvements in family communication, parenting practices, and overall family dynamics, with both tiers reinforcing each other's content to enhance the overall impact. Conclusion: The Tuko Pamoja program demonstrates the potential to improve family dynamics and mental health awareness in LMIC settings by synergistically combining prevention and treatment tiers. Attenders felt that the program's prevention component played a crucial role in reducing stigma, improving family communication, and strengthening family relationships. This study contributes to the understanding of implementing family-based mental health interventions in LMICs, offering valuable insights into how integrated approaches can effectively address complex psychosocial needs within family systems. Addressing barriers to participation and enhancing program accessibility will be important for broadening the program's reach and efficacy. Keywords: Family-based interventions, Mental health, LMIC, Community-embedded model, Tuko Pamoja, Tuko Pamoja Home, Tuko Pamoja Family Days, Kenya, Qualitative research.