Browsing by Author "Kip, Esther C."

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    Cultural adaptation of an evidence-based psychosocial screening tool for adolescents living with HIV/AIDS in adolescents’ antiretroviral therapy program in Zomba, Malawi
    (Kamuzu University of Health Sciencies, 7-07-21) Kip, Esther C.
    Executive Summary D. Title of the study: Cultural adaptation of an evidence-based psychosocial screening tool for adolescents living with HIV/AIDS in adolescents’ antiretroviral therapy program in Malawi Problem Statement: In Malawi, a study on depression among adolescents living with HIV (ALHIV) revealed a prevalence rate of 18.9%3. Despite the high prevalence and impact of depression on ALHIV health outcomes, lack of awareness and stigma around mental health services leave ALHIV with depression undetected and there are few culturally, sensitive, standardized, and validated instruments available for depression screening in the African region1,6. The Home, Education, Activities, Drugs, Sexuality, Suicide/Depression (HEADSS) psychosocial screening tool, is an efficacious evidence-based intervention (EBI)8-10 to improve identification of psychosocial issues, such as depression screening and risky behavior. This tool was recommended for use in the adolescent antiretroviral therapy (ART) program called Teen Club (TC) in Malawi in an attempt to identify the above-mentioned challenges. However, its introduction has had poor uptake. Our previous formative study on “Implementation barriers of the HEADSS screening tool in Teen Club Program in two districts in Malawi” found that HEADSS was too long, time consuming and not culturally appropriate to the Malawi setting and some of the suggestions included modification of this tool in order to be culturally acceptable for use in Malawi. Therefore, this current study builds upon our previous findings. Main objective of the study: The long-term goal of this study is to culturally adapt the HEADSS psychosocial screening tool based on our formative work, identify the barriers and facilitators to implementing the modified HEADSS, and identify implementation strategies to address identified barriers to improve the mental health outcomes among ALHIV in Malawi. Specific Objectives are to: 1) Review prior formative study findings and conduct systematic modifications process of the existing HEADSS psychosocial screening tool. 2) Identify the barriers and facilitators to the implementation of the adapted HEADSS among the HCPs in Teen Club program and ALHIV in order to understand the usability and acceptability of the adapted HEADSS screening tool. 3) Based on the findings in objective 2, identify implementation strategies to address the identified barriers to improve the mental health outcomes among ALHIV in Malawi. Methodology: This will be a cross-sectional descriptive qualitative study design and it will take place in Zomba district (Zomba Central Hospital and 1 health center). A purposive sampling approach will be used to select the participants. In-depth interviews (IDIs) using a semi-structured questionnaire will be conducted with key informants (KIs) and health care providers (HCPs) then FGDs with adolescents living with HIV (ALHIV) between 12 and 18 years old. The sample will comprise of 1 clinical psychologist, 1 psychosocial counsellor, 1 Adolescent Coordinators from the NGOs, 1 District Nursing Officer as key informants and 4 HCPs from the Health center and 2 from Zomba Central Hospital Teen Club Program (Lighthouse). A similar proportion of male and female ALHIV will be included in the FGDs from each site, totalling to 20 ALHIV in the 2 sites. An estimated total of 30 research participants will be included in this study. Potential constraints: Not many ALHIV might feel comfortable to speak up, however, our formative study showed that the ALHIV were open and expressed themselves without any problem. The training will be provided to the Research Assistant prior to commencement of data collection, and this will deliver specialized communication skills to enable ALHIV to feel free and speak out on their experiences. Support will be provided to those ALHIV who need to be referred to specialized mental health services and the research team will be trained to ensure that a correct support and referral system is in place before the start of data collection. Some participants may also experience discomfort to respond to the questions, however, they will be informed during the consenting process that they have the right to refuse to answer any question that makes them uncomfortable and to stop the interview at any time. In addition, while the research is aiming to reach an equal number of females and males, it may not be possible be get a gender balanced participation. However, we will communicate these limitations clearly during feedback, recommendation and dissemination activities. Additionally, due to the Covid pandemic, it might be a challenge to get the number of ALHIV on the appointed date as there is limited number of staff and ALHIV assigned for each day. We might even have to do face-to face interviews instead of FGDs depending on how the situation will be during