Suubi(Hope)4StrongerFamilies: Addressing Child Behavioral Health by Strengthening Financial Stability and Parenting among Families in Uganda

Suubi（希望）4StrongerFamilies：通过加强乌干达家庭的财务稳定和养育子女来解决儿童行为健康问题

• 批准号: 10613504
• 负责人: Mary McKernan McKay
• 金额: $ 66.83万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-25 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10613504
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adolescence; Adolescent; Adult; Affect; Africa; Africa South of the Sahara; African; Behavioral; Caregivers; Child; Child Development; Child Mental Health; Child Rearing; Childhood; Collaborations; Communities; Disruptive Behavior Disorder; Economics; Faith; Family; Family Process; Food; Ghana; HIV/AIDS; Health; Housing; Incentives; Income; Institution; Intervention; Investments; Kenya; Knowledge; Left; Letters; Mediating; Mediator; Mental Health; Mental Health Services; Mentorship; Parent-Child Relations; Participant; Perception; Play; Policies; Population; Poverty; Prevalence; Primary Schools; Public Health; Randomized; Research; Resource-limited setting; Resources; Role; Savings; Schools; Scientist; Stream; Symptoms; System; Systems Theory; Testing; Time; Training; Uganda; World Health Organization; Youth; behavioral health; cohesion; community setting; design; economic impact; empowerment; experience; financial literacy; food insecurity; forging; help-seeking behavior; improved; intervention effect; longitudinal design; physical conditioning; population based; programs; response; safety net; social; social influence; social stigma; systematic review; theories; therapy design; treatment arm

PROJECT ABSTRACT Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs. A recent systematic review estimated that 1 in 7 children in SSA struggle with a serious mental health issue. The World Health Organization estimates prevalence rates may be even higher (20%). Across SSA, high rates of poverty, HIV/AIDS, food insecurity, stigma and an inadequate health safety net system exacerbate serious childhood behavioral health (CBH) needs and impede an effective response. Disruptive behavioral disorders (DBDs) are particularly concerning as they persist through adolescence and adulthood. DBDs are also highly related to poor physical health and interpersonal challenges in adulthood. Hence, addressing the context-specific social influences on CBH is critical given that children in SSA comprise more than half of the total regional population. If children’s needs are to be met in SSA, then: 1) implementing interventions designed and tested in SSA, and which mobilize resources within existing child-focused institutions is critical; 2) combined interventions that simultaneously target SSA-specific influences on CBH and can be delivered in collaboration with child/family- serving community settings are necessary; and 3) group, community and population approaches to CBH are needed to drive scalable solutions. Guided by Social Action, Asset, and Family Systems theories, the proposed study will examine the mechanisms by which EE and FS interventions targeting social, familial and context- specific drivers affect the mental health of 900 Ugandan children in mid-upper primary school (10 to 14 years). The study uses an experimental, longitudinal design across 30 cluster randomized primary schools to compare single and combination intervention options; influences of EE and FS on economic, perceptual and functioning mediators; and context-specific moderators. The three study conditions are: 1) EE only, 2) MFG-based FS only, 3) combined EE+MFG-based FS. The interventions will be provided for 12 months; and assessments will occur at baseline, 12, 24 and 36 months. The specific aims are: Aim 1: Examine the impact of EE only, MFG-based FS only, and combined EE+MFG-based FS on children’s DBD symptoms and behavioral functioning; Aim 2: Test the influence of EE only, MFG-based FS only, and combined EE+MFG-based FS on family financial stability (e.g., food and housing stability, material assets, savings), parenting and protective family processes (e.g., family organization, caregiver/child interaction, cohesion, support) and perceptions related to help seeking (e.g., stigma) on CBH and functioning; and assess whether these change mechanism mediate intervention effects on DBD symptoms and behavioral functioning, and explore moderation by context-specific moderators of intervention effects; and Aim 3: Qualitatively examine participants’ experiences with each intervention arm. The investigative team will leverage their long-term partnerships in SSA to maximize the public health impact of the research findings and to shorten the time gap from new knowledge to system and population-level improvement.

项目摘要 撒哈拉以南非洲（SSA）的儿童被大量未满足的心理健康需求烧毁。最近 系统评价估计，SSA中有7个儿童中有1个与严重的心理健康问题斗争。世界 卫生组织估计患病率可能甚至更高（20％）。在SSA中，贫困率高， 艾滋病毒/艾滋病，粮食不安全，污名和健康安全网系统不足 行为健康（CBH）需要并阻碍有效的反应。破坏性行为障碍（DBD）是 特别关心，因为它们持续到青少年和成年。 DBD也与差的差相关 成年期的身体健康和人际挑战。因此，解决特定环境的社会 鉴于SSA中的儿童建立了整个地区人口的一半以上，对CBH的影响至关重要。 如果要在SSA中满足儿童的需求，则：1）在SSA中设计和测试的干预措施，以及 在现有的以儿童为中心的机构中动员资源至关重要； 2）结合干预措施 类似地，针对SSA特定对CBH的影响，可以与儿童/家庭合作交付 服务社区环境是必要的； 3）CBH的社区和人口方法是 需要驱动可扩展解决方案。在社会行动，资产和家庭系统理论的指导下，提议 研究将研究针对社会，家庭和环境的EE和FS干预措施的机制 - 特定的驱动因素会影响中学中小学900名乌干达儿童的心理健康（10至14岁）。 该研究使用30个群集随机小学的实验，纵向设计来比较 单一和组合干预选项； EE和FS对经济，感知和功能的影响 调解人；和上下文特定的主持人。这三个研究条件是：1）仅EE，2）仅基于MFG的FS， 3）基于EE+MFG的FS组合。干预措施将提供12个月；并将进行评估 在基线，12、24和36个月。具体目的是：目标1：仅检查基于MFG的EE的影响 仅FS，并将基于EE+MFG的FS组合在儿童的DBD症状和行为功能上；目标2： 仅测试EE仅基于MFG的FS的影响，并将基于EE+MFG的FS组合对家庭财务稳定性 （例如，食品和住房稳定性，材料资产，储蓄），育儿和受保护的家庭流程（例如家庭 组织，照顾者/儿童互动，凝聚力，支持）和与寻求帮助有关的看法（例如， 污名）在CBH上和功能；并评估这些变化机制是否介导了干预对 DBD症状和行为功能，并通过上下文特定的主持人进行节制 干预效果；目标3：定性检查参与者在每个干预部门的经历。 调查团队将利用其在SSA的长期合作伙伴关系，以最大程度地提高公共卫生的影响 研究发现，并缩短从新知识到系统和人群水平改进的时间差距。