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 撒哈拉以南非洲地区 (SSA) 的儿童面临着严重未满足的心理健康需求。 一项系统审查估计，SSA 的儿童中有七分之一患有严重的心理健康问题。 卫生组织估计，整个撒哈拉以南非洲地区的贫困率可能更高（20%）。 艾滋病毒/艾滋病、粮食不安全、耻辱和健康安全网系统不足加剧了儿童的严重问题 行为健康 (CBH) 需求并阻碍有效应对。 尤其值得关注的是，这种疾病在青春期和成年期持续存在，也与贫困密切相关。 因此，要解决成年后的身体健康和人际关系挑战。 鉴于 SSA 儿童占该地区总人口的一半以上，对 CBH 的影响至关重要。 如果要在 SSA 满足儿童的需求，那么：1) 实施在 SSA 设计和测试的干预措施，以及 在现有以儿童为中心的机构内调动资源至关重要；2) 采取综合干预措施； 同时针对 SSA 对 CBH 的特定影响，并可以与儿童/家庭合作提供 为社区环境提供服务是必要的；3) 针对 CBH 的群体、社区和人口方法是必要的； 在社会行动、资产和家庭系统理论的指导下，需要推动可扩展的解决方案。 研究将探讨针对社会、家庭和环境的 EE 和 FS 干预措施的机制 特定的驱动因素影响着 900 名乌干达小学中高年级儿童（10 至 14 岁）的心理健康。 该研究采用实验性纵向设计，对 30 所整群随机小学进行比较 单一和组合干预方案；EE 和 FS 对经济、感知和功能的影响 中介者；以及特定情境的调节者：1) 仅 EE，2) 仅基于 MFG 的 FS， 3) 联合 EE+基于 MFG 的干预措施将持续 12 个月并进行评估； 在基线、12、24 和 36 个月的具体目标是： 目标 1：仅检查基于 MFG 的 EE 的影响。 仅 FS，以及针对儿童 DBD 症状和行为功能的基于 EE+MFG 的组合 FS；目标 2： 测试仅 EE、仅基于 MFG 的 FS 以及 EE+基于 MFG 的 FS 组合对家庭财务稳定性的影响 （例如，粮食和住房稳定、物质资产、储蓄）、养育子女和保护性家庭进程（例如，家庭 组织、照顾者/儿童互动、凝聚力、支持）以及与寻求帮助相关的看法（例如， 污名）对 CBH 和功能的影响；并评估这些变化机制是否介导干预效果 DBD 症状和行为功能，并探索特定环境调节因素的调节 干预效果；目标 3：定性检查参与者对每个干预组的体验。 调查小组将利用他们在 SSA 的长期合作伙伴关系，最大限度地提高公共卫生影响 研究成果，缩短从新知识到系统和人群水平改进的时间差距。