Community-sourced Interventions for Global Mental Health
The burden of disease attributable to mental, neurological, and substance-abuse disorders is greater than that of any other disease category. Although research in recent decades has elucidated the extensive health and economic impacts of mental disorders globally, only recently have such efforts been met with increased attention and funding to reduce the disease burden. In high-income countries,
decades of research have contributed to a strong evidence base regarding effective psychological interventions. However, the burden of mental disorders in low- and middle-income countries (LMICs) remains largely unaddressed. Barriers to implementation of evidence-based interventions in LMIC settings include shortage of human resources for mental healthcare, cultural differences in understanding of mental health and illness, and stigma regarding mental disorders and seeking mental healthcare. These shortcomings can be addressed through implementation science research, which attends to the ways that existing evidence-based interventions can be implemented across diverse contexts for greatest reach, acceptability, and fidelity. The proposed project integrates training and research designed to develop my expertise in implementation of evidence-based psychological interventions among underserved populations.
The proposed project will build on my strong research background in anthropology and epidemiology, by providing training in (1) implementation science principles and practice, (2) implementation-effectiveness hybrid designs for psychological interventions, and (3) strategies to optimize fidelity to intervention mechanisms of change in diverse implementation settings. The training plan includes coursework, directed readings, seminars, mentored research, and participation in national and international conferences
and workshops. The proposed research will apply implementation science concepts in an implementation-effectiveness hybrid design of Tuko Pamoja (Swahili: "We are Together"), an evidence-based family-therapy intervention aiming to improve family dynamics and mental health in the context of Kenya. First, I will perform quantitative and qualitative analyses of existing pilot study data from the Tuko Pamoja intervention. I will systematically identify community-sourced practices that are predictive of positive implementation outcomes (acceptability and fidelity) and effectiveness outcomes (mental health and family functioning) within the pilot study. I will then develop an implementation strategy that formally incorporates these community-sourced practices into the intervention, and I will implement and evaluate the revised intervention. I will use qualitative methods to evaluate implementation outcomes and will use a
series of single-case (N=1) studies to evaluate effectiveness outcomes. This research will inform the field of global mental health and contribute to its nascent development of implementation science processes for translating evidence-based psychological interventions to varied contexts. At the completion of this fellowship, I will have specialized expertise in implementation methodologies for psychological interventions and will be prepared to pursue a program of independent research in global mental health.