Barriers and Facilitators to Father’s Engagement in a Depression and Alcohol Use Intervention in Kenya: Father, Family, and Community Factors
Abstract
:1. Introduction
2. Methods
2.1. Overview and Guiding Frameworks
2.2. Setting
2.3. Participants
Recruitment
2.4. Procedures
2.5. Analysis
3. Results
3.1. Overview
3.2. Innovation-Level
The program sounds very good because of this good leader and good father aspect in it. This are the things that we need to teach this man that is growing up. You see a role model who has gone through it has become role model despite whether he was taught or not but has become a good father and a good leader. So, we are instilling those values into now this man again.—Hospital Psychiatrist
3.3. Outer Setting
There is the cultural aspect where the men have [themselves] together. Man is not supposed to say that I am overwhelmed, so the culture is assuming that the man has to have himself together. Two, men are known to drink, culturally, you are not supposed to say that I cannot drink. Three, there is the fear of failure. The stigma associated with it, if want to seek help for mental health, there is already the stigma of that you are weak. You are crazy and some sort. So, someone may know that they need help but they are afraid on how the society will view them.—Policy Maker
Mostly they do not seek help [unless] they have a strong person in the family to consider them and even persuade them to seek help. Like now in a family, if the husband result to a lot alcoholism, the wife will have to talk to the family members, talk to the closest friends and if they have resources to meet the expenses for the rehabilitation and the rest, they will go for it.—Mental Health Nurse Counselor
I think the resource that we have in our country is the community itself. The way we are arranged in our neighborhood, the families are close to each other, they are aware of each other, and we live in a communal way so that we have adapted that culture of if somebody’s child is struggling with this problem, it is my problem too. That kind of arrangement is a big resource. That is why I am saying that using the community, as the entry point could be the best approach ever.—National Policy Maker
3.4. Inner Setting
3.5. Individual-Level: Participants and Providers
3.6. Sustainability (ISF)
Number one, any program that is going to be started now, for example for mental health, you need to incorporate the county, which will be owned by the county itself. This is because if it is owned by the county and we are just supporting the county to push for that. For example, our governor, he is very good at fighting for those mental issues.
The other thing is to get champions, what I have seen with my little experience is to get people on the ground who can advocate. Whether they are patients or health care workers, who after the program is done, they are willing to keep fighting for it. It is not enough to train people; it is enough to get a champion, someone who is very passionate about such a program. Because otherwise when the turbulence of life happens and maybe there is low workload, less payment or whatever else, the program is likely to die if there is no one who is continuously financing for it.
3.7. Characteristics of Systems (CFIR-LMIC)
In terms of linking the men to care, there is a real gap. One, mostly the ones that I know [who receive care] are people who are known, but [for] those who come from less privileged family backgrounds, it will be very difficult cater for this individuals… the ones living in slums they are only arrested, they are threatened and told that if you continue with this alcohol or this and this, we find you next time we will charge you like this. It is like enforcement of behavior change.
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Interviewee | Interview Type | Number Conducted (# Participants) |
---|---|---|
Community Leaders | KII | 4 Interviews (4 participants) |
Policy Makers | KII | 3 Interviews (3 participants) |
Hospital Leaders | KII | 5 Interviews (5 participants) |
Past LEAD Providers | KII | 3 Interviews (3 participants) |
Past LEAD Patients | KII | 3 Interviews (3 participants) |
Community Leaders | FGD | 2 Groups (4 participants) |
MH and AUD Providers | FGD | 3 Groups (21 participants) |
Current Patients | FGD | 2 Groups (6 participants) |
Total # Interviews/Participants | — | KII: 18 interviews (18 participants) FGD: 7 Groups (31 participants) |
CFIR/ISF Domain | Implementation Barriers (−), Facilitators (+), and Opportunities (*) | |
---|---|---|
INNOVATION | + Short time commitments (≤5 sessions) + Intervention integrates peer support + Intervention highlights culturally relevant values, such as leadership ± Group-based format facilitates peer support, but is less private - Recording sessions may be uncomfortable for participants - Some men may not wish to incorporate their families in treatment * Introducing support groups at the end of the intervention to improve sustainability | |
OUTER SETTING | + Communities and families support each other ± Cultural norms surrounding alcohol use - Cultural norms surrounding masculinity and stigma may impact engagement with treatment - Lack of financial resources * Family and community members may support with referral and engagement * Connecting with community and religious leaders to support program implementation | |
INNER SETTING | * Intervention should be delivered far from alcohol use locations * Intervention could be delivered in more accessible locations within communities, such as community centers | |
INDIVIDUAL | Participants + Men who self-refer may be more likely to succeed - Men may be impacted by severe alcohol dependence and/or polysubstance use | Providers - Fear of doctors in medical settings - Skepticism of individuals from outside the community * Incorporate perspectives of community members in recovery * Providers should have some training and status in community |
SUSTAINABILITY | * Incorporating county-level officials and policymakers early in implementation * Integrate services into other community structures, such as churches, where individuals may expect to volunteer and support each other * Incorporate content into primary education as a preventive measure | |
CHARACTERISTICS OF SYSTEMS (CFIR-LMIC) | + Existing spirituality-based rehabilitation programs - Limited existing services and difficulties linking men to care - Limited providers and resources to support new interventions - Lack of equitable policies * Linking community and hospital services |
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Giusto, A.; Jaguga, F.; Pereira-Sanchez, V.; Rono, W.; Triplett, N.; Rukh-E-Qamar, H.; Parker, M.; Wainberg, M.L. Barriers and Facilitators to Father’s Engagement in a Depression and Alcohol Use Intervention in Kenya: Father, Family, and Community Factors. Int. J. Environ. Res. Public Health 2023, 20, 4830. https://doi.org/10.3390/ijerph20064830
Giusto A, Jaguga F, Pereira-Sanchez V, Rono W, Triplett N, Rukh-E-Qamar H, Parker M, Wainberg ML. Barriers and Facilitators to Father’s Engagement in a Depression and Alcohol Use Intervention in Kenya: Father, Family, and Community Factors. International Journal of Environmental Research and Public Health. 2023; 20(6):4830. https://doi.org/10.3390/ijerph20064830
Chicago/Turabian StyleGiusto, Ali, Florence Jaguga, Victor Pereira-Sanchez, Wilter Rono, Noah Triplett, Hani Rukh-E-Qamar, Mattea Parker, and Milton L. Wainberg. 2023. "Barriers and Facilitators to Father’s Engagement in a Depression and Alcohol Use Intervention in Kenya: Father, Family, and Community Factors" International Journal of Environmental Research and Public Health 20, no. 6: 4830. https://doi.org/10.3390/ijerph20064830