Browsing by Author "Kasujja, Rosco"

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    Culturally adapting a mindfulness and acceptance-based intervention to support the mental health of adolescents on antiretroviral therapy in Uganda
    (PLOS Global Public Health, 2023) Musanje, Khamisi; Camlin, Carol S.; Kamya, Moses R.; Kirabo, Hope; Nangendo, Joan; Kiweewa, John; White, Ross G.; Kasujja, Rosco
    The dual burden of living with HIV and negotiating life stage changes has been identified as a contributing factor to lapsed adherence among adolescents with HIV in sub-Saharan Africa. While psychosocial support can promote medication adherence, most interventions in use with adolescents were originally developed for the general population creating a gap in appropriate support. Life-stage-appropriate, evidence-based psychosocial support interventions have been used with young people in high-income contexts, prompting interest in their use in low-income contexts. However, many interventions are less effective when implemented outside of their original settings, hence the need for modifications before implementation. We aimed to culturally adapt an evidence-based psychosocial support intervention designed to improve the mental health of young people for use among adolescents with HIV in a sub-Saharan African context and to explore the acceptability of the adapted intervention among adolescents. We engaged thirty stakeholders (n = 30) in Kampala, Uganda including psychologists, psychiatrists, social workers, HIV counselors, religious leaders and adolescent peers from December 2021 to April 2022 to modify an evidence-based intervention for adolescents. Key adaptations included simplifying the language, adding local practices, integrating locally relevant slang and stories into therapy, introducing racially-congruent visuals and cards representing emotions, and adjusting therapy materials for use in resource-constrained settings. We then tested the acceptability of the intervention in a small sample of service users using a qualitative approach. We recruited nine adolescents with HIV from a participating clinic in Kampala, delivered six 90-minute sessions of the adapted intervention across three weeks and conducted in-depth interviews to assess the acceptability of the intervention. We used thematic analysis to analyze the qualitative data. The adapted intervention was perceived as acceptable among adolescents with HIV, with many stating that it helped them overcome fears, increased their self-acceptance, and gave them the confidence to make careful health-enhancing decisions.
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    Exploring The Mental Health And Psychosocial Problems Of Congolese Refugees Living In Refugee Settings In Rwanda And Uganda: A Rapid Qualitative Study
    (Conflict and Health, 2020) Chiumento, Anna; Rutayisire, Theoneste; Sarabwe, Emmanuel; Hasan, Tasdik; Kasujja, Rosco; Nabirinde, Rachel; Mugarura, Joseph; Kagabo, Daniel M.; Bangirana, Paul; Jansen, Stefan; Ventevogel, Peter; Robinson, Jude; White, Ross G.
    Refugees fleeing conflict often experience poor mental health due to experiences in their country of origin, during displacement, and in new host environments. Conditions in refugee camps and settlements, and the wider socio-political and economic context of refugees’ lives, create structural conditions that compound the effects of previous adversity. Mental health and psychosocial support services must address the daily stressors and adversities refugees face by being grounded in the lived reality of refugee’s lives and addressing issues relevant to them.We undertook a rapid qualitative study between March and May 2019 to understand the local prioritisation of problems facing Congolese refugees living in two refugee settings in Uganda and Rwanda. Thirty free list interviews were conducted in each setting, followed by 11 key informant interviews in Uganda and 12 in Rwanda.Results from all interviews were thematically analysed following a deductive process by the in-country research teams. Free list interview findings highlight priority problems of basic needs such as food, shelter, and healthcare access; alongside contextual social problems including discrimination/inequity and a lack of gender equality. Priority problems relating to mental and psychosocial health explored in key informant interviews include discrimination and inequity; alcohol and substance abuse; and violence and gender-based violence.Our findings strongly resonate with models of mental health and psychosocial wellbeing that emphasise their socially determined and contextually embedded nature. Specifically, findings foreground the structural conditions of refugees’ lives such as the physical organisation of camp spaces or refugee policies that are stigmatising through restricting the right to work or pursue education. This structural environment can lead to disruptions in social relationships at the familial and community levels, giving rise to discrimination/inequity and gender-based violence. Therefore, our findings foreground that one consequence of living in situations of pervasive adversity caused by experiences of discrimination, inequity, and violence is poor mental health and psychosocial wellbeing. This understanding reinforces the relevance of feasible and acceptable intervention approaches that aim to strengthening familial and community-level social relationships, building upon existing community resources to promote positive mental health and psychosocial wellbeing among Congolese refugees in these settings.
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    Perspectives on competency-based feedback for training non-specialists to deliver psychological interventions: multi-site qualitative study of the EQUIP competency-based approach
    (Cambridge University Press, 2024-05) Elnasseh, Abdelrhman; Mehta, Varun S; Manolova, Gergana; Pedersen, Gloria A; Golden, Shannon; Eloul, Liyam; Gebrekristos, Frezgi; Collins, Pamela Y; Mutavi, Teresia; Mbwayo, Anne W; Mathai, Muthoni; Concepcion, Tessa; El Masri, Rozane; Steen, Frederik; Galea, Jerome T; Contreras, Carmen; Akellot, Josephine; Kasujja, Rosco; Wasereka, Samuel; Mutamba, Byamah Brian; Tol, Wietse A.; Raji, Mansurat; Moufarrej, Sacha; Schafer, Alison; Kohrt, Brandon A
    Abstract Background The use of feedback to address gaps and reinforce skills is a key component of successful competency-based mental health and psychosocial support intervention training approaches. Competency-based feedback during training and supervision for personnel delivering psychological interventions is vital for safe and effective care. Aims For non-specialists trained in low-resource settings, there is a lack of standardised feedback systems. This study explores perspectives on competency-based feedback, using structured role-plays that are featured on the Ensuring Quality in Psychosocial and Mental Health Care (EQUIP) platform developed by the World Health Organization and United Nations Children’s Fund. Method Qualitative data were collected from supervisors, trainers and trainees from multiple EQUIP training sites (Ethiopia, Kenya, Lebanon, Peru and Uganda), from 18 key informant interviews and five focus group discussions (N = 41 participants). Qualitative analysis was conducted in Dedoose, using a codebook with deductively and inductively developed themes. Results Four main themes demonstrated how a competency-based structure enhanced the feedback process: (a) competency-based feedback was personalised and goal-specific, (b) competency-based feedback supported a feedback loop, (c) competency-based feedback supported a comfortable and objective feedback environment, and (d) competency-based feedback created greater opportunities for flexibility in training and supervision. Conclusions A better understanding of the role of feedback supports the implementation of competency-based training that is systematic and effective for trainers and supervisors, which ultimately benefits the learning process for trainees.
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    Sociocultural considerations of mental health care and help-seeking in Uganda
    (Elsevier Ltd, 2023-12) Asiimwe, Ronald; Nuwagaba-K, Racheal D; Dwanyen, Lekie; Kasujja, Rosco
    Sociocultural factors largely shape how communities conceptualize, express, and respond to mental and relational health problems. This paper reviews and summarizes literature on mental health in Uganda, with specific attention to Uganda's mental health policy, relevant sociocultural idioms of distress, and considerations. We include a discussion on stigma, as one key response to mental and relational health problems in Uganda. Further, we use clinical examples from Uganda to describe salient and common sociocultural idioms of distress that shape how Ugandans experience and express various mental health problems, and subsequent help-seeking behaviors. We end with a discussion by offering implications for sociocultural experiences and considerations to improve mental health service delivery in Uganda.