Implementing an early childhood school-based mental health promotion intervention in low-resource Ugandan schools: study protocol for a cluster randomized controlled trial
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
Trials
Abstract
Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs, but this
region has limited access to mental health workers and resources to address these needs. Despite the successes of
numerous school-based interventions for promoting child mental health, most evidence-based interventions are
not available in SSA. This study will investigate the transportability of an evidence-based program from a developed
country (United States) to a SSA country (Uganda). The approach includes task-shifting to early childhood teachers
and consists of professional development (five days) to introduce strategies for effective behavior management and
positive teacher-student interactions, and group-based consultation (14 sessions) to support adoption of effective
practices and tailoring to meet the needs of individual students.
Methods/Design: The design of this study is guided by two implementation frameworks, the Consolidated
Framework for Implementation Research and the Teacher Training Implementation Model, that consider
multidimensional aspects of intervention fidelity and contextual predictors that may influence implementation and
teacher outcomes. Using a cluster randomized design, 10 schools in Uganda will be randomized to either the
intervention group (five schools) or the waitlist control group (five schools). A total of 80 to 100 early childhood
teachers will be enrolled in the study. Teacher utilization of evidence-based strategies and practices will be assessed
at baseline, immediate post-intervention (six months after baseline), and at seven months post-intervention (during
a new academic year). Fidelity measures will be assessed throughout the program implementation period (during
professional development and consultation sessions). Individual teacher and contextual factors will be assessed at
baseline. Data will be collected from multiple sources. Linear mixed-effect modeling, adjusting for school nesting,
will be applied to address study questions.
Discussion: The study will produce important information regarding the value of an evidence-based early intervention,
and a theory-guided implementation process and tools designed for use in implementing early childhood
evidence-based programs in SSA countries or resource-constrained community settings.
Description
Keywords
School program, Mental health, Prevention, Implementation, Uganda, Sub-saharan Africa, Low-income country, Early childhood, Task shifting, Consolidated framework for implementation research
Citation
Huang, K. Y., Nakigudde, J., Calzada, E., Boivin, M. J., Ogedegbe, G., & Brotman, L. M. (2014). Implementing an early childhood school-based mental health promotion intervention in low-resource Ugandan schools: study protocol for a cluster randomized controlled trial. Trials, 15(1), 1-9. doi:10.1186/1745-6215-15-471