Kabarambi Anita, Kizito Samuel, Kiyingi Joshua, Namatovu Phionah, Nartey Portia, Nabunya Proscovia, Ssewamala Fred M
Brown School, Washington University in St. Louis, St. Louis, Missouri, USA.
International Center for Child Health and Development, Uganda.
Evid Based Pract Child Adolesc Ment Health. 2025 Apr 1. doi: 10.1080/23794925.2025.2485082.
Globally, one in seven 10-19-year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group. In low- and middle-income countries (LMICs), many children and adolescents face serious mental health disorders, including disruptive behavioral disorders (DBDs), which often begin in childhood and adolescence. Between 2016 and 2021, a large cluster randomized controlled trial was conducted in Uganda under the SMART Africa initiative to examine the impact and implementation of the Multiple Family Group (MFG) intervention for children with behavioral problems and their families. The intervention proved efficacious in reducing impaired functioning and had the potential to improve family dynamics, whether delivered by community members or parents. With limited mental health experts in Uganda, understanding the fidelity of this mental health intervention with task shifting will be critical.
This study systematically assesses the fidelity of the MFG intervention, focusing on the dose dimension, which includes the frequency and duration of intervention sessions and adherence to the intervention manual.
The fidelity assessment was embedded within the SMART Africa trial and conducted after every MFG session for facilitators and caregivers and at 25% of the sessions (sessions 4, 8, 12, and 16) by research staff. Facilitators and participants completed a 5-minute fidelity assessment checklist at the end of each session, while independent fidelity observations were conducted for 25% of the sessions by trained research assistants. Data were analyzed to assess the relationship between planned and actual implementation.
In this study, the MFG intervention included 1,290 participants and caregivers, with children having an average age of 12 years and most caregivers being female with a primary education. Each session had an average attendance of over 70%, with 33% of participants attending all 15 sessions and 77.4% attending at least 11 sessions, indicating good adherence. Participants completed 16,470 fidelity assessment surveys, showing excellent coverage of intervention content (95%-100%), which improved over time. Research assistants reported high fidelity, with 567 assessments showing 93%-98% coverage. Facilitators filled out 2,189 surveys, with a mean session component coverage of 98.6%.
The fidelity assessment indicates that the MFG intervention was well-delivered in Uganda. High adherence and positive feedback affirm the intervention's successful implementation and support for task shifting mental health interventions while maintaining high fidelity in countries with limited mental health experts.
在全球范围内，每七名10至19岁的青少年中就有一人患有精神障碍，占该年龄组全球疾病负担的13%。在低收入和中等收入国家（LMICs），许多儿童和青少年面临严重的心理健康障碍，包括破坏性行为障碍（DBDs），这些障碍通常始于儿童期和青少年期。2016年至2021年期间，在“非洲明智行动”倡议下，乌干达进行了一项大型整群随机对照试验，以研究多家庭小组（MFG）干预措施对有行为问题的儿童及其家庭的影响和实施情况。事实证明，该干预措施在减少功能受损方面有效，并且无论由社区成员还是父母实施，都有可能改善家庭动态。由于乌干达心理健康专家有限，了解这种心理健康干预措施在任务转移情况下的保真度至关重要。
本研究系统评估MFG干预措施的保真度，重点关注剂量维度，其中包括干预课程的频率和持续时间以及对干预手册的依从性。
保真度评估嵌入在“非洲明智行动”试验中，在每次MFG课程结束后由促进者和照顾者进行，研究人员在25%的课程（第4、8、12和16节）中进行。促进者和参与者在每节课结束时完成一份5分钟的保真度评估清单，同时由训练有素的研究助理对25%的课程进行独立的保真度观察。对数据进行分析，以评估计划实施与实际实施之间的关系。
在本研究中，MFG干预措施包括1290名参与者和照顾者，儿童的平均年龄为12岁，大多数照顾者为女性，具有小学教育程度。每节课的平均出勤率超过70%，33%的参与者参加了全部15节课，77.4%的参与者至少参加了11节课，表明依从性良好。参与者完成了16470份保真度评估调查，显示干预内容的覆盖率极高（95%-100%），且随着时间的推移有所提高。研究助理报告保真度较高，567次评估显示覆盖率为93%-98%。促进者填写了2189份调查问卷，每节课内容的平均覆盖率为98.6%。
保真度评估表明，MFG干预措施在乌干达得到了良好的实施。高依从性和积极反馈证实了该干预措施的成功实施，并支持在心理健康专家有限的国家进行任务转移心理健康干预的同时保持高保真度。
