Mental Health Literacy and Mental Health Promotion With Urban Refugee Youth in Kampala, Uganda

Study Overview
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Brief Summary
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From our previous studies, we know that urban refugee youth commonly report depressive symptoms. The primary aim of this study is to compare the effectiveness of youth-tailored interventions to improve mental health literacy and reduce mental health stigma among urban refugee youth in Kampala, Uganda. There will be two intervention arms and one control arm. The first intervention arm will involve a VR experience that focuses on mental health literacy and coping strategies, as well as SMS check-ins from peer navigators (PN) trained in psychological first aid. The second intervention arm will involve an adapted version of the WHO's Group Problem Management Plus. The primary outcomes are to a) increase mental health literacy (knowledge and understanding of mental health generally and of specific disorders; b) increase attitudes towards mental health help-seeking, c) reduce depression, d) increase adaptive coping strategies; e) reduce mental health stigma, f) improve mental wellbeing, and g) increase level of functioning. Participants will complete a pre- and post-intervention survey as well as a follow-up survey.

Official Title
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Tushirikiane4MH: Mental Health Literacy and Mental Health Promotion With Urban Refugee Youth in Kampala, Uganda

Conditions
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Mental Health

Intervention / Treatment
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* Behavioral: VR + MHL intervention
* Behavioral: Group PM+


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: living in one of the 5 informal settlements in Kampala we already work with (Nsambya, Katwe, Rubaga, Kabalagala, Kansanga); self identify as a woman or man (transgender inclusive); identify as a refugee/displaced person/having refugee parents; aged 16-25; own a mobile phone; speak Swahili, Luganda, Kirundi, Kinyarwanda, French or English and can provide informed consent. Exclusion Criteria: -

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 25 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The two intervention arms will be compared to the control arm of the study using a pre- and post-intervention survey. There will also be a follow-up survey 8 weeks after the study is complete.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Virtual reality and mental health literacy intervention<br>This arm will participate in an interactive virtual reality experience to learn and practice mental health literacy and psychological first aid skills, supplemented by mhealth SMS with informational bidirectional messages. | Behavioral: VR + MHL intervention<br>* The intervention will include: 1) a Virtual Reality (VR) interactive and immersive 30-minute session viewed using a low cost VR headset; and 2) an 8-week program of weekly WelTel SMS check-ins managed by Peer Navigators (PNs), weekly WelTel SMS blasts informed by Psychological First Aid (PFA) with mental health literacy (MHL) messages developed with PN, and weekly WelTel web-based secure platform social group discussions on MHL, stress coping, and stigma moderated by PN alongside a trained Coordinator. Weekly MHL WelTel platform moderated discussion foci will address MHL, stigma and stress coping strategies, including self-compassion and other strategies that emerge from the urban refugee youth interviews and focus groups, through diverse methods, including: 'scenarios' mimicking real life situations; a 'question box'; sharing photos demonstrating stress coping strategies; memes; songs; and ways participants interrupted stigma in their daily lives.<br>|
| Experimental: Group Problem Management+ and VR/mental health literacy<br>This arm will participate in an interactive virtual reality experience to learn and practice mental health literacy and psychological first aid skills, supplemented by mhealth SMS with informational bidirectional messages. This arm will also participate in an 5-week Group Problem Management Plus intervention, a group based problem solving intervention. | Behavioral: Group PM+<br>* Participants will attend small groups (5-6 participants with a PN and a coordinator supporting) outdoors with physically distancing, for Group PM+ sessions following the adapted WHO Group-PM+ manual (adaptations made in Phase 1 explain above) 5 weekly 3-hour sessions delivered by PN who will co-facilitate sessions with the Coordinator. Each session has a mechanism of action: Managing stress: mechanism of action-identify goals, learn deep breathing and techniques for stress management Managing problems: mechanism of action-identify 1 solvable practical problem, brainstorm possible solutions together Get going, keep doing: mechanism of action-learn about depression and inactivity, identify and plan small enjoyable activities Strengthen social support: mechanism of action-discuss a range of social support resources, make plan to increase social support Staying well: mechanism of action- this session reviews all of the mechanisms of action in the prior 4 sessions<br>|
| No Intervention: Control<br>This is a waitlist control. After Arms 1 and 2 are complete, the waitlist will receive the Group Problem Management Plus 5 week intervention on its own. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mental health literacy | Measured using a modified depression literacy scale validated in Low- and Middle- Income Countries (LMICs) | change from baseline at 16 weeks | 
| Attitudes towards mental health help seeking | Measured using the Inventory of Attitudes towards Seeking Mental Health Services | change from baseline at 16 weeks | 
| Depression | Measured using the PHQ-9 | change from baseline at 16 weeks | 
| Adaptive coping strategies | Measured by the Kidcope and Self-Compassion Scale for Youth | change from baseline at 16 weeks | 
| Mental Health Stigma | Measured using the Brief Version of the Internalized Stigma of Mental Illness (ISMI) Scale | change from baseline at 16 weeks | 
| Mental wellbeing | Measured using the WHO-Five Wellbeing Scale | change from baseline at 16 weeks | 
| Level of functioning | Measured usingWHO Disability Assessment Schedule | change from baseline at 16 weeks |