IMPACT: implementation of a multisectoral programme to improve indigenous adolescent mental health in Brazil and Dominica

Background

The Latin American and Caribbean region is home to ~55 million Indigenous people who experience high levels of poverty due to historic structural discrimination. An urgent concern is the higher rates of mental health (MH) problems among Indigenous compared with non-Indigenous people, including higher rates of substance use and suicide among adolescents. There is a pressing need for culturally responsive MH programmes for Indigenous adolescents’ MH and for an understanding of how contexts shape programme implementation processes.

Aims

We aim to work in partnership with trained Indigenous people from their communities, to implement and evaluate a culturally adapted evidence-based multisectoral programme (Indigenous leaders requested the word ‘intervention’ to be replaced by ‘programme’ as ‘intervention’ was felt to have an authoritarian emphasis) to improve Indigenous adolescent (10-18 years) MH in Brazil and Dominica.

Project plan

The proposed study will be guided by the following specific aims:
(i) To engage Indigenous community stakeholders, including Indigenous adolescents, teachers, community health workers (ICHWs), nurses, social workers, village leaders, community champions, and policy actors in a collaborative process to maximise the effectiveness of a culturally adapted evidence-based adolescent mental health (MH) programme;
(ii) To build the capacity of Indigenous community stakeholders to promote culturally adapted MH messages to raise awareness of the importance of good MH, prevention, and treatment; and teachers, social workers, ICHWs and primary health care (PHC) nurses to identify and manage common adolescent MH problems, using culturally adapted WHO mental health Gap Action Programme – Implementation Guide (mhGAP-IG); (iii) To understand how the Indigenous contexts influence implementation strategies and outcomes;
(iv) To disseminate findings at community, national, regional and policy levels in collaboration with Indigenous adolescents and older youths. See Figure 1 for aims and objectives

Our study includes 4 Work Packages (WP):

WP1: Partnership and co-development: establish an Indigenous Adolescent Stakeholder Group (ASG) and a Stakeholder Implementation Group (SIG) at each site; co-develop culturally adapted evidence-based positive messages to be promoted during school and village activities; co-adapt the WHO’s Mental Health Gap Action Plan – Intervention Guides (mhGAP-IG) integrating culturally centred knowledge and customs.

WP2: Training implementors: train teachers, Indigenous community health workers (ICHWs) and community champions to embed the MH promotion messages, co-developed in
WP1, in community activities; use the adapted mhGAP-IG to train ICHWs and primary health care (PHC) practitioners to identify and manage common adolescent MH problems.

WP3: Programme evaluation: include ~1400 pupils aged 10-18 yrs in schools, local community clubs and PHC Centres and conduct mixed-method case studies to gain in-depth understanding of context and linkages affecting processes and outcomes (including MH, risk behaviours, general health); conduct site-specific programme economic evaluations.

WP4: Knowledge exchange and impact: support Indigenous adolescents to contribute to multi-media dissemination; support ASG and SIG on using findings for strengthening the responsiveness of their schools and PHC.

We focus on the prevention of MH disorders at a critical stage of the life course among Indigenous adolescents. Addressing health equity is also key . Nowhere is this more pertinent than for Indigenous adolescents who face the challenge of a legacy of social injustices and poor health. We are deeply aware that there has been a historic imposition of western-based research agendas on Indigenous communities. Our participatory methodologies and knowledge co-production are based on Indigenous worldviews. Longstanding partnerships between our research team and Indigenous communities allow us to explore an ambitious programme that spans education, health and community sectors.

Funding organisations

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