From “4Rs and 2Ss” to “Amaka Amasanyufu” (Happy Families): Adapting a U.S.-based Evidence-Based Intervention to the Uganda Context

In Uganda, one in five children presents mental health challenges, including disruptive behavior disorders (DBDs). DBDs can persist through adulthood and result in negative outcomes. Effective interventions for DBDs have been developed and tested in high-poverty communities in developed countries. Yet, most African countries, such as Uganda, lack such interventions. This paper describes the adaptation process of an evidence-based intervention of U.S. origin to optimize fit to context with intervention fidelity, as part of a randomized trial conducted with youth that exhibit behavioral challenges and their caregivers in 30 schools in Uganda. The process involved: initial meetings with headteachers and teachers to introduce the study and the main concepts of the intervention; initial manual review focusing on 4Rs and 2Ss content by the Uganda team; engagement of community stakeholders for additional feedback on content and cultural relevance; final revision of the manual; and collection of children’s drawings for the illustration of the manual. This paper describes both similarities and differences between the original and adapted intervention content and methods of delivery. The findings also highlight the importance of involving community stakeholders in the adaptation process.     

The role of illness uncertainty on coping with fibromyalgia symptoms.

This study examined the role of illness uncertainty in pain coping among women with fibromyalgia (FM), a chronic pain condition of unknown origin. Fifty-one FM participants completed initial demographic and illness uncertainty questionnaires and underwent 10-12 weekly interviews regarding pain, coping difficulty, and coping efficacy. Main outcome measures included weekly levels of difficulty coping with FM symptoms and coping efficacy. Multilevel analyses indicated that pain elevations for those high in illness uncertainty predicted increases in coping difficulty. Furthermore, when participants had more difficulty coping, they reported lower levels of coping efficacy. Results were consistent with hypothesized effects. Illness uncertainty accompanied by episodic pain negatively influenced coping efficacy, an important resource in adaptation to FM.     

The Role of Status in Producing Depressed Entitlement in Women's and Men's Pay Allocations

Extensive empirical evidence confirms a depressed entitlement effect wherein women pay themselves less than men for comparable work and believe the allocation fair. The present study tests the hypothesis that status subordination linked to being female underlies at least some of this effect. A 2 × 3 design crossed 180 undergraduates' gender with a control condition, which successfully established the depressed entitlement effect, and two experimental conditions. In one, women's status was enhanced through legitimation of women's task abilities; in the other, both women's and men's status was enhanced by adding educational credentials relevant to task ability. Follow-up analyses of the significant interaction revealed that the gap in self-pay demonstrated in the control condition disappeared when women's status was enhanced such that higher-status women's self-pay equaled that of men and exceeded that of control women. Although these findings confirm that status plays a role in producing depressed entitlement in self-pay, ancillary analyses of participants' perceptions point to the persistence of shifting standards and men's resistance to status threats.     

Reducing STD/HIV Stigmatizing Attitudes Through Community Popular Opinion Leaders in Chinese Markets

Reducing STDs and HIV/AIDS incidence requires campaigns designed to change knowledge, attitudes, and practices of risky sexual behavior. In China, a significant obstacle to such changes is the stigma associated with these diseases. Thus 1 campaign intervention strategy is to train credible community leaders to discuss these issues in everyday social venues. This study tested the effectiveness of such an approach on reducing HIV/AIDS stigma, across 2 years, from a sample of over 4,500 market vendors, in 3 conditions. Results showed an increasing growth in market communication about intervention messages, and concomitant declines in stigmatizing attitudes, across time, with the greatest changes in community popular opinion leaders, significant changes in intervention nonopinion leaders, and little change in the control markets.     

The Heart of the Matter: An Essay about the Effects of Managed Care on Family Therapy with Children*

This essay is based on a pilot study that examined the effects of managed care on the treatment of children and families, with special attention to community mental health. We embarked on the pilot study to test the accuracy and generalizability of our impression that family therapy and other systemic practices have been marginalized in ordinary clinics and agencies, and to understand the reasons why. We interviewed managed care providers, researchers, family therapy trainers, and clinicians in the Northeast. Our findings led to seven themes that support our impression that, even though there is a consensus about the need for coordinated family-based services, there is a disconnection between state policies, contractual requirements and what is actually occurring at the implementation level. This study suggests that our knowledge of human systems may be in danger of being disqualified and lost, with damaging consequences for the care of children. Yet, as systemic thinkers and practitioners, it is our belief that ethical and effective treatment need not be at odds with care that is cost-efficient. The direction of our future research will be to study whether the involvement of all stakeholders at all levels of planning and training leads to systemic family-based practices that consistently save costs and provide high-quality care.