Participatory research to support the development of culturally sensitive mental health and wellbeing services for the Kankuamo people of Colombia
Lead Research Organisation:
University of Liverpool
Department Name: Primary Care and Mental Health
Abstract
Phase 1: Knowledge Dialogue (Months 1-8)
A) Literature review - application of capability approach with indigenous populations;
B) Five stakeholder engagement workshops aimed at enhancing understanding about the mental health and quality of life of the Kankuamo people will be held. Sixty individuals (including traditional healers, community elders, health workers) will be purposively sampled from across the twelve Kankuamo communities. Data will be collected using Module One the Design, Implementation, Monitoring and Evaluation (DIME) approach. Module 1 of DIME elicits relevant qualitative information about: 1) Problems that adults in the community face; 2) The key function/tasks that adults are required to frequently undertake for themselves, their families, and their communities; 3) The advice that is currently provided by recognised community experts (i.e. key informants) to address the problems. Building on our work in Uganda and Rwanda as part of the ESRC funded COSTAR project (ES/S000976/1), this work will include a focus on the Capability Approach (Sen, 1999) through the inclusion of an additional question that will ask community members to indicate: 'What does a good life mean to you?'.
Phase II: Developing Assessment Instruments (Months 9-13)
A) Development or adaptation of assessment instruments for: i) common mental disorders, ii) quality of life based on the qualitative findings from Phase I. This will be guided by Module two of the DIME approach and will utilise the data collected in Phase 1.
B) Piloting of Assessment Instrument - the two assessment instruments developed in Phase IIA will be piloted according to Module Three of the DIME Approach. Data collection will take place via a survey of 380 households across the 12 Kankuamo and will be undertaken by the participants of phase I, accompanied by members from the research team. The survey will include the novel assessment instruments for common mental disorders and quality of life, as well as internationally recognised standardised measures of depressive symptoms (i.e. PHQ-9) and quality of life (WHOQoL-BREF). Following the completion of the survey, purposive sampling will be used to recruit a subsample of participants into focus groups discussions (1 FGD of 10 people for each of the 12 communities; total N = 120) to provide qualitative feedback about the assessment instruments (including the cultural acceptability).
C) Validation of the assessment instruments - Correlational analyses will be conducted on the data collected in Phase IIB to determine the construct validity of the new assessment instruments compared to PHQ9 and WHOQoL-BREF.
Phase III: Guideline development (Months 13-20)
Members from all 12 Kankuamo communities (N=120) will be invited to a combination of focus groups, workshops and interactive activities over a 2-day period to co-produce guidelines for the development and delivery of culturally sensitive primary care community mental health support. This will include consideration of ethical and legal obligations of stakeholders.
Phase IV: Development and evaluation of the training program (Months 20-30)
This phase will involve the development, delivery and evaluation of a training program aimed at training Community Wellbeing Advocate (CWA) to identify people experiencing mental health difficulties within the Kankuamo community, and to signpost them to appropriate, locally available, forms of support.
A) Develop a short 3-day CWA training program based on the findings from Phase I, Phase II and Phase III.
B) Deliver a 3-day CWA training program to participants (N=60).
C) Evaluate: i) the acceptability of the CWA training program (two FGD of up to 8 CWA trainees 1-month post-training, ii) feedback from community members who have interacted with the CWA (2 FGD of up to 8 community members).
D) Adjust the CWA training programme according to feedback received from the CWA trainees and community members in Phase IVC.
A) Literature review - application of capability approach with indigenous populations;
B) Five stakeholder engagement workshops aimed at enhancing understanding about the mental health and quality of life of the Kankuamo people will be held. Sixty individuals (including traditional healers, community elders, health workers) will be purposively sampled from across the twelve Kankuamo communities. Data will be collected using Module One the Design, Implementation, Monitoring and Evaluation (DIME) approach. Module 1 of DIME elicits relevant qualitative information about: 1) Problems that adults in the community face; 2) The key function/tasks that adults are required to frequently undertake for themselves, their families, and their communities; 3) The advice that is currently provided by recognised community experts (i.e. key informants) to address the problems. Building on our work in Uganda and Rwanda as part of the ESRC funded COSTAR project (ES/S000976/1), this work will include a focus on the Capability Approach (Sen, 1999) through the inclusion of an additional question that will ask community members to indicate: 'What does a good life mean to you?'.
Phase II: Developing Assessment Instruments (Months 9-13)
A) Development or adaptation of assessment instruments for: i) common mental disorders, ii) quality of life based on the qualitative findings from Phase I. This will be guided by Module two of the DIME approach and will utilise the data collected in Phase 1.
B) Piloting of Assessment Instrument - the two assessment instruments developed in Phase IIA will be piloted according to Module Three of the DIME Approach. Data collection will take place via a survey of 380 households across the 12 Kankuamo and will be undertaken by the participants of phase I, accompanied by members from the research team. The survey will include the novel assessment instruments for common mental disorders and quality of life, as well as internationally recognised standardised measures of depressive symptoms (i.e. PHQ-9) and quality of life (WHOQoL-BREF). Following the completion of the survey, purposive sampling will be used to recruit a subsample of participants into focus groups discussions (1 FGD of 10 people for each of the 12 communities; total N = 120) to provide qualitative feedback about the assessment instruments (including the cultural acceptability).
C) Validation of the assessment instruments - Correlational analyses will be conducted on the data collected in Phase IIB to determine the construct validity of the new assessment instruments compared to PHQ9 and WHOQoL-BREF.
Phase III: Guideline development (Months 13-20)
Members from all 12 Kankuamo communities (N=120) will be invited to a combination of focus groups, workshops and interactive activities over a 2-day period to co-produce guidelines for the development and delivery of culturally sensitive primary care community mental health support. This will include consideration of ethical and legal obligations of stakeholders.
Phase IV: Development and evaluation of the training program (Months 20-30)
This phase will involve the development, delivery and evaluation of a training program aimed at training Community Wellbeing Advocate (CWA) to identify people experiencing mental health difficulties within the Kankuamo community, and to signpost them to appropriate, locally available, forms of support.
A) Develop a short 3-day CWA training program based on the findings from Phase I, Phase II and Phase III.
B) Deliver a 3-day CWA training program to participants (N=60).
C) Evaluate: i) the acceptability of the CWA training program (two FGD of up to 8 CWA trainees 1-month post-training, ii) feedback from community members who have interacted with the CWA (2 FGD of up to 8 community members).
D) Adjust the CWA training programme according to feedback received from the CWA trainees and community members in Phase IVC.
Publications
Van Der Boor C
(2022)
Application of the capability approach to Indigenous People's health and well-being: protocol for a mixed-methods scoping review.
in BMJ open
| Description | We have developed an assessment instrument / questionnaire (the Kankuamo Wellbeing Scale) that allows health workers working with the Kankuamo indigenous people in Colombia to assess community members' wellbeing. This is the first questionnaire of its type. |
| Exploitation Route | We hope that Kankuamo Wellbeing Scale can be used to benefit the Kankuamo communities living in Colombia. |
| Sectors | Communities and Social Services/Policy,Healthcare |
| Title | The Kankuamo Wellbeing Scale |
| Description | The SÉYAKA project has been developing the first culturally sensitive assessment instrument (the Kankuamo Wellbeing Scale) for use with the indigenous Kankaumo people of Colombia. We will produce guidelines that will allow representatives from the indigenous health services to use the Kankuamo Wellbeing Scale in appropriate ways to facilitate the monitoring of the community members' wellbeing for the first time. |
| Type Of Material | Physiological assessment or outcome measure |
| Year Produced | 2022 |
| Provided To Others? | No |
| Impact | The Colombian Government estimates that the Kankuamo population consists of approximately 17,000 people living in the Sierra Nevada of Santa Marta region of Northern Colombia. An academic paper reporting on the development of the Kankuamo Wellbeing Scale and the completion of guidelines that will allow representatives from the indigenous health services to appropriately use the Kankuamo Wellbeing Scale to monitor community members' wellbeing. This is the first time that this will have been possible and is consistent with Colombian government and United Nations policy highlighting the need to tailor mental health assessment and support to indigenous community needs. |
| Title | A preliminary analysis of the psychometric properties of the Kankuamo Wellbeing Scale |
| Description | Data collected during fieldwork in February 2022 that surveyed members of the Kankuamo communities to facilitate a preliminary analysis of the psychometric properties of the Kankuamo Wellbeing Scale. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | No |
| Impact | No notable impact as yet. |
| Description | SÉYAKA collaboration with colleagues at Universidad Externado de Colombia, Bogota, Colombia |
| Organisation | Externado University of Colombia |
| Country | Colombia |
| Sector | Academic/University |
| PI Contribution | The SÉYAKA project aims to use participatory action research to support the mental health and wellbeing of the Kankuamo indigenous peoples of Colombia that the UK team are undertaking in partnership with Colombian academic colleagues based at Universidad Externado de Colombia in Bogota. The Colombian Government estimates that the Kankuamo population consists of approximately 17,000 people living in the Sierra Nevada of Santa Marta region of Northern Colombia. The project is using inclusive participatory action research methods which have meant that representatives from the Kankuamo communities are core members of the research team. Fieldwork conducted with the Kankuamo communities will be completed by a member of the UK research team in collaboration with colleagues at Externado Universidad de Colombia. This will lead to the preparation of three research papers: 1. A qualitative exploration of what a 'good life' means to the indigenous Kankuamo peoples of Colombia (in Spanish) 2. The development and validation of the 'Kankuamo Wellbeing Scale': a validation study with the indigenous Kankuamo peoples of Colombia (in English) 3. Application of the Capability Approach to support indigenous people's health and wellbeing: a mixed method scoping review (in English) In addition, we will work with our academic partners in Colombia and representatives from the Kankuamo communities to produce guidelines that will allow representatives from the indigenous health services to use the Kankuamo Wellbeing Scale in appropriate ways to facilitate the monitoring of the community members' wellbeing for the first time. |
| Collaborator Contribution | Colleagues based at Universidad Externado de Colombia, Bogota have built considerable good will and trust with the Kankuamo communities that will be pivotal for the progress of the work. They have expert knowledge of the local geography and cultural context that will be invaluable to the progress of the work. |
| Impact | This is a multidisciplinary project incorporating expertise in clinical psychology, global mental health, ethics, applied social science, psychiatry and anthropology. There are no outputs to date. |
| Start Year | 2021 |
| Description | Colombia Mental Health 2020 Grant Holder Meet and Greet - organised by UKRI (ESRC) |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other audiences |
| Results and Impact | This was an online meeting that brought together the investigators working on the projects funded by the ESRC/Newton Fund investigating mental health in post-conflict Colombia. The investigators presented their respective projects and discussed mutually relevant themes and topics. |
| Year(s) Of Engagement Activity | 2021 |