Adapting and piloting a cognitive-behavioural group therapy-based anxiety intervention programme for vulnerable children from a disadvantaged background within the South African context

Myburgh, Naomi (2019-12)

Thesis (PhD)--Stellenbosch University, 2019.

Thesis

ENGLISH ABSTRACT: Anxiety is a prevalent psychological problem amongst children worldwide and has been identified as a concerning mental health issue in need of intervention, especially amongst vulnerable children within disadvantaged South African contexts. Within such contexts, access to mental health services is particularly limited due to a lack of resources that diminish service delivery capacity. Importantly, anxiety symptoms have demonstrated a trend towards the development of anxiety disorders and numerous associated negative outcomes in the absence of intervention. Cognitive-behavioural therapy (CBT)-based programmes have been established as an efficacious response to child anxiety disorders and effective as a preventive approach. Notably, preventive interventions have the potential to reduce demands on resources and increase reach with more universal dissemination by non-expert programme facilitators. Recent advances in CBT-based anxiety intervention research have pointed to the potential of brief, intensive formats as a cost-effective, accessible and child-friendly treatment alternative for childhood anxiety problems. The potential value of the contextual adaptation of evidence-based programmes and outcomes measures to fit with new priority populations has also been established. The adaptation of existing interventions may overcome context-specific barriers to the delivery of programmes. The current study was motivated by a dearth of intervention research in the South African context and the need for accessible, cost-effective and contextually tailored mental health services for vulnerable children in disadvantaged semi-rural farming communities in South Africa. In response, the current study was implemented in two phases. Phase 1 entailed the contextual adaptation of the group, CBT-based, Dutch Dappere Kat anxiety prevention programme, based on information obtained from multiple community consultations. This resulted in the formulation of the brief, intensive, Afrikaans Ek is Dapper (BRAVE) group CBT-based anxiety prevention programme. Phase 2 entailed a pilot study implementation and evaluation of the BRAVE programme with a mixed methods quasi-experimental design (with an immediate intervention group, a delayed intervention group, and pre-, post- and follow-up outcomes measures). A sample of 21 children (aged 9 to 14 and in Grades 3 to 7) participated in the pilot study implementation and programme evaluation on three semi-rural farm sites. Quantitative data pertaining to the preliminary effectiveness of the BRAVE programme were collected at four-time points (T1-T4). Qualitative data pertaining to the perceived effectiveness, feasibility and acceptability of the BRAVE programme were collected session-wise and at 3-months post-intervention. The pilot study mixed methods preliminary effectiveness evaluation produced promising trends in response to the BRAVE programme with a significant reduction in overall anxiety symptom scores over time. However, significance findings were variable and were interpreted with caution in the context of concerns with the outcomes measures identified in Phase 1 and the relatively small sample size of Phase 2. Qualitative data indicated promising outcomes in terms of the perceived effectiveness and benefit of the programme with reports of the acquisition, application and generalisation of programme-based coping skills post-intervention. Furthermore, feasibility outcomes were good and indicated that a brief, intensive implementation on farm sites by programme facilitators is worth considering. Finally, the programme and its adaptations yielded good acceptability as reported by both participants and programme implementation observers. The outcomes and findings of the current South African study, a first of its kind, was critically reviewed with recommendations for future research of a similar nature. Keywords: anxiety symptoms, vulnerable children, CBT-based programmes, brief intensive prevention, contextual adaptation, vulnerable children, pilot study.

AFRIKAANSE OPSOMMING: Angs is ʼn heersende sielkundige probleem onder kinders en is geïdentifiseer as ʼn sorgwekkende geestesgesondheidskwessie wat intervensie benodig, veral onder kwesbare kinders in agtergeblewe Suid-Afrikaanse kontekste. Binne hierdie kontekste is toegang tot geestesgesondheidsdienste veral beperk weens menslike hulpbron-, logistiese- en geldtekorte en dit beïnvloed dus die beskikbaarheid van behandeling. Veral van belang hier, is dat angs wat nie aangespreek word nie, geneig is om te lei tot die ontwikkeling van simptome van angsversteurings en ander verwante negatiewe uitkomste. Kognitiewe gedragsterapie (KGT)-gebaseerde programme is bewys as ʼn effektiewe respons tot angsversteurings by kinders en ook as ʼn voorkomende benadering vir kwesbare kinders. Dit is belowend, aangesien sulke voorkomende intervensies die potensiaal het om die eise op hulpbronne te verminder. Van verdere belang, is dat onlangse navorsing met betrekking tot KGT-gebaseerde intervensie, dui op die doeltreffendheid van korter, meer intensiewe formate in die verskaffing van koste-effektiewe, toeganklike en kindervriendelike behandeling vir kinder angsprobleme. Nuwe neigings in intervensie-navorsing dui ook op die potensiële waarde daarvan om hierdie programme, wat reeds as effektief vasgestel is, aan te pas vir ander kontekste sodat dit geskik is vir nuwe prioriteit-populasies. Hierdie aanpassing het ten doel om konteksspesifieke hindernisse tot die lewering van programme te oorkom en die effektiwiteits-uitkomstemetings ook kruis-kultureel aan te pas. Die huidige studie is gemotiveer deur die tekort aan intervensienavorsing en geestesgesondheidsdienslewering in semi-landelike plaasgemeenskappe in Suid-Afrika, en fokus daarop om kontekstueel en bestaande effektiewe KGT-gebaseerde voorkomingsintervensie-programme aan te pas, om die aangepaste program in ʼn semi-landelike gemeenskapkonteks te implementeer, en om die voorlopige effektiwiteit, lewensvatbaarheid en aanvaarbaarheid daarvan te evalueer as ʼn respons tot kinderangs-probleme binne hierdie konteks. In reaksie op hierdie doelstelling, is die studie in twee fases geïmplementeer. Fase 1 het die kontekstuele aanpassing van die groep-, KGT-gebaseerde Nederlandse Dappere Kat angsvoorkomingsprogram behels deur middel van inligting wat uit veelvoudige gemeenskapskonsultasies verkry is. Dit het gelei tot die formulering van die kort, intensiewe Afrikaanse Ek is Dapper (genoem die DAPPER) groep-, KGT-gebaseerde angsvoorkomingsprogram. Fase 2 het die implementering en evaluasie van ʼn loodsprojek van die DAPPER-program behels met gemengde metodes, kwasi-eksperimentele ontwerp (met ʼn onmiddellike intervensiegroep, ʼn uitgestelde intervensiegroep en pre-, post- en opvolg-uitkomstemetings). ʼn Steekproef van 21 kinders (van ouderdomme 9 tot 14 en in Graad 3 tot 7) op drie semi-landelike plase het aan die loodsprojek se implementering en program-evaluasie deelgeneem. Kwantitatiewe data wat verband hou met die voorlopige effektiwiteit van die DAPPER-programme is tydens vier tydpunte (T1-T4) ingesamel. Kwalitatiewe data wat verband hou met die persepsies rondom effektiwiteit, lewensvatbaarheid en aanvaarbaarheid van die DAPPER-program is sessie-wyd asook 3 maande post-intervensie, ingesamel. Die loodsprojek se gemengde-metode, voorlopige effektiwiteits-evaluasie het belowende tendense getoon met betrekking tot die DAPPER-programme, met ʼn beduidende vermindering oor tyd in die algehele angssimptoom-tellings. Nietemin, bevindinge oor beduidendheid is veranderlik en is versigtig geïnterpreteer binne die konteks van bekommernis oor uitkomste-maatstawwe in Fase 1 en die relatiewe klein steekproefgrootte van Fase 2. Kwalitatiewe data het post-intervensie belowende uitkomste getoon in terme van die waargenome effektiwiteit en voordele van die program met rapportering van die verkryging, toepassing en veralgemening van programgebaseerde hanteringsvaardighede. Verder was lewensvatbaarheidsuitkomste goed en het daarop gedui dat kort, intensiewe implementering deur programfasiliteerders op die plase die moeite werd is om te oorweeg. Laastens het die program en die aanpassings daarvan goeie aanvaarbaarheid, soos gerapporteer deur beide deelnemers en waarnemers van die program-implementering opgelewer. Die uitkomste en bevindinge van die huidige Suid-Afrikaanse studie, die eerste van hierdie aard, is krities in oënskou geneem met aanbevelings vir toekomstige navorsing van ʼn soortgelyke aard. Sleutelwoorde: angssimptome, kwesbare kinders, KGT-gebaseerde programme, kort intensiewe voorkoming, kontekstuele aanpassing, loodsprogram.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/107086
This item appears in the following collections: