Simplified Cognitive Behaviour Therapy (CBT) Methodologies To Address Household-Based Challenges: Lessons from Rakai Communities in Uganda

It is possible for child-bearing girls and women to become better equipped to adopt health promoting practices if provided targeted services such as family planning, sexual-reproductive products, health-seeking practices and household income improvement opportunities and supported through facilitated and mentored training.

Health workers trained in enabling and responsive context analysis; recalling and examining stories about the contexts; and applying research methods to collect data to be used to generate reports, become knowledgeable, skilled and use their agency to share findings during community outreaches and among peers e.g., during Public Health Grand Rounds. The health workers are able to present thematic articles based on pre-arranged tracks which can be used as community outreach themes promoting healthy living outcomes.

The Rakai Community-Based health Project (RACHEP) came up with a simplified version of Cognitive Behavior Therapy (CBT) provided through group sessions targeting health workers. The sessions empower health workers through acquiring knowledge, skills and the attitude to provide better postpartum care, promote uptake of health-seeking practices, engage in nutrition rehabilitation and establish zero-violence spaces in their households. The aim was to establish risk-mitigating mechanisms in villages such as Katuntu, Kabona, Kyanika, Njala, Ndolo, Kakundi, Kabusita, Bugona, Butiti, Kanoni, Kasensero and Bitibago. Empowering health workers enables them to develop advocacy products in form of write-ups and case-studies too which can be shared widely in a form that allows for lessons to be shared. These tools were cues that helped the health workers to engage household or community members in therapy sessions to alleviate symptoms of fear, anxiety and depression. Advancing practices such as family planning, use of sexual-reproductive products and household income improvement opportunities promotes good health and wellbeing as well as healthy living outcomes.

The training sessions were opportunities for health workers to examine the character and influencing elements within the enabling and responsive contexts defined as: Political, economic, social, cultural, structural, cultural, legal, bio-medical, behavioural and civic dimensions.

We used lived experiences, how the stories become cues for lifestyles. This is when we examine the lifestyles to gauge how they affect the Quality of Life (QoL) and Life outcomes.

Some of the stories we picked out had an effect on gender and nutrition so we had to design social justice infused interventions. Some instances of the stories are:

“My husband wants be to get bigger and grow a large behind. That is why I am the only one supposed to take the milk and the children have to do with plain tea.”

“An extremely malnourished child is a sign of “Namunye.” The solution is that the household needs to consult a special healer. So, the household members have to look up that special healer and be subjected to the instructions of the special healer until the child heals.”

The health workers reach out to households drawn from social maps developed earlier and through this tool we were able to identify the most vulnerable who needed support. The eligibility criteria: households that expressed need for Family Planning, nutrition rehab, drug and alcohol abuse detox support services; households and communities targeted for social-economic transformation skilling; households where symptoms of depression, anxiety and pain following use of Family Planning methods need addressing or follow up; eligible adolescents, young and adult females who needed comprehensive HIV Prevention methods including PrEP, Vaginal Rings and Injectable PrEP; eligible adolescents, young and adult males who needed comprehensive HIV Prevention methods including PrEP, VMMC, Abstinence knowledge support, Delaying Sexual Debut, rehabilitation following drug/alcohol/substance/tobacco abuse (DASTA); Delaying drug/alcohol/substance/tobacco use (DASTU); and referral of those who will benefit from clinic based care.

The trainings are built on the concepts of CBT, which is considered the gold standard in counseling, works to modify beliefs and assumptions and can lead to positive changes in behaviour and overall improvements to social, physical and mental health.

The sessions are designed to empower health workers to draw social maps of the catchment area; design stakeholder maps; use skills to identify and question?unhelpful thoughts, using stories which focused on how thoughts can impact mood and behaviours that are important for overall health outcomes. The process allowed for discussions through which there was room to engage in problem-posing, solving challenges and build social connections.

In regard to health-seeking behaviour, socialization, fears, attributes, recognition, reward, depression and anxiety affect so many of the behaviours and skills that are important in the process of considering, demanding and uptake of heath promoting services, use and acting on one’s health outcomes intentions.

Empowering health workers to use the health education and promotion models we developed was helpful to them because they were able to manage and address predictors of risks and vulnerabilities. Strategic plans were in place to ensure lasting effects, to motivate people to make demands and improve uptake of services.

When health workers are provided advocacy skills to address the challenges they improve their own mental health and that of the people they serve. They encourage behaviours that will help to address concerns and promote good health and wellbeing.

There is need to engage in identifying households that need interventions. This contributes to creating priorities for care and empowering household members to share their stories which promotes connection with other members. This connection brings about opening-up, empathy, compassion and sharing responsibilities. With shared responsibilities members are able to care for each other’s concerns.

Health workers need to be provided the knowledge and skills to examine the enabling and responsive contexts characterised along Political, economic, social, cultural, structural, cultural, legal, bio-medical, behavioural and civic dimensions, they are able to develop stakeholder referral lists. These referral lists come in handy when they need to refer household members for further support. Referral networks make it possible to break down barriers, fears and stigma.

Providing health workers with knowledge and skills to engage in minor interventions greatly increases access to social, physical and mental health services for all people.

?