COVID-19 Crisis Psychoeducation Training for Community Leaders in Informal Settlements in Brazil and Kenya

Background and Purpose: COVID-19 has had a devastating impact on mental health globally. In the informal settlements surrounding Rio de Janeiro, Brazil, and Nairobi, Kenya, among the largest in the world, adversities such as high rates of poverty, psychological distress, substance abuse, and suicidality were greatly exacerbated. In the absence of resources and support, community leaders are and remain front line service providers as they also live and cope. The purpose of this pilot project was to demonstrate feasibility of a web-based crisis psychoeducation training to reduce pandemic-related mental health consequences for community leaders. Psychoeducation is an evidence-based intervention that attends to the lived experiences of participants through the core principle of exchange of knowledge between group members and facilitators, which encourages perspective-taking, active listening, empathy, and behavior change. Through this intervention, leaders’ self-efficacy and capacity is strengthened to locally respond to crises as they address their own mental health needs.

Methods: Using a mixed methods approach, community collaborative boards in each city shared development of study protocols prior to study enrollment. Recruited leaders completed assessments capturing mental health, self efficacy, and knowledge outcomes prior to and immediately post-intervention. In each city, from February-April, 2021, six weekly, 120-minute online training modules were delivered by investigators to leaders on: (1) core elements of psychoeducation, (2) grief and loss, (3) mental health and coping, (4) impacts of racism, stigma, and discrimination (5) interpersonal violence, and (6) social supports. WhatsApp connected researchers and participants for between session communications and to build and sustain community connections and support.

Results: Thirty-seven community leaders (n=16 in Brazil, n=21 in Kenya) enrolled. High attendance (above 76%) demonstrated feasibility of psychoeducation groups. Increased participant engagement and expression over time during and between sessions demonstrated growing group cohesion and support. Trends in preliminary descriptive statistics suggest that the training reduced depression and somatization and increased coping, hope, and general self-efficacy as well as knowledge of the components of psychoeducation; however, results from pairwise t-tests did not show significant differences between pre- and post-tests. In qualitative reports, participants described “rich exchanges” of “experience, practice, and shared knowledge,” were “professionally enriching” and “the space of collective care strengthened” them individually. Some reported that the trainings helped them feel as if they were “not the only one who felt the weight and difficulties of social action.”

Conclusions and Implications: Findings suggest that community health workers both strengthened individual as well as professional skills and capacity to intervene using a psychoeducation approach. While the small sample size limited detection of significant differences in quantitative measures across time, high attendance and participation, consistent and continued use of the Whatsapp forum for communication during and after the trainings, and expressions of belonging during sessions and in the Whatsapp forum suggest these trainings have been an important tool for building community support among leaders in informal settlements during the COVID-19 pandemic and strengthening their capacity and efficacy as trainers to offer similar trainings to enhance the health and mental health within their own communities.