Head Teachers’ Perspectives on the Acceptability of an Evidence-Based Mental Health Intervention in Ugandan Schools: A Qualitative Study

Background: Up to 41% of adolescents suffer from emotional and behavioral difficulties in sub-Saharan Africa. However, little research has been conducted on child mental health services in sub-Saharan African countries, where 23% of the population is aged 10–19 years. Moreover, there is limited evidence on efficacious implementation of school-based interventions in low-income countries. This paper presents a qualitative evaluation of the acceptability of the evidence-based multiple family group (MFG) intervention in schools by focusing on the implementation experiences of school head teachers.

Methods: As part of the SMART Africa-Uganda randomized clinical trial, eight head teachers were selected for interviews using stratified purposive sampling. Interviews explored school experiences with hosting the program, school staff perceptions of the program, as well as facilitators and barriers to program sustainability and uptake. Interviews were conducted in Luganda using a semi-structured questionnaire, which were then transcribed verbatim and translated into English. Thematic analysis, using both a priori and open coding, was utilized to analyze the data.

Results: Head teachers reported positive experiences with MFG and emphasized its benefits to the school and community at large. MFG intervention was considered beneficial in building rapport between the school and community, improving participants’ socioemotional skills, and improving student-teacher relationships. The incorporation of school-wide activities and community resources, such as the church, into the intervention was valued by many head teachers as an integral part of ensuring the intervention's continuity. A significant challenge head teachers emphasized was funding issues related to sustaining the program. According to the head teachers, a critical component of sustaining the MFG intervention was integrating it into the school schedule.

Conclusion: The findings indicate that the high acceptability of the MFG intervention in school settings comes from the support the intervention provided for fostering positive caregiver–child relationships directly and better caregiver–school relationships indirectly. This qualitative study contributes to the literature on how sociocultural context can inform the acceptability and sustainability of school-based interventions.