Adaptation and Testing a Combined Intervention for Intimate Partner Violence and Mental Health for Women Living in Two Informal Settlements in Nairobi, Kenya

Background

In sub-Saharan Africa, 36.6% of women have experienced intimate partner violence (IPV), and some face consequential mental health disorders. In Kenya, 39% have encountered IPV, though these high rates likely underestimate the prevalence of IPV in informal settlements. IPV and common mental health disorders (CMDs) are highly prevalent in low-resource settings, particularly within informal settlements in Kenya. These communities deal with significant shortages of healthcare facilities, trained professionals, and services associated with IPV and mental health. Consequently, researchers, practitioners, and policymakers should consider integrating low-cost interventions to address these issues effectively. Brief, combined interventions delivered by non-experts offer a promising strategy for simultaneously tackling IPV and mental health concerns. However, such integrated approaches remain underexplored.

Methods

This study outlines the adaptation and implementation of a combined intervention called WINGS of Hope (WINGS) for intimate partner violence (IPV) and Problem Management Plus (PM+) for mental health, collectively referred to as WINGS+PM+. The intervention was developed through a multi-stage process, building on previous stand-alone implementations of WINGS and PM+ to comprehensively address life challenges, including IPV, that affect mental health. The adaptation process included three formative phases. In phase 1, in-depth interviews (n=30) were conducted with medical staff from two clinics (Kianda 42 in Kibera and Upendo in Mathare) in addition to four focused group discussions (FGDs) with community health promoters (n=24, with 6 participants per group). In phase 2, a community advisory board (CAB) (n=12) and a community consultation group (CCG) (n=12) were established to provide high-level oversight and ensure alignment with IPV response priorities. In phase 3, a randomized controlled trial was conducted among 260 IPV survivors in two informal settlements in Nairobi, Kenya, with trained community health promoters facilitating the intervention.

Results

This study is the first to combine and test WINGS and PM+. Central to the successful adaptation and implementation in this study was the collection of information on the key components of the intervention, the adaptation process (strengths of adaptation including high enrollment, iterative CCG and CAB workshops and meetings, and attendance; challenges of adaptation, such as barriers to FGDs and interview attendance and engagement, and barriers to CCG attendance and engagement), and the implementation strategies (e.g., strengths of implementation, such as meeting basic needs for participants, physical accessibility, trauma-informed care, high study enrollment and attendance; challenges of implementation, including barriers to session attendance and engagement, technology access and control, and challenges faced by participants actively experiencing IPV). We also report attendance rates, barriers to engagement, challenges faced, and solutions employed during delivery.

Conclusion

Findings show that it is feasible to implement a combined IPV and mental health intervention in informal settlements, with promising potential for scaling up. Community health promoters can effectively deliver these interventions, and common barriers can be addressed through adaptive, context-sensitive strategies. This study offers valuable insights into the integration of IPV and mental health interventions in low-resource settings. It also underscores the significance of community-based facilitators in addressing implementation challenges and boosting participant engagement.