Elsevier

Behavior Therapy

Volume 50, Issue 2, March 2019, Pages 459-473
Behavior Therapy

A Direct Observational Measure of Family Functioning for a Low-Resource Setting: Adaptation and Feasibility in a Kenyan Sample,☆☆

https://doi.org/10.1016/j.beth.2018.08.004Get rights and content

Highlights

  • Observational assessment of family functioning was feasible and acceptable in Kenya

  • Existing tools can be adapted for diverse, low-resource settings

  • The adapted tool changed to capture context-specific functioning

Abstract

Family interactions are recognized as highly influential for youth development of psychopathology. Key challenges for assessing family functioning include cross-cultural variability in functioning and self-report measurement challenges. Observational measures—adapted to cultural context—provide an approach to addressing challenges. This study aimed to adapt a direct observational tool for assessing family interaction patterns in Kenya, to outline a replicable adaptation process, and to explore tool feasibility and acceptability. We reviewed existing tools to assess their adaptability based on compatibility with context-specific data. After initial modifications, the measure was iteratively adapted through pilot testing and collaborative discussions between U.S. and Kenyan collaborators that drove changes and further piloting. The measure was administered to 26 families. The Family Problem Solving Code was chosen for adaptation. The tool’s activity structure was feasible to administer, but activity content showed low acceptability, requiring new content. Final activities included (a) a hands-on problem-solving task, (b) a discussion of marital conflict with couples, and (c) a structured discussion of family hopes. Codes were adapted to reflect culturally congruent descriptions of behavior, expressions, and interactions, including an emphasis on nonverbal interactions. The scoring system was modified to facilitate training and consistent rating among trainees with limited experience. Observational tool findings were consistent with those of an interview assessing family functioning, rated by clinical and non-clinical raters. Adaptation resulted in a culturally relevant tool assessing family functioning that proved feasible and acceptable. The adaptation process also proved feasible and efficient in a low-resource setting, suggesting its utility for other contexts.

Section snippets

Setting

Study activities were conducted in peri-urban communities outside of Eldoret, Kenya. Eldoret is the third largest town in Kenya and is located on a main transportation route that runs from a costal port through Nairobi and into Uganda. The town lies within the Rift Valley and is home to multiple ethnic groups including Kalenjin, Luhya, Kikuyu, and Luo populations.

Participants

Participants included families with at least one caregiver over age 18 and at least one child between the ages of 10 and 17. We used

Context-Specific Qualitative Findings

Interview, FGD, and video-recorded role-play data resulted in context-specific indicators of family functioning. Core themes included the importance of structure and hierarchies; communication, emotional trust and respect; problem solving and planning, particularly regarding managing finances in the face of poverty; gendered family processes; and risks of discrimination and favoritism. Related to behaviors likely to emerge in direct observation, the strong emphasis on hierarchy and boundaries

Discussion

Through a multistep process, we adapted an observational measure of family functioning that proved feasible and acceptable to administer and rate in a low-resource context. Results yielded a direct observational tool for assessing family functioning that could be adapted across other low-resource settings. FAMPROS was chosen as the anchoring measure for adaptation and was initially modified based on context-specific family interaction data. Through iterative pilot testing, collaborative

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

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  • We wish to thank the team of enumerators and coders who administered and rated activities and family interactions, as well as all the families who participated. Dr. Kaiser was supported by an NRSA postdoctoral fellowship from the National Institute of Mental Health (MH113288). Drs. Puffer and Kaiser are fellows of the Implementation Research Institute.

    ☆☆

    Funding: This work was supported by the Duke Global Health Institute.

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