ABSTRACT

Development of a Culture - Specific Scale for Assessing Behavior and Emotional Problems in Kenyan Adolescents

by

Bernard K. Njuguna

Child and adolescent mental health assessment in Sub-Saharan Africa has by large been acknowledged as requiring specific homegrown culture-sensitive scales for epidemiological, and intervention purposes (e.g. Abubaker et al., Harder et al. 2014; 2007; Ndetei & Achenbach 2012). The vicious cycle ensuing scarcity of validated and reliable data constrains advocacy for relevant and effective policies, which should address the quality of adolescents’ mental health in Africa. Kenya is no exception, and continues to observe increasing manifestations of psychopathology and related behavioral and emotional problems among adolescents (Harder et al. 2014; Kuria & Ndetei 2011). This study was designed to evaluate the development of a culture – based adolescent centered instrument for assessing adolescents’ behavior and emotional problems within the Kenyan cultural context. The initiative for creating a new instrument is part of a response to a larger quest for culture-sensitive tools for psychological assessment in sub-Saharan Africa (e.g. Abubaker et al., 2007; Mpofu, 2002b; Harder et al. 2014; Ndetei & Achenbach 2012). As a cross-national and poly-culture driven psychometric scale, the process of creating, drafting and testing the scale was done through long-term consultations and corroboration with the targeted cultural population, their care providers, mental health workers educationists, ordained faith ministers, local culture experts and ordinary local citizens. I surveyed 1473 adolescents aged 13–18 years drawn from the Kenyan cities of Mombasa, Nairobi, and Kisumu. The sample identified their cultural and traditional roots in 45 of the 48 counties of the Republic of Kenya which translates to a 93.7% inclusion of the diverse traditions and cultural communities in the study. The instrument evaluated in this study was a product of consultation and collaboration with local teenagers and their care providers consistent with Abubaker et al., (2007) recommendations. The process included focused group discussions with teenagers of diverse cultural heritage, their care providers and identified cultural experts. I conducted cognitive interviews with a prototype of the target population ranging from standard seven to form four (equivalent to grade eight through 12 US education system). I used the feedback from the cognitive interviews to refine the instrument, and used the adjusted version to conduct a pilot exercise to refine content and data collection strategies (e.g. Yin 1994; & Robson, 1999).

A principal component analysis procedure using orthogonal rotation method established a reduced 25- item clinical scale consisting of three-subscales with a minimum of five items in [each subscale. The nosological aspects of the subscales were guided by philosophical underpinnings consistent with the science of childhood and adolescent psychopathology. Each of the subscales demonstrated high levels of internal consistency evidenced by the Cronbach alpha for each subscale: Cognitive and Attention Problems (CAP) (nine items; α = .79); Depression and Anxiety Problems ( DAP) (10 items; α = .79); Conduct and Disruptive Problems ( CDP) (six items; α = .76); and a strong stability showing moderate positive correlation between time 1 and time 2, r = .44, p < .01. DAP subscale depicted a significant strong positive relationship, r = .74, p < .01; consistent with the universally admissible reliability index for clinical scales (Kleine,1999). Implications of the findings compel strong recommendations for advancement to validate the Kenya Adolescent Behavior and Emotional Problems scale (K_ABEP) scale.