UCLA

The gap between the need for mental health treatment and access to services is vast, especially in low- and middle-income countries (LMICs; Wang et al., 2007), and particularly among children and adolescents in these under-resourced settings (Patel et al., 2008). Closing the gap has become a public health priority in recent years (Lancet Global Mental Health Group, 2007). Task sharing and scaling up evidence-based treatments (EBTs) have been identified as two possible strategies to addressing the gap, with promising results (Singla et al., 2014). However, questions remain concerning the transportability of treatments developed in the West to populations for whom they were not initially intended, and in contexts that bear little resemblance to the highly controlled research settings in which they were conceived. The goal of this dissertation was to describe the process of building a context-sensitive, context-centered intervention using an evidence-informed design system and to evaluate user acceptability, satisfaction, and engagement. The first study used qualitative methods to document the iterative process of developing a treatment protocol in collaboration with local stakeholders and experts. Results demonstrate the central role that cultural/contextual considerations, protocol material and content, and complexity played in the design process, providing a blueprint for bringing together established treatment design principles with local knowledge to develop an intervention that is acceptable to providers and satisfying for youth participants in low-resource settings. The second study evaluated youth engagement in the intervention, as well the overall acceptability, feasibility, and fit of treatment from the youth and provider perspectives. Findings revealed that youth and providers largely perceived the treatment to be engaging, acceptable, and appropriate for the context. These results, along with participant recommendations for improvements, have the potential to inform the development of resources that promote youth engagement in the intervention. Taken together, these studies provide an inside look at the collaborative design-in-context approach of building an intervention in a low-resource setting along with users’ experience with the intervention in an initial pilot. Findings have the potential to narrow the treatment gap through promoting the development and scale up of acceptable, effective, and sustainable mental health treatments for one of the most vulnerable populations: children and adolescents in LMICs.