Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138

A qualitative exploration of participants’ preferred

elements of the 4-week, youth-led, youth-focused,

group-based Shamiri intervention: A brief

overview

Cecilia E. Jakobsson, Ruth Wangari, Symon Murage, Leroy Mwasaru, Veronica Ngatia, Tom

Osborn

Shamiri Institute, Nairobi, Kenya

Abstract

Introduction:

Adolescent mental health challenges have been identified as a public health

concern globally, especially in low- and middle-income countries (LMICs), due to the scarcity of

services, where help-seeking is often hampered by social stigma. A strategy

to increase the

availability of services is to implement, brief, stigma-free, and scalable interventions. The Shamiri

Intervention (the Kiswahili word for “thrive”) is an example of a 4-week, group-based intervention

which is implemented via 1-hour sessions within high school settings.

Purpose

: The present study employed qualitative methods to explore participant feedback on

their preferred elements of Shamiri Intervention. The aim is to use the feedback to help to guide

and improve intervention effectiveness, acceptability, and appropriateness. The results have the

potential to understand better lay-provided mental health service delivery and design among high

school students in LMICs, particularly in sub-Saharan Africa.

Methodology: The project employed a qualitative phenomenological design to collect participant

feedback, and reflective thematic analysis was used to analyze the data.

Results: The researchers

constructed the following themes to summarize the participants’

responses: learning (acquiring new knowledge related to the core components of the Shamiri

Intervention, i.e., growth mindset, values affirmation, and gratitude); rewards (e.g., prizes award

that encouraged participation); positive interaction (i.e., the peer-lead delivery); and solutions-

oriented (e.g., the practicality of the Shamiri Intervention).

Conclusion

: The preferred components of the Shamiri Intervention were learning, rewards for

participation, positive interactions with other people, and the solution-

oriented nature of the

sessions. The mentioning of the features of the Shamiri Intervention could also suggest that,

indeed, they are appropriate for the target population. Additionally

, the support for the lay

providers is critical in Shamiri intervention cost-effectiveness, accessibility, and scalability.

Keywords

Mental Health, Kenya, Youth-Friendly, Intervention

Address for correspondence:

Cecilia Jakobsson, Research Fellow, Postal Address:

Shamiri Institute, 13th Floor,

Pioneer Point (CMS Africa), Chania Avenue, Nairobi, Kenya, E-mail:

jakobsson@shamiri.institute

This work is licensed under a Creative Commons Attribution-Non-Commercial 4.0 International

License (CC BY-NC 4.0).

©Copyright: Jakobsson, 2023

Publisher: Sciendo (De Gruyter)

DOI: https://doi.org/10.56508/mhgcj.v6i1.155

Submitted for publication: 11

March 2023

Revised: 24 April 2023

Accepted for publication: 03

May 2023

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138

Introduction

Mental health challenges, such as depression

and anxiety, among adolescents aged 15 to 19

years have been identified as a global public

health concern globally (World Health

Organization [WHO], 2017). An even bigger

burden is experienced in low and middle-income

countries (LMICs) such as Sub-Saharan Africa

(SSA) (Vigo, Thornicroft & Alun, 2016), where

mental health services are scarce, require

expertise and are often lengthy and expensive

services (Weiz et al., 2017). The need to seek and

provide mental health services is also highly

hampered by social stigma (Ndetei et al., 2016),

which can be fueled by the fact that traditional

mental health care services focus on addressing

mental illness.

Among the key proposed ways to deal with

mental health challenges burden, especially in

SSA, lies in formulating and embracing simple,

brief, stigma-free, and scalable interventions

(Yotham et al., 2018), which focus on specific

psychological processes, offers a key strategy to

embrace the scarcity of mental health services.

Such programs include the Shamiri Intervention

(the Kiswahili word for “thrive”). This character

strength intervention anchored on “wise”

interventions that seek to change behavior by

targeting specific psychological processes for

better and improved life outcomes (Walton &

Wilson, 2018). The Shamiri intervention is

implemented via 4-week, group-based, 1-hour

sessions within high school settings. Recent high

school graduates aged 18 to 22 are recruited and

trained for at least 10 hours to effectively deliver

Shamiri Intervention to the students.

Previous research studies indicate that the

Shamiri intervention positively impact high school

students, such as reducing depression and

anxiety symptoms and improving their academic

performance and interpersonal relationships

(Osborn et al., 2021). The highlighted impact was

successfully measured and evaluated by

analyzing data from three gold-standard RCTs

(Venturo-Conerly et al., 2021). However, the self-

reported qualitative data on the program feedback

provides insight into the participants’ views,

thoughts, and feelings about the Shamiri program

remains largely unexplored. Thus, this paper

explores participants’ program feedback on what

elements of the Shamiri program students

preferred. This will help to guide and improve

intervention effectiveness, acceptability, and

appropriateness based on the thoughts and

feelings of high school adolescents who are the

program's target population.

Purpose

The present study employed qualitative

methods to explore participant feedback on their

preferred elements of Shamiri Intervention. These

results are a first step to helping inform and

improve the development and implementation of

the Shamiri intervention. Further, the results also

have the potential to better understand lay-

provided mental health service delivery and

design among high school students. They can

help address the care burden and treatment gap

for youth-mental health in SSA.

Methodology

Sample

We used convenience sampling/purposive to

target a sample of 413 high-school students (13-

18 years) with elevated levels of depression and

anxiety as measured by GAD-7 and PHQ-8 to

participate in the Shamiri intervention. [For more

information on the sample, see Osborn et al.

(2021)]. The students were selected from four

high schools within Nairobi and Kiambu counties

in Kenya. Parental consent was sought for the

minors, and written assent was before the

students participated in the study. The students

were also informed of their right to withdraw from

their studies.

Eligibility criteria

To participate in the study, participants were

required to meet the following inclusion criteria;

aged between 13-18 years old, enrolled in the 4-

week Shamiri intervention programs, and able to

read the questionnaire and give responses in the

English language and have elevated levels of

depression and anxiety.

Design

To gather qualitative information, the study

adopted a phenomenological qualitative design

(Moustakas, 1994). In the study, the students

described what they thought or felt was their

favorite about the Shamiri 4-week program (post-

treatment). To understand their experiences, the

data collected was analyzed in a structured way,

and the authors developed themes to highlight the

essence of students’ experiences.

Analysis

The authors employed the six stages of

Reflective Thematic Analysis by Braun & Clark

(2006; 2019) to analyze the qualitative data.

These include familiarization, generating initial

codes, searching for themes, reviewing themes,

defining and naming themes, and the write-up.

The reliability analysis was also conducted to

ensure reliable and consistent theme consensus.

Two Kappa scores were measured between three

coders on two different data sections, at 0.8 and

0.6, indicating good inter-rater reliability.

Further, Lincoln and Guba’s (1985) criteria and

Creswell’s (2018) methods helped guide the

reliability and validity of the findings. To achieve

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138

Intervention

Group

Learning/Less

ons

Neuroplasticit

Gratitude

Values

Time

management

Rewards

Positive

Interactions

Group

leadership

Friendly,

understanding,

relatable

Free

interactions/

free speech

Confidentialit

New

connections/

friends

Solutions-

oriented Helpful

credibility and confirmability, the authors used

multiple coders. The large sample size and data

saturation supported transferability. The

dependability of the results was ensured by a

rigorous and detailed thematic analysis process,

which is summarized in a thematic map (See

Figure 1). Quotes were also reported verbatim to

ensure data-driven results. The themes were

generated by a multi-cultural group of

researchers, each with different experiences and

expertise; they met on several occasions to

discuss the findings and support ongoing

reflexivity.

Figure 1. Thematic Map

Results

The researchers constructed the following

themes to summarize the participants’ responses.

The key themes include learning, rewards,

positive interaction, and solutions-oriented.

Learning

Learning themes involved responses directly

related to acquiring new knowledge. Several

participants endorsed the central components of

the Shamiri Intervention, which include

Neuroplasticity (growth mindset), Gratitude, and

Values. The components of the intervention each

made up a sub-theme for this category:

Neuroplasticity

Neuroplasticity (growth mindset) refers to the

fact that the human brain can grow, improve, and

perform better. Neuroplasticity indicates that

humans can learn new things and improve

through effort and practice. When people are

open to growth, they are not comfortable in one

zone; they challenge themselves and see growth

opportunities even during difficult situations.

“The study of growth mindset because I grew

really.” Participant 704

“I was able to learn how the brain works and if

you want to you can change things which cannot

help you at all.” Participant 1592

Gratitude

Gratitude involves embracing feelings of

appreciation. Gratitude is not ignoring what we

already have, what we are good at, but being

thankful for appreciating what we have, being

thankful for what we are good at. When

embraced, gratitude can improve how a person

feels and treats others.

“The fact that there are many things to be

grateful for and also that we should not be

discouraged but work hard in anything that we

do.” Participant 1381

Values

Values refer to key ideas that people hold

important in their lives. Values guide people in

making their decisions, during interactions with

other people, as well as achieving important goals

in their lives.

“It made me discover that my brain is rapidly

growing over time and my attitude determines its

nature.” Participant 292

Rewards

Rewards encompassed responses related to

the prizes awarded to the participants to

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138

encourage more participation and engagement

throughout the Shamiri Intervention program. A

few students commented that this was their

favorite part of the intervention. However, the

rewards are not a component of the Shamiri

intervention, but a supporting element used to

encourage session attendance.

“The part where I won a shirt.” Participant 4305

Positive interactions

Positive interactions highlighted the

participants' acknowledgement of the group

leaders and the peer-led delivery nature of the

Shamiri intervention. Several participants

commented on the support they received from the

group leaders that delivered the intervention.

Shamiri intervention is lay-provided, and the lay

providers are young people who have recently

graduated from high schools, an aspect that

allows them to relate well with the participants.

The positive interaction’s theme was further

divided into the following sub-themes,

Peer Group Leadership

Peer Group Leadership involved special

acknowledgement to the Shamiri Institute leaders.

“The group leaders were understanding, and

they made one to understand everything.”

Participant 224

“The fact that the trainers are really

understanding and can relate to our experiences.”

Participant 449

“We would get to share ideas as a group about

something which helped so much.” Participant

801

“The program has really helped me to realize

that if I try hard, I will achieve what I am after.”

Participant 2067

Free Speech

Free Speech some participants specified the

importance of having a confidential, safe space to

share their experiences without fear that their

contribitions would be repeated or feel judged.

“I got a chance to speak my mind, and to learn

from others.” Participant 793

“I had the freedom to express myself as

honestly as I could. I cannot actually tell these to

the most trusted friend.” Participant 339

“Understanding. Privacy and confidentiality.”

Participant 732

New connections

New connections captured the participants'

appreciation of interacting and connecting with

new people. It may indicate strength in the fact

that the intervention is delivered by individuals

who come from without the school setting–

individuals that the students have not interacted

with before– which may be an important

consideration in the future scaling-up efforts of

Shamiri.

“Interacting with new people and growing as a

person.” Participant 1071

Interestingly, neither Rewards nor Peer Group

Leaders are part of the intervention but appear to

be an important component of the Shamiri

intervention program delivery.

Solutions-oriented

Solution-oriented addressed the responses

around the practicality of the intervention. This

theme helps describe the impact of the Shamiri

intervention. Several participants appreciated the

practicality, relatability, and applicability of the

intervention.

“Interacting and sharing my problems then

getting solutions.” Participant 649

“Knowing how to solve a problem. Knowledge

of how to achieve my goals and even how to

make my worries get over me. Knowing that

practice and more practice makes perfect.”

Participant 9142.

Conclusions

The preferred components of the Shamiri

Intervention were learning, rewards for

participation, positive interactions with other

people, and the solution-oriented nature of the

sessions. The first theme consisted of the core

components of the Shamiri Intervention (growth

mindset, gratitude and values affirmation), which

may suggest that the three concepts are

appropriate and key character strengths for this

population and context. Moreover, the qualitative

feedback provides additional affirmation of the

ability of these evidence-based therapeutic

elements to help deal with many challenges facing

the provision of quality mental health care among

young people. The mentioning of the Shamiri

Intervention features could also suggest that,

indeed, they are; a) simple, in that despite being

broad, they can be easily understood by the target

adolescent population. The simple aspect of the

three components of Shamiri Intervention plays a

significant role in making the intervention

accessible—as it does not require expertise to

deliver and can be lay-provided, b) stigma-free—it

utilizes simple terms that do not refer to

psychopathology, c) scalable—an extended

impact of the intervention being lay-provided, thus

can be low cost (Osborn and Wasanga, 2020).

Interestingly, the delivery of Shamiri

Intervention also appeared to have been

significant. For example, the participants seemed

to prefer lay providers, who—as mentioned

previously—make the intervention provision

relatable to high school adolescents and low-cost.

Additionally, the positive interactions adopted in

the group-led sessions that adopt unconditional

positive regard also seemed to impact participants

significantly. Positive reinforcement, in the form of

prizes/rewards accorded to active participants

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138

who constantly engage and on other merits, did

have a significant impact. These highlights are

essential because the use of lay providers is key

in Shamiri intervention cost-effectiveness,

accessibility and scalability. The lay providers

(young people with limited mental health training)

are readily available in Africa and particularly

Kenya. In totality, these aspects—low-cost,

scalable, accessible—are important during scaling

up mental health care services that can help

address the treatment gap to the increasing

mental health needs. Additional qualitative studies

are required to evaluate further how we can

improve the effectiveness and sustainability of the

Shamiri Intervention.

Finally, our findings support task-sharing using

lay providers (peer leaders) and group-based

interventions as an appropriate and cost-effective

method to scale-up services in this service. We

believe that the preferred elements, i.e., rewards,

learning, positive interactions and solutions-

oriented, are essential components of the

effective youth-friendly intervention in this context.

Conflict of interest

The authors declare that they have no conflicts

of interest.

Acknowledgements

We are very grateful to the participants who

shared their feedback with us; their contribution

shaped this paper and helped inform ongoing

developments of the Shamiri Intervention and

support efforts to promote mental health wellbeing

in Kenya

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