title: Using Mixed-Methods Research to Adapt and Evaluate a Family Strengthening Intervention in Rwanda.
abstract: BACKGROUND
  Research in several international settings indicates that children and adolescents affected by HIV and other compounded adversities are at increased risk for a range of mental health problems including depression, anxiety, and social withdrawal. More intervention research is needed to develop valid measurement and intervention tools to address child mental health in such settings.
  
  
  OBJECTIVE
  This article presents a collaborative mixed-methods approach to designing and evaluating a mental health intervention to assist families facing multiple adversities in Rwanda.
  
  
  METHODS
  Qualitative methods were used to gain knowledge of culturally-relevant mental health problems in children and adolescents, individual, family and community resources, and contextual dynamics among HIV-affected families. This data was used to guide the selection and adaptation of mental health measures to assess intervention outcomes. Measures were subjected to a quantitative validation exercise. Qualitative data and community advisory board input also informed the selection and adaptation of a family-based preventive intervention to reduce the risk for mental health problems among children in families affected by HIV.. Community-based participatory methods were used to ensure that the intervention targeted relevant problems manifest in Rwandan children and families and built on local strengths.
  
  
  RESULTS
  Qualitative data on culturally-appropriate practices for building resilience in vulnerable families has enriched the development of a Family-Strengthening Intervention (FSI). Input from community partners has also contributed to creating a feasible and culturally-relevant intervention. Mental health measures demonstrate strong performance in this population.
  
  
  CONCLUSIONS
  The mixed-methods model discussed represents a refined, multi-phase protocol for incorporating qualitative data and community input in the development and evaluation of feasible, culturally-sound quantitative assessments and intervention models. The mixed-methods approach may be applied to research in other parts of sub-Saharan Africa and beyond.
authors.affiliation: Harvard School of Public Health, François-Xavier Bagnoud Center for Health and Human Rights.
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
authors.affiliation: Harvard School of Public Health, François-Xavier Bagnoud Center for Health and Human Rights.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Meyers-Ohki
authors.affiliation: Harvard School of Public Health, François-Xavier Bagnoud Center for Health and Human Rights.
authors.forename: Anne
authors.initials: A
authors.lastname: Stevenson
authors.affiliation: Partners In Health, Rwanda/ Inshuti Mu Buzima.
authors.forename: Charles
authors.initials: C
authors.lastname: Ingabire
authors.affiliation: Partners In Health, Rwanda/ Inshuti Mu Buzima.
authors.forename: Fredrick
authors.initials: F
authors.lastname: Kanyanganzi
authors.affiliation: Partners In Health, Rwanda/ Inshuti Mu Buzima.
authors.forename: Morris
authors.initials: M
authors.lastname: Munyana
authors.affiliation: Partners In Health, Rwanda/ Inshuti Mu Buzima.
authors.forename: Christina
authors.initials: C
authors.lastname: Mushashi
authors.affiliation: Partners In Health, Rwanda/ Inshuti Mu Buzima.
authors.forename: Sharon
authors.initials: S
authors.lastname: Teta
authors.affiliation: Partners In Health, Rwanda/ Inshuti Mu Buzima.
authors.forename: Ildephonse
authors.initials: I
authors.lastname: Fayida
authors.affiliation: Partners In Health, Rwanda/ Inshuti Mu Buzima.
authors.forename: Felix Rwabukwisi
authors.initials: FR
authors.lastname: Cyamatare
authors.affiliation: Partners In Health, Rwanda/ Inshuti Mu Buzima.
authors.forename: Sara
authors.initials: S
authors.lastname: Stulac
authors.affiliation: Children's Hospital Boston.
authors.forename: William R
authors.initials: WR
authors.lastname: Beardslee