Learning something new - easier in your own accent

The survey enumerators for our project are learning to enter survey data electronically on pda devices, thanks to programming help from Eric Green . One of the most difficult things in teaching such a detailed process is that our American accents seem to disguise some words, even with enumerators who speak excellent English. Jack, one team member, is always reminding us, "Shape your mouth more clearly so I can understand what you are saying." My research coordinator, Jessica Pian, discovered that asking one of our team members to explain some of the steps was a more efficient way of making sure everyone is on the same page - or screen. This is Hellen, one of our team members, who caught on quickly to the pda. She is explaining to the others how to input the correct identifying information of an interviewee.

A New Survey Team...Practice Underway

This is training week for the new survey enumerators for the READY project. We have a strong team of men and women from Muhuru, and they have been spending this week practicing interviews they will conduct with youth and their caregivers in the community. Their work will be a large part of how we evaluate the READY intervention.

Here is just a glimpse of our practice today. We have community volunteers here so that the interviews are a bit more realistic. (Both have agreed for this video to be put online, and the volunteer is playing a role - not answering questions about his own life).

Random Selection...from a trash can

We are beginning a randomized controlled pilot trial of the READY intervention - a family and church-based program to prevent HIV and improve mental health of youth in Muhuru. Only 4 out of the 57 churches in Muhuru will receive the intervention, so we needed to be careful how those were selected. So yesterday we invited the Chiefs from across Muhuru to participate in the random selection by drawing slips of paper with the church names. After my explanation, they understood and accepted the process - but they were not at all satisfied with our carefully prepared envelopes from which we asked them to draw. These envelopes, they explained, would not allow us to "mix them thoroughly." I had to agree. So the head chief looked around the room for an acceptable container and decided the trash can was perfect. He emptied it and it indeed allowed us to mix thoroughly, thereby making sure the process was fair.

Good thing we called the chiefs together, as random selection resulted in only two of the four geographic locations of Muhuru represented among the churches. I will definitely do it this way again in the future - I will just bring along a big enough hat to pull from.

"A Brand New Kenya"

“It is time for a new brand of a brand new Kenya,” said Caroline Nderitu
in her poem at the promulgation ceremony for the new Kenyan Constitution. Even I could feel the excitement as I watched through my apartment television a few miles from Uhuru Park. I was amazed by the enormous crowd as the camera showed sections of people breaking into excited dancing and others climbing trees to catch a glimpse of the excitement.

All weekend since the ceremony, I’ve been asking cab drivers and Kenyan co-workers how they feel about the new Constitution…

“We are so happy – you will now find us all smiling here in Kenya.”
“Now we are really happy – there are so many good changes. Now even a normal Kenyan can finally get something.”
“Now we can go and see our Ministers, tell them what we want.”

In each response – hope, optimism, empowerment.

I rarely see direct, concrete examples of how structural-level change at the policy level can truly affect individuals’ mental health and well-being. But I think that this Constitution has the potential to do that in a very tangible way. People are waiting and hoping for increased support from their leaders – and this hope is already translating into improved moods and renewed motivation to reach goals in individuals and families.

I am traveling to Muhuru Bay again this week and I will be excited to hear what they have to say.

Observations from our Family-Based Approach

We have now delivered READY Sessions #2 (Emotional Support in the Family) and #3 (Learning and Talking about HIV as a Family). In both sessions, we used role play and discussions to open up a dialogue about some of the cultural factors that influence families' abilities to both provide emotional support to each other and to talk about sexuality and HIV with youth.

Overall, participants are responding positively to the family-based approach. These are a few observations my research team and I have made over the past two sessions:

(1) Male caregivers are very interested in communication skills...Since the first session in which male caregivers were reluctant to talk with their wives about money, they have become surprisingly receptive to the idea that family communication is one of the most important factors in helping their youth. In addition, without prompting by facilitators, they asked to learn about communication within their marriages because the noticed that tension between parents can be stressful for youth.

(2) Female caregivers have concerns about relationships with in-laws. In Muhuru, when women get married, they usually go to live with their husband's family. Therefore, when we go to churches, often the women are attending with their husband and members of the husband's families. Many of the mothers have said they cannot be open and comfortable to practice communication with their husbands and children because their mothers-in-law are also there, and they are typically the female authority in the family.

(3) In our sessions on economics and emotional support, caregivers participated freely and youth needed more encouragement. This completely switched during the third session that focused on HIV education. Activities asked families to play games answering questions about HIV facts and to discuss questions they have about HIV. The youth were the ones answering all the questions. We clearly saw that the youth are learning HIV facts in school, but lack of adult HIV knowledge is a big barrier to encouraging family communication and problem-solving about issues related to sex and HIV.

1st READY Pilot Session

We piloted the first session of the READY program today at a Seventh Day Adventist Church in Muhuru. We focused on Family Communication in the context of Economic Empowerment. Our Community Advisory Committee felt strongly that economic issues should be discussed FIRST because poverty is a main source of family stress and also an underlying factor related to HIV risk.

Fifty people attended - half youth and half adults. Most came together as families, which was important for the emphasis on family communication. It was clear that asking families to talk with one another during a group program was a new approach, but families participated and reported they enjoyed it. Families talked together to plan "small steps of hope" related to making an economic plan for their family.

Men among the participants brought up an interesting issue several times during the discussion. They expressed reluctance to share the amount of their salaries with their wives, saying that their wives may "plan big budgets" if they are aware of the amount of money available. The facilitator for the male caregivers said that there was some disagreement on this point, however, which opened the door to discuss the possible benefits of having open communication about money within a marriage.

READY Workshops to Develop Intervention

This week, the READY advisory committee and other community members – men, women, and youth - have been meeting in evening workshops to develop the first sessions of the READY program. We have 3 intervention development groups: (1) Building Strength in Sexuality and Relationships, (2) Building Economic Strength, (3) Building Emotional and Family Strength.

One advantage of a participatory approach to program development is that examples and activities are more likely to be relevant. Another is that people from the community know the appropriate limits in discussing sensitive issues - they know how and when to push new ideas.

Three ideas from the workshops:

#1 Challenge to use Local Resources

The economic empowerment group asked participants to list local resources and posed the question, “Are we REALLY poor?” They asked families to choose a local, free resource and to generate ideas for taking small steps to make money with that resource.

#2 Role of Fathers in Supporting Healthy Sexuality

One group presented a skit in which two young girls try to share with their fathers a song about private body parts they learned in school. One father rejected and dismissed the child, while the other took the opportunity to teach the child that sexuality can be positive within the context of a loving relationship – and after finishing school.

#3 Fish Net Illustration for Family Communication

Muhuru is a fishing community. One group worked on the session, “Building Encouraging Families.” They drew posters of two scenes in which groups of people were trying to pull in the two sides of a very large fishing net. In the first, trees were blocking the fishermen from communicating as they pulled in the net – therefore, the net was uneven and the fish escaped. In the second, the men were able to communicate easily and they caught many fish. The lesson: Families who communicate to solve problems together can reach their goals.