Naomi Myburgh’s research while affiliated with Stellenbosch University and other places

Background Mental health problems often emerge during middle childhood and adolescence. In South Africa, and in the context of high rates of poverty, violence, and adversity, many children are at a considerable risk for developing mental health problems. Access to and costs of mental health services preclude treatment for most. There is evidence that universal school-based prevention programmes are effective in well-resourced settings. However, little is known about the feasibility and acceptability of such programmes in low- and middle-income countries (LMICs), including South Africa. Methods This is a feasibility pilot study of 4 Steps To My Future (4STMF), a Cognitive Behaviour Therapy (CBT) school-based programme for young adolescents in the Western Cape, South Africa. This eight-session intervention will be delivered to children in grade 5 (aged 10–13 years approximately) attending two public government-run schools in the Western Cape, South Africa. We aim to enrol approximately 224 children in grade 5. We will randomise which school receives the intervention first and the other will be a delayed intervention group. We will train individuals with a post-graduate degree in psychology to facilitate the programme. We will collect demographic data on participants as well as data on primary (feasibility measures) and secondary outcomes (mental health and well-being measures). We will collect data at baseline, post-intervention, and at 1-month follow-up. Discussion This pilot study will provide data on the acceptability and feasibility of delivering a universal school-based prevention programme in South African schools. The study will provide preliminary data to inform the design of a full-scale randomised controlled trial (RCT) of a universal school-based mental health programme aimed at preventing mental health problems. Trial registration This trial is registered with the Pan African Clinical Trial Registry ( https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=10881 ) database, with unique identification number for the registry: PACTR202004803366609. Registered on 24 April 2020.

An important challenge to enhancing community access to mental health interventions in marginalised, transcultural settings is the development of culturally relevant screening measures. Cross-cultural adaptation (CCA) and translation methods offer guidelines for the adaption of existing screening measures for use across cultures with the aim of preserving semantic and construct equivalence as well as validity. Yet, the application of CCA methods has been inconsistent and validation strategies have focused predominantly on expert review and quantitative validity testing. Additionally, potentially important context-specific interpretations of measure items have been lost in translation-heavy approaches. The missing link in the CCA of existing measures may be the addition of culturally sensitive, community-based evaluative methods. This paper presents a report of the application of a seven-step CCA method developed by the first author to address the issue of cultural relevance in the translation and cross-cultural adaptation of the Spence Child Anxiety Scale (SCAS) an anxiety measure for use in a specific South African community context. The findings emphasise the surprising context-specific interpretations of items in measures applied transculturally, which support the case for qualitative, community-based validation of translated, CCA screening measures used to explore the effectiveness of mental health interventions across cultural contexts.

Background Children within historically disadvantaged non-Western South African communities are considered as particularly vulnerable to the development of anxiety problems. Although the need for accessible mental health interventions is evident, this need has remained unmet in a country with extreme socio-economic disparities and a lack of mental health resources. Cognitive behavioural therapy-based (CBT-based) interventions that employ brief and intensive delivery methods may overcome existing barriers to access to mental health services faced by many South African children and may ameliorate the burden placed on under-resourced mental health care services. Aim To provide preliminary evidence on the effectiveness of a brief, intensive CBT-based anxiety prevention intervention conducted in a South African context. Method A mixed-methods approach, with quantitative and qualitative data, was used to evaluate the effects of the CBT-based programme in a sample of 21 farmworkers’ children aged 9–14 years living in disadvantaged semi-rural communities of the Western Cape. A quasi-experimental design with an immediate intervention (experimental) group and a delayed intervention (control) group was applied in the quantitative component of the study. The qualitative component was based on focus group data. Results In general, positive effects were noted for the CBT-based anxiety prevention programme in these vulnerable children. Quantitative data revealed a trend reflecting a reduction of self-reported anxiety levels. Qualitative support for the acquisition and application of the CBT-based programme skills was also found. Conclusion This pilot study indicates that a brief, intensive CBT-based prevention programme holds promise for the effective reduction of anxiety in vulnerable South African children.