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
6
61
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
62
Mental Health: Global Challenges Journal
https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138
Intervention
Group
Learning/Less
ons
Neuroplasticit
y
Gratitude
Values
Time
management
Rewards
Positive
Interactions
Group
leadership
Friendly,
understanding,
relatable
Free
interactions/
free speech
Confidentialit
y
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
63
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
64