Megan Laughlin, Louise Uwineza

Adult perceptions of psychosocial wellbeing and health among children and families: A qualitative evaluation of a community program in Rwanda

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Children in post-genocide Rwanda face a number of challenges, including entrenched poverty, high rates of disease, and social isolation. The purpose of this qualitative evaluation was to gauge how a weekly children’s club program impacted participants’ psychosocial wellbeing and health behaviors. In the program, children ages 7 to 14 meet in neighborhood groups of 35 participants. Community volunteers lead each club, using a curriculum designed to improve preventative health practices (hygiene, sanitation, malaria prevention, etc) and social skills (communication, respect, etc). The program, located about 15 km outside of the capital Kigali, currently serves about 1,000 children in clubs. Social learning, improved self-efficacy, and improved peer support are hypothesized to enable children to enact and sustain health behavior change. Focus groups (n=8) were used to explore the depth, breadth and pathways of change from the perspective of parents/caregivers of children participating in the clubs. Other focus groups consisted of adult volunteers, since they are familiar with the attitudes and practices of club children and their families. Focus groups were divided evenly between parents and volunteers and town and rural areas. Using a semi-structured discussion guide translated into the local language, focus groups explored to what extent children contributed to positive change in their households—including health behaviors and quality of family relationships. They also examined how parents valued any changes. Parents and volunteers endorsed high levels of change in the psychosocial wellbeing and health behaviors not only among children participating directly in the club but also their families.

Parents’ perceptions of children’s respect and cooperation were closely linked to their perceptions of children’s initiative to improve family health. Both parent and volunteer focus groups attributed improved relationships between parents, siblings and child club participants to increases in children’s self-esteem, self-confidence and social support they receive from club peers and volunteers. To a lesser extent, parents generalized improved social relationships to include neighboring families, saying stronger relationships between children led to reduced community conflict. Surprisingly, parents and volunteers attributed improved academic performance to club children’s increased self-confidence and hopefulness. This finding was unexpected as the program has little focus on explicit academic lessons. Another positive finding was the perceived decrease in the use of physical discipline in the home as a result of improved parental-child relationships. Volunteers, who specifically addressed physical abuse, also attributed declines to volunteer interventions with parents. Both parent and volunteer focus groups questioned the impact of peer-to-peer education, which involves club children sharing the weekly health message with three peers who do not attend club. Parents, to a greater extent than volunteers, said it improved neither club children’s self-confidence nor recipients’ health practices. While parents felt this was due to a lack of skill among peer educators, volunteers believed that the recipients of peer education lacked supportive relationships with adults (especially volunteers) that are necessary for change. These results will be used to inform and improve future program activities.