Participatory research to support the development of culturally sensitive mental health and wellbeing services for the Kankuamo people of Colombia

Phase 1: Knowledge Dialogue (Months 1-8) A) Literature review - application of capability approach with indigenous populations;

B) Five stakeholder engagement workshops aimed at enhancing understanding about the mental health and quality of life of the Kankuamo people will be held. Sixty individuals (including traditional healers, community elders, health workers) will be purposively sampled from across the twelve Kankuamo communities. Data will be collected using Module One the Design, Implementation, Monitoring and Evaluation (DIME) approach.

Module 1 of DIME elicits relevant qualitative information about: 1) Problems that adults in the community face; 2) The key function/tasks that adults are required to frequently undertake for themselves, their families, and their communities; 3) The advice that is currently provided by recognised community experts (i.e. key informants) to address the problems. Building on our work in Uganda and Rwanda as part of the ESRC funded COSTAR project (ES/S000976/1), this work will include a focus on the Capability Approach (Sen, 1999) through the inclusion of an additional question that will ask community members to indicate: 'What does a good life mean to you?'.

Phase II: Developing Assessment Instruments (Months 9-13)

A) Development or adaptation of assessment instruments for: i) common mental disorders, ii) quality of life based on the qualitative findings from Phase I. This will be guided by Module two of the DIME approach and will utilise the data collected in Phase 1.

B) Piloting of Assessment Instrument - the two assessment instruments developed in Phase IIA will be piloted according to Module Three of the DIME Approach. Data collection will take place via a survey of 380 households across the 12 Kankuamo and will be undertaken by the participants of phase I, accompanied by members from the research team. The survey will include the novel assessment instruments for common mental disorders and quality of life, as well as internationally recognised standardised measures of depressive symptoms (i.e.

PHQ-9) and quality of life (WHOQoL-BREF). Following the completion of the survey, purposive sampling will be used to recruit a subsample of participants into focus groups discussions (1 FGD of 10 people for each of the 12 communities; total N = 120) to provide qualitative feedback about the assessment instruments (including the cultural acceptability).

C) Validation of the assessment instruments - Correlational analyses will be conducted on the data collected in Phase IIB to determine the construct validity of the new assessment instruments compared to PHQ9 and WHOQoL-BREF. Phase III: Guideline development (Months 13-20)

Members from all 12 Kankuamo communities (N=120) will be invited to a combination of focus groups, workshops and interactive activities over a 2-day period to co-produce guidelines for the development and delivery of culturally sensitive primary care community mental health support. This will include consideration of ethical and legal obligations of stakeholders.

Phase IV: Development and evaluation of the training program (Months 20-30)

This phase will involve the development, delivery and evaluation of a training program aimed at training Community Wellbeing Advocate (CWA) to identify people experiencing mental health difficulties within the Kankuamo community, and to signpost them to appropriate, locally available, forms of support.

A) Develop a short 3-day CWA training program based on the findings from Phase I, Phase II and Phase III. B) Deliver a 3-day CWA training program to participants (N=60).

C) Evaluate: i) the acceptability of the CWA training program (two FGD of up to 8 CWA trainees 1-month post-training, ii) feedback from community members who have interacted with the CWA (2 FGD of up to 8 community members).

D) Adjust the CWA training programme according to feedback received from the CWA trainees and community members in Phase IVC.