Follow-up and Mediation Outcomes of a Movement-Based Mental Health Promotion Intervention for Refugee Children in Uganda

Abstract

Objective: There is limited evidence for the effectiveness of mental health promotion interventions in low- and middle-income settings, especially for longer-term benefits. This study evaluates the 5-month follow-up outcomes of a movement-based mental health promotion intervention (TeamUp) for refugee children in Northern Uganda (West Nile) and further investigates what explains longer-term benefits. Methods: This quasi-experimental study was conducted in four primary schools, randomly allocated to an experimental or a control condition. Enrolled in the study were 549 children ages 10–15 years (n = 265 TeamUp;n = 284 control group). Primary outcomes were psychosocial well-being (Stirling Children’s Wellbeing Scale), attitude toward school, and satisfaction with friendships (Multidimensional Students Life Satisfaction Scale [Friends and School subscales]). Mediators included social connectedness and sense of agency. Results: At 5 months postintervention, 467 (85.1%) children were retained. Intent-to-treat analyses demonstrated sustained benefits for TeamUp for well-being (estimated mean difference −1.88, 95% CI −3.14 to −0.66, p =.003, effect size Cohen’s d = 0.25) and friendships (−1.52, 95% CI −2.55 to −0.48, p =.005, d = 0.25). There were no significant between-group differences for attitude toward school. Secondary benefits were shown for traumatic stress (2.18, 95% CI 0.45 to 3.91, p =.014, d = 0.21), quality of life (−1.29, 95% CI −2.31 to −0.30, p =.014, d = 0.21), bullying (0.53, 95% CI 0.08 to 0.97, p =.020, d = 0.20), and depression symptoms (1.31, 95% CI 0.09 to 2.52, p =.035, d = 0.18). Increased sense of connectedness mediates the effect of TeamUp on improving well-being (indirect effect = 0.30, SE = 0.13, p =.001), explaining 15% of variance. Conclusion: This study shows sustained benefits of a mental health promotion intervention 5 months postintervention. Prolonged benefits are explained by an increase in social connectedness.