Asian Journal of Complementary and Alternative Medicine

School Professional and Caregiver Understanding of Causes of Children Mental Health Concerns in Rural Darjeeling, India

Amita Bollapragada, BS*, Juliana Vanderburg, MS, Priscilla Giri, MS, Surekha Bhattarai, MS, Anamika Sharma, MS, Swasthika Thapa, MS, Aashwin Pradhan, BTech, Michael Matergia, MD, Christina M. Cruz, MD

UNC School of Medicine, USA

Abstract

Objectives: The mental health needs of children in low-and-middle income countries (LMICs) such as India often go unmet due to the scarcity of mental health professionals. Pilot trials in Darjeeling, India have illustrated the potential of Tealeaf (Teachers Leading the Frontlines), a task-shifting model with teachers as lay counselors, to improve child mental health symptoms within an LMIC context. Understanding the cultural context in which Tealeaf has shown signals of efficacy has not yet been studied but  is key to understanding Tealeaf’s efficacy results (trial ongoing). This study aims to specifically explore school professional and caregiver culturally held beliefs about causes of child mental health concerns.    

Methods: Twelve semi-structured interviews (SSIs) were conducted March-April 2022 with purposively selected principals, teachers, and caregivers. With the goal of qualitative description, SSIs were coded using deductive content analysis to understand stakeholder perceptions of causes of mental health concerns, with codes fitted to The Culturally-Infused Engagement (CIE) model.     

Results: Participants believed that major determinants of children’s behavior are biological and the home environment, with guidance from parents and peer influences leading to different outcomes. Younger children are perceived to be capable of feeling stress and sadness only related to academics. Participants also believe that children have a developing ability to feel these emotions and express their thoughts.    

Conclusions: Exploring communities culturally held beliefs about causes of children’s mental health concerns is the first step in understanding how stakeholders think Tealeaf can improve children’s mental health. The findings provide insight into a key facet underlying a task-shifted system of care in which Tealeaf can engage with the specific cultural context of Darjeeling, India more sustainably.    

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