Creating a Scalable Training Manual for Community Mobilizers Supporting Youths Participating in Global Dialogues' Narrative Contest about Intimate Partner Violence in Nicaragua Open Access

Abstract

Low- and middle-income countries that lack the health infrastructure and capacity to treat mental illness require innovative approaches for the delivery of mental health and psychosocial support services. Various forms of narrative therapy have been developed to reduce symptoms of trauma and post-traumatic stress disorder (PTSD). Narrative development engages cognitive processes such as critical reflection and meaning-making that are similarly activated through transformative learning, an approach to adult education that has been used to build capacity and transform communities in developing countries. As a vehicle of generating social awareness and promoting behavior change, Global Dialogues' international narrative contest challenges young people from around the world to create compelling narratives and participate in dialogue surrounding sensitive and taboo topics such as intimate partner violence. Using a transformative learning approach, we created a manual to train contest mobilizers in Nicaragua to support the development of narratives for the contest and to facilitate a safe learning environment through contest participation for young people who may have previously experienced trauma due to intimate partner violence or who may be indirectly exposed to it. The manual was developed based on a literature review of transformative learning theory, narrative therapy, and the cultural context of intimate partner violence in Nicaragua. Based on feedback from participants in a pilot training workshop and our implementing partner in Matagalpa, we revised the manual to be concise, to incorporate linkages to more accessible local resources, and to clarify concepts by drawing from more familiar constructs and frames of reference. The manual was well received overall in its pilot test. A rigorous impact evaluation of the manual is required to investigate any potential association between the use of the manual by contest mobilizers and the mental health and emotional wellness of contest participants.

Table of Contents

Table of Contents

Chapter I: Introduction...........................................................................................................1

Introduction and Significance......................................................................................................1

Figure 1: WHO Service Organization Pyramid for an Optimal Mix of Services for Mental Health ............2

Problem Statement....................................................................................................................4

Purpose Statement....................................................................................................................4

Definition of Terms and Abbreviations..........................................................................................5

Chapter II: Literature Review.................................................................................................6

The Transformative Learning Approach........................................................................................6

Narrative Therapy.....................................................................................................................9

Narrative Development and Story-Telling for Trauma....................................................................11

Intimate Partner Violence in Nicaragua.......................................................................................13

Chapter III: Methods.............................................................................................................15

Development of Manual Curriculum and Content..........................................................................15

Pilot Test................................................................................................................................16

Figure 2: Timeline of Pilot Test..................................................................................................17

Data Collection Instruments......................................................................................................17

Data Analysis..........................................................................................................................18

Chapter IV: Results...............................................................................................................19

Manual Curriculum and Content.................................................................................................19

Figure 3: Manual Development Logic Model.................................................................................20

Table 1: Original Manual Outline................................................................................................24

Manual Pilot Test.....................................................................................................................26

Questionnaire 1.......................................................................................................................27

Questionnaire 2.......................................................................................................................29

Key Informant Interview...........................................................................................................31

Manual Revisions.....................................................................................................................31

Table 2: Revised Manual Outline................................................................................................33

Chapter V: Discussion............................................................................................................36

Strengths and Limitations.........................................................................................................36

Recommendations...................................................................................................................38

Conclusion..............................................................................................................................40

References............................................................................................................................42

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Education, Curriculum and Instruction Health Sciences, Mental Health
Keyword	Narrative Therapy Nicaragua Intimate Partner Violence Global Dialogues Narrative Development Community Mobilization Mental Health Curriculum Development Trauma Transformative Learning
Committee Chair / Thesis Advisor	Winskell Enger, Kate, Emory University
Committee Members	Singleton, Robyn , Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.)

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