Abstract
Background:
Despite high levels of substance use, domestic violence and psychological distress among indigenous communities in Guatemala, community-based interventions, which have the potential to address upstream determinants, are lacking. We aimed to explore impacts and change mechanisms of a participatory, dialogue-based intervention to improve psychosocial health and wellbeing in indigenous communities in Guatemala.
Methods:
We conducted 69 narrative interviews with participants across two intervention communities using the most significant change technique1. We analyzed interview transcripts to identify impacts and change pathways using a combination of inductive and deductive thematic coding. Deductive codes included social conditions thought to influence indigenous wellbeing, as identified in prior research and by participants at the project’s outset.
Results:
Participants described reductions in mental distress and substance use, improvements in wellbeing and social relationships, and an increased sense of community solidarity. Participant-identified change pathways included a) new knowledge and attitudes toward social conditions underlying wellbeing (e.g. self-care, time with family, gender equality) arising from fuzzy cognitive mapping2; b) improved self-esteem and empowerment arising from the dialogue approach; c) increased social support arising from regular meetings with peers; and d) practicing sports and other strategies for stress-relief learned through group activities.
Implications:
Participants’ narratives suggest that participatory dialogue groups may be an effective strategy for promoting psychosocial health and wellbeing among indigenous populations in Guatemala. The approach was aligned with local understandings of wellbeing, rooted in community solidarity and social relations. These qualitative results will inform our interpretation of a quantitative impact assessment reported elsewhere.
1 Dart, J., & Davies, R. (2003). A dialogical, story-based evaluation tool: The most significant change technique. American Journal of Evaluation, 24(2), 137-155.
2Khan, M. S., & Quaddus, M. (2004). Group decision support using fuzzy cognitive maps for causal reasoning. Group Decision and Negotiation, 13(5), 463-480.
