# Potential enablers for the implementation of multiple family group therapy intervention in the lower Manya Krobo District, Ghana: Perspectives of multiple stakeholders

## TL;DR

This study explores factors that can help implement multiple family group therapy for adolescents living with HIV in Ghana, based on input from various stakeholders.

## Contribution

The study identifies specific enablers for implementing MFGT in a low-income Ghanaian context for adolescents living with HIV.

## Key findings

- Six key enablers for MFGT implementation were identified, including existing support systems and health worker willingness.
- Practical considerations like scheduling and privacy were highlighted as important for successful implementation.
- Implementation strategies should include training diverse facilitators and incorporating spiritual elements.

## Abstract

The Multiple Family Group Therapy (MFGT) has demonstrated effectiveness in addressing behavioral problems and mental health disorders among adolescents in high-income settings. Limited evidence exists on whether the MFGT can be implemented successfully in Ghana and other SSA for adolescents living with HIV (ALHIV), given the contextual differences between Ghana and high-income countries. This study aimed to identify factors and processes from multiple stakeholders that can support a successful implementation of the MFGT intervention for ALHIV and their families in the Lower Manya Krobo District of Ghana. A qualitative exploratory study was conducted at Atua Government Hospital. Data were collected through focus group discussions with ALHIV (n = 12), caregivers (n = 13), and health professionals (n = 5), supplemented by three in-depth interviews (with ALHIV). Contextual thematic analysis was employed to identify patterns and themes within the data, with attention to rigor through triangulation, member checking, and reflexivity. Six key enablers for MFGT implementation emerged: (1) existing support systems and infrastructure, including established HIV programs and dedicated adolescent clinic days; (2) willingness of health workers to participate and sustain the intervention; (3) practical implementation considerations including scheduling preferences and privacy concerns; (4) participation support needs such as material and logistical support and preference for diverse educational approaches(5) content preferences emphasizing comprehensive topics beyond HIV management and interactive learning approaches. Five key enablers emerged for successful MFGT implementation. Implementation strategies should integrate MFGT into existing adolescent clinic days, provide transportation assistance and reminder systems, accommodate Sunday scheduling preferences, train diverse facilitators, including peer mentors, and incorporate spiritual elements while maintaining flexible group compositions based on discussion topics.