P0225 - Community Perceptions and Interventions for the Long-term Impact of Adverse Childhood Experiences in Kisii, Kenya: A Qualitative Study

Background: Adverse childhood experiences (ACEs) encompass various types of childhood trauma that contribute to poor adult health outcomes. Community perceptions of the impact of ACEs can affect preventative measures such as positive parenting as well as health-seeking behaviors. We sought to gain a greater understanding of community perceptions of the long-term effect of ACEs.

Methods: Subcounty medical officers in Kisii, Kenya identified a sublocation where the study was conducted between 1/20 to 2/21/2020. Qualitative research methods including narrative interviews, focus group discussions, and key informant interviews were completed with caregivers, teachers, community health volunteers (CHVs), and the local assistant chief. Primary school and secondary school children and youth out of school were also interviewed. All interviews were audio recorded and translated from Ekegusii to English.

Results: Three narrative interviews, seven focus group discussions (including three of children), and one informant interview were completed, reviewed, and analyzed for common themes. There was a widespread understanding among community members of the long-term mental health effects of ACEs such as anxiety, depression, and suicide; in fact, all seven focus groups mentioned mental health effects. Participants also expressed understanding of increases in high-risk behaviors including drug use and high-risk sexual behaviors. However, the risk for physical health effects including stroke, cancer, diabetes, and heart disease were not well understood and were not mentioned by any participants. The community proposed multiple solutions to intervene on the long-term effects of ACEs, which are described in Figure 1.

Discussion: The community in a subcounty of Kisii, Kenya noted a high prevalence of ACEs, but a low understanding of the long-term physical health effects. Understanding the long-term effects of ACEs can increase community investment in interventions. Working with communities to identify strategies to reduce ACEs can lead to effective interventions at all levels of the socioecological model.