Development and Testing of BAJJAJJA: An Intervention to Promote Economic Empowerment and Health of Grandmothers who Provide Primary Care for Grandchildren in Uganda

PROJECT SUMMARY/ABSTRACT The proposed K01 award describes a research training program for Dr. Schola Matovu, an Assistant Professor at the University of Utah College of Nursing. Her overarching goal is to become an independent investigator conducting global health and gerontological research studies to improve the health and quality of life of older

adults with caregiving responsibilities, such as grandmother-caregivers (GMCs). This award provides support for Dr. Matovu to achieve the following Career Development Goals to gain expertise in: 1) developing and testing multi-component and culturally appropriate behavioral interventions in low-resourced settings; 2)

implementing aging and health disparities research related to aging, and performing geriatric health assessment and coaching of community-dwelling GMCs; 3) behavioral clinical trial methodology; and 4) research leadership and management skills. To achieve these goals, Dr. Matovu has assembled a dedicated

team of mentors and advisors with expertise in family caregiving research (Dr. Lee Ellington, US Primary Mentor), design and implementation of psychosocial interventions for Ugandan populations impacted by HIV/AIDS (Dr. Noeline Nakasujja, Uganda Primary Mentor), mixed research methods and behavioral

interventions (Dr. Melissa Watt), gerontological nursing, rural care, and nurse-led health coaching (Dr. Heather Young), microfinance and social protection interventions (Dr. Fred Ssewamala), economics and women’s empowerment (Dr. Eve Namisango), and biostatistics (Dr. Xiaoming Sheng). There are an estimated 163 million children worldwide who are under the care of their grandparents or other

relatives. In Uganda, social determinants of health (i.e., poverty, wars, and maternal and perinatal conditions) threaten the middle generation (age 15-49) and leave older adults, especially grandmothers (Bajjajja), to become the safety net. Yet, in this region, knowledge about effective interventions that support the health and

wellbeing of these GMCs is limited to nonexistent. As such, Dr. Matovu proposes to refine, adapt, and test her BAJJAJJA intervention. This will be achieved through three Specific Aims: 1) Refine and adapt the BAJJAJJA intervention components through a collaborative and iterative feedback process with a diverse community

group of 18 members; 2) Test the feasibility, acceptability and preliminary efficacy of the BAJJAJJA intervention in improving economic and health outcomes among 24 Ugandan GMCs; and 3) Explore the barriers and facilitators to (3a) maintenance of the BAJJAJJA individual intervention benefits and (3b)

sustainability of the income generating activity at 6 months post-intervention. This innovative study will be the first in Uganda (to our knowledge) to utilize a community-engaged approach that emphasizes the meaningful involvement of community partners to develop an intervention that targets GMCs. Her outcomes will support

her future efficacy clinical trial to test a novel multi-component and community-engaged BAJJAJJA intervention to promote the mental, physical, and economic wellbeing of GMCs.