The research focuses on adapting an acceptance-based mental health intervention called Acceptance and Commitment Training (ACT-W), which was developed by Dr Paul Flaxman and Ross McIntosh at City St George's, to fit Uganda's unique socio-cultural and economic environment.
With Uganda's workforce facing mental health challenges due to precarious work conditions, there is a need for accessible and effective mental health promotion programmes. The programme promises to address this gap by equipping employees with the tools they need to manage stress, anxiety, and other common mental health issues at work. The study has been published in PLOS Mental Health .
Mental health issues
It is estimated that 15% of all working adults suffer mental health-related challenges across the globe, costing approximately US$ 1 trillion and 12 billion working days annually. The mental health burden appears even higher in low and middle-income countries (LAMICs), where 75% of the world's labour force lives. In LAMICs like Uganda, mental health conditions also often go untreated due to a lack of resources, and an estimated 68% of Ugandan workers experience some form of mental health challenge, according to the study.
Despite this, over 78% of Ugandan employers offer no formal mental health support. This gap in services is compounded by the stigma associated with mental health in Ugandan society, which prevents many workers from seeking help. The research highlights that workers are often left to cope with stress, anxiety, and other mental health issues without proper support, negatively impacting their productivity and quality of life.
A culturally sensitive approach to promote mental health at work
Acceptance and Commitment Training for the workplace (ACT-W) was originally developed at City St George's and tested in high-income countries such as the UK. This training has been widely adopted in the UK's National Health Service (NHS) to help improve mental health among healthcare staff . The training cultivates psychological flexibility, which refers to a willingness to experience internal states that may arise while pursuing personally valued actions and goals. The programme helps workers become much more aware of the everyday actions that carry personal meaning, and learn how to engage in those actions even when experiencing difficult thoughts and emotions.
While ACT-W has been a great success in high-income countries, the research team realised that Uganda's cultural and economic context required adjustments to make the programme relevant for its workforce. For instance, in Uganda, communal values are highly significant, so the training needed to emphasise group well-being, rather than solely focusing on individual goals.
To accommodate this, the researchers engaged with 14 mental health providers living and working in Kampala in Uganda, and the programme's content was adapted to include more references to community-based values. The language and metaphors used in the training were also adjusted to better align with Ugandan culture, which often views mental health through a lens of spirituality and traditional beliefs.
Reducing mental health stigma
One of the key challenges identified in the study is the stigma surrounding mental health in Uganda. As a result, many Ugandans are reluctant to talk openly about their mental health, especially in the workplace.
To address this, the ACT-W programme incorporates elements of mental health awareness and education. The goal is to reduce stigma by showing that mental health can be improved by learning psychological and behavioural skills.
Benefits for Ugandan workers and employers
The potential benefits of ACT-W for Ugandan workers are significant. The programme teaches workers how to relate skilfully to their emotions, and stay mindful of personal values, even in difficult circumstances. This could lead to improved mental well-being, greater job satisfaction, and increased productivity.
For employers, the advantages are clear. Healthier, more resilient employees are likely to perform better, take fewer sick days, and contribute to a more positive workplace atmosphere. In a country where mental health support is currently lacking, programmes like ACT-W could represent one cost-effective way to improve employee well-being and, in turn, business outcomes.
Dr Khamisi Musanje, the lead researcher from Makerere University, said: "Improving mental health in the workplace is not only about individual well-being, but also about creating a healthier, more productive workforce for Uganda's future."
Dr Paul Flaxman, co-researcher and Reader in the Department of Psychology at City St George's, said: "The findings from this study are exciting because they demonstrate that evidence-based mental health training programmes like ACT-W can be adapted to diverse cultural contexts. Our hope is that ACT-W will increase Ugandan workers' access to the type of training that has proved popular and effective among workers here in the UK."
The next stage of the project involves rolling out the adapted ACT-W programme in Ugandan workplaces and evaluating its effectiveness. If successful, it could become a model for other low-resource settings looking to improve mental health at work.
