Towards Culturally Responsive Practices: A Scoping Review of Systemic Family Therapy Interventions in Africa

Towards Culturally Responsive Practices: A Scoping Review of Systemic Family Therapy Interventions in Africa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Towards Culturally Responsive Practices: A Scoping Review of Systemic Family Therapy Interventions in Africa Anita Kateregga, Ronald Asiimwe, Ibrahim Luberenga, Pendo Galukande This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8717252/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Systemic Family therapy is slowly gaining momentum across Africa, with a growing number of family therapy interventions being implemented to address mental, emotional, and relational health challenges. However, most widely used family therapy approaches were developed in the Global North, and to date, we know little about the extent to which these interventions are culturally adapted and for which target outcomes in African contexts. This paper reviewed and synthesized existing literature on family therapy interventions in Africa to identify target outcomes and gaps in cultural adaptation, to inform future directions for family therapy research and practice on the continent. Methods Our review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We identified 761 studies from scholarly sources, published between 2014–2025. Results Among the 14 empirical studies included, the interventions reflected diverse systemic family therapy models including Behavioral Family Therapy, Multiple Family Groups, Tuko Pamoja (family-strengthening intervention), Multi-Couple Therapy, African Family Counseling, Transgenerational Family Therapy, Adlerian Family Therapy, Structural Family Therapy, Emotionally Focused Therapy, and Rational Emotive Family Health Therapy. Cultural adaptations included integration of traditional storytelling, religious leadership involvement, and respect for hierarchical family norms. Across studies, we noticed an absence of clarity on systematic, theory-driven cultural adaptation processes. Conclusion Findings from this review advance the field by providing insights into the importance of conducting thorough cultural adaptations of family interventions before implementation in African settings as a foundation for advancing culturally relevant family therapy practices in African settings. Systemic Family Therapy Cultural Adaptation Family Therapy Interventions African Contexts Figures Figure 1 Introduction Systemic Family Therapy (SFT) or often referred to as couple and family therapy (CFT) interventions focus on improving family dynamics through treating the family as a system, rather than focusing on individual members in isolation (Wampler & Patterson, 2020 ). Systemic Family Therapy views emotional, psychological, behavioral symptoms as being embedded within, and influenced by the larger context of people’s relationships such as in families, communities, and larger sociocultural and political events, including historical and current ones, rather than symptoms residing solely within individuals. Given the collectivistic nature of many African societies, SFT ideas are particularly relevant and well-aligned because family relationships in these contexts, not only include the nuclear unit but also extended family members, kinship networks, and the communal relationships (Ariyo et al., 2019 ; Asiimwe, et al., 2021 ; 2026 ). Similar to families and communities around the world, African couples and families are increasingly navigating a multitude of stressors, including family and community trauma, war and chronic health burdens such as HIV/AIDS, shifting gender roles, and rapid technological and societal changes, that place significant strain on relational dynamics among couples and families on the continent (Roman et al., 2025 ). For instance, evidence indicates that approximately 38.5% of married and co-habiting women in 24 studied sub-Saharan African countries reported experiencing some form of intimate partner violence (IPV; Aboagye et al., 2022 ). Furthermore, systematic reviews show that mental health problems among children and adolescents are highly prevalent in the region: about 23% currently have mental health problems (with depression at 19% and anxiety at 20%) according to one meta-analysis of studies in sub-Saharan Africa (Hunduma et al., 2021 ). Together, these patterns suggest that the relational unit, including couples and families, is under mounting pressure, making it critically important to implement interventions that directly engage families and their relational dynamics, support parenting, couple communication, and family resilience, not merely individual-level treatment. Of great advantage is that family therapists and family therapy interventions are uniquely positioned to address these complex and interrelated issues because they target relational systems rather than individuals in isolation (Bobek et al., 2025 ). However, despite empirical evidence supporting the effectiveness of family therapy interventions in strengthening family functioning, mental and relational wellbeing of families across the world (Roberts et al., 2014 ), little has been written about such interventions on the African continent, specifically, where they have been implemented, the populations they target, their intended or achieved outcomes, and cultural adaptation, where necessary. As a result, our understanding remains limited regarding how effectively these interventions have been culturally adapted to fit the lived realities of African families. Given the growing application of systemic family therapy (SFT) in Africa, this scoping review aims to synthesize empirical studies implementing SFT interventions, examine cultural adaptations and target outcomes, identify implementation gaps, and use these findings to discuss broader implications for advancing culturally and contextually resonant family therapy practice and research across African contexts. Global Origins of Family Therapy and Influences in Africa To date, evidence still suggests that major family therapy models currently in circulation in many parts of Africa have origins in the Global North, particularly in the United States of America (Nichols & Davis, 2019 ). As a result, several individual studies have implemented family therapy models in various African settings, demonstrating the growing recognition of the family as a key context for promoting mental health and relational well-being. While these models are largely grounded in systems theory, which in many ways resonates with the collective cultural values common across African societies (Asiimwe et al., 2021 ), critical cultural dynamics must still be carefully considered when applying them in African contexts. These include differing family structures, power hierarchies, and communication patterns that influence how systemic interventions are received and practiced. Moreover, many of the family therapy models were originally shaped around Western nuclear family structures that emphasize ideals such as individual autonomy, direct emotional expression, and egalitarian family roles (Gritti, 2019 ; Hwang, 2011 ). Such assumptions often stand in contrast to African collectivist community values, where extended family involvement, hierarchical roles, indirect conflict resolution, and community interdependence are central and shape people’s perceptions as well as help-seeking behaviors for most families in Africa (Adaki, 2023; Asiimwe et al., 2023 ). The legacy of colonialism in Africa further complicates this mismatch, as Western mental health frameworks have historically displaced indigenous support systems and ways of healing, such as storytelling, communal and spiritual practices, and the Ubuntu philosophy of interconnectedness. Consequently, implementing family therapy interventions in African settings requires thoughtful cultural adaptation to ensure alignment with local traditions, norms, and relational dynamics. The Growing Movement Toward Culturally and Contextually Relevant Systemic Therapies in Africa In 2021, Asiimwe and colleagues published the first article to explicitly examine the growth of systemic family therapy (SFT) in Africa, titled “Expanding our international reach: Trends in the development of systemic family therapy training and implementation in Africa” in the Journal of Marital and Family Therapy . In this work, they argued that while SFT on the continent was gaining momentum through the establishment of MFT graduate programs in countries such as Kenya, local capacity-building efforts, and international partnerships, its long-term sustainability depended largely on adapting systemic models to African sociocultural and familial contexts rather than directly exporting Western approaches unchanged. This argument aligns with a broader shift in 21st-century family therapy discourse toward recognizing the centrality of culture, context, and diversity in shaping both theory and practice (Jhamb et al., 2024 ). As scholars increasingly acknowledge that family systems are embedded within distinct sociocultural and historical realities, there has been a global movement to critically examine and culturally adapt existing family therapy frameworks to better reflect local values, relational norms, and indigenous worldviews. Within this global movement, contemporary African family therapy scholars such as Nwoye ( 2006 ) and Asiimwe et al. ( 2021 ) have emphasized the urgent need to adapt therapeutic models to reflect African cultural traditions and family structures. They argue that Western family therapy frameworks often fail to capture the communal, spiritual, and hierarchical dynamics that define many African families, and therefore risk misrepresenting or overlooking the core relational processes that shape healing and well-being on the continent. Specifically, Nwoye ( 2006 ) has called for therapeutic interventions in Africa to integrate narrative, ritual, and communal healing practices that honor other sources of distress, such as ancestral influence and spiritual imbalance. He contends that conventional Western narrative therapy’s individualistic focus must be expanded to emphasize community and family as the primary contexts of healing, which would better align with African therapeutic practices that value collective meaning-making. Similarly, Asiimwe et al., ( 2021 ) highlight the limitations of simply translating Western models and advocate for culturally responsive systemic interventions co-created with local communities, emphasizing storytelling, as well as extended family involvement. In their article that reviewed parenting programs in Africa, Asiimwe et al. ( 2023 ) highlighted the effectiveness of interventions that integrate indigenous practices and relational norms while critiquing those that fail to address power, privilege, and sustainability. Complementary perspectives come from Adams et al. ( 2020 ), who advocate for Afrocentric and decolonial approaches to therapy and counselling that include communal identity, relational importance, and gendered power dynamics within family systems. Moreover, Ayesu et al. ( 2024 ) extends this line of thinking by highlighting the relevance of culturally relevant practices in healing grief and trauma, highlighting the role of communal mourning and moral perspectives in Ghanaian psychosocial responses. Concrete examples of successful contextualization can be seen in the Family Psychosocial Involvement Intervention (FAPII) in Uganda. This program showed that culturally grounded family therapy mental health approaches that actively engage family members and respect traditional beliefs led to improvements in treatment adherence, stigma reduction, and overall wellbeing (Alinaitwe et al., 2024 ). These developments collectively illustrate a growing movement across the continent to decolonize mental health care and develop systemic therapies that are contextually relevant, spiritually sensitive, and relationally attuned. It is thus critical to note that a failure to conduct necessary adaptations risks perpetuating the historical oppression of African families and clients, even within the emerging and growing profession of family therapy on the African continent. Although emerging interventions across Africa are beginning to integrate systemic principles with cultural adaptations, responsiveness and implementation processes are rarely examined (Mabunda et al., 2022 ). Many programs such as community-based parenting interventions, family-inclusive mental health treatments, and indigenous narrative therapies are promising but often lack thorough review, including follow-up studies, randomized controlled trials, as well as culturally valid measurement tools (Goodkind et al., 2017 ). Therefore, there is a need to synthesize what has been done across the continent and outline directions for future research and clinical practice. T he current review and aims Thus, the main aims of this scoping review are three-fold. First, we aim to synthesize existing evidence of empirical studies implementing systemic family interventions across African countries, with a focus on what cultural adaptations were conducted before implementing these programs. Second, the review also aims to clearly identify target clinical outcomes of the implemented interventions as well as implementation gaps. Lastly, the review aims to use the findings of the first two objectives to identify and discuss broader implications for the advancement of family therapy within African contexts. A critical contextual consideration is that Africa is not a cultural monolith. The continent is comprised of 54 countries with profound diversity in language, religion, ethnicity, gender norms, and socio-political histories. Although this review includes studies from across East, West, and Southern Africa, the synthesis of findings should not be interpreted as representative of a single African cultural context. Rather, this approach was necessitated by the limited number of empirical studies focusing on SFT interventions in specific national and ethnic settings. Methods A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews to ensure transparent and systematic reporting (Page et al., 2021). The databases searched for this review included African Journals Online (AJOL), Academic Search Premier, and Scopus. The selection of these databases was deliberate in order to align with our review’s focus on systemic family therapy in African contexts. AJOL is the largest online database of peer reviewed studies published from African journals. Academic Search Premier was chosen due to its interdisciplinary coverage including psychology, family studies, and public health, which ensure a broad search in social science literature. Scopus was included because of its thorough indexing of international peer reviewed literature, citation tracking and access to high-impact journals. We used Google Scholar for our first search and generated key words for the database search. Eligibility Criteria To ensure that the findings were grounded in real-world practice, this review included only empirical studies, whether quantitative, qualitative, or mixed methods in design. To maintain contextual relevance, only studies that focused on African populations and conducted within African countries were considered for review. Eligible studies must have applied a systemic, relational, or family therapy model to treat certain mental and emotional issues relevant to the target setting. Additionally, only studies published in English were included to ensure consistency in interpretation, as this is the common language shared by the reviewers. We included studies published between 2014 and 2025 to be able to capture the most recent, contextually relevant developments in systemic family therapy. Conversely, the review excluded conceptual papers, literature reviews, and opinion pieces in order to concentrate solely on interventions that have been empirically tested or piloted, even if only in early stages. Studies conducted outside of African settings and those not published in English were excluded to maintain contextual integrity, and any interventions that do not involve systemic or relational therapeutic approaches are also omitted. Search Process The search process was conducted across four academic databases: Academic Search Premier via EBSCOhost (n = 234), Scopus (n = 367), and African Journals Online (AJOL) (n = 158), and 2 studies from other sources (citation searching) resulting in a total of 761 records. All the screening and selection procedures were carried out using Covidence (Veritas Health Innovation, Melbourne, Australia), a systematic review management tool. The first author (AK) conducted the initial title and abstract screening between October 2024 and January 2025 and identified eligible studies based on the inclusion criteria. These studies were then independently reviewed by the first (AK), third (IL) and fourth (PG) authors to assess their eligibility and conduct data extraction. The discrepancies in the inclusion decisions were resolved through weekly discussions between February 2025 and May 2025. Key words, search terms, subjects and titles were created to be able to capture varying descriptions of systemic family interventions in Africa. For example, in Academic Search Premier, we used these; “Systemic family therapy” OR “family therapy” OR “structural family therapy” OR “narrative therapy” OR “solution-focused therapy” OR “family counseling” OR “relational therapy” OR “Adlerian family therapy” OR “couple therapy” OR “marital counselling” AND "Africa" OR "African countries" OR "sub-Saharan Africa" OR "North Africa" OR "East Africa" OR "West Africa" OR "Southern Africa" OR "Central Africa" OR "South Africa" OR "Sub-Saharan Africa" OR "Uganda" OR "Kenya" OR "Nigeria" OR “Ghana” OR “Ethiopia” AND "Mental health interventions" OR "family interventions" OR "therapy outcomes" OR "marital conflict" OR "family dynamics" OR "parenting challenges" OR "trauma recovery" OR "domestic violence" OR "family conflict resolution". Date filters were applied (2014 to 2025). Among the articles found, the team filtered out abstracts and titles that did not meet the inclusion criteria. After removing 118 duplicates using the built-in de-duplication tools available in Covidence, 642 records remained. Three members of the research team including the first (AK), third (IL) and fourth (PG) authors then conducted further screening by reviewing titles and abstracts of articles. During this stage, 588 records were excluded for failing to meet the inclusion criteria. These excluded studies either implemented a non-relational approach, were implemented outside Africa, were systematic reviews, or not in the English language. Seventeen of these studies were excluded as they were narrative and conceptual papers. A total of 37 full-text articles were assessed for eligibility. An additional 24 studies were excluded after full-text review. Reasons for exclusion at this stage were solely due to studies implementing a non-MFT model ( See PRISMA flowchart in Fig. I ). Fig. I A PRISMA flow chart showing the selection process including database search results, screening, and the final study inclusion Table 1 Summary of included studies Author(s) Title SFT Intervention Methodology Key Outcomes Ankwasiize & Kiyingi (2016) African Family Counselling as a pivot for Cohesive Parenting. A Case of juvenile protection home in KCCA – Uganda African Family Counselling Quantitative and thematic analysis with 136 family members using Family Environment Scale Enhanced parental cohesion, adaptability, and reduced parental psychological control. Amanyire et al. ( 2023 ) Effectiveness of Behavioral Family Therapy in reducing depressive symptoms among older persons living with HIV/AIDS in Mbarara city, southwestern Uganda Behavioral Family Therapy Randomized controlled trial (RCT), 22 participants Small non-significant effect on reducing depressive symptoms; recommended integration with routine care. Neswiswa & Jacobs ( 2024 ) Hearing the voices of Black Africans: Essential components for culturally relevant marriage enrichment programs in South Africa Marriage Enrichment Program Qualitative descriptive phenomenological study, interviews and pilot with couples and leaders High acceptability, integration of traditional and modern marital practices, improved marital satisfaction. Ankwasiize & Kiyingi (2017) Structural Family Counselling and Transformation of Home Financial Constraints: a case of selected families in Kampala, Uganda Structural Family Therapy Quantitative study with Family Environment Scale, 217 family members Family subsystems positively influence home financial constraints; Structural therapy improves financial management. Lesch et al. ( 2018 ) A Pilot Implementation of the Emotionally Focused Couple Therapy Group Psychoeducation Program in a South African Setting Emotionally Focused Therapy Qualitative pilot study, thematic analysis, interviews with 10 couples Improved couple relationships, emotional communication, and relationship depth. Ugwuoke et al. ( 2023 ) Family health therapy for treating anxiety symptoms in flood victims Rational Emotive Family Health Therapy (REFHT) Randomized control trial, 120 farmers affected by floods Significant reduction in anxiety disorders among flood-affected farmers. Onogwu et al. ( 2023 ) Using social media-based drama therapy and family counselling to treat symptoms of postpartum depression among women Drama therapy and Family Counselling Quasi-experimental design with 303 participants Significant reduction of postpartum depression in women; improved spousal support, particularly when husbands received counselling. Ankwasiize & Kiyingi (2017) Adlerian Family Counselling And Mindful Parenting In Kampala Capital City - Uganda Adlerian Family Counselling Quantitative and thematic analysis, 217 family members using Five-Facet Mindfulness Questionnaire Increased family cohesion, emotional awareness, parental mindfulness, and compassion. Puffer et al. ( 2020 ) Development and Implementation of a Family Therapy Intervention in Kenya: a Community-Embedded Lay Provider Model Community-based Family Therapy Intervention Qualitative feasibility study, lay-counselor delivered interventions with 10 families Feasible implementation, high acceptability, improved trust and engagement, clinical competency. Puffer et al. ( 2021 ) Family Functioning and Mental Health Changes Following a Family Therapy Intervention in Kenya: a Pilot Trial Solution-Focused Family Therapy (Tuko Pamoja) Mixed-method pilot trial, single-group pre-post design, 10 families Reductions in family dysfunction, harsh discipline, intimate partner violence, and improved mental health. Byansi et al. ( 2024 ) The longitudinal impact of an evidence-based multiple family group intervention ( Amaka Amasanyufu ) on family cohesion among children in Uganda: Analysis of the cluster randomized SMART Africa-Uganda scale-up study (2016–2022) Amaka Amasanyufu Multiple Family Group Therapy Cluster randomized controlled trial, 636 participants from 26 schools Significant improvements in family cohesion and reductions in child behavioral issues. Ankwasiize & Kiyingi (2019) Trans-Generational Family Counselling and Management of Home Financial Constraints: A Case Study of Kampala Capital City Authority (Uganda) Trans-Generational Family Counselling Mixed-method case study, interviews, FGDs, structured questionnaires, 217 participants Trans-generational therapy effective in managing financial constraints; reduces financial abuses within families. Morgan et al. ( 2017 ) The Development and Implementation of a Multi-Couple Therapy Model with Torture Survivors in the Democratic Republic of the Congo Multi-Couple Therapy Model Single group pre-post design with 3 groups with 13 couples in total using ethnographic individual interviews. Participants reported improved communication, greater emotional closeness, and better conflict management. Asfaw & Alene ( 2023 ) Effectiveness of a marital relationship skills training intervention on marital adjustment among individuals in Hosanna Town, Southwest Ethiopia: A randomized-controlled trial Marital Relationship Skills Training Randomized-controlled trial, 80 married individuals Significant improvements in marital adjustment and reduced marital distress. Results Overview of Included Studies In this review, fourteen empirical studies that implemented systemic family therapy interventions made it to the final analysis. These studies reported on implementation conducted in five African countries: Uganda ( n = 6; Amanyire et al. ( 2023 ); Ankwasiize & Kiyingi (2016); Ankwasiize & Kiyingi (2017); Ankwasiize & Kiyingi (2017b); Ankwasiize & Kiyingi (2019) Byansi et al., 2024 ), Kenya ( n = 2; Puffer et al., 2020 a, 2021a), Congo ( n = 1; Morgan et al., 2017 ), Nigeria ( n = 2; Onogwu et al., 2023 ; Ugwuoke et al., 2023 ), South Africa ( n = 2; Lesch et al., 2018 ; Neswiswa & Jacobs, 2024 ), and Ethiopia ( n = 1; Asfaw & Alene, 2023 ). The studies employed diverse designs including randomized controlled trials, mixed-methods, case study design, and qualitative explorations. Sample sizes varied widely, ranging from small pilot studies with 10 participants to larger interventions involving over 200 families. Target populations included adolescents, parents, older adults living with HIV, families facing economic hardship, and survivors of environmental hazards. Implemented Interventions and Target Outcomes The studies we reviewed implemented a variety of family therapy interventions, including behavioral approaches, structural approaches, cognitive and emotional restructuring techniques, narrative and drama-based therapies, as well as trans-generational and community-focused models. Each type of intervention used unique methods, and strategies to address mental, emotional, and relational challenges within the family system. Behavioral Family Therapy (BFT) Behavioral Family Therapy was implemented in one study that emphasized observable behaviors, parent-child interactions, and communication patterns within family units. These interventions primarily targeted improving relational patterns, reducing conflict, enhancing parental skills, and increasing emotional regulation among family members. In Uganda, BFT was adapted specifically for older adults living with HIV, targeting depressive symptoms and relational conflicts through structured interventions including teaching communication and problem-solving skills (Amanyire et al., 2023 a). Outcomes indicated only moderate effects on depression, however, the therapy facilitated better communication skills and recommended further integration within routine care contexts. Structural Family Therapy Structural Family Therapy, implemented in a study in Uganda, targeted hierarchical family dynamics, boundary setting, and the shaping of family roles and subsystems to enhance relational functioning. These interventions focused on establishing clear and adaptive boundaries to support healthy interactions among family members. In their study, Ankwasiize & Kiyingi (2017) implemented Structural Family Counselling and focused on the family structure, family subsystems and family boundaries, engaged extended family members and hierarchical structures to resolve relational and communication problems. These interventions proved particularly effective in addressing financial constraints and relational conflicts arising from unclear boundaries and roles. Solution-Focused Family Therapy Solution-focused systemic interventions were used in two studies in Kenya and identified strengths, resources, and solutions rather than solely addressing problems. Therapists guided families toward achievable goals through brief, solution-oriented sessions, and empowered families through the active recognition of their strengths and capacities. The Tuko Pamoja program in Kenya employed solution-focused principles through lay counsellors embedded within the community. Interventions involved families actively co-constructing practical solutions to reduce intimate partner violence, harsh discipline practices, and improve overall family functioning and mental health (Puffer et al., 2020 , 2021 ). Multiple Family Group (MFG)Therapy Multiple Family Group Therapy was applied in one study in Uganda and utilized group-based therapeutic environments involving multiple families simultaneously. This systemic approach facilitated mutual learning, collective problem-solving, peer support, and community mentorship which align closely with communal values in many African cultures. The Amaka Amasanyufu intervention in Uganda was an MFG model specifically adapted for families experiencing child behavioral difficulties. It fostered communal parenting strategies, peer-to-peer support, and collective problem-solving, which significantly improved family cohesion, parental efficacy, and child outcomes (Byansi et al., 2024 ). Rational Emotive Family Health Therapy (REFHT) Rational Emotive Family Health Therapy utilized cognitive-behavioural principles within a systemic family context. This approach aimed at cognitive restructuring, addressing irrational beliefs and maladaptive cognitive patterns within families, particularly in response to environmental and psychosocial stressors. REFHT was implemented in Nigeria among families affected by flood disasters. The intervention explicitly addressed anxiety by altering and disputing maladaptive beliefs, restructuring family perceptions, which led to significant reductions in anxiety symptoms and improved family resilience (Ugwuoke et al., 2023 ). Narrative Family and Drama Therapy Narrative and drama-based therapeutic interventions focused on the re-writing of personal and family narratives, utilizing storytelling, drama, and role-play. These approaches used the cultural tradition of storytelling in African communities and provided emotional spaces for healing and recovery. In Nigeria, a social media-based drama therapy intervention addressed postpartum depression among women, creatively utilizing drama, role-play, storytelling, and digital media platforms (e.g., WhatsApp). This intervention demonstrated significant reductions in postpartum symptoms and increased spousal support, which revealed the relevance and effectiveness of narrative therapy (Onogwu et al., 2023 ). Trans-generational Family Therapy Trans-generational systemic interventions examined patterns and emotional processes across multiple generations. These interventions targeted unresolved emotional issues, multi-generational stress transmission, and relational patterns in order to promote emotional differentiation and functional family dynamics. In their study, Ankwasiize & Kiyingi (2019) used Trans-generational Family Therapy to address intergenerational financial constraints and emotional processes within families. They used Bowenian concepts such as differentiation, triangulation, and emotional cut-off, and these interventions improved emotional functioning and financial management among different families. Multi-Couple Therapy (MCT) The MCT model was designed to support Congolese couples that had gone through torture and sexual violence and were struggling with significant relational and psychological distress (Morgan et al., 2017 ). This therapy integrated elements from trauma-focused care, couple therapy and group process theory to deliver a structured communal intervention. In this model, there was emphasis on safety, communication exercises, normalization of trauma responses and emotional reconnection. Adlerian Family Counselling Adlerian systemic approaches emphasized family cohesion, individual goals within a family context, and mindfulness practices. These interventions prioritized nurturing individual responsibility and empathy within relational systems to achieve balanced and cohesive family dynamics. In Uganda, Adlerian Family Counselling promoted mindful parenting practices and emotional awareness within family systems. This approach significantly increased family cohesion, emotional openness, and compassionate interactions among family members (Ankwasiize & Kiyingi, 2017). Emotionally Focused Couple Therapy (EFCT) Emotionally Focused Therapy interventions targeted emotional bonding, attachment processes, and emotional communication within couples. EFCT is rooted in attachment theory, and it prioritized creating secure emotional connections, enhancing intimacy, and reducing relational distress. The South African EFT-based psychoeducation program, Hold Me Tight, explicitly focused on improving emotional connectivity and attachment bonds within couples. The program demonstrated effectiveness in enhancing emotional intimacy, relational satisfaction, and conflict resolution skills among participating couples (Lesch et al., 2018 ). Marital Relationship Skills Training and Marriage Enrichment Programs In this review, two interventions targeted marital relationships and emphasized structured skill-building related to communication, conflict resolution, and intimacy. These systemic approaches provided psychoeducational sessions, guided exercises, and structured discussions designed to build relational wellness among couples. Such interventions involved teaching practical skills alongside culturally relevant relational insights to foster healthier, more satisfying marital relationships. In Ethiopia, a structured marital skills training intervention focused on enhancing communication, emotional intimacy, and problem-solving skills among couples. The program demonstrated significant positive effects, including improved marital adjustment, increased relationship satisfaction, and a reduction in marital distress (Asfaw & Alene, 2023 ). The Marriage Enrichment Program (MEP) in South Africa, adapted from the international PREP 8.0 curriculum, was designed explicitly to integrate modern relationship skills with culturally meaningful marital practices such as bogadi (bridewealth negotiations) and go laya (traditional elder guidance). This program led to enhanced communication, deeper emotional intimacy, improved conflict-resolution skills, and higher overall marital satisfaction. The involvement of traditional community leaders and the blending of contemporary psychoeducational content with indigenous relational traditions resulted in a high degree of acceptability, engagement, and effectiveness among participants (Neswiswa & Jacobs, 2024 ). African Family Counselling African Family Counselling is an intervention approach deeply rooted in indigenous family structures and relational philosophies. It emphasizes cohesion, communal parenting, collective problem-solving, and the reinforcement of traditional family values. This approach integrates extended family members and community perspectives, rather than focusing solely on nuclear family dynamics, which aligns with collective rather than individualistic ways. In their study, Ankwasiize & Kiyingi (2016) used the African Family Counselling alongside cohesive parenting to enhance parenting and focused on strengthening parental cohesion, adaptability, and reducing psychological control. The intervention employed counselling sessions that incorporated traditional stories, conflict resolution methods, and community dialogue. Participants reported improvements in emotional connection among family members, enhanced cooperation in parenting roles, and greater adaptability in addressing family stressors and discipline issues. Cultural Adaptation Strategies Across the reviewed studies, a recurring theme was the integration of local cultural and contextual elements like local languages, and the use of local idioms into SFT interventions. It is important to note that culturally responsive adaptations aimed at enhancing relevance, acceptability, and therapeutic engagement within the community. In Uganda, the Amaka Amasanyufu Multiple Family Group (MFG) intervention emphasized communal mentorship by employing community health workers and parent peers, culturally appropriate parenting narratives, and local language (Luganda) materials to facilitate meaningful connections among participants (Byansi et al., 2024 ). In South Africa, the Marriage Enrichment Program (MEP) explicitly incorporated traditional marital practices such as bogadi (bridewealth negotiations) and go laya (traditional guidance by elders), ensuring culturally sensitive alignment with indigenous marital values and norms (Neswiswa & Jacobs, 2024 ) Similarly, interventions such as Tuko Pamoja in Kenya and MCT in Congo strategically involved lay counsellors embedded within the community, enabling flexible delivery approaches tailored to culturally specific economic, gender, and parenting dynamics (Morgan et al., 2017 ; Puffer et al., 2020 a). Moreso, Nigerian-based interventions like Rational Emotive Family Health Therapy (REFHT) integrated culturally relevant frameworks, explicitly addressing local crises (e.g., flooding disasters) by linking cognitive restructuring techniques to relevant emotional coping strategies for farmers that were experiencing anxiety due to flooding (Ugwuoke et al., 2023 ). Another example was the social media-based drama therapy combined with family counselling in Nigeria, which used digital platforms to deliver culturally attuned interventions addressing postpartum depression and spousal support, which effectively blended social media (e.g., WhatsApp) with culturally nuanced therapeutic strategies including storytelling and use of Nigerian metaphors (Onogwu et al., 2023 ). Additionally, considering the centrality of spirituality and religion in African relational contexts, six studies discussed an integration of spiritual leaders or religious frameworks within their delivery models. For example, REFHT in Nigeria specifically incorporated local spiritual and religious beliefs in addressing anxiety related to natural disasters such as flooding (Ugwuoke et al., 2023 ). Similarly, the Ethiopian marital relationship skills training intervention acknowledged local religious values and norms as central aspects of marital relationships, thus promoting meaningful interventions that connect with the culture (Asfaw & Alene, 2023 ). In the marriage enrichment program in South Africa, delivery of the intervention happened in collaboration with church-based groups, and program content included Christian values of forgiveness and respect in marriage (Neswiswa & Jacobs, 2024 ). In the pilot trial of a family therapy intervention in Kenya, they involved clergy as occasional co-facilitators to align the intervention with the families’ spiritual coping mechanisms (Puffer et al., 2020 ). Religion plays a significant role in African family life, reflecting the importance of incorporating some religious aspects in intervention delivery. Furthermore, five interventions adapted their structural approaches to respect existing hierarchical family dynamics, including involving extended family members in therapeutic processes. This approach capitalized on pre-existing family strengths and promoted communal healing. For instance, Structural and Trans-generational Family Counselling approaches in Uganda explicitly included intergenerational family structures, emphasizing clear hierarchical roles and responsibility distributions to address systemic relational issues effectively (Ankwasiize & Kiyingi, 2017, 2019). Moreover, the Amaka Amasanyufu Multiple Family Group intervention strategically used peer support and collective learning approaches, which align with communal relational values and multi-family support structures (Byansi et al., 2024 ). Finally, in three studies, interventions were carefully adapted to address specific gender dynamics and needs, including explicitly recognizing and addressing power imbalances (men hold more power than women), gender-based violence, postpartum mental health, and marital relationship dynamics. For instance, EFT in South Africa and the MEP explicitly addressed gendered relational dynamics, emotional intimacy, and communication barriers between spouses, actively promoting gender-sensitive marital relationship enrichment (Lesch et al., 2018 ; Neswiswa & Jacobs, 2024 ). Moreover, the Nigerian drama therapy and family counselling intervention included specific sessions on enhancing spousal support and male engagement during postpartum periods, which directly addressed gendered roles and relational expectations in the African traditions (Onogwu et al., 2023 ). The inclusion of gender-sensitive components in these studies demonstrated an understanding of the socio-cultural realities of African family dynamics. Gaps in Cultural Adaptations Despite studies mentioning and, in some instances, integrating culturally resonant rituals and practices in implementation, we noticed a gap in the use of established cultural adaptation frameworks in the development and implementation of the interventions. For example, none of the studies we reviewed explicitly applied empirically validated frameworks for conducting adaptation such as Bernal et al.’s ( 1995 ) Ecological Validity Model, the ADAPT-ITT framework, or the Cultural Adaptation Process Model (CAPM) (Domenech Rodríguez & Bernal, 2012 ) to inform how they tailored content, delivery and evaluation strategies. Moreover, the adaptations were mainly referred to as cultural considerations instead of deeply being grounded in theory-informed cultural adaptation processes that thoroughly assess key cultural domains. Across the reviewed studies, cultural adaptations were mainly at the surface level. These focused on adjustments such as translating materials (Amanyire et al., 2023 ), using local names for interventions (Byansi et al., 2024 ), and delivering interventions in community settings (Asfaw & Alene, 2023 ; Neswiswa & Jacobs, 2024 ; Puffer et al., 2020 b, 2021). According to Bernal et al. ( 1995 ), effective cultural adaptations go beyond linguistic translation to include structural alignment with local core values through multiple dimensions such as language, metaphors, content, concepts, goals, metaphors and context. There was limited re-modification of core mechanisms of change in the Western models (e.g., EFT, Adlerian therapy, BFT) to ensure conceptual equivalence with African cultural contexts. In Ankwasiize & Kiyingi’s (2017) study that implemented Adlerian Family Counselling and Mindful Parenting, they retained democratic parenting styles and individual goal setting yet provided limited reflection on whether these approaches align with the parenting norms and structures in the Ugandan context. The concern here is that some interventions may impose Euro-American family assumptions that misalign with the collective, hierarchical and interdependent nature of many African family systems. There was lack of transparency in how the cultural adaptations were implemented. Most papers reported translating the materials (Byansi et al., 2024 ), engaging community stakeholders in intervention implementation and cultural consultation (Neswiswa & Jacobs, 2024 ; Puffer et al., 2021 ) but did not provide the detailed processes through which these were done. There was limited reporting on the adaptation protocols, stakeholder input, or the decision-making criteria they used to modify the content in these interventions. Clear documentation of adaptation procedures is critical for replication, scalability, and cross-cultural learning. Additionally, there was minimal evidence of co-design approached in adapting interventions, and yet this is an essential step in ensuring that cultural adaptation is a bottom-up process (Domenech Rodríguez & Bernal, 2012 ). Studies like the MFG intervention in Uganda, and Tuko Pamoja in Kenya recruited parent peers, engaged village and religious leaders in recruitment and facilitating the interventions (Byansi et al., 2024 ; Puffer et al., 2021 ), but these were surface level collaborations and gate keeper involvement to foster trust in the community. There was lack of thorough participatory elements needed in the cultural adaptation process that involve feedback loops where community feedback leads to refinement of the intervention content, methods, measurement, and delivery. Even in Amaka Amasanyufu , where facilitators were local, the adaptation process focused more on delivery than on deep structural adaptation of the therapeutic constructs (Byansi et al., 2024 ). In summary, several studies have taken culture into consideration while implementing SFT interventions across African contexts, such as incorporating local languages, drawing on traditional values, and engaging community leaders. However, many adaptations remain under-reported, partial, top-down, and lacking in methodological rigor. Without comprehensive strategies that involve communities as co-creators and not just recipients, interventions risk cultural misalignment and reduced sustainability. So, to ensure deeper cultural effectiveness, future studies must prioritize inclusive design, apply adaptation models systematically, and build evidence through iterative evaluation and community feedback loops. Cultural adaptation must not be treated as a small add-on but as an integral process of intervention implementation. Barriers to Implementation The results across papers showed substantial therapeutic outcomes for families. However, they consistently highlighted several barriers impacting implementation and sustainability of the SFT interventions. Among these were logistical and limitations in infrastructure (e.g., transportation and communication barriers, especially in rural settings), low psychological literacy, and persistent stigma around mental health. For example, the Ugandan Structural Family Therapy and Kenyan community-based interventions cited difficulties in training and retaining adequately skilled lay therapists while maintaining fidelity within the models (Ankwasiize & Kiyingi, 2017; Puffer et al., 2020 ). Furthermore, limited funding, resource scarcity, shortages of trained marriage and family therapists, and a lack of culturally validated and contextually appropriate measurement tools consistently limited scaling intervention and outcome evaluation. Despite these challenges, using community-based delivery models, integrating interventions with religious institutions, and training lay community members emerged as promising strategies to mitigate these barriers and enhance intervention acceptability and sustainability across multiple settings. Discussion The findings of this scoping review serve to show the potential and cultural relevance of systemic family therapy in the diverse settings of Africa, when thoughtful adaptations are conducted. We included fourteen studies from six African countries namely; Uganda, Kenya, Nigeria, Ethiopia, Congo and South Africa that implemented a variety of interventions targeting systemic/relational change outcomes. The interventions in our review were implemented to mainly address a variety of systemic/relational change issues in families, including but not limited to, marital conflict, parenting stress, depression, among others. Through this review, we found that implemented interventions demonstrated an emerging trend of cultural responsiveness in family therapy in Africa. These developments signal a critical and emerging shift from simply importing Euro-American based models to actively finding ways to integrate interventions with locally relevant culturally responsive practices that center African community norms and traditions (Asiimwe et al., 2026 ; Chilisa et al., 2016 ). This shift also means that there is a growing commitment to decolonizing mental health care as well as recognizing the importance of African cultural values, perspectives and family structures in shaping couple and family therapy work. Importantly, this transformation has even broader implications for the future of systemic family therapy across the continent. First, culturally grounded systemic interventions hold great potential to significantly increase access to care in low-resource and rural areas while also reducing stigma around mental health. Since therapy could be embedded within familiar traditions (e.g., storytelling, faith, communal practices), these models can make therapy more relatable and invite participation from individuals and families that may otherwise remain unreached. In their review, Mascayano and colleagues ( 2020 ) had similar conclusions, emphasizing that mental health stigma can be significantly reduced when interventions resonate with the culture. After analyzing 25 stigma-reduction programs across low- and middle-income countries (LMICs), they found that in the interventions that incorporated culturally meaningful elements like language, community norms, values and belief systems, participants reported higher engagement, lower stigma, and greater openness to seeking mental health support (Mascayano et al., 2020 ). Second, culturally responsive SFT models in Africa can help families navigate distress relationally, rather than individually. For instance, when intergenerational issues, gender dynamics, or even collective decision-making norms are explicitly addressed within a family therapy intervention, the outcomes can be more sustainable and relevant to the people. Previous research also showed that interventions that align with the local beliefs about health and wellbeing, family and moral development, are more likely to increase ownership, promote healing while also shifting long-standing relational patterns (Arundell et al., 2021 ; Marsiglia & Booth, 2015 ; Mishu et al., 2023 ). Building on this growing momentum, our review analyzed how systemic interventions were culturally adapted and delivered in different studies. Strategies such as the integration of indigenous storytelling traditions, communal mentorship models, religious and spiritual frameworks, and the use of local language, emerged as the main ways interventions were adapted to fit local context in the target setting (Asfaw & Alene, 2023 ; Byansi et al., 2024 ; Morgan et al., 2017 ; Puffer et al., 2020 ). This finding was not surprising to us as a team of African family therapy scholars but rather, it affirmed that integrating culturally rooted practices such as indigenous storytelling, communal mentorship, religious and spiritual frameworks, and local languages is a key strategy for making family therapy interventions more relevant and acceptable in African contexts (Bah et al., 2025 ). Previous studies in diverse cultural settings (Bah et al., 2025 ; James et al., 2021 ; Marsiglia & Booth, 2015 ; O’Donnell et al., 2022 ), have similarly highlighted that tailoring interventions to include locally meaningful traditions and communication styles strengthens cultural fit and improves engagement and outcomes. These culturally relevant elements fostered community trust, increased participant engagement, and strengthened intervention fidelity. The success of programs like Tuko Pamoja in Kenya (Puffer et al., 2021 ) and the Amaka Amasanyufu MFG in Uganda (Byansi et al., 2024 ) showed the feasibility and efficacy of culturally grounded systemic approaches. These models demonstrated significant improvements in family cohesion, emotional regulation, parenting practices, and mental health outcomes even in low-resource, high-stigma environments. Despite these strategies, we observed several key gaps in cultural adaptation. First, while many interventions incorporated surface-level adaptations (e.g., using local language or involving community leaders), there was limited evidence of deeper structural and functional adaptations as described in frameworks like Bernal et al.’s ( 1995 ), which emphasize modification of intervention logic to increase cultural fit. Only a few studies engaged in participatory processes with community members (Byansi et al., 2024 ; Puffer et al., 2021 ) which is an essential step for ensuring that adaptation is informed by local voices. This strategy has been proven to be effective by similar studies that leveraged lay providers to bridge in access to family therapy (Jordans et al., 2019 ). However, critical components of sustainable adaptation with community involvement and co-ownership as discussed by Treichler et al. ( 2022 ) in their study, were missing. We contend that the absence of these strategies reduces the systematic rigor of the adaptations and limits both replicability and transparency. Additionally, majority of studies lacked robust evaluation designs, with only a handful including follow-up assessments, control groups, or culturally validated measures (Byansi et al., 2024 ; Puffer et al., 2021 ). This reduces the ability to track long-term outcomes and generalize effectiveness across diverse African contexts. This echoes broader critiques from scholars like Bernal & Sáez-Santiago ( 2024 ) and Castro et al. ( 2004 ) who have advocated for the use of contextual measurement tools as a part of cultural adaptation. Critiques in similar reviews mirror our observation that many culturally adapted interventions still lack standardized follow-up, as well as validated outcome measures (Bosqui et al., 2024 ; Mabunda et al., 2022 ; Rathod et al., 2010 ; Shehadeh et al., 2016 ). These methodological limitations further reduce confidence in the long-term effectiveness of interventions and also call for systematic cultural adaptation frameworks in global mental health research. Implications The findings point to several opportunities for strengthening culturally grounded family therapy across Africa. Future interventions should prioritize co-design processes that include local families, traditional leaders, and community-based mental health practitioners as partners in the adaptation and implementation process. Participatory approaches not only enhance cultural fit but also build community ownership, which is essential for sustainability, as demonstrated by Belgrave et al. ( 2022 ), Edge et al. ( 2016 ) and Renwick et al. ( 2025 ) who achieved great cultural fit and community ownership in their studies, culturally adapting interventions with the community. More so, there is an urgent need to develop and validate culturally grounded assessment tools, including measures of family functioning, relational wellbeing, and intergenerational communication, that move beyond the existing Euro-centric measures. Efforts like those led by Asiimwe et al. ( 2025 ) and Mugarura et al. ( 2025 ) are exemplary in their attention to building local capacity and validating tools including the Alabama Parenting Questionnaire, and the CompACT questionnaire respectively to resonate with African family and community structures. Despite the promising outcomes from studies in this review, systemic family therapy in Africa continues to face persistent structural challenges. Key barriers include underfunding, inadequate infrastructure for therapist training and supervision, stigma surrounding mental health services, and the absence of culturally validated assessment tools tailored to diverse African family systems. These challenges limit scalability, sustainability, and policy integration, and it is our conviction that there is an urgent need for investments in systemic therapy capacity-building and culturally relevant theoretical frameworks. In this context, Heiden-Rootes and colleagues ( 2025 ) emphasize that when building family therapy in African contexts, it is critical to start with community-driven research. This means asking what communities need, what’s already working, and how the existing evidence-based models like EFT, can be adapted to fit the communal values like attachment to the extended family. Conclusion This scoping review reveals that culturally adapted systemic family therapy interventions are relevant in enhancing emotional, relational, and psychosocial wellbeing across African family systems. Interventions that integrated traditional values, religious practices, and community-based delivery models demonstrated improvements in mental health, family functioning, parenting practices, and stigma reduction. The synthesis shows that African families benefit most when systemic approaches are intentionally adapted to reflect traditional cultural values, extended family dynamics, and communal healing traditions. Cultural responsiveness was a core mechanism of engagement and impact and not just an accessory to the effectiveness of the interventions implemented. Overall, systemic family therapy offers a powerful pathway for advancing relational health, strengthening families, and promoting collective wellbeing across Africa when cultural values are incorporated. Given these findings, we strongly advocate for more research dedicated to cultural adaptation of SFT interventions. Declarations Author Contribution A.K: Conceptualization, designed the review protocol, conducted the literature search, and led data extraction and synthesis. Writing - Original Draft, Writing - Review & Editing. R.A: Conceptualization, designed the protocol, Validated extracted data, writing – Subsequent drafts, editing and reviewing. I.L: Study screening, Data extraction, review and editing manuscript P.G: Study screening, Data extraction, Review and Editing manuscript References Adams, G., Osei-Tutu, A., & Affram, A. A. (2020). Decolonial Perspectives on Psychology and Development. Oxford University Press . https://doi.org/10.1093/acrefore/9780190236557.013.514 Aboagye, R. G., Dadzie, L. K., Arthur-Holmes, F., Okyere, J., Agbaglo, E., Ahinkorah, B. O., & Seidu, A. A. (2022). Intimate partner violence against married and cohabiting women in sub-Saharan Africa: does sexual autonomy matter? Reproductive health, 19(1), 79. https://doi.org/10.1186/s12978-022-01382-1 Alinaitwe, R., Seggane, M., Turiho, A., Bird, V., Priebe, S., & Sewankambo, N. (2024). Family Psycho-Social Involvement Intervention for severe mental illness in Uganda. South African Journal of Psychiatry , 30 , 1–10. https://doi.org/10.4102/sajpsychiatry.v30i0.2138 Amanyire, J. M., Aheisibwe, I., Kaggwa, M. M., & Rukundo, G. Z. (2023). Effectiveness of Behavioral Family Therapy in reducing depressive symptoms among older persons living with HIV / AIDS in Mbarara city, southwestern Uganda. International Journal of Scientific Research and Engineering Development , 6 (5), 1066–1077. Ariyo, E., Mortelmans, D., & Wouters, E. (2019). The African Child in Kinship Care: A Systematic Review. Children and Youth Services Review , 98 , 178–187. https://doi.org/10.1016/j.childyouth.2018.12.013 Arundell, L. L., Barnett, P., Buckman, J. E. J., Saunders, R., & Pilling, S. (2021). The effectiveness of adapted psychological interventions for people from ethnic minority groups: A systematic review and conceptual typology. Clinical Psychology Review , 83 , 102063. https://doi.org/10.1016/j.cpr.2021.102063 Asfaw, L. S., & Alene, G. D. (2023). Effectiveness of a marital relationship skills training intervention on marital adjustment among individuals in Hosanna Town, Southwest Ethiopia: A randomized-controlled trial. Journal of Marital and Family Therapy , 49 (3), 541–560. https://doi.org/10.1111/jmft.12641 Asiimwe, R., Blow, A. J., Mugumya, F., Birungi, M., & Tumuhairwe, T. J. B. (2025). Culturally Informed Parenting Assessment: The Adaptation of the Alabama Parenting Questionnaire With Input From Ugandan Experts and Parents. Family Process , 64 (2). https://doi.org/10.1111/famp.70035 Asiimwe, R., Dwanyen, L., Subramaniam, S., Kasujja, R., & Blow, A. J. (2023). Training of interventionists and cultural adaptation procedures: A systematic review of culturally adapted evidence-based parenting programs in Africa. Family Process , 62 (1), 160–181. https://doi.org/10.1111/famp.12780 Asiimwe, R., Karume, M., & Kasujja, R. (2023). Systemic family therapy in Africa: Past, present, and future trends. In The Routledge International Handbook of Couple and Family Therapy. https://doi.org/10.4324/9781003297871-14 Asiimwe, R., Lesch, E., Karume, M., & Blow, A. J. (2021). Expanding our international reach: Trends in the development of systemic family therapy training and implementation in Africa. Journal of Marital and Family Therapy , 47 (4), 815–830. https://doi.org/10.1111/jmft.12514 Asiimwe, R., McIntosh, L. D., Gathumbi, N. R., & Kasujja, R. (2026). Cultural threads: An Afrocentric paradigm for integrating social justice principles in the practice of family therapy in Africa. Journal of Marital and Family Therapy , 52 (1), 1752–0606. https://doi.org/10.1111/jmft.70091 Ayesu, S. M., Buami, E. K., Adjei, D. A., Abraham, I., Adom, D., & Crentsil, T. (2024). The use of culturally acceptable mourning clothes in Ghana: psychological implications on the bereaved. African Identities , 00 (00), 1–22. https://doi.org/10.1080/14725843.2024.2415585 Bah, A. J., Wurie, H. R., Samai, M., Horn, R., & Ager, A. (2025). The cultural adaptation of the Friendship Bench Intervention to address perinatal psychological distress in Sierra Leone: an application of the ADAPT-ITT framework and the Ecological Validity Model. Frontiers in Psychiatry , 16 . https://doi.org/10.3389/fpsyt.2025.1441936 Belgrave, A. B., Bermudez, V. N., Chew, P., Lin, Y., Ahn, J., Bustamante, A. S., Alvarez-Vargas, D., Villegas, J., & Arciniega, M., P (2022). Using a Participatory Design Approach for Co-creating Culturally Situated STEM Enrichment Activities. Journal of Applied Developmental Psychology , 82. https://doi.org/10.1016/j.appdev.2022.101451 Bernal, G., Bonilla, J., & Bellido, C. (1995). Ecological Validity and Cultural Sensitivity for Outcome Research: Issues for the Cultural Adaptation and Development of Psychosocial Treatments with Hispanics. In Journal of Abnormal Child Psychology , 23 , 67–82. https://doi.org/10.1007/BF01447045 Bernal, G., & Sáez-Santiago, E. (2024). Culturally Centered Psychosocial Interventions. Focus , 22 (4), 508–514. https://doi.org/10.1176/appi.focus.24022022 Bobek, M., Hogue, A., Porter, N., MacLean, A., Bourdeau, T., Cromley, T., Higa-MacMillan, C., Thompson, T., Wagner, J., & Daleiden, E. (2025). Core Practices in Systemic Family Therapy for Adolescent Behavior Problems: A Comprehensive Modular Pathway. Contemporary Family Therapy , 47 , 419–434. https://doi.org/10.1007/s10591-025-09738-y Bosqui, T., Gardner, F., McLuckie, A., & Wessels, I. (2024). Parenting and family interventions for mental health in low- and middle-income countries: A systematic review and meta-analysis of effectiveness and implementation factors. Children and Youth Services Review , 155 , 107419. https://doi.org/10.1016/j.childyouth.2024.107419 Byansi, W., Sensoy Bahar, O., Small, L., Namatovu, P., Nabayinda, J., Kiyingi, J., Mwebembezi, A., Nakigozi, G., Hoagwood, K., McKay, M. M., & Ssewamala, F. M. (2024). The longitudinal impact of an evidence-based multiple family group intervention (Amaka Amasanyufu) on family cohesion among children in Uganda: Analysis of the cluster randomized SMART Africa-Uganda scale-up study (2016–2022 ). Family Process, December 2023 , 1851–1866. https://doi.org/10.1111/famp.13007 Castro, F. G., Barrera, M., & Martinez, C. R. (2004). The Cultural Adaptation of Prevention Interventions: Resolving Tensions Between Fidelity and Fit. In Prevention Science , 5 , 41–45. https://doi.org/10.1023/B:PREV.0000013980.12412.cd Chilisa, B., Major, T. E., Gaotlhobogwe, M., & Mokgolodi, H. (2016). Decolonizing and indigenizing evaluation practice in Africa: Toward African relational evaluation approaches. Canadian Journal of Program Evaluation , 30 (3), 313–328. https://doi.org/10.3138/cjpe.30.3.05 Domenech Rodríguez, M. M., & Bernal, G. (2012). Frameworks, models, and guidelines for cultural adaptation. In Cultural adaptations: Tools for evidence-based practice with diverse populations. American Psychological Association , 23–44. https://doi.org/10.1037/13752-002 Edge, D., Degnan, A., Cotterill, S., Berry, K., Drake, R., Baker, J., Barrowclough, C., Hughes-Morley, A., Grey, P., Bhugra, D., Cahoon, P., Tarrier, N., Lewis, S., & Abel, K. (2016). Culturally-adapted Family Intervention (CaFI) for African-Caribbeans diagnosed with schizophrenia and their families: A feasibility study protocol of implementation and acceptability. Pilot and Feasibility Studies , 2 (1). https://doi.org/10.1186/s40814-016-0070-2 Evarist, A. G., & Kiyingi, F. P. (2017). Structural Family Counselling and Transformation of Home Financial Constraints: a case of selected families in Kampala, Uganda. Nkumba Business Journal (NBJ), 16(October), 153–171. Evarist, A., & Pio, K. F. (2017). Adlerian Family Counselling And Mindful Parenting In Kampala Capital City - Uganda. Research Journal of Sociology, 5(8), 1–15. Evarist, A. G., & Pio, K. F. (2016). African Family Counselling as a pivot for Cohesive Parenting. A Case of juvenile protection home in KCCA – Uganda. 2(i). Evarist, A., & Pio, K. F. (2019). Trans-Generational Family Counselling and Management of Home Financial Constraints: A Case Study of Kampala Capital City Authority (Uganda). III(Vi), 113–122. Goodkind, J. R., Amer, S., Christian, C., Hess, J. M., Bybee, D., Isakson, B. L., Baca, B., Ndayisenga, M., Greene, R. N., & Shantzek, C. (2017). Challenges and Innovations in a Community-Based Participatory Randomized Controlled Trial. Health Education and Behavior , 44 (1), 123–130. https://doi.org/10.1177/1090198116639243 Gritti, P. (2019). A note on cultural sensitivity in family system therapy. JPS , 3 (1), 1–5. https://doi.org/10.23823/jps.v3i1.48 Heiden-Rootes, K., Asiimwe, R., Rastogi, M., & Miller, R. B. (2025). Pathways for Public Impact: Utilizing Engaged Scholarship for Translating Systemic Family Therapy Research to Policy and Practice. Journal of Marital and Family Therapy , 51 (4). https://doi.org/10.1111/jmft.70076 Hunduma, G., Dessie, Y., Geda, B., Yadeta, T. A., & Deyessa, N. (2021). Common mental health problems among adolescents in sub-Saharan Africa: a systematic review and meta-analysis. Journal of Child & Adolescent Mental Health , 33 (1–3), 90–110. Hwang, W. C. (2011). Cultural Adaptations: A Complex Interplay Between Clinical and Cultural Issues. Clinical Psychology: Science and Practice , 18 (3), 238–241. https://doi.org/10.1111/j.1468-2850.2011.01255.x James, T., Mukadam, N., Sommerlad, A., Guerra Ceballos, S., & Livingston, G. (2021). Culturally tailored therapeutic interventions for people affected by dementia: a systematic review and new conceptual model. In The Lancet Healthy Longevity (Vol. 2, Issue 3, pp. e171–e179). Elsevier Ltd. https://doi.org/10.1016/S2666-7568(21)00001-5 Jhamb, S., Kolte, A., Prashanth, A., Roy, A. S., Roy, H., Maheshwari, K., Mathur, P., Raj, R. K., Abhyankar, S., & Rani, A. (2024). A Theoretical Article: Exploring the Evolutionary Dynamics of Couples and Family Therapy. The Family Journal , 32 (4), 669–678. https://doi.org/10.1177/10664807241269544 Jordans, M. J. D., Luitel, N. P., Kohrt, B. A., Rathod, S. D., Garman, E. C., De Silva, M., Komproe, I. H., Patel, V., & Lund, C. (2019). Community-, facility-, and individual-level outcomes of a district mental healthcare plan in a low-resource setting in Nepal: A population-based evaluation. PLoS Medicine , 16 (2). https://doi.org/10.1371/journal.pmed.1002748 Kpanake, L. (2018). Cultural concepts of the person and mental health in Africa. Transcultural Psychiatry , 55 (2), 198–218. https://doi.org/10.1177/1363461517749435 Lesch, E., de Bruin, K., & Anderson, C. (2018). A Pilot Implementation of the Emotionally Focused Couple Therapy Group Psychoeducation Program in a South African Setting. Journal of Couple and Relationship Therapy , 17 (4), 313–337. https://doi.org/10.1080/15332691.2017.1417940 Mabunda, D., Oliveira, D., Sidat, M., Cavalcanti, M. T., Cumbe, V., Mandlate, F., Wainberg, M., & Cournos, F. (2022). & de Jesus Mari, J. Cultural adaptation of psychological interventions for people with mental disorders delivered by lay health workers in Africa: scoping review and expert consultation. In International Journal of Mental Health Systems (Vol. 16, Issue 1). BioMed Central Ltd . https://doi.org/10.1186/s13033-022-00526-x Marsiglia, F. F., & Booth, J. M. (2015). Cultural Adaptation of Interventions in Real Practice Settings. Research on Social Work Practice , 25 (4), 423–432. https://doi.org/10.1177/1049731514535989 Mascayano, F., Toso-Salman, J., Ho, Y. C. S., Dev, S., Tapia, T., Thornicroft, G., Cabassa, L. J., Khenti, A., Sapag, J., Bobbili, S. J., Alvarado, R., Yang, L. H., & Susser, E. (2020). Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries. Transcultural Psychiatry , 57 (1), 140–160. https://doi.org/10.1177/1363461519890964 Mishu, M. P., Tindall, L., Kerrigan, P., & Gega, L. (2023). Cross-culturally adapted psychological interventions for the treatment of depression and/or anxiety among young people: A scoping review. PLOS ONE , 18 (10), e0290653. https://doi.org/10.1371/journal.pone.0290653 Morgan, E., Wieling, E., Hubbard, J., & Kraus, E. (2017). The development and implementation of a multi-couple therapy model with torture survivors in the Democratic Republic of the Congo. Journal of Marital and Family Therapy , 44 (2), 235–247. https://doi.org/10.1111/jmft.12287 Mugarura, J., Musanje, K., Levine, M. E., Asiimwe, R., Ndeezi, M., Kizito, S., White, R. G., & Kasujja, R. (2025). Adapting the comprehensive assessment of acceptance and commitment therapy processes (CompACT) questionnaire for contextual relevance in Uganda: A comprehensive approach. Cambridge Prisms: Global Mental Health, 12. https://doi.org/10.1017/gmh.2025.10018 Neswiswa, K. G., & Jacobs, S. (2024). Hearing the voices of Black Africans: Essential components for culturally relevant marriage enrichment programs in South Africa. Journal of Marital and Family Therapy , 50 (2), 407–433. https://doi.org/10.1111/jmft.12696 Nichols, M. P., & Davis, S. D. (2019). The essentials of family therapy (7th ed.). Merrill Social Work and Human Services. Nwoye, A. (2006). Theory and method of marriage therapy in contemporary Africa. Contemporary Family Therapy , 28 (4), 437–457. https://doi.org/10.1007/s10591-006-9021-z O’Donnell, A., Anderson, P., Schmidt, C., Braddick, F., Lopez-Pelayo, H., Mejía-Trujillo, J., Natera, G., Arroyo, M., Bautista, N., Piazza, M., Bustamante, I. V., Kokole, D., Jackson, K., Jane-Llopis, E., Gual, A., & Schulte, B. (2022). Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America. Global Health Action , 15 (1). https://doi.org/10.1080/16549716.2022.2080344 Onogwu, E. O., Alidu, O. S., Anibueze, A. U., Okwuowulu, C., Ekwueme, O., Erojikwe, I., & Gever, V. C. (2023). Using social media-based drama therapy and family counselling to treat symptoms of postpartum depression among women. Australian and New Zealand Journal of Family Therapy , 44 (3), 368–378. https://doi.org/10.1002/anzf.1550 Puffer, E. S., Healy, F., Green, E., Giusto, E. P. M., Kaiser, A. N., Patel, B., P., & Ayuku, D. (2020). Family Functioning and Mental Health Changes Following a Family Therapy Intervention in Kenya: a Pilot Trial. Journal of Child and Family Studies , 29 (12), 3493–3508. https://doi.org/10.1007/s10826-020-01816-z Puffer, E. S., Friis-Healy, E. A., Giusto, A., Stafford, S., & Ayuku, D. (2021). Development and Implementation of a Family Therapy Intervention in Kenya: a Community-Embedded Lay Provider Model. Global Social Welfare , 8 (1), 11–28. https://doi.org/10.1007/s40609-019-00151-6 Rathod, S., Kingdon, D., Phiri, P., & Gobbi, M. Developing Culturally Sensitive Cognitive Behaviour Therapy for Psychosis for Ethnic Minority Patients by Exploration and Incorporation of Service Users’ and Health Professionals’ Views and Opinions. Behavioral and Cognitive Psychotherapy 2010;38(5):511–533. https://doi:10.1017/S1352465810000378 . Renwick, L., Susanti, H., Keliat, B., Wulandari, D., Suherman, Fadilah, R., Diorarta, R., Brooks, H., Bee, P., & Lovell, K. (2025). Culturally adapting family interventions for people with schizophrenia in Indonesia: An intervention development study using programme theory. International Journal of Nursing Studies Advances , 9. https://doi.org/10.1016/j.ijnsa.2025.100409 Roberts, J., Abu-Baker, K., Diez Fernández, C., Chong Garcia, N., Fredman, G., Kamya, H., & Vega, Z., R (2014). Up close: Family therapy challenges and innovations around the world. Family Process , 53 (3), 544–576. https://doi.org/10.1111/famp.12093 Roman, N. V., Balogun, T. V., Butler-Kruger, L., Danga, S. D., Therese de Lange, J., Human-Hendricks, A., Khaile, T., October, F., K. R., & Olabiyi, O. J. (2025). Strengthening Family Bonds: A Systematic Review of Factors and Interventions That Enhance Family Cohesion. Social Sciences , 14 (6), 371. https://doi.org/10.3390/socsci14060371 Shehadeh, M. H., Heim, E., Chowdhary, N., Maercker, A., & Knaevelsrud, C. (2016). Cultural adaptation of minimally guided interventions for common mental disorders: A systematic review and meta-analysis. JMIR Mental Health , 3 (3), e44. https://doi.org/10.2196/mental.5776 Ssewamala, F. M., Brathwaite, R., Sensoy Bahar, O., Namatovu, P., Neilands, T. B., Kiyingi, J., Huang, K. Y., & McKay, M. M. (2023). The Post-intervention Impact of Amaka Amasanyufu on Behavioral and Mental Health Functioning of Children and Adolescents in Low-Resource Communities in Uganda: Analysis of a Cluster-Randomized Trial From the SMART Africa-Uganda Study (2016–2022). Journal of Adolescent Health , 72 (5), S3–S10. https://doi.org/10.1016/j.jadohealth.2022.09.035 Treichler, E. B. H., Mercado, R., Oakes, D., Perivoliotis, D., Gallegos-Rodriguez, Y., Sosa, E., Cisneros, E., Spaulding, W. D., Granholm, E., Light, G. A., & Rabin, B. (2022). Using a stakeholder-engaged, iterative, and systematic approach to adapting collaborative decision skills training for implementation in VA psychosocial rehabilitation and recovery centers. BMC Health Services Research , 22 (1). https://doi.org/10.1186/s12913-022-08833-2 Ugwuoke, C. U., Ede, K. R., Ede, M. O., & Oneli, J. O. (2023). Family health therapy for treating anxiety symptoms in flood victims. Medicine (United States) , 102 (16), E33574. https://doi.org/10.1097/MD.0000000000033574 Veritas Health Innovation (2024). Covidence systematic review software. Melbourne, Australia. Retrieved from https://www.covidence.org Wampler, K. S., & Patterson, J. E. (2020). The importance of family and the role of systemic family therapy. In The Handbook of Systemic Family Therapy, Set (Vols. 1–4). https://doi.org/10.1002/9781119438519.ch1 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 03 Feb, 2026 Reviewers invited by journal 03 Feb, 2026 Editor assigned by journal 29 Jan, 2026 Submission checks completed at journal 29 Jan, 2026 First submitted to journal 28 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8717252","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":585240777,"identity":"4b8804d7-b9c4-49e2-8042-30225dc680bd","order_by":0,"name":"Anita Kateregga","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYBACCTBpICHHD+EzE6MFpKjCwliygTQtZyoSNxwgVotk+/mDjyvbJBg338hOe8BQYZ3YQEiLNE8ys+HZNglmsxu52w0YzqQT1iLHkMwm2dgmwQbUsk2Cse0wEVr4H7P/BGrhMZ4B0vKPCC3SEslsjA1nJCQMJEBaGojQIjnjMTB8K4A6zrzdJpFwLN2YoBaJ84kPPzYY1NX3twNt+VBjLUtQCypIIE35KBgFo2AUjAJcAAAXcjqUPmPJSAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Minnesota","correspondingAuthor":true,"prefix":"","firstName":"Anita","middleName":"","lastName":"Kateregga","suffix":""},{"id":585240778,"identity":"93d885da-788c-494e-ad1a-5dcc37b55f2b","order_by":1,"name":"Ronald Asiimwe","email":"","orcid":"","institution":"University of Minnesota","correspondingAuthor":false,"prefix":"","firstName":"Ronald","middleName":"","lastName":"Asiimwe","suffix":""},{"id":585240779,"identity":"5186dfd2-7a1f-40d7-b554-59469831b427","order_by":2,"name":"Ibrahim Luberenga","email":"","orcid":"","institution":"Michigan State University","correspondingAuthor":false,"prefix":"","firstName":"Ibrahim","middleName":"","lastName":"Luberenga","suffix":""},{"id":585240780,"identity":"ca15a973-e40c-4dbe-ba41-0ae5e4b9f533","order_by":3,"name":"Pendo Galukande","email":"","orcid":"","institution":"Michigan State University","correspondingAuthor":false,"prefix":"","firstName":"Pendo","middleName":"","lastName":"Galukande","suffix":""}],"badges":[],"createdAt":"2026-01-28 06:39:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8717252/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8717252/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101948365,"identity":"18bae0cf-6ef6-4dee-8e58-9078d8ccf1a0","added_by":"auto","created_at":"2026-02-05 10:12:58","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":95091,"visible":true,"origin":"","legend":"\u003cp\u003eA PRISMA flow chart showing the selection process including database search results, screening, and the final study inclusion\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8717252/v1/0d21b11b3b79f01beef6f655.jpeg"},{"id":101948384,"identity":"f15b6b08-e726-4b1a-b0b8-52f0a9e101e3","added_by":"auto","created_at":"2026-02-05 10:13:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1129893,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8717252/v1/57763b11-62fd-4322-bb86-26582333628c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Towards Culturally Responsive Practices: A Scoping Review of Systemic Family Therapy Interventions in Africa","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSystemic Family Therapy (SFT) or often referred to as couple and family therapy (CFT) interventions focus on improving family dynamics through treating the family as a system, rather than focusing on individual members in isolation (Wampler \u0026amp; Patterson, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Systemic Family Therapy views emotional, psychological, behavioral symptoms as being embedded within, and influenced by the larger context of people\u0026rsquo;s relationships such as in families, communities, and larger sociocultural and political events, including historical and current ones, rather than symptoms residing solely within individuals. Given the collectivistic nature of many African societies, SFT ideas are particularly relevant and well-aligned because family relationships in these contexts, not only include the nuclear unit but also extended family members, kinship networks, and the communal relationships (Ariyo et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Asiimwe, et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2026\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilar to families and communities around the world, African couples and families are increasingly navigating a multitude of stressors, including family and community trauma, war and chronic health burdens such as HIV/AIDS, shifting gender roles, and rapid technological and societal changes, that place significant strain on relational dynamics among couples and families on the continent (Roman et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). For instance, evidence indicates that approximately 38.5% of married and co-habiting women in 24 studied sub-Saharan African countries reported experiencing some form of intimate partner violence (IPV; Aboagye et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Furthermore, systematic reviews show that mental health problems among children and adolescents are highly prevalent in the region: about 23% currently have mental health problems (with depression at 19% and anxiety at 20%) according to one meta-analysis of studies in sub-Saharan Africa (Hunduma et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Together, these patterns suggest that the relational unit, including couples and families, is under mounting pressure, making it critically important to implement interventions that directly engage families and their relational dynamics, support parenting, couple communication, and family resilience, not merely individual-level treatment.\u003c/p\u003e \u003cp\u003eOf great advantage is that family therapists and family therapy interventions are uniquely positioned to address these complex and interrelated issues because they target relational systems rather than individuals in isolation (Bobek et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). However, despite empirical evidence supporting the effectiveness of family therapy interventions in strengthening family functioning, mental and relational wellbeing of families across the world (Roberts et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), little has been written about such interventions on the African continent, specifically, where they have been implemented, the populations they target, their intended or achieved outcomes, and cultural adaptation, where necessary.\u003c/p\u003e \u003cp\u003eAs a result, our understanding remains limited regarding how effectively these interventions have been culturally adapted to fit the lived realities of African families. Given the growing application of systemic family therapy (SFT) in Africa, this scoping review aims to synthesize empirical studies implementing SFT interventions, examine cultural adaptations and target outcomes, identify implementation gaps, and use these findings to discuss broader implications for advancing culturally and contextually resonant family therapy practice and research across African contexts.\u003c/p\u003e\n\u003ch3\u003eGlobal Origins of Family Therapy and Influences in Africa\u003c/h3\u003e\n\u003cp\u003eTo date, evidence still suggests that major family therapy models currently in circulation in many parts of Africa have origins in the Global North, particularly in the United States of America (Nichols \u0026amp; Davis, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). As a result, several individual studies have implemented family therapy models in various African settings, demonstrating the growing recognition of the family as a key context for promoting mental health and relational well-being. While these models are largely grounded in systems theory, which in many ways resonates with the collective cultural values common across African societies (Asiimwe et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), critical cultural dynamics must still be carefully considered when applying them in African contexts. These include differing family structures, power hierarchies, and communication patterns that influence how systemic interventions are received and practiced.\u003c/p\u003e \u003cp\u003eMoreover, many of the family therapy models were originally shaped around Western nuclear family structures that emphasize ideals such as individual autonomy, direct emotional expression, and egalitarian family roles (Gritti, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Hwang, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Such assumptions often stand in contrast to African collectivist community values, where extended family involvement, hierarchical roles, indirect conflict resolution, and community interdependence are central and shape people\u0026rsquo;s perceptions as well as help-seeking behaviors for most families in Africa (Adaki, 2023; Asiimwe et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The legacy of colonialism in Africa further complicates this mismatch, as Western mental health frameworks have historically displaced indigenous support systems and ways of healing, such as storytelling, communal and spiritual practices, and the Ubuntu philosophy of interconnectedness. Consequently, implementing family therapy interventions in African settings requires thoughtful cultural adaptation to ensure alignment with local traditions, norms, and relational dynamics.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThe Growing Movement Toward Culturally and Contextually Relevant Systemic Therapies in Africa\u003c/h2\u003e \u003cp\u003eIn 2021, Asiimwe and colleagues published the first article to explicitly examine the growth of systemic family therapy (SFT) in Africa, titled \u003cem\u003e\u0026ldquo;Expanding our international reach: Trends in the development of systemic family therapy training and implementation in Africa\u0026rdquo;\u003c/em\u003e in the \u003cem\u003eJournal of Marital and Family Therapy\u003c/em\u003e. In this work, they argued that while SFT on the continent was gaining momentum through the establishment of MFT graduate programs in countries such as Kenya, local capacity-building efforts, and international partnerships, its long-term sustainability depended largely on adapting systemic models to African sociocultural and familial contexts rather than directly exporting Western approaches unchanged. This argument aligns with a broader shift in 21st-century family therapy discourse toward recognizing the centrality of culture, context, and diversity in shaping both theory and practice (Jhamb et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). As scholars increasingly acknowledge that family systems are embedded within distinct sociocultural and historical realities, there has been a global movement to critically examine and culturally adapt existing family therapy frameworks to better reflect local values, relational norms, and indigenous worldviews.\u003c/p\u003e \u003cp\u003eWithin this global movement, contemporary African family therapy scholars such as Nwoye (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) and Asiimwe et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) have emphasized the urgent need to adapt therapeutic models to reflect African cultural traditions and family structures. They argue that Western family therapy frameworks often fail to capture the communal, spiritual, and hierarchical dynamics that define many African families, and therefore risk misrepresenting or overlooking the core relational processes that shape healing and well-being on the continent.\u003c/p\u003e \u003cp\u003eSpecifically, Nwoye (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) has called for therapeutic interventions in Africa to integrate narrative, ritual, and communal healing practices that honor other sources of distress, such as ancestral influence and spiritual imbalance. He contends that conventional Western narrative therapy\u0026rsquo;s individualistic focus must be expanded to emphasize community and family as the primary contexts of healing, which would better align with African therapeutic practices that value collective meaning-making. Similarly, Asiimwe et al., (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) highlight the limitations of simply translating Western models and advocate for culturally responsive systemic interventions co-created with local communities, emphasizing storytelling, as well as extended family involvement. In their article that reviewed parenting programs in Africa, Asiimwe et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) highlighted the effectiveness of interventions that integrate indigenous practices and relational norms while critiquing those that fail to address power, privilege, and sustainability.\u003c/p\u003e \u003cp\u003eComplementary perspectives come from Adams et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), who advocate for Afrocentric and decolonial approaches to therapy and counselling that include communal identity, relational importance, and gendered power dynamics within family systems. Moreover, Ayesu et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) extends this line of thinking by highlighting the relevance of culturally relevant practices in healing grief and trauma, highlighting the role of communal mourning and moral perspectives in Ghanaian psychosocial responses.\u003c/p\u003e \u003cp\u003eConcrete examples of successful contextualization can be seen in the Family Psychosocial Involvement Intervention (FAPII) in Uganda. This program showed that culturally grounded family therapy mental health approaches that actively engage family members and respect traditional beliefs led to improvements in treatment adherence, stigma reduction, and overall wellbeing (Alinaitwe et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). These developments collectively illustrate a growing movement across the continent to decolonize mental health care and develop systemic therapies that are contextually relevant, spiritually sensitive, and relationally attuned. It is thus critical to note that a failure to conduct necessary adaptations risks perpetuating the historical oppression of African families and clients, even within the emerging and growing profession of family therapy on the African continent.\u003c/p\u003e \u003cp\u003eAlthough emerging interventions across Africa are beginning to integrate systemic principles with cultural adaptations, responsiveness and implementation processes are rarely examined (Mabunda et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Many programs such as community-based parenting interventions, family-inclusive mental health treatments, and indigenous narrative therapies are promising but often lack thorough review, including follow-up studies, randomized controlled trials, as well as culturally valid measurement tools (Goodkind et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Therefore, there is a need to synthesize what has been done across the continent and outline directions for future research and clinical practice.\u003c/p\u003e \u003cp\u003eT\u003cb\u003ehe current review and aims\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThus, the main aims of this scoping review are three-fold. First, we aim to synthesize existing evidence of empirical studies implementing systemic family interventions across African countries, with a focus on what cultural adaptations were conducted before implementing these programs. Second, the review also aims to clearly identify target clinical outcomes of the implemented interventions as well as implementation gaps. Lastly, the review aims to use the findings of the first two objectives to identify and discuss broader implications for the advancement of family therapy within African contexts.\u003c/p\u003e \u003cp\u003eA critical contextual consideration is that Africa is not a cultural monolith. The continent is comprised of 54 countries with profound diversity in language, religion, ethnicity, gender norms, and socio-political histories. Although this review includes studies from across East, West, and Southern Africa, the synthesis of findings should not be interpreted as representative of a single African cultural context. Rather, this approach was necessitated by the limited number of empirical studies focusing on SFT interventions in specific national and ethnic settings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cp\u003e A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews to ensure transparent and systematic reporting (Page et al., 2021). The databases searched for this review included African Journals Online (AJOL), Academic Search Premier, and Scopus. The selection of these databases was deliberate in order to align with our review\u0026rsquo;s focus on systemic family therapy in African contexts. AJOL is the largest online database of peer reviewed studies published from African journals. Academic Search Premier was chosen due to its interdisciplinary coverage including psychology, family studies, and public health, which ensure a broad search in social science literature. Scopus was included because of its thorough indexing of international peer reviewed literature, citation tracking and access to high-impact journals. We used Google Scholar for our first search and generated key words for the database search.\u003c/p\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cp\u003e To ensure that the findings were grounded in real-world practice, this review included only empirical studies, whether quantitative, qualitative, or mixed methods in design. To maintain contextual relevance, only studies that focused on African populations and conducted within African countries were considered for review. Eligible studies must have applied a systemic, relational, or family therapy model to treat certain mental and emotional issues relevant to the target setting. Additionally, only studies published in English were included to ensure consistency in interpretation, as this is the common language shared by the reviewers. We included studies published between 2014 and 2025 to be able to capture the most recent, contextually relevant developments in systemic family therapy. Conversely, the review excluded conceptual papers, literature reviews, and opinion pieces in order to concentrate solely on interventions that have been empirically tested or piloted, even if only in early stages. Studies conducted outside of African settings and those not published in English were excluded to maintain contextual integrity, and any interventions that do not involve systemic or relational therapeutic approaches are also omitted.\u003c/p\u003e\n\u003ch3\u003eSearch Process\u003c/h3\u003e\n\u003cp\u003eThe search process was conducted across four academic databases: Academic Search Premier via EBSCOhost (n\u0026thinsp;=\u0026thinsp;234), Scopus (n\u0026thinsp;=\u0026thinsp;367), and African Journals Online (AJOL) (n\u0026thinsp;=\u0026thinsp;158), and 2 studies from other sources (citation searching) resulting in a total of 761 records. All the screening and selection procedures were carried out using Covidence (Veritas Health Innovation, Melbourne, Australia), a systematic review management tool. The first author (AK) conducted the initial title and abstract screening between October 2024 and January 2025 and identified eligible studies based on the inclusion criteria. These studies were then independently reviewed by the first (AK), third (IL) and fourth (PG) authors to assess their eligibility and conduct data extraction. The discrepancies in the inclusion decisions were resolved through weekly discussions between February 2025 and May 2025.\u003c/p\u003e \u003cp\u003eKey words, search terms, subjects and titles were created to be able to capture varying descriptions of systemic family interventions in Africa. For example, in Academic Search Premier, we used these; \u003cem\u003e\u0026ldquo;Systemic family therapy\u0026rdquo; OR \u0026ldquo;family therapy\u0026rdquo; OR \u0026ldquo;structural family therapy\u0026rdquo; OR \u0026ldquo;narrative therapy\u0026rdquo; OR \u0026ldquo;solution-focused therapy\u0026rdquo; OR \u0026ldquo;family counseling\u0026rdquo; OR \u0026ldquo;relational therapy\u0026rdquo; OR \u0026ldquo;Adlerian family therapy\u0026rdquo; OR \u0026ldquo;couple therapy\u0026rdquo; OR \u0026ldquo;marital counselling\u0026rdquo; AND \"Africa\" OR \"African countries\" OR \"sub-Saharan Africa\" OR \"North Africa\" OR \"East Africa\" OR \"West Africa\" OR \"Southern Africa\" OR \"Central Africa\" OR \"South Africa\" OR \"Sub-Saharan Africa\" OR \"Uganda\" OR \"Kenya\" OR \"Nigeria\" OR \u0026ldquo;Ghana\u0026rdquo; OR \u0026ldquo;Ethiopia\u0026rdquo; AND \"Mental health interventions\" OR \"family interventions\" OR \"therapy outcomes\" OR \"marital conflict\" OR \"family dynamics\" OR \"parenting challenges\" OR \"trauma recovery\" OR \"domestic violence\" OR \"family conflict resolution\".\u003c/em\u003e Date filters were applied (2014 to 2025). Among the articles found, the team filtered out abstracts and titles that did not meet the inclusion criteria.\u003c/p\u003e \u003cp\u003eAfter removing 118 duplicates using the built-in de-duplication tools available in Covidence, 642 records remained. Three members of the research team including the first (AK), third (IL) and fourth (PG) authors then conducted further screening by reviewing titles and abstracts of articles. During this stage, 588 records were excluded for failing to meet the inclusion criteria. These excluded studies either implemented a non-relational approach, were implemented outside Africa, were systematic reviews, or not in the English language. Seventeen of these studies were excluded as they were narrative and conceptual papers. A total of 37 full-text articles were assessed for eligibility. An additional 24 studies were excluded after full-text review. Reasons for exclusion at this stage were solely due to studies implementing a non-MFT model (\u003cem\u003eSee PRISMA flowchart in Fig. I\u003c/em\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eFig. I\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA PRISMA flow chart showing the selection process including database search results, screening, and the final study inclusion\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of included studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor(s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTitle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSFT Intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMethodology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKey Outcomes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnkwasiize \u0026amp; Kiyingi (2016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfrican Family Counselling as a pivot for Cohesive Parenting. A Case of juvenile protection home in KCCA \u0026ndash; Uganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfrican Family Counselling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQuantitative and thematic analysis with 136 family members using Family Environment Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEnhanced parental cohesion, adaptability, and reduced parental psychological control.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmanyire et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEffectiveness of Behavioral Family Therapy in reducing depressive symptoms among older persons living with HIV/AIDS in Mbarara city, southwestern Uganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBehavioral Family Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRandomized controlled trial (RCT), 22 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSmall non-significant effect on reducing depressive symptoms; recommended integration with routine care.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeswiswa \u0026amp; Jacobs (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHearing the voices of Black Africans: Essential components for culturally relevant marriage enrichment programs in South Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarriage Enrichment Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQualitative descriptive phenomenological study, interviews and pilot with couples and leaders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh acceptability, integration of traditional and modern marital practices, improved marital satisfaction.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnkwasiize \u0026amp; Kiyingi (2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStructural Family Counselling and Transformation of Home Financial Constraints: a case of selected families in Kampala, Uganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStructural Family Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQuantitative study with Family Environment Scale, 217 family members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFamily subsystems positively influence home financial constraints; Structural therapy improves financial management.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesch et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA Pilot Implementation of the Emotionally Focused Couple Therapy Group Psychoeducation Program in a South African Setting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmotionally Focused Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQualitative pilot study, thematic analysis, interviews with 10 couples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eImproved couple relationships, emotional communication, and relationship depth.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUgwuoke et al. (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily health therapy for treating anxiety symptoms in flood victims\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRational Emotive Family Health Therapy (REFHT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRandomized control trial, 120 farmers affected by floods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant reduction in anxiety disorders among flood-affected farmers.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnogwu et al. (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUsing social media-based drama therapy and family counselling to treat symptoms of postpartum depression among women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDrama therapy and Family Counselling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQuasi-experimental design with 303 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant reduction of postpartum depression in women; improved spousal support, particularly when husbands received counselling.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnkwasiize \u0026amp; Kiyingi (2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdlerian Family Counselling And Mindful Parenting In Kampala Capital City - Uganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdlerian Family Counselling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQuantitative and thematic analysis, 217 family members using Five-Facet Mindfulness Questionnaire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIncreased family cohesion, emotional awareness, parental mindfulness, and compassion.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePuffer et al. (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDevelopment and Implementation of a Family Therapy Intervention in Kenya: a Community-Embedded Lay Provider Model\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCommunity-based Family Therapy Intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQualitative feasibility study, lay-counselor delivered interventions with 10 families\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFeasible implementation, high acceptability, improved trust and engagement, clinical competency.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePuffer et al. (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily Functioning and Mental Health Changes Following a Family Therapy Intervention in Kenya: a Pilot Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSolution-Focused Family Therapy (Tuko Pamoja)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMixed-method pilot trial, single-group pre-post design, 10 families\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReductions in family dysfunction, harsh discipline, intimate partner violence, and improved mental health.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eByansi et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe longitudinal impact of an evidence-based multiple family group intervention (\u003cem\u003eAmaka Amasanyufu\u003c/em\u003e) on family cohesion among children in Uganda: Analysis of the cluster randomized SMART Africa-Uganda scale-up study (2016\u0026ndash;2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmaka Amasanyufu Multiple Family Group Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCluster randomized controlled trial, 636 participants from 26 schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant improvements in family cohesion and reductions in child behavioral issues.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnkwasiize \u0026amp; Kiyingi (2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrans-Generational Family Counselling and Management of Home Financial Constraints: A Case Study of Kampala Capital City Authority (Uganda)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTrans-Generational Family Counselling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMixed-method case study, interviews, FGDs, structured questionnaires, 217 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrans-generational therapy effective in managing financial constraints; reduces financial abuses within families.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorgan et al. (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe Development and Implementation of a Multi-Couple Therapy Model with Torture Survivors in the Democratic Republic of the Congo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMulti-Couple Therapy Model\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle group pre-post design with 3 groups with 13 couples in total using ethnographic individual interviews.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eParticipants reported improved communication, greater emotional closeness, and better conflict management.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsfaw \u0026amp; Alene (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEffectiveness of a marital relationship skills training intervention on marital adjustment among individuals in Hosanna Town, Southwest Ethiopia: A randomized-controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarital Relationship Skills Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRandomized-controlled trial, 80 married individuals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant improvements in marital adjustment and reduced marital distress.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOverview of Included Studies\u003c/h2\u003e \u003cp\u003eIn this review, fourteen empirical studies that implemented systemic family therapy interventions made it to the final analysis. These studies reported on implementation conducted in five African countries: Uganda (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6; Amanyire et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e); Ankwasiize \u0026amp; Kiyingi (2016); Ankwasiize \u0026amp; Kiyingi (2017); Ankwasiize \u0026amp; Kiyingi (2017b); Ankwasiize \u0026amp; Kiyingi (2019) Byansi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), Kenya (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2; Puffer et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2020\u003c/span\u003ea, 2021a), Congo (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1; Morgan et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), Nigeria (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2; Onogwu et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ugwuoke et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), South Africa (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2; Lesch et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Neswiswa \u0026amp; Jacobs, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), and Ethiopia (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1; Asfaw \u0026amp; Alene, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The studies employed diverse designs including randomized controlled trials, mixed-methods, case study design, and qualitative explorations. Sample sizes varied widely, ranging from small pilot studies with 10 participants to larger interventions involving over 200 families. Target populations included adolescents, parents, older adults living with HIV, families facing economic hardship, and survivors of environmental hazards.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eImplemented Interventions and Target Outcomes\u003c/h3\u003e\n\u003cp\u003e The studies we reviewed implemented a variety of family therapy interventions, including behavioral approaches, structural approaches, cognitive and emotional restructuring techniques, narrative and drama-based therapies, as well as trans-generational and community-focused models. Each type of intervention used unique methods, and strategies to address mental, emotional, and relational challenges within the family system.\u003c/p\u003e\n\u003ch3\u003eBehavioral Family Therapy (BFT)\u003c/h3\u003e\n\u003cp\u003eBehavioral Family Therapy was implemented in one study that emphasized observable behaviors, parent-child interactions, and communication patterns within family units. These interventions primarily targeted improving relational patterns, reducing conflict, enhancing parental skills, and increasing emotional regulation among family members. In Uganda, BFT was adapted specifically for older adults living with HIV, targeting depressive symptoms and relational conflicts through structured interventions including teaching communication and problem-solving skills (Amanyire et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003ea). Outcomes indicated only moderate effects on depression, however, the therapy facilitated better communication skills and recommended further integration within routine care contexts.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStructural Family Therapy\u003c/h2\u003e \u003cp\u003eStructural Family Therapy, implemented in a study in Uganda, targeted hierarchical family dynamics, boundary setting, and the shaping of family roles and subsystems to enhance relational functioning. These interventions focused on establishing clear and adaptive boundaries to support healthy interactions among family members. In their study, Ankwasiize \u0026amp; Kiyingi (2017) implemented Structural Family Counselling and focused on the family structure, family subsystems and family boundaries, engaged extended family members and hierarchical structures to resolve relational and communication problems. These interventions proved particularly effective in addressing financial constraints and relational conflicts arising from unclear boundaries and roles.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSolution-Focused Family Therapy\u003c/h2\u003e \u003cp\u003eSolution-focused systemic interventions were used in two studies in Kenya and identified strengths, resources, and solutions rather than solely addressing problems. Therapists guided families toward achievable goals through brief, solution-oriented sessions, and empowered families through the active recognition of their strengths and capacities. The \u003cem\u003eTuko Pamoja\u003c/em\u003e program in Kenya employed solution-focused principles through lay counsellors embedded within the community. Interventions involved families actively co-constructing practical solutions to reduce intimate partner violence, harsh discipline practices, and improve overall family functioning and mental health (Puffer et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMultiple Family Group (MFG)Therapy\u003c/h2\u003e \u003cp\u003eMultiple Family Group Therapy was applied in one study in Uganda and utilized group-based therapeutic environments involving multiple families simultaneously. This systemic approach facilitated mutual learning, collective problem-solving, peer support, and community mentorship which align closely with communal values in many African cultures. The \u003cem\u003eAmaka Amasanyufu\u003c/em\u003e intervention in Uganda was an MFG model specifically adapted for families experiencing child behavioral difficulties. It fostered communal parenting strategies, peer-to-peer support, and collective problem-solving, which significantly improved family cohesion, parental efficacy, and child outcomes (Byansi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eRational Emotive Family Health Therapy (REFHT)\u003c/h2\u003e \u003cp\u003eRational Emotive Family Health Therapy utilized cognitive-behavioural principles within a systemic family context. This approach aimed at cognitive restructuring, addressing irrational beliefs and maladaptive cognitive patterns within families, particularly in response to environmental and psychosocial stressors. REFHT was implemented in Nigeria among families affected by flood disasters. The intervention explicitly addressed anxiety by altering and disputing maladaptive beliefs, restructuring family perceptions, which led to significant reductions in anxiety symptoms and improved family resilience (Ugwuoke et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eNarrative Family and Drama Therapy\u003c/h2\u003e \u003cp\u003eNarrative and drama-based therapeutic interventions focused on the re-writing of personal and family narratives, utilizing storytelling, drama, and role-play. These approaches used the cultural tradition of storytelling in African communities and provided emotional spaces for healing and recovery. In Nigeria, a social media-based drama therapy intervention addressed postpartum depression among women, creatively utilizing drama, role-play, storytelling, and digital media platforms (e.g., WhatsApp). This intervention demonstrated significant reductions in postpartum symptoms and increased spousal support, which revealed the relevance and effectiveness of narrative therapy (Onogwu et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTrans-generational Family Therapy\u003c/h2\u003e \u003cp\u003eTrans-generational systemic interventions examined patterns and emotional processes across multiple generations. These interventions targeted unresolved emotional issues, multi-generational stress transmission, and relational patterns in order to promote emotional differentiation and functional family dynamics. In their study, Ankwasiize \u0026amp; Kiyingi (2019) used Trans-generational Family Therapy to address intergenerational financial constraints and emotional processes within families. They used Bowenian concepts such as differentiation, triangulation, and emotional cut-off, and these interventions improved emotional functioning and financial management among different families.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eMulti-Couple Therapy (MCT)\u003c/h2\u003e \u003cp\u003eThe MCT model was designed to support Congolese couples that had gone through torture and sexual violence and were struggling with significant relational and psychological distress (Morgan et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). This therapy integrated elements from trauma-focused care, couple therapy and group process theory to deliver a structured communal intervention. In this model, there was emphasis on safety, communication exercises, normalization of trauma responses and emotional reconnection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eAdlerian Family Counselling\u003c/h2\u003e \u003cp\u003eAdlerian systemic approaches emphasized family cohesion, individual goals within a family context, and mindfulness practices. These interventions prioritized nurturing individual responsibility and empathy within relational systems to achieve balanced and cohesive family dynamics. In Uganda, Adlerian Family Counselling promoted mindful parenting practices and emotional awareness within family systems. This approach significantly increased family cohesion, emotional openness, and compassionate interactions among family members (Ankwasiize \u0026amp; Kiyingi, 2017).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eEmotionally Focused Couple Therapy (EFCT)\u003c/h2\u003e \u003cp\u003eEmotionally Focused Therapy interventions targeted emotional bonding, attachment processes, and emotional communication within couples. EFCT is rooted in attachment theory, and it prioritized creating secure emotional connections, enhancing intimacy, and reducing relational distress. The South African EFT-based psychoeducation program, Hold Me Tight, explicitly focused on improving emotional connectivity and attachment bonds within couples. The program demonstrated effectiveness in enhancing emotional intimacy, relational satisfaction, and conflict resolution skills among participating couples (Lesch et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eMarital Relationship Skills Training and Marriage Enrichment Programs\u003c/h2\u003e \u003cp\u003eIn this review, two interventions targeted marital relationships and emphasized structured skill-building related to communication, conflict resolution, and intimacy. These systemic approaches provided psychoeducational sessions, guided exercises, and structured discussions designed to build relational wellness among couples. Such interventions involved teaching practical skills alongside culturally relevant relational insights to foster healthier, more satisfying marital relationships. In Ethiopia, a structured marital skills training intervention focused on enhancing communication, emotional intimacy, and problem-solving skills among couples. The program demonstrated significant positive effects, including improved marital adjustment, increased relationship satisfaction, and a reduction in marital distress (Asfaw \u0026amp; Alene, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Marriage Enrichment Program (MEP) in South Africa, adapted from the international PREP 8.0 curriculum, was designed explicitly to integrate modern relationship skills with culturally meaningful marital practices such as \u003cem\u003ebogadi\u003c/em\u003e (bridewealth negotiations) and \u003cem\u003ego laya\u003c/em\u003e (traditional elder guidance). This program led to enhanced communication, deeper emotional intimacy, improved conflict-resolution skills, and higher overall marital satisfaction. The involvement of traditional community leaders and the blending of contemporary psychoeducational content with indigenous relational traditions resulted in a high degree of acceptability, engagement, and effectiveness among participants (Neswiswa \u0026amp; Jacobs, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eAfrican Family Counselling\u003c/h2\u003e \u003cp\u003eAfrican Family Counselling is an intervention approach deeply rooted in indigenous family structures and relational philosophies. It emphasizes cohesion, communal parenting, collective problem-solving, and the reinforcement of traditional family values. This approach integrates extended family members and community perspectives, rather than focusing solely on nuclear family dynamics, which aligns with collective rather than individualistic ways. In their study, Ankwasiize \u0026amp; Kiyingi (2016) used the African Family Counselling alongside cohesive parenting to enhance parenting and focused on strengthening parental cohesion, adaptability, and reducing psychological control. The intervention employed counselling sessions that incorporated traditional stories, conflict resolution methods, and community dialogue. Participants reported improvements in emotional connection among family members, enhanced cooperation in parenting roles, and greater adaptability in addressing family stressors and discipline issues.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eCultural Adaptation Strategies\u003c/h2\u003e \u003cp\u003eAcross the reviewed studies, a recurring theme was the integration of local cultural and contextual elements like local languages, and the use of local idioms into SFT interventions. It is important to note that culturally responsive adaptations aimed at enhancing relevance, acceptability, and therapeutic engagement within the community.\u003c/p\u003e \u003cp\u003eIn Uganda, the \u003cem\u003eAmaka Amasanyufu\u003c/em\u003e Multiple Family Group (MFG) intervention emphasized communal mentorship by employing community health workers and parent peers, culturally appropriate parenting narratives, and local language (Luganda) materials to facilitate meaningful connections among participants (Byansi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In South Africa, the Marriage Enrichment Program (MEP) explicitly incorporated traditional marital practices such as \u003cem\u003ebogadi\u003c/em\u003e (bridewealth negotiations) and \u003cem\u003ego laya\u003c/em\u003e (traditional guidance by elders), ensuring culturally sensitive alignment with indigenous marital values and norms (Neswiswa \u0026amp; Jacobs, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eSimilarly, interventions such as \u003cem\u003eTuko Pamoja\u003c/em\u003e in Kenya and MCT in Congo strategically involved lay counsellors embedded within the community, enabling flexible delivery approaches tailored to culturally specific economic, gender, and parenting dynamics (Morgan et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Puffer et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2020\u003c/span\u003ea). Moreso, Nigerian-based interventions like Rational Emotive Family Health Therapy (REFHT) integrated culturally relevant frameworks, explicitly addressing local crises (e.g., flooding disasters) by linking cognitive restructuring techniques to relevant emotional coping strategies for farmers that were experiencing anxiety due to flooding (Ugwuoke et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Another example was the social media-based drama therapy combined with family counselling in Nigeria, which used digital platforms to deliver culturally attuned interventions addressing postpartum depression and spousal support, which effectively blended social media (e.g., WhatsApp) with culturally nuanced therapeutic strategies including storytelling and use of Nigerian metaphors (Onogwu et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, considering the centrality of spirituality and religion in African relational contexts, six studies discussed an integration of spiritual leaders or religious frameworks within their delivery models. For example, REFHT in Nigeria specifically incorporated local spiritual and religious beliefs in addressing anxiety related to natural disasters such as flooding (Ugwuoke et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Similarly, the Ethiopian marital relationship skills training intervention acknowledged local religious values and norms as central aspects of marital relationships, thus promoting meaningful interventions that connect with the culture (Asfaw \u0026amp; Alene, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In the marriage enrichment program in South Africa, delivery of the intervention happened in collaboration with church-based groups, and program content included Christian values of forgiveness and respect in marriage (Neswiswa \u0026amp; Jacobs, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In the pilot trial of a family therapy intervention in Kenya, they involved clergy as occasional co-facilitators to align the intervention with the families\u0026rsquo; spiritual coping mechanisms (Puffer et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Religion plays a significant role in African family life, reflecting the importance of incorporating some religious aspects in intervention delivery.\u003c/p\u003e \u003cp\u003eFurthermore, five interventions adapted their structural approaches to respect existing hierarchical family dynamics, including involving extended family members in therapeutic processes. This approach capitalized on pre-existing family strengths and promoted communal healing. For instance, Structural and Trans-generational Family Counselling approaches in Uganda explicitly included intergenerational family structures, emphasizing clear hierarchical roles and responsibility distributions to address systemic relational issues effectively (Ankwasiize \u0026amp; Kiyingi, 2017, 2019). Moreover, the \u003cem\u003eAmaka Amasanyufu\u003c/em\u003e Multiple Family Group intervention strategically used peer support and collective learning approaches, which align with communal relational values and multi-family support structures (Byansi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, in three studies, interventions were carefully adapted to address specific gender dynamics and needs, including explicitly recognizing and addressing power imbalances (men hold more power than women), gender-based violence, postpartum mental health, and marital relationship dynamics. For instance, EFT in South Africa and the MEP explicitly addressed gendered relational dynamics, emotional intimacy, and communication barriers between spouses, actively promoting gender-sensitive marital relationship enrichment (Lesch et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Neswiswa \u0026amp; Jacobs, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Moreover, the Nigerian drama therapy and family counselling intervention included specific sessions on enhancing spousal support and male engagement during postpartum periods, which directly addressed gendered roles and relational expectations in the African traditions (Onogwu et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The inclusion of gender-sensitive components in these studies demonstrated an understanding of the socio-cultural realities of African family dynamics.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eGaps in Cultural Adaptations\u003c/h2\u003e \u003cp\u003eDespite studies mentioning and, in some instances, integrating culturally resonant rituals and practices in implementation, we noticed a gap in the use of established cultural adaptation frameworks in the development and implementation of the interventions. For example, none of the studies we reviewed explicitly applied empirically validated frameworks for conducting adaptation such as Bernal et al.\u0026rsquo;s (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1995\u003c/span\u003e) Ecological Validity Model, the ADAPT-ITT framework, or the Cultural Adaptation Process Model (CAPM) (Domenech Rodr\u0026iacute;guez \u0026amp; Bernal, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) to inform how they tailored content, delivery and evaluation strategies. Moreover, the adaptations were mainly referred to as cultural considerations instead of deeply being grounded in theory-informed cultural adaptation processes that thoroughly assess key cultural domains.\u003c/p\u003e \u003cp\u003eAcross the reviewed studies, cultural adaptations were mainly at the surface level. These focused on adjustments such as translating materials (Amanyire et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), using local names for interventions (Byansi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), and delivering interventions in community settings (Asfaw \u0026amp; Alene, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Neswiswa \u0026amp; Jacobs, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Puffer et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2020\u003c/span\u003eb, 2021). According to Bernal et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1995\u003c/span\u003e), effective cultural adaptations go beyond linguistic translation to include structural alignment with local core values through multiple dimensions such as language, metaphors, content, concepts, goals, metaphors and context. There was limited re-modification of core mechanisms of change in the Western models (e.g., EFT, Adlerian therapy, BFT) to ensure conceptual equivalence with African cultural contexts. In Ankwasiize \u0026amp; Kiyingi\u0026rsquo;s (2017) study that implemented Adlerian Family Counselling and Mindful Parenting, they retained democratic parenting styles and individual goal setting yet provided limited reflection on whether these approaches align with the parenting norms and structures in the Ugandan context. The concern here is that some interventions may impose Euro-American family assumptions that misalign with the collective, hierarchical and interdependent nature of many African family systems.\u003c/p\u003e \u003cp\u003eThere was lack of transparency in how the cultural adaptations were implemented. Most papers reported translating the materials (Byansi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), engaging community stakeholders in intervention implementation and cultural consultation (Neswiswa \u0026amp; Jacobs, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Puffer et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) but did not provide the detailed processes through which these were done. There was limited reporting on the adaptation protocols, stakeholder input, or the decision-making criteria they used to modify the content in these interventions. Clear documentation of adaptation procedures is critical for replication, scalability, and cross-cultural learning.\u003c/p\u003e \u003cp\u003eAdditionally, there was minimal evidence of co-design approached in adapting interventions, and yet this is an essential step in ensuring that cultural adaptation is a bottom-up process (Domenech Rodr\u0026iacute;guez \u0026amp; Bernal, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Studies like the MFG intervention in Uganda, and \u003cem\u003eTuko Pamoja\u003c/em\u003e in Kenya recruited parent peers, engaged village and religious leaders in recruitment and facilitating the interventions (Byansi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Puffer et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), but these were surface level collaborations and gate keeper involvement to foster trust in the community. There was lack of thorough participatory elements needed in the cultural adaptation process that involve feedback loops where community feedback leads to refinement of the intervention content, methods, measurement, and delivery. Even in \u003cem\u003eAmaka Amasanyufu\u003c/em\u003e, where facilitators were local, the adaptation process focused more on delivery than on deep structural adaptation of the therapeutic constructs (Byansi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn summary, several studies have taken culture into consideration while implementing SFT interventions across African contexts, such as incorporating local languages, drawing on traditional values, and engaging community leaders. However, many adaptations remain under-reported, partial, top-down, and lacking in methodological rigor. Without comprehensive strategies that involve communities as co-creators and not just recipients, interventions risk cultural misalignment and reduced sustainability. So, to ensure deeper cultural effectiveness, future studies must prioritize inclusive design, apply adaptation models systematically, and build evidence through iterative evaluation and community feedback loops. Cultural adaptation must not be treated as a small add-on but as an integral process of intervention implementation.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eBarriers to Implementation\u003c/h2\u003e \u003cp\u003eThe results across papers showed substantial therapeutic outcomes for families. However, they consistently highlighted several barriers impacting implementation and sustainability of the SFT interventions. Among these were logistical and limitations in infrastructure (e.g., transportation and communication barriers, especially in rural settings), low psychological literacy, and persistent stigma around mental health. For example, the Ugandan Structural Family Therapy and Kenyan community-based interventions cited difficulties in training and retaining adequately skilled lay therapists while maintaining fidelity within the models (Ankwasiize \u0026amp; Kiyingi, 2017; Puffer et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, limited funding, resource scarcity, shortages of trained marriage and family therapists, and a lack of culturally validated and contextually appropriate measurement tools consistently limited scaling intervention and outcome evaluation. Despite these challenges, using community-based delivery models, integrating interventions with religious institutions, and training lay community members emerged as promising strategies to mitigate these barriers and enhance intervention acceptability and sustainability across multiple settings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this scoping review serve to show the potential and cultural relevance of systemic family therapy in the diverse settings of Africa, when thoughtful adaptations are conducted. We included fourteen studies from six African countries namely; Uganda, Kenya, Nigeria, Ethiopia, Congo and South Africa that implemented a variety of interventions targeting systemic/relational change outcomes. The interventions in our review were implemented to mainly address a variety of systemic/relational change issues in families, including but not limited to, marital conflict, parenting stress, depression, among others.\u003c/p\u003e \u003cp\u003eThrough this review, we found that implemented interventions demonstrated an emerging trend of cultural responsiveness in family therapy in Africa. These developments signal a critical and emerging shift from simply importing Euro-American based models to actively finding ways to integrate interventions with locally relevant culturally responsive practices that center African community norms and traditions (Asiimwe et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2026\u003c/span\u003e; Chilisa et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This shift also means that there is a growing commitment to decolonizing mental health care as well as recognizing the importance of African cultural values, perspectives and family structures in shaping couple and family therapy work.\u003c/p\u003e \u003cp\u003eImportantly, this transformation has even broader implications for the future of systemic family therapy across the continent. First, culturally grounded systemic interventions hold great potential to significantly increase access to care in low-resource and rural areas while also reducing stigma around mental health. Since therapy could be embedded within familiar traditions (e.g., storytelling, faith, communal practices), these models can make therapy more relatable and invite participation from individuals and families that may otherwise remain unreached. In their review, Mascayano and colleagues (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) had similar conclusions, emphasizing that mental health stigma can be significantly reduced when interventions resonate with the culture. After analyzing 25 stigma-reduction programs across low- and middle-income countries (LMICs), they found that in the interventions that incorporated culturally meaningful elements like language, community norms, values and belief systems, participants reported higher engagement, lower stigma, and greater openness to seeking mental health support (Mascayano et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSecond, culturally responsive SFT models in Africa can help families navigate distress relationally, rather than individually. For instance, when intergenerational issues, gender dynamics, or even collective decision-making norms are explicitly addressed within a family therapy intervention, the outcomes can be more sustainable and relevant to the people. Previous research also showed that interventions that align with the local beliefs about health and wellbeing, family and moral development, are more likely to increase ownership, promote healing while also shifting long-standing relational patterns (Arundell et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Marsiglia \u0026amp; Booth, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Mishu et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Building on this growing momentum, our review analyzed how systemic interventions were culturally adapted and delivered in different studies. Strategies such as the integration of indigenous storytelling traditions, communal mentorship models, religious and spiritual frameworks, and the use of local language, emerged as the main ways interventions were adapted to fit local context in the target setting (Asfaw \u0026amp; Alene, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Byansi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Morgan et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Puffer et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This finding was not surprising to us as a team of African family therapy scholars but rather, it affirmed that integrating culturally rooted practices such as indigenous storytelling, communal mentorship, religious and spiritual frameworks, and local languages is a key strategy for making family therapy interventions more relevant and acceptable in African contexts (Bah et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Previous studies in diverse cultural settings (Bah et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; James et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Marsiglia \u0026amp; Booth, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; O\u0026rsquo;Donnell et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), have similarly highlighted that tailoring interventions to include locally meaningful traditions and communication styles strengthens cultural fit and improves engagement and outcomes. These culturally relevant elements fostered community trust, increased participant engagement, and strengthened intervention fidelity. The success of programs like \u003cem\u003eTuko Pamoja\u003c/em\u003e in Kenya (Puffer et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and the \u003cem\u003eAmaka Amasanyufu\u003c/em\u003e MFG in Uganda (Byansi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) showed the feasibility and efficacy of culturally grounded systemic approaches. These models demonstrated significant improvements in family cohesion, emotional regulation, parenting practices, and mental health outcomes even in low-resource, high-stigma environments.\u003c/p\u003e \u003cp\u003eDespite these strategies, we observed several key gaps in cultural adaptation. First, while many interventions incorporated surface-level adaptations (e.g., using local language or involving community leaders), there was limited evidence of deeper structural and functional adaptations as described in frameworks like Bernal et al.\u0026rsquo;s (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1995\u003c/span\u003e), which emphasize modification of intervention logic to increase cultural fit. Only a few studies engaged in participatory processes with community members (Byansi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Puffer et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) which is an essential step for ensuring that adaptation is informed by local voices. This strategy has been proven to be effective by similar studies that leveraged lay providers to bridge in access to family therapy (Jordans et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). However, critical components of sustainable adaptation with community involvement and co-ownership as discussed by Treichler et al. (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) in their study, were missing. We contend that the absence of these strategies reduces the systematic rigor of the adaptations and limits both replicability and transparency.\u003c/p\u003e \u003cp\u003eAdditionally, majority of studies lacked robust evaluation designs, with only a handful including follow-up assessments, control groups, or culturally validated measures (Byansi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Puffer et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This reduces the ability to track long-term outcomes and generalize effectiveness across diverse African contexts. This echoes broader critiques from scholars like Bernal \u0026amp; S\u0026aacute;ez-Santiago (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) and Castro et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2004\u003c/span\u003e) who have advocated for the use of contextual measurement tools as a part of cultural adaptation. Critiques in similar reviews mirror our observation that many culturally adapted interventions still lack standardized follow-up, as well as validated outcome measures (Bosqui et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Mabunda et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Rathod et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Shehadeh et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). These methodological limitations further reduce confidence in the long-term effectiveness of interventions and also call for systematic cultural adaptation frameworks in global mental health research.\u003c/p\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eImplications\u003c/h2\u003e \u003cp\u003eThe findings point to several opportunities for strengthening culturally grounded family therapy across Africa. Future interventions should prioritize co-design processes that include local families, traditional leaders, and community-based mental health practitioners as partners in the adaptation and implementation process. Participatory approaches not only enhance cultural fit but also build community ownership, which is essential for sustainability, as demonstrated by Belgrave et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), Edge et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) and Renwick et al. (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) who achieved great cultural fit and community ownership in their studies, culturally adapting interventions with the community.\u003c/p\u003e \u003cp\u003eMore so, there is an urgent need to develop and validate culturally grounded assessment tools, including measures of family functioning, relational wellbeing, and intergenerational communication, that move beyond the existing Euro-centric measures. Efforts like those led by Asiimwe et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) and Mugarura et al. (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) are exemplary in their attention to building local capacity and validating tools including the Alabama Parenting Questionnaire, and the CompACT questionnaire respectively to resonate with African family and community structures.\u003c/p\u003e \u003cp\u003eDespite the promising outcomes from studies in this review, systemic family therapy in Africa continues to face persistent structural challenges. Key barriers include underfunding, inadequate infrastructure for therapist training and supervision, stigma surrounding mental health services, and the absence of culturally validated assessment tools tailored to diverse African family systems. These challenges limit scalability, sustainability, and policy integration, and it is our conviction that there is an urgent need for investments in systemic therapy capacity-building and culturally relevant theoretical frameworks. In this context, Heiden-Rootes and colleagues (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) emphasize that when building family therapy in African contexts, it is critical to start with community-driven research. This means asking what communities need, what\u0026rsquo;s already working, and how the existing evidence-based models like EFT, can be adapted to fit the communal values like attachment to the extended family.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis scoping review reveals that culturally adapted systemic family therapy interventions are relevant in enhancing emotional, relational, and psychosocial wellbeing across African family systems. Interventions that integrated traditional values, religious practices, and community-based delivery models demonstrated improvements in mental health, family functioning, parenting practices, and stigma reduction. The synthesis shows that African families benefit most when systemic approaches are intentionally adapted to reflect traditional cultural values, extended family dynamics, and communal healing traditions. Cultural responsiveness was a core mechanism of engagement and impact and not just an accessory to the effectiveness of the interventions implemented. Overall, systemic family therapy offers a powerful pathway for advancing relational health, strengthening families, and promoting collective wellbeing across Africa when cultural values are incorporated. Given these findings, we strongly advocate for more research dedicated to cultural adaptation of SFT interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.K: Conceptualization, designed the review protocol, conducted the literature search, and led data extraction and synthesis. Writing - Original Draft, Writing - Review \u0026amp; Editing. R.A: Conceptualization, designed the protocol, Validated extracted data, writing \u0026ndash; Subsequent drafts, editing and reviewing. I.L: Study screening, Data extraction, review and editing manuscript P.G: Study screening, Data extraction, Review and Editing manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdams, G., Osei-Tutu, A., \u0026amp; Affram, A. A. (2020). Decolonial Perspectives on Psychology and Development. \u003cem\u003eOxford University Press\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/acrefore/9780190236557.013.514\u003c/span\u003e\u003cspan address=\"10.1093/acrefore/9780190236557.013.514\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAboagye, R. G., Dadzie, L. K., Arthur-Holmes, F., Okyere, J., Agbaglo, E., Ahinkorah, B. O., \u0026amp; Seidu, A. A. (2022). Intimate partner violence against married and cohabiting women in sub-Saharan Africa: does sexual autonomy matter? \u003cem\u003eReproductive health, 19(1), 79.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12978-022-01382-1\u003c/span\u003e\u003cspan address=\"10.1186/s12978-022-01382-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlinaitwe, R., Seggane, M., Turiho, A., Bird, V., Priebe, S., \u0026amp; Sewankambo, N. (2024). Family Psycho-Social Involvement Intervention for severe mental illness in Uganda. \u003cem\u003eSouth African Journal of Psychiatry\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e, 1\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4102/sajpsychiatry.v30i0.2138\u003c/span\u003e\u003cspan address=\"10.4102/sajpsychiatry.v30i0.2138\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmanyire, J. M., Aheisibwe, I., Kaggwa, M. M., \u0026amp; Rukundo, G. Z. (2023). Effectiveness of Behavioral Family Therapy in reducing depressive symptoms among older persons living with HIV / AIDS in Mbarara city, southwestern Uganda. \u003cem\u003eInternational Journal of Scientific Research and Engineering Development\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(5), 1066\u0026ndash;1077.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAriyo, E., Mortelmans, D., \u0026amp; Wouters, E. (2019). The African Child in Kinship Care: A Systematic Review. \u003cem\u003eChildren and Youth Services Review\u003c/em\u003e, \u003cem\u003e98\u003c/em\u003e, 178\u0026ndash;187. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.childyouth.2018.12.013\u003c/span\u003e\u003cspan address=\"10.1016/j.childyouth.2018.12.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArundell, L. L., Barnett, P., Buckman, J. E. J., Saunders, R., \u0026amp; Pilling, S. (2021). The effectiveness of adapted psychological interventions for people from ethnic minority groups: A systematic review and conceptual typology. \u003cem\u003eClinical Psychology Review\u003c/em\u003e, \u003cem\u003e83\u003c/em\u003e, 102063. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.cpr.2021.102063\u003c/span\u003e\u003cspan address=\"10.1016/j.cpr.2021.102063\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsfaw, L. S., \u0026amp; Alene, G. D. (2023). Effectiveness of a marital relationship skills training intervention on marital adjustment among individuals in Hosanna Town, Southwest Ethiopia: A randomized-controlled trial. \u003cem\u003eJournal of Marital and Family Therapy\u003c/em\u003e, \u003cem\u003e49\u003c/em\u003e(3), 541\u0026ndash;560. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jmft.12641\u003c/span\u003e\u003cspan address=\"10.1111/jmft.12641\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsiimwe, R., Blow, A. J., Mugumya, F., Birungi, M., \u0026amp; Tumuhairwe, T. J. B. (2025). Culturally Informed Parenting Assessment: The Adaptation of the Alabama Parenting Questionnaire With Input From Ugandan Experts and Parents. \u003cem\u003eFamily Process\u003c/em\u003e, \u003cem\u003e64\u003c/em\u003e(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/famp.70035\u003c/span\u003e\u003cspan address=\"10.1111/famp.70035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsiimwe, R., Dwanyen, L., Subramaniam, S., Kasujja, R., \u0026amp; Blow, A. J. (2023). Training of interventionists and cultural adaptation procedures: A systematic review of culturally adapted evidence-based parenting programs in Africa. \u003cem\u003eFamily Process\u003c/em\u003e, \u003cem\u003e62\u003c/em\u003e(1), 160\u0026ndash;181. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/famp.12780\u003c/span\u003e\u003cspan address=\"10.1111/famp.12780\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsiimwe, R., Karume, M., \u0026amp; Kasujja, R. (2023). Systemic family therapy in Africa: Past, present, and future trends. \u003cem\u003eIn The Routledge International Handbook of Couple and Family Therapy.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4324/9781003297871-14\u003c/span\u003e\u003cspan address=\"10.4324/9781003297871-14\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsiimwe, R., Lesch, E., Karume, M., \u0026amp; Blow, A. J. (2021). Expanding our international reach: Trends in the development of systemic family therapy training and implementation in Africa. \u003cem\u003eJournal of Marital and Family Therapy\u003c/em\u003e, \u003cem\u003e47\u003c/em\u003e(4), 815\u0026ndash;830. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jmft.12514\u003c/span\u003e\u003cspan address=\"10.1111/jmft.12514\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsiimwe, R., McIntosh, L. D., Gathumbi, N. R., \u0026amp; Kasujja, R. (2026). Cultural threads: An Afrocentric paradigm for integrating social justice principles in the practice of family therapy in Africa. \u003cem\u003eJournal of Marital and Family Therapy\u003c/em\u003e, \u003cem\u003e52\u003c/em\u003e(1), 1752\u0026ndash;0606. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jmft.70091\u003c/span\u003e\u003cspan address=\"10.1111/jmft.70091\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyesu, S. M., Buami, E. K., Adjei, D. A., Abraham, I., Adom, D., \u0026amp; Crentsil, T. (2024). The use of culturally acceptable mourning clothes in Ghana: psychological implications on the bereaved. \u003cem\u003eAfrican Identities\u003c/em\u003e, \u003cem\u003e00\u003c/em\u003e(00), 1\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/14725843.2024.2415585\u003c/span\u003e\u003cspan address=\"10.1080/14725843.2024.2415585\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBah, A. J., Wurie, H. R., Samai, M., Horn, R., \u0026amp; Ager, A. (2025). The cultural adaptation of the Friendship Bench Intervention to address perinatal psychological distress in Sierra Leone: an application of the ADAPT-ITT framework and the Ecological Validity Model. \u003cem\u003eFrontiers in Psychiatry\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyt.2025.1441936\u003c/span\u003e\u003cspan address=\"10.3389/fpsyt.2025.1441936\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBelgrave, A. B., Bermudez, V. N., Chew, P., Lin, Y., Ahn, J., Bustamante, A. S., Alvarez-Vargas, D., Villegas, J., \u0026amp; Arciniega, M., P (2022). Using a Participatory Design Approach for Co-creating Culturally Situated STEM Enrichment Activities. \u003cem\u003eJournal of Applied Developmental Psychology\u003c/em\u003e, 82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.appdev.2022.101451\u003c/span\u003e\u003cspan address=\"10.1016/j.appdev.2022.101451\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernal, G., Bonilla, J., \u0026amp; Bellido, C. (1995). Ecological Validity and Cultural Sensitivity for Outcome Research: Issues for the Cultural Adaptation and Development of Psychosocial Treatments with Hispanics. \u003cem\u003eIn Journal of Abnormal Child Psychology\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e, 67\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/BF01447045\u003c/span\u003e\u003cspan address=\"10.1007/BF01447045\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernal, G., \u0026amp; S\u0026aacute;ez-Santiago, E. (2024). Culturally Centered Psychosocial Interventions. \u003cem\u003eFocus\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(4), 508\u0026ndash;514. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1176/appi.focus.24022022\u003c/span\u003e\u003cspan address=\"10.1176/appi.focus.24022022\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBobek, M., Hogue, A., Porter, N., MacLean, A., Bourdeau, T., Cromley, T., Higa-MacMillan, C., Thompson, T., Wagner, J., \u0026amp; Daleiden, E. (2025). Core Practices in Systemic Family Therapy for Adolescent Behavior Problems: A Comprehensive Modular Pathway. \u003cem\u003eContemporary Family Therapy\u003c/em\u003e, \u003cem\u003e47\u003c/em\u003e, 419\u0026ndash;434. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10591-025-09738-y\u003c/span\u003e\u003cspan address=\"10.1007/s10591-025-09738-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBosqui, T., Gardner, F., McLuckie, A., \u0026amp; Wessels, I. (2024). Parenting and family interventions for mental health in low- and middle-income countries: A systematic review and meta-analysis of effectiveness and implementation factors. \u003cem\u003eChildren and Youth Services Review\u003c/em\u003e, \u003cem\u003e155\u003c/em\u003e, 107419. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.childyouth.2024.107419\u003c/span\u003e\u003cspan address=\"10.1016/j.childyouth.2024.107419\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eByansi, W., Sensoy Bahar, O., Small, L., Namatovu, P., Nabayinda, J., Kiyingi, J., Mwebembezi, A., Nakigozi, G., Hoagwood, K., McKay, M. M., \u0026amp; Ssewamala, F. M. (2024). The longitudinal impact of an evidence-based multiple family group intervention (Amaka Amasanyufu) on family cohesion among children in Uganda: Analysis of the cluster randomized SMART Africa-Uganda scale-up study (2016\u0026ndash;2022\u003cem\u003e). Family Process, December 2023\u003c/em\u003e, 1851\u0026ndash;1866. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/famp.13007\u003c/span\u003e\u003cspan address=\"10.1111/famp.13007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCastro, F. G., Barrera, M., \u0026amp; Martinez, C. R. (2004). The Cultural Adaptation of Prevention Interventions: Resolving Tensions Between Fidelity and Fit. \u003cem\u003eIn Prevention Science\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e, 41\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1023/B:PREV.0000013980.12412.cd\u003c/span\u003e\u003cspan address=\"10.1023/B:PREV.0000013980.12412.cd\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChilisa, B., Major, T. E., Gaotlhobogwe, M., \u0026amp; Mokgolodi, H. (2016). Decolonizing and indigenizing evaluation practice in Africa: Toward African relational evaluation approaches. \u003cem\u003eCanadian Journal of Program Evaluation\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(3), 313\u0026ndash;328. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3138/cjpe.30.3.05\u003c/span\u003e\u003cspan address=\"10.3138/cjpe.30.3.05\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDomenech Rodr\u0026iacute;guez, M. M., \u0026amp; Bernal, G. (2012). Frameworks, models, and guidelines for cultural adaptation. In Cultural adaptations: Tools for evidence-based practice with diverse populations. \u003cem\u003eAmerican Psychological Association\u003c/em\u003e, 23\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/13752-002\u003c/span\u003e\u003cspan address=\"10.1037/13752-002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdge, D., Degnan, A., Cotterill, S., Berry, K., Drake, R., Baker, J., Barrowclough, C., Hughes-Morley, A., Grey, P., Bhugra, D., Cahoon, P., Tarrier, N., Lewis, S., \u0026amp; Abel, K. (2016). Culturally-adapted Family Intervention (CaFI) for African-Caribbeans diagnosed with schizophrenia and their families: A feasibility study protocol of implementation and acceptability. \u003cem\u003ePilot and Feasibility Studies\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40814-016-0070-2\u003c/span\u003e\u003cspan address=\"10.1186/s40814-016-0070-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvarist, A. G., \u0026amp; Kiyingi, F. P. (2017). Structural Family Counselling and Transformation of Home Financial Constraints: a case of selected families in Kampala, Uganda. \u003cem\u003eNkumba Business Journal (NBJ), 16(October), 153\u0026ndash;171.\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvarist, A., \u0026amp; Pio, K. F. (2017). Adlerian Family Counselling And Mindful Parenting In Kampala Capital City - Uganda. \u003cem\u003eResearch Journal of Sociology, 5(8), 1\u0026ndash;15.\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvarist, A. G., \u0026amp; Pio, K. F. (2016). African Family Counselling as a pivot for Cohesive Parenting. A Case of juvenile protection home in KCCA \u0026ndash; \u003cem\u003eUganda. 2(i).\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvarist, A., \u0026amp; Pio, K. F. (2019). Trans-Generational Family Counselling and Management of Home Financial Constraints: A Case Study of Kampala Capital City Authority (Uganda). \u003cem\u003eIII(Vi), 113\u0026ndash;122.\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoodkind, J. R., Amer, S., Christian, C., Hess, J. M., Bybee, D., Isakson, B. L., Baca, B., Ndayisenga, M., Greene, R. N., \u0026amp; Shantzek, C. (2017). Challenges and Innovations in a Community-Based Participatory Randomized Controlled Trial. \u003cem\u003eHealth Education and Behavior\u003c/em\u003e, \u003cem\u003e44\u003c/em\u003e(1), 123\u0026ndash;130. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1090198116639243\u003c/span\u003e\u003cspan address=\"10.1177/1090198116639243\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGritti, P. (2019). A note on cultural sensitivity in family system therapy. \u003cem\u003eJPS\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(1), 1\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.23823/jps.v3i1.48\u003c/span\u003e\u003cspan address=\"10.23823/jps.v3i1.48\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeiden-Rootes, K., Asiimwe, R., Rastogi, M., \u0026amp; Miller, R. B. (2025). Pathways for Public Impact: Utilizing Engaged Scholarship for Translating Systemic Family Therapy Research to Policy and Practice. \u003cem\u003eJournal of Marital and Family Therapy\u003c/em\u003e, \u003cem\u003e51\u003c/em\u003e(4). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jmft.70076\u003c/span\u003e\u003cspan address=\"10.1111/jmft.70076\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHunduma, G., Dessie, Y., Geda, B., Yadeta, T. A., \u0026amp; Deyessa, N. (2021). Common mental health problems among adolescents in sub-Saharan Africa: a systematic review and meta-analysis. \u003cem\u003eJournal of Child \u0026amp; Adolescent Mental Health\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(1\u0026ndash;3), 90\u0026ndash;110.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHwang, W. C. (2011). Cultural Adaptations: A Complex Interplay Between Clinical and Cultural Issues. \u003cem\u003eClinical Psychology: Science and Practice\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(3), 238\u0026ndash;241. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1468-2850.2011.01255.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1468-2850.2011.01255.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJames, T., Mukadam, N., Sommerlad, A., Guerra Ceballos, S., \u0026amp; Livingston, G. (2021). Culturally tailored therapeutic interventions for people affected by dementia: a systematic review and new conceptual model. \u003cem\u003eIn The Lancet Healthy Longevity (Vol. 2, Issue 3, pp. e171\u0026ndash;e179). Elsevier Ltd.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S2666-7568(21)00001-5\u003c/span\u003e\u003cspan address=\"10.1016/S2666-7568(21)00001-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJhamb, S., Kolte, A., Prashanth, A., Roy, A. S., Roy, H., Maheshwari, K., Mathur, P., Raj, R. K., Abhyankar, S., \u0026amp; Rani, A. (2024). A Theoretical Article: Exploring the Evolutionary Dynamics of Couples and Family Therapy. \u003cem\u003eThe Family Journal\u003c/em\u003e, \u003cem\u003e32\u003c/em\u003e(4), 669\u0026ndash;678. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/10664807241269544\u003c/span\u003e\u003cspan address=\"10.1177/10664807241269544\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJordans, M. J. D., Luitel, N. P., Kohrt, B. A., Rathod, S. D., Garman, E. C., De Silva, M., Komproe, I. H., Patel, V., \u0026amp; Lund, C. (2019). Community-, facility-, and individual-level outcomes of a district mental healthcare plan in a low-resource setting in Nepal: A population-based evaluation. \u003cem\u003ePLoS Medicine\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pmed.1002748\u003c/span\u003e\u003cspan address=\"10.1371/journal.pmed.1002748\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKpanake, L. (2018). Cultural concepts of the person and mental health in Africa. \u003cem\u003eTranscultural Psychiatry\u003c/em\u003e, \u003cem\u003e55\u003c/em\u003e(2), 198\u0026ndash;218. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1363461517749435\u003c/span\u003e\u003cspan address=\"10.1177/1363461517749435\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLesch, E., de Bruin, K., \u0026amp; Anderson, C. (2018). A Pilot Implementation of the Emotionally Focused Couple Therapy Group Psychoeducation Program in a South African Setting. \u003cem\u003eJournal of Couple and Relationship Therapy\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(4), 313\u0026ndash;337. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/15332691.2017.1417940\u003c/span\u003e\u003cspan address=\"10.1080/15332691.2017.1417940\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMabunda, D., Oliveira, D., Sidat, M., Cavalcanti, M. T., Cumbe, V., Mandlate, F., Wainberg, M., \u0026amp; Cournos, F. (2022). \u0026amp; de Jesus Mari, J. Cultural adaptation of psychological interventions for people with mental disorders delivered by lay health workers in Africa: scoping review and expert consultation. \u003cem\u003eIn International Journal of Mental Health Systems (Vol. 16, Issue 1). BioMed Central Ltd\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13033-022-00526-x\u003c/span\u003e\u003cspan address=\"10.1186/s13033-022-00526-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarsiglia, F. F., \u0026amp; Booth, J. M. (2015). Cultural Adaptation of Interventions in Real Practice Settings. \u003cem\u003eResearch on Social Work Practice\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(4), 423\u0026ndash;432. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1049731514535989\u003c/span\u003e\u003cspan address=\"10.1177/1049731514535989\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMascayano, F., Toso-Salman, J., Ho, Y. C. S., Dev, S., Tapia, T., Thornicroft, G., Cabassa, L. J., Khenti, A., Sapag, J., Bobbili, S. J., Alvarado, R., Yang, L. H., \u0026amp; Susser, E. (2020). Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries. \u003cem\u003eTranscultural Psychiatry\u003c/em\u003e, \u003cem\u003e57\u003c/em\u003e(1), 140\u0026ndash;160. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1363461519890964\u003c/span\u003e\u003cspan address=\"10.1177/1363461519890964\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMishu, M. P., Tindall, L., Kerrigan, P., \u0026amp; Gega, L. (2023). Cross-culturally adapted psychological interventions for the treatment of depression and/or anxiety among young people: A scoping review. \u003cem\u003ePLOS ONE\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(10), e0290653. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0290653\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0290653\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan, E., Wieling, E., Hubbard, J., \u0026amp; Kraus, E. (2017). The development and implementation of a multi-couple therapy model with torture survivors in the Democratic Republic of the Congo. \u003cem\u003eJournal of Marital and Family Therapy\u003c/em\u003e, \u003cem\u003e44\u003c/em\u003e(2), 235\u0026ndash;247. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jmft.12287\u003c/span\u003e\u003cspan address=\"10.1111/jmft.12287\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMugarura, J., Musanje, K., Levine, M. E., Asiimwe, R., Ndeezi, M., Kizito, S., White, R. G., \u0026amp; Kasujja, R. (2025). Adapting the comprehensive assessment of acceptance and commitment therapy processes (CompACT) questionnaire for contextual relevance in Uganda: A comprehensive approach. Cambridge Prisms: \u003cem\u003eGlobal Mental Health, 12.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/gmh.2025.10018\u003c/span\u003e\u003cspan address=\"10.1017/gmh.2025.10018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeswiswa, K. G., \u0026amp; Jacobs, S. (2024). Hearing the voices of Black Africans: Essential components for culturally relevant marriage enrichment programs in South Africa. \u003cem\u003eJournal of Marital and Family Therapy\u003c/em\u003e, \u003cem\u003e50\u003c/em\u003e(2), 407\u0026ndash;433. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jmft.12696\u003c/span\u003e\u003cspan address=\"10.1111/jmft.12696\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNichols, M. P., \u0026amp; Davis, S. D. (2019). \u003cem\u003eThe essentials of family therapy\u003c/em\u003e (7th ed.). Merrill Social Work and Human Services.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNwoye, A. (2006). Theory and method of marriage therapy in contemporary Africa. \u003cem\u003eContemporary Family Therapy\u003c/em\u003e, \u003cem\u003e28\u003c/em\u003e(4), 437\u0026ndash;457. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10591-006-9021-z\u003c/span\u003e\u003cspan address=\"10.1007/s10591-006-9021-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Donnell, A., Anderson, P., Schmidt, C., Braddick, F., Lopez-Pelayo, H., Mej\u0026iacute;a-Trujillo, J., Natera, G., Arroyo, M., Bautista, N., Piazza, M., Bustamante, I. V., Kokole, D., Jackson, K., Jane-Llopis, E., Gual, A., \u0026amp; Schulte, B. (2022). Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America. \u003cem\u003eGlobal Health Action\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/16549716.2022.2080344\u003c/span\u003e\u003cspan address=\"10.1080/16549716.2022.2080344\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOnogwu, E. O., Alidu, O. S., Anibueze, A. U., Okwuowulu, C., Ekwueme, O., Erojikwe, I., \u0026amp; Gever, V. C. (2023). Using social media-based drama therapy and family counselling to treat symptoms of postpartum depression among women. \u003cem\u003eAustralian and New Zealand Journal of Family Therapy\u003c/em\u003e, \u003cem\u003e44\u003c/em\u003e(3), 368\u0026ndash;378. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/anzf.1550\u003c/span\u003e\u003cspan address=\"10.1002/anzf.1550\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePuffer, E. S., Healy, F., Green, E., Giusto, E. P. M., Kaiser, A. N., Patel, B., P., \u0026amp; Ayuku, D. (2020). Family Functioning and Mental Health Changes Following a Family Therapy Intervention in Kenya: a Pilot Trial. \u003cem\u003eJournal of Child and Family Studies\u003c/em\u003e, \u003cem\u003e29\u003c/em\u003e(12), 3493\u0026ndash;3508. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10826-020-01816-z\u003c/span\u003e\u003cspan address=\"10.1007/s10826-020-01816-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePuffer, E. S., Friis-Healy, E. A., Giusto, A., Stafford, S., \u0026amp; Ayuku, D. (2021). Development and Implementation of a Family Therapy Intervention in Kenya: a Community-Embedded Lay Provider Model. \u003cem\u003eGlobal Social Welfare\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(1), 11\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40609-019-00151-6\u003c/span\u003e\u003cspan address=\"10.1007/s40609-019-00151-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRathod, S., Kingdon, D., Phiri, P., \u0026amp; Gobbi, M. Developing Culturally Sensitive Cognitive Behaviour Therapy for Psychosis for Ethnic Minority Patients by Exploration and Incorporation of Service Users\u0026rsquo; and Health Professionals\u0026rsquo; Views and Opinions. \u003cem\u003eBehavioral and Cognitive Psychotherapy\u003c/em\u003e 2010;38(5):511\u0026ndash;533. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi:10.1017/S1352465810000378\u003c/span\u003e\u003cspan address=\"https://doi:10.1017/S1352465810000378\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRenwick, L., Susanti, H., Keliat, B., Wulandari, D., Suherman, Fadilah, R., Diorarta, R., Brooks, H., Bee, P., \u0026amp; Lovell, K. (2025). Culturally adapting family interventions for people with schizophrenia in Indonesia: An intervention development study using programme theory. \u003cem\u003eInternational Journal of Nursing Studies Advances\u003c/em\u003e, 9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijnsa.2025.100409\u003c/span\u003e\u003cspan address=\"10.1016/j.ijnsa.2025.100409\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoberts, J., Abu-Baker, K., Diez Fern\u0026aacute;ndez, C., Chong Garcia, N., Fredman, G., Kamya, H., \u0026amp; Vega, Z., R (2014). Up close: Family therapy challenges and innovations around the world. \u003cem\u003eFamily Process\u003c/em\u003e, \u003cem\u003e53\u003c/em\u003e(3), 544\u0026ndash;576. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/famp.12093\u003c/span\u003e\u003cspan address=\"10.1111/famp.12093\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoman, N. V., Balogun, T. V., Butler-Kruger, L., Danga, S. D., Therese de Lange, J., Human-Hendricks, A., Khaile, T., October, F., K. R., \u0026amp; Olabiyi, O. J. (2025). Strengthening Family Bonds: A Systematic Review of Factors and Interventions That Enhance Family Cohesion. \u003cem\u003eSocial Sciences\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e(6), 371. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/socsci14060371\u003c/span\u003e\u003cspan address=\"10.3390/socsci14060371\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShehadeh, M. H., Heim, E., Chowdhary, N., Maercker, A., \u0026amp; Knaevelsrud, C. (2016). Cultural adaptation of minimally guided interventions for common mental disorders: A systematic review and meta-analysis. \u003cem\u003eJMIR Mental Health\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(3), e44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/mental.5776\u003c/span\u003e\u003cspan address=\"10.2196/mental.5776\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSsewamala, F. M., Brathwaite, R., Sensoy Bahar, O., Namatovu, P., Neilands, T. B., Kiyingi, J., Huang, K. Y., \u0026amp; McKay, M. M. (2023). The Post-intervention Impact of Amaka Amasanyufu on Behavioral and Mental Health Functioning of Children and Adolescents in Low-Resource Communities in Uganda: Analysis of a Cluster-Randomized Trial From the SMART Africa-Uganda Study (2016\u0026ndash;2022). \u003cem\u003eJournal of Adolescent Health\u003c/em\u003e, \u003cem\u003e72\u003c/em\u003e(5), S3\u0026ndash;S10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jadohealth.2022.09.035\u003c/span\u003e\u003cspan address=\"10.1016/j.jadohealth.2022.09.035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTreichler, E. B. H., Mercado, R., Oakes, D., Perivoliotis, D., Gallegos-Rodriguez, Y., Sosa, E., Cisneros, E., Spaulding, W. D., Granholm, E., Light, G. A., \u0026amp; Rabin, B. (2022). Using a stakeholder-engaged, iterative, and systematic approach to adapting collaborative decision skills training for implementation in VA psychosocial rehabilitation and recovery centers. \u003cem\u003eBMC Health Services Research\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12913-022-08833-2\u003c/span\u003e\u003cspan address=\"10.1186/s12913-022-08833-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUgwuoke, C. U., Ede, K. R., Ede, M. O., \u0026amp; Oneli, J. O. (2023). Family health therapy for treating anxiety symptoms in flood victims. \u003cem\u003eMedicine (United States)\u003c/em\u003e, \u003cem\u003e102\u003c/em\u003e(16), E33574. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/MD.0000000000033574\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000033574\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVeritas Health Innovation (2024). Covidence systematic review software. Melbourne, Australia. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.covidence.org\u003c/span\u003e\u003cspan address=\"https://www.covidence.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWampler, K. S., \u0026amp; Patterson, J. E. (2020). The importance of family and the role of systemic family therapy. \u003cem\u003eIn The Handbook of Systemic Family Therapy, Set\u003c/em\u003e (Vols. 1\u0026ndash;4). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/9781119438519.ch1\u003c/span\u003e\u003cspan address=\"10.1002/9781119438519.ch1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"contemporary-family-therapy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"coft","sideBox":"Learn more about [Contemporary Family Therapy](http://link.springer.com/journal/10591)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/coft/default.aspx","title":"Contemporary Family Therapy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Systemic Family Therapy, Cultural Adaptation, Family Therapy Interventions, African Contexts","lastPublishedDoi":"10.21203/rs.3.rs-8717252/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8717252/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSystemic Family therapy is slowly gaining momentum across Africa, with a growing number of family therapy interventions being implemented to address mental, emotional, and relational health challenges. However, most widely used family therapy approaches were developed in the Global North, and to date, we know little about the extent to which these interventions are culturally adapted and for which target outcomes in African contexts. This paper reviewed and synthesized existing literature on family therapy interventions in Africa to identify target outcomes and gaps in cultural adaptation, to inform future directions for family therapy research and practice on the continent.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e Our review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We identified 761 studies from scholarly sources, published between 2014\u0026ndash;2025.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 14 empirical studies included, the interventions reflected diverse systemic family therapy models including Behavioral Family Therapy, Multiple Family Groups, \u003cem\u003eTuko Pamoja\u003c/em\u003e (family-strengthening intervention), Multi-Couple Therapy, African Family Counseling, Transgenerational Family Therapy, Adlerian Family Therapy, Structural Family Therapy, Emotionally Focused Therapy, and Rational Emotive Family Health Therapy. Cultural adaptations included integration of traditional storytelling, religious leadership involvement, and respect for hierarchical family norms. Across studies, we noticed an absence of clarity on systematic, theory-driven cultural adaptation processes.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eFindings from this review advance the field by providing insights into the importance of conducting thorough cultural adaptations of family interventions before implementation in African settings as a foundation for advancing culturally relevant family therapy practices in African settings.\u003c/p\u003e","manuscriptTitle":"Towards Culturally Responsive Practices: A Scoping Review of Systemic Family Therapy Interventions in Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-05 10:11:47","doi":"10.21203/rs.3.rs-8717252/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"167143318842905760397503951502486550407","date":"2026-02-03T15:55:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-03T13:30:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-30T04:24:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-30T04:23:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"Contemporary Family Therapy","date":"2026-01-28T06:24:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"contemporary-family-therapy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"coft","sideBox":"Learn more about [Contemporary Family Therapy](http://link.springer.com/journal/10591)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/coft/default.aspx","title":"Contemporary Family Therapy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"f710fbbe-6df3-42a0-8db2-b6cb69a755bf","owner":[],"postedDate":"February 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-05T10:11:47+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-05 10:11:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8717252","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8717252","identity":"rs-8717252","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}