Attachment and Its Social Determinants, Kenyan Child and Adolescent Perspective from Two Informal Settlements in Nairobi: A Qualitative Study

Abstract

There has been a sustained interest in examining social determinants of health (SDH) for late childhood and adolescence to shift the focus from individual risk factors to social patterns, material conditions and to improve long-term health outcomes. This study offers an opportunity to look at the number of risk and protective factors associated with SDH using children's narratives around their attachment relationships. The research was carried out in Kariobangi and Kangemi health centers of Nairobi County, Kenya. All 83 participants were recruited from the community with the assistance of community health workers. Fifty-seven percent of participants were girls; 65.1% of ages 12–14 and 34.9% of ages 8–11 years. Child Attachment Interview (Target et al., 2003) was used to study attachment security as well as adolescents’ understanding of their relational and social world. Inductive thematic analysis was informed by preexisting themes identified from the literature on “risk” and “protective” factors within different layers of SDH and focused on identifying children’s understanding and appraisals of those factors. Secure attachment with both parents had 37.3% of participants 33.7% had insecure attachment with one parent, and 28.9% had insecure attachment with both parents. The overarching themes included poverty, parenting, religion, and schooling. Some factors commonly classified as protective or risk factors were described and appraised by children as a more complex and multidimensional phenomenon. Apart from it, these factors appeared interconnected and interrelated with each other on different levels of SDH.