From Shouting to Calm Conversations: A Qualitative Study of Family Communication Transformation Through a Culturally Adapted Multiple Family Group Therapy in HIV‐Affected Families in Ghana

Family communication dysfunction significantly impacts HIV medication adherence and mental health outcomes among adolescents in sub-Saharan Africa, yet evidence-based family interventions remain scarce in resource-limited settings. This qualitative descriptive study examined family communication transformation following culturally adapted Multiple Family Group Therapy (MFGT) for adolescents living with HIV and their families in rural Ghana. Focus group discussions were conducted with 20 caregivers and 19 adolescents who completed the 11-session intervention. All core therapeutic content was delivered across sessions 1 through 10; the 11th session comprised a graduation ceremony and sustainability planning. Reflexive thematic analysis revealed four major themes: preintervention dysfunction (public shaming, adolescent defiance, spousal teknonymy, extended family triangulation); MFGT-facilitated skills (tone modulation, privacy-preserving correction, active listening); postintervention transformation (caregiver behavioral consolidation, adolescent reciprocal adaptation, spousal reconnection); and sustaining mechanisms (observational learning, metacognitive awareness, positive reinforcement, peer accountability). Communication improvements occurred bidirectionally, with caregiver changes catalyzing adolescent adaptations. Findings are theoretically interpreted through family systems theory, communication accommodation theory, social cognitive theory, and self-determination theory. Culturally adapted MFGT successfully transformed communication patterns while preserving traditional authority structures, suggesting potential for integration within HIV care systems in resource-limited settings.