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Abstract Background Child well-being is associated with caregiver mental health. Research has focused on the absence or presence of mental health problems, such as depression, in caregivers. However, positive mental health – defined as the presence of positive emotions, psychological functioning, and social functioning – likely prevents depression and in caregivers may benefit children more than the mere absence of mental health problems. Little attention has been given to how caregivers sustain positive mental health, particularly when doing challenging work in impoverished settings. Objective The study's objective was to determine what successful caregivers of orphaned and vulnerable children (OVC) in diverse countries do to sustain their positive mental health. Methods Using a mixed-methods, cross-sectional study design, trained local interviewers recruited a convenience sample of OVC caregivers through residential care institutions from five geographic regions (Kenya; Ethiopia; Cambodia; Hyderabad, India; and Nagaland, India). Participants completed surveys and in-depth interviews about strategies used to sustain their mental health over time or improve it during challenging times. Results Sixty-nine OVC caregivers from 28 residential care institutions participated. Positive mental health survey scores were high. We organized the strategies named into six categories ordered from most to least frequently named: Religious Practices; Engaging in Caregiving; Social Support; Pleasurable Activities; Emotion Regulation; and Removing Oneself from Work. Prayer and reading religious texts arose as common strategies. Participants reported promoting positive emotions by focusing on their work's meaning and playing with children. The similar findings across diverse regions were striking. Some differences included more emphasis on emotion control in Ethiopia; listening to music/singing in Kenya and Hyderabad; and involving children in the tasks the participants enjoyed less (e.g., cleaning) in Cambodia. Conclusions Under real-world conditions, small daily activities appeared to help sustain positive mental health. In addition, fostering structures that allow caregivers to engage regularly in rewarding caregiving tasks may be an affordable and scalable idea which could potentially benefit caregivers, children, and employers. Highlights • Similar positive mental health strategies were named by caregivers in four countries. • Engaging in enjoyable/meaningful time with children may improve caregivers' emotions. • Caregiver strategies to sustain positive mental health included religious practices. • Caregiver strategies to sustain positive mental health included emotion regulation. • Taking breaks from caregiving was named less often than other strategies. [ABSTRACT FROM AUTHOR]

• Caregivers find meaning in educational activities, supervising, and caregiving. • Caregivers most enjoy informal educational activities and supervising children. • Caregivers find cleaning unpleasant and yet spend substantial time on it. • Enjoyment of caring for children may be undermined by behavior problems. There are many orphaned and separated children (OSC) in the world and caregivers play a crucial role in raising them. Frameworks on employee mental health incorporate elements of both enjoyment/difficulties and values (i.e., hedonic and eudaimonic elements), yet existing studies focus on caregivers' mental illness and overlook their specific work activities. We collected diary activity log, survey, and interview data from caregivers from five geographic locations: Hyderabad, India; Nagaland, India; Ethiopia; Kenya; and Cambodia. We coded and calculated the amount of time spent on five frequent activities: cleaning, cooking, caring for children, supervising children, and informal educational activities. We calculated the mean scores of perceived importance, meaningfulness, enjoyment, and unpleasantness for each of the five activities by geographic location. A total of 82 participants completed surveys and activity logs, and 69 of them participated in interviews. Mean time spent per day for the five activities combined ranged from 4.4 h (Nagaland) to 9.0 h (Ethiopia). Cooking and cleaning constituted a large portion of caregivers' days, ranging from 0.8 h per caregiver per day in Nagaland to 4.7 h in Cambodia, and informal educational activities (such as advising, teaching children their letters, and teaching from religious texts) constituted the least time, ranging from 0.1 h per caregiver per day in Hyderabad to 1.1 h in Nagaland. Participants rated all activities high in importance, with cleaning being relatively lower. Overall, enjoyment scores were lower than importance and meaningfulness scores. Informal educational activities had the highest enjoyment scores in three locations, whereas supervising children did in two locations. Participants rated cleaning as the most unpleasant activity in each geographic region except Cambodia, where it was rated on par with educational activities. OSC caregivers consider several regular activities to be very important and meaningful. Enjoyment may be improved through additional support in child behavior management or spending more time providing informal educational activities; at minimum, caregiver mental health should be considered before turning informal educational activities over to volunteers. [ABSTRACT FROM AUTHOR]