TY - JOUR
T1 - Developing an integrated intervention to address intimate partner violence and psychological distress in Congolese refugee women in Tanzania
AU - Greene, M. Claire
AU - Rees, Susan
AU - Likindikoki, Samuel
AU - Bonz, Ann G.
AU - Joscelyne, Amy
AU - Kaysen, Debra
AU - Nixon, Reginald D.V.
AU - Njau, Tasiana
AU - Tankink, Marian T.A.
AU - Tiwari, Agnes
AU - Ventevogel, Peter
AU - Mbwambo, Jessie K.K.
AU - Tol, Wietse A.
N1 - Funding Information:
Funding for this study was provided by the Research for Health in Humanitarian Crises (R2HC) initiative, co-funded by the Department for International Development (DFID) and the Wellcome Trust, overseen by Elrha (http://www.elrha.org/). The sponsor did not have any role in the study design, collection, management, analysis and interpretation of the data, writing of the report, and the decision to submit for publication, nor ultimate authority for these activities. MCG is supported by the National Institute of Mental Health (T32MH096724).
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/8/17
Y1 - 2019/8/17
N2 - Background: Multi-sectoral, integrated interventions have long been recommended for addressing mental health and its social determinants (e.g., gender-based violence) in settings of ongoing adversity. We developed an integrated health and protection intervention to reduce psychological distress and intimate partner violence (IPV), and tested its delivery by lay facilitators in a low-resource refugee setting. Methods: Formative research to develop the intervention consisted of a structured desk review, consultation with experts and local stakeholders (refugee incentive workers, representatives of humanitarian agencies, and clinical experts), and qualitative interviews (40 free list interviews with refugees, 15 key informant interviews). Given existing efforts by humanitarian agencies to prevent gender-based violence in this particular refugee camp, including with (potential) perpetrators, we focused on a complementary effort to develop an integrated intervention with potential to reduce IPV and associated mental health impacts with female IPV survivors. We enrolled Congolese refugee women with elevated psychological distress and past-year histories of IPV (n = 60) who received the intervention delivered by trained and supervised lay refugee facilitators. Relevance, feasibility and acceptability of the intervention were evaluated through quantitative and qualitative interviews with participants. We assessed instrument test-retest reliability (n = 24), inter-rater reliability (n = 5 interviews), internal consistency, and construct validity (n = 60). Results: We designed an 8-session intervention, termed Nguvu ('strength'), incorporating brief Cognitive Processing Therapy (focused on helping clients obtaining skills to overcome negative thoughts and self-perceptions and gain control over the impact these have on their lives) and Advocacy Counseling (focused on increasing autonomy, empowerment and strengthening linkages to community supports). On average, participants attended two-thirds of the sessions. In qualitative interviews, participants recommended adaptations to specific intervention components and provided recommendations regarding coordination, retention, safety concerns and intervention participation incentives. Analysis of the performance of outcome instruments overall revealed acceptable reliability and validity. Conclusions: We found it feasible to develop and implement an integrated, multi-sectoral mental health and IPV intervention in a refugee camp setting. Implementation challenges were identified and may be informative for future implementation and evaluation of multi-sectoral strategies for populations facing ongoing adversity. Trial registration: ISRCTN65771265, June 27, 2016.
AB - Background: Multi-sectoral, integrated interventions have long been recommended for addressing mental health and its social determinants (e.g., gender-based violence) in settings of ongoing adversity. We developed an integrated health and protection intervention to reduce psychological distress and intimate partner violence (IPV), and tested its delivery by lay facilitators in a low-resource refugee setting. Methods: Formative research to develop the intervention consisted of a structured desk review, consultation with experts and local stakeholders (refugee incentive workers, representatives of humanitarian agencies, and clinical experts), and qualitative interviews (40 free list interviews with refugees, 15 key informant interviews). Given existing efforts by humanitarian agencies to prevent gender-based violence in this particular refugee camp, including with (potential) perpetrators, we focused on a complementary effort to develop an integrated intervention with potential to reduce IPV and associated mental health impacts with female IPV survivors. We enrolled Congolese refugee women with elevated psychological distress and past-year histories of IPV (n = 60) who received the intervention delivered by trained and supervised lay refugee facilitators. Relevance, feasibility and acceptability of the intervention were evaluated through quantitative and qualitative interviews with participants. We assessed instrument test-retest reliability (n = 24), inter-rater reliability (n = 5 interviews), internal consistency, and construct validity (n = 60). Results: We designed an 8-session intervention, termed Nguvu ('strength'), incorporating brief Cognitive Processing Therapy (focused on helping clients obtaining skills to overcome negative thoughts and self-perceptions and gain control over the impact these have on their lives) and Advocacy Counseling (focused on increasing autonomy, empowerment and strengthening linkages to community supports). On average, participants attended two-thirds of the sessions. In qualitative interviews, participants recommended adaptations to specific intervention components and provided recommendations regarding coordination, retention, safety concerns and intervention participation incentives. Analysis of the performance of outcome instruments overall revealed acceptable reliability and validity. Conclusions: We found it feasible to develop and implement an integrated, multi-sectoral mental health and IPV intervention in a refugee camp setting. Implementation challenges were identified and may be informative for future implementation and evaluation of multi-sectoral strategies for populations facing ongoing adversity. Trial registration: ISRCTN65771265, June 27, 2016.
KW - Advocacy
KW - Cognitive processing therapy
KW - Democratic Republic of the Congo
KW - Empowerment
KW - Intimate partner violence
KW - Mental health
KW - Psychological distress
KW - Refugees
KW - Tanzania
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UR - http://www.scopus.com/inward/citedby.url?scp=85070870719&partnerID=8YFLogxK
U2 - 10.1186/s13031-019-0222-0
DO - 10.1186/s13031-019-0222-0
M3 - Article
C2 - 31428190
AN - SCOPUS:85070870719
SN - 1752-1505
VL - 13
JO - Conflict and Health
JF - Conflict and Health
IS - 1
M1 - 38
ER -