An integrated intervention to reduce intimate partner violence and psychological distress with refugees in low-resource settings: study protocol for the Nguvu cluster randomized trial

Abstract

BackgroundIntimate partner violence (IPV) is a critical public health and human rights concern globally, including for refugee women in low-resource settings. Little is known about effective interventions for this population. IPV and psychological distress have a bi-directional relationship, indicating the potential benefit of a structured psychological component as part of efforts to reduce IPV for women currently in violent relationships.MethodsThis protocol describes a cluster randomized controlled trial aimed at evaluating an 8-session integrated psychological and advocacy intervention (Nguvu) with female adult survivors of past-year IPV displaying moderate to severe psychological distress. Outcomes are reductions in: recurrence of IPV; symptoms of anxiety, depression and post-traumatic stress (primary); and functional impairment (secondary). Hypothesized mediators of the intervention are improvements in social support, coping skills and support seeking. We will recruit 400 participants from existing women’s support groups operating within villages in Nyarugusu refugee camp, Tanzania. Women’s groups will be randomized to receive the intervention (Nguvu and usual care) or usual care alone. All eligible women will complete a baseline assessment (week 0) followed by a post-treatment (week 9) and a 3-month post-treatment assessment (week 20). The efficacy of the intervention will be determined by between-group differences in the longitudinal trajectories of primary outcomes evaluated using mixed-effects models. Study procedures have been approved by Institutional Review Boards in the United States and Tanzania.DiscussionThis trial will provide evidence on the efficacy of a novel integrated group intervention aimed at secondary prevention of IPV that includes a structured psychological component to address psychological distress. The psychological and advocacy components of the proposed intervention have been shown to be efficacious for their respective outcomes when delivered in isolation; however, administering these approaches through a single, integrated intervention may result in synergistic effects given the interrelated, bidirectional relationship between IPV and mental health. Furthermore, this trial will provide information regarding the feasibility of implementing a structured intervention for IPV and mental health in a protracted humanitarian setting.Trial registration ISRCTN65771265, June 27, 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1338-7) contains supplementary material, which is available to authorized users.

An intimate partner violence prevention intervention for men, women, and couples in Ethiopia: Additional findings on substance use and depressive symptoms from a cluster-randomized controlled trial

“…An implication for future programming is that similar interventions should explore the inclusion of additional content linked to coping with stress and trauma linked to IPV. For example, a trial currently underway in Congolese refugee camps in Tanzania seeks to evaluate an IPV intervention that integrates advocacy and structured psychosocial support; the authors argue that integrating this psychosocial support may render the preventive intervention more effective, vis-à-vis an intervention that focuses solely on advocacy [ 60 ]. Other recent literature has highlighted the limited evidence base around the effects of mental health interventions on the prevention and reduction of IPV [ 61 ], suggesting the potential importance of further exploring the role of targeted interventions addressing the nexus between IPV and mental health.…”

Translation, adaptation, and pilot of a guided self-help intervention to reduce psychological distress in South Sudanese refugees in Uganda

“…large group, relatively light training and supervision requirements) would allow for easier integration as compared with other psychotherapeutic interventions. If proven effective, SH+ could be more feasibly integrated into other humanitarian programs, which may assist in breaking observed vicious cycles between social determinants (e.g., poverty and intimate partner violence) and psychological distress (Lund et al , 2011 ; Tol et al , 2017 ).…”

Interpersonal violence and suicidality among former child soldiers and war-exposed civilian children in Nepal

“…In conflict settings, individuals may be at a greater risk for thwarted belongingness, due to forced displacement and family separation, and perceived burdensomeness, due to changes in livelihood and having to care for oneself and family, in the context of the humanitarian crisis (Van Orden et al 2010 ). In other settings of armed conflict, an integrated psychological and advocacy group intervention was developed to reduce psychological distress among refugee women (Tol et al 2017 ).…”