Developing an integrated intervention to address intimate partner violence and psychological distress in Congolese refugee women in Tanzania

Abstract

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.

Lay-delivered talk therapies for adults affected by humanitarian crises in low- and middle-income countries

“…The included texts reported on 10 studies evaluating patient outcomes [ 67 – 76 , 90 , 91 ], seven evaluating implementation outcomes [ 77 – 83 , 92 ], and six evaluating both patient and implementation outcomes [ 84 – 89 , 93 ]. Three were qualitative [ 78 , 79 , 83 , 92 ], 15 were quantitative (including Rahman et al 2007, which also reported qualitative results irrelevant to this review) [ 67 , 68 , 70 – 72 , 74 – 77 , 80 , 84 – 87 , 90 , 91 , 93 , 94 ], and the remainder were multi-method studies [ 73 , 81 , 82 , 88 , 89 ]. Of those evaluating patient outcomes quantitatively, 12 used a comparison group [ 67 – 72 , 74 – 76 , 84 , 88 – 91 , 93 ].…”

Interpersonal violence and mental health: a social justice framework to advance research and practice

“…the wear and tear on mind and body associated with repeated, overwhelming, activation of the stress response system), in turn further compromise opportunities for women to escape the odds stacked against them. For example, IPV may result in cognitive styles characterized by self-blame and low self-esteem, which may make it harder for women to act out of a position of strength and independence (Kohrt and Bourey, 2016; Greene et al ., 2019; Tol et al ., 2019).…”

Improving mental health and psychosocial wellbeing in humanitarian settings: reflections on research funded through R2HC

“…Bizouerne and coworkers tested the (cost) effectiveness of an intervention that combined nutrition and psychosocial support for young children with severe acute malnutrition in Nepal. Tol and colleagues studied an intervention that combined women’s intimate partner violence protection activities and cognitive processing therapy with Congolese refugee women in Tanzania [ 21 , 22 ]. García-Moreno, Ellsberg and colleagues are evaluating the feasibility and acceptability of a brief empowerment counselling intervention in antenatal care for pregnant women and girl refugees from the Democratic Republic of the Congo (DRC) and Burundi in Tanzania who have experienced intimate partner violence.…”

“…Finally, Tol and colleagues developed an 8-session group intervention combining a women’s protection intervention (empowerment counseling, including safety planning, a danger assessment, and provision of information on protection options) and a psychological intervention (group cognitive processing therapy), aimed at reducing intimate partner violence victimization and psychological distress for female Congolese refugees in Tanzania who experienced intimate partner violence in the last year [ 22 , 49 , 50 ]. A feasibility cluster randomized controlled trial was conducted with n = 311, results of which are currently under review for publication.…”