NETfacts: An integrated intervention at the individual and collective level to treat communities affected by organized violence

Abstract

War and crises affect mental health, social attitudes, and cultural norms, which can exacerbate the state of long-term insecurity. With decades of armed conflict, the Democratic Republic of Congo is one example, and violence has become normalized in civilian settings. In this study, we tested the effectiveness of the NETfacts health system, an integrated model of evidence-based individual trauma treatment (Narrative Exposure Therapy [NET]) and a trauma-informed community-based intervention (NETfacts). Alongside changes in mental health outcomes (posttraumatic stress disorder, depression, social disapproval, and shame) we also investigated change in attitudes, including rape myth acceptance, stigmatization of survivors of sexual violence, and skepticism about the reintegration of former combatants. To test whether the additional community intervention is superior to individual NET alone, we implemented a randomized controlled design with six villages and interviewed a sample of 1,066 community members. Our results demonstrate that the NETfacts health system in comparison with NET alone more effectively reduced rape myth acceptance and with it ongoing victimization and perpetration. Community members of the NETfacts group also presented with less stigmatizing attitudes against survivors of sexual violence. Skepticism about the reintegration of former combatants declined in both groups. NETfacts appears to have increased motivation to engage in individual treatment. Synergizing the healing effects of individual and collective trauma exposure, the NETfacts health system appears to be an effective and scalable approach to correct degrading or ignominious norms and restore functioning and mental health in postconflict communities.

Community-based models of care for adolescent and adult depression, suicidal behavior, anxiety, trauma, and substance use in Africa: a scoping review

“…All studies found the CBC interventions to Elements of care and intervention approach categories (n = 206). (Green et al, 2020;Robjant et al, 2022) explicitly used the term engagement as an outcome measure. Green et al 's (2020) publication described a telehealth intervention using an artificial intelligence app to provide psychosocial support to pregnant women with depression.…”

“…In this publication, engagement was defined as frequency and duration of app usage. On the other hand, Robjant et al 's (2022) publication described a trauma therapy intervention for postconflict communities, where engagement was defined as uptake of trauma-specific treatment after referral. The other five publications examined help-seeking as an outcome (Odenwald et al, 2012;Wright and Chiwandira, 2016;Akena et al, 2021;Atilola et al, 2022;Logie et al, 2022), three of which focused on mental health literacy, the ability to recognize the signs and symptoms of mental illness, understand their causes, and identify sources of help.…”

Improving access to evidence‐based interventions for trauma‐exposed adults in low‐ and middle‐income countries

“…Some transdiagnostic interventions also aim to reduce the risk for other public health issues that commonly affect trauma‐exposed populations in LMICs. For example, NETfacts (Robjant et al., 2022), an adaptation of NET, was found to reduce mental health symptoms, violence perpetration, and stigma towards sexual violence in the DRC. CETA has been found to reduce interpersonal partner violence among Zambian adults living with HIV (Murray et al., 2020), and its effectiveness in improving HIV treatment outcomes is currently being trialed with women experiencing intimate partner violence in South Africa (Pascoe et al., 2022).…”