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Greene MC, Scognamiglio T, Likindikoki SL, Misinzo L, Njau T, Bonz A, Ventevogel P, Mbwambo JKK, Tol WA. Examining implementation of an intervention to reduce psychological distress and intimate partner violence in a refugee camp setting. Glob Public Health 2022; 17:2868-2882. [PMID: 35108167 DOI: 10.1080/17441692.2022.2029926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An integrated approach to reduce intimate partner violence and improve mental health in humanitarian settings requires coordination across health and protection services. We developed and tested the Nguvu intervention, which combined evidence-based interventions for psychological distress and intimate partner violence among Congolese refugee women in Nyarugusu refugee camp (Tanzania). We conducted 29 semi-structured interviews with Nguvu participants and stakeholders to explore the relevance, acceptability, feasibility, and impact of this intervention. Participants reported that the intervention aligned with needs and filled a gap in programming, yet further adaptations may improve the fit of the intervention. The Nguvu intervention was acceptable to participants, including group discussion of sensitive topics. Confidentiality was highly regarded among staff and participants, which improved safety and acceptability. It was feasible to train non-specialist refugee workers to deliver the intervention with adequate supervision. Facilitators noted contextual challenges that made it difficult to implement the intervention: limited infrastructure, competing priorities, and population mobility. The intervention was perceived to improve awareness of the association between violence and mental health, reduce self-blame, and build skills to improve wellbeing. Recommended adaptations reveal promising, yet challenging future directions for addressing social determinants of mental health and implementing multi-sectoral programmes in complex humanitarian settings.
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Affiliation(s)
- M Claire Greene
- Program on Forced Migration and Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Samuel L Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lusia Misinzo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tasiana Njau
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Jessie K K Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wietse A Tol
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Hertzog L, Banougnin BH, Stöckl H, Toska E. Accelerating ontological security for South African adolescents living in high HIV-prevalence areas: a longitudinal study. PSYCHOL HEALTH MED 2022; 27:27-48. [PMID: 35929899 PMCID: PMC9729385 DOI: 10.1080/13548506.2022.2108079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ontological security is the personal need to build fundamental certainty about the continuity of life events. It is central to long-term human development, particularly among adolescents in highly vulnerable communities in South Africa. We examined the cumulative effects of eight hypothesised provisions (development accelerators) in reducing the risks of ontological insecurity outcomes aligned with Sustainable Development Goals (SDGs) targets. Three waves of survey data from adolescents living in high HIV prevalence areas in South Africa were analysed. We used standardised tools to measure twelve outcomes linked to two dimensions of ontological security: mental health and violence. Sustained receipt (at baseline and follow-ups) of eight hypothesised accelerators were examined: emotional and social support, parental/caregiver monitoring, food sufficiency, accessible health care, government cash transfers to households, basic economic security, positive parenting/caregiving, and participation in extramural activities. Associations of all accelerators with outcomes were evaluated using multivariable regressions controlling for age, sex, orphanhood and HIV status, rural/urban location, and informal housing. Cumulative effects were tested using marginal effects modelling. Of 1,519 adolescents interviewed at baseline, 1,353 (89%) completed the interviews at two follow-ups. Mean age was 13.8 at baseline; 56.6% were female. Four provisions were associated with reductions in twelve outcomes. Combinations of accelerators resulted in a percentage reduction risk in individual indicators up to 18.3%. Emotional and social support, parental/caregiver monitoring, food sufficiency and accessible health care by themselves and in combination showed cumulative reductions across twelve outcomes. These results deepen an essential understanding of the long-term effects of consistent exposure to accelerators on multi-dimensional human development. They could be directly implemented by existing evidence-based interventions such as peer-based psychosocial support, parenting programmes, adolescent-responsive healthcare and food support, providing safer and healthier environments for South African adolescents to thrive.
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Affiliation(s)
- Lucas Hertzog
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | | | - Heidi Stöckl
- Institute of Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa,Department of Social Policy and Intervention, Oxford University, Oxford, United Kingdom,Department of Sociology, University of Cape Town, Cape Town, South Africa
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Greene MC, Bencomo C, Rees S, Ventevogel P, Likindikoki S, Nemiro A, Bonz A, Mbwambo JKK, Tol WA, McGovern TM. Multilevel Determinants of Integrated Service Delivery for Intimate Partner Violence and Mental Health in Humanitarian Settings. Int J Environ Res Public Health 2021; 18:12484. [PMID: 34886211 PMCID: PMC8656517 DOI: 10.3390/ijerph182312484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022]
Abstract
Inter-agency guidelines recommend that survivors of intimate partner violence in humanitarian settings receive multisectoral services consistent with a survivor-centered approach. Providing integrated services across sectors is challenging, and aspirations often fall short in practice. In this study, we explore factors that influence the implementation of a multisectoral, integrated intervention intended to reduce psychological distress and intimate partner violence in Nyarugusu Refugee Camp, Tanzania. We analyzed data from a desk review of donor, legal, and policy documents; a gender-based violence services mapping conducted through 15 interviews and 6 focus group discussions; and a qualitative process evaluation with 29 stakeholders involved in the implementation of the integrated psychosocial program. We identified the challenges of implementing a multisectoral, integrated intervention for refugee survivors of intimate partner violence at the structural, inter-institutional, intra-institutional, and in social and interpersonal levels. Key determinants of successful implementation included the legal context, financing, inter-agency coordination, engagement and ownership, and the ability to manage competing priorities. Implementing a multisectoral, integrated response for survivors of intimate partner violence is complex and influenced by interrelated factors from policy and financing to institutional and stakeholder engagement. Further investment in identifying strategies to overcome the existing challenges of implementing multisectoral approaches that align with global guidelines is needed to effectively address the burden of intimate partner violence in humanitarian settings.
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Affiliation(s)
- M. Claire Greene
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA; (M.C.G.); (C.B.)
| | - Clarisa Bencomo
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA; (M.C.G.); (C.B.)
| | - Susan Rees
- School of Psychiatry, University of New South Wales, Sydney, NSW 2033, Australia;
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees (UNHCR), Rue de Montbrillant 94, 1201 Geneva, Switzerland;
| | - Samuel Likindikoki
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam P.O. Box 65001, Tanzania; (S.L.); (J.K.K.M.)
| | - Ashley Nemiro
- The MHPSS Collaborative, Rosenørns Allé 12, 1634 Copenhagen, Denmark;
| | | | - Jessie K. K. Mbwambo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam P.O. Box 65001, Tanzania; (S.L.); (J.K.K.M.)
| | - Wietse A. Tol
- Department of Public Health, Global Health Section, University of Copenhagen, Nørregade 10, 1165 Copenhagen, Denmark;
| | - Terry M. McGovern
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA; (M.C.G.); (C.B.)
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Jefferson K, Stanhope KK, Jones-Harrell C, Vester A, Tyano E, Hall CDX. A scoping review of recommendations in the English language on conducting research with trauma-exposed populations since publication of the Belmont report; thematic review of existing recommendations on research with trauma-exposed populations. PLoS One 2021; 16:e0254003. [PMID: 34324528 PMCID: PMC8321367 DOI: 10.1371/journal.pone.0254003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To identify recommendations for conducting public health research with trauma-exposed populations. METHODS Researchers searched Embase, PubMed, Scopus, Web of Science, Open Grey, and Google Scholar for recommendations. Trauma that causes psychological impact was our exposure of interest and we excluded clinical articles on treating physical trauma. We reviewed titles and abstracts of 8,070 articles and full text of 300 articles. We analyzed recommendations with thematic analysis, generated questions from the existing pool of recommendations, and then summarized select gaps. RESULTS We abstracted recommendations from 145 articles in five categories: community benefit, participant benefit, safety, researcher well-being, and recommendations for conduct of trauma research. CONCLUSIONS Gold standards to guide the conduct of trauma-informed public health research do not yet exist. The literature suggests participation in trauma research is not inherently harmful, and current recommendations concern using research to benefit communities and participants, protecting participants and researchers from harm, and improving professional practice. As public health researchers increasingly analyze trauma as a determinant of health, gold standards for the conduct of trauma-informed public health research would be appropriate and timely.
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Affiliation(s)
- Kevin Jefferson
- Independent Researcher, Atlanta, Georgia, United States of America
| | - Kaitlyn K. Stanhope
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Carla Jones-Harrell
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Aimée Vester
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Emma Tyano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Casey D. Xavier Hall
- Institute for Sexual and Gender Minority Health and Well-being, Northwestern University, Evanston, Illinois, United States of America
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois, United States of America
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White RG, Van der Boor C. Enhancing the capabilities of forcibly displaced people: a human development approach to conflict- and displacement-related stressors. Epidemiol Psychiatr Sci 2021; 30:e34. [PMID: 33910675 PMCID: PMC8157507 DOI: 10.1017/s2045796021000263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/26/2021] [Accepted: 04/08/2021] [Indexed: 11/07/2022] Open
Abstract
AIMS The mental health of individuals who have been forcibly displaced can be impacted both by war-related traumatic events and displacement-related stressors, which arise as a consequence of their migratory journey and subsequent experiences. In addition to focusing on mental disorders, there is a need to explore broader psychosocial outcomes that are important for forcibly displaced people. Our aim is to present a coherent explanatory framework to understand how both past traumatic events and ongoing stressors operating throughout forcibly displaced people's social environment can impact mental health and psychosocial wellbeing. METHODS We describe the capability approach (CA), a human development framework that foregrounds individuals' freedom to engage in forms of being and doing that are valuable to them. We consider the opportunities that the CA provides for understanding how a myriad of factors can impact forcibly displaced people, and how different forms of support can be configured to meet the needs of particular people and communities. RESULTS The CA recognises that various factors can share a common putative causal mechanism in their impact on forcibly displaced people, i.e. these factors limit a person's ability to develop capabilities and their freedom to engage in valued forms of being and doing. The rights based ethos of the CA enables multisectoral and coordinated activity, which can be directed towards addressing factors across the social environment. Importantly, the CA helps to explain why particular forms of support may be more beneficial for individuals or communities at certain times compared to others. CONCLUSION The application of the CA can help to guard against the risk that the aspirations of assessment instruments and interventions aimed at supporting forcibly displaced people are narrowly focused on addressing distress and disorders, to instead adopt a more expansive focus on forcibly displaced people's potential and the possibilities that they wish to realise.
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Affiliation(s)
- Ross G. White
- Institute of Population Health, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK
| | - Catharina Van der Boor
- Institute of Population Health, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK
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Miller KE, Jordans MJD, Tol WA, Galappatti A. A call for greater conceptual clarity in the field of mental health and psychosocial support in humanitarian settings. Epidemiol Psychiatr Sci 2021; 30:e5. [PMID: 33413736 PMCID: PMC8057504 DOI: 10.1017/s2045796020001110] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/18/2020] [Accepted: 11/26/2020] [Indexed: 01/29/2023] Open
Abstract
AIMS When the Interagency Standing Committee (IASC) adopted the composite term mental health and psychosocial support (MHPSS) and published its guidelines for MHPSS in emergency settings in 2007, it aimed to build consensus and strengthen coordination among relevant humanitarian actors. The term MHPSS offered an inclusive tent by welcoming the different terminologies, explanatory models and intervention methods of diverse actors across several humanitarian sectors (e.g., health, protection, education, nutrition). Since its introduction, the term has become well-established within the global humanitarian system. However, it has also been critiqued for papering over substantive differences in the intervention priorities and conceptual frameworks that inform the wide range of interventions described as MHPSS. Our aims are to clarify those conceptual frameworks, to argue for their essential complementarity and to illustrate the perils of failing to adequately consider the causal models and theories of change that underlie our interventions. METHODS We describe the historical backdrop against which the term MHPSS and the IASC guidelines were developed, as well as their impact on improving relations and coordination among different aid sectors. We consider the conceptual fuzziness in the field of MHPSS and the lack of clear articulation of the different conceptual frameworks that guide interventions. We describe the explanatory models and intervention approaches of two primary frameworks within MHPSS, which we label clinical and social-environmental. Using the examples of intimate partner violence and compromised parenting in humanitarian settings, we illustrate the complementarity of these two frameworks, as well as the challenges that can arise when either framework is inappropriately applied. RESULTS Clinical interventions prioritise the role of intrapersonal variables, biological and/or psychological, as mediators of change in the treatment of distress. Social-environmental interventions emphasise the role of social determinants of distress and target factors in the social and material environments in order to lower distress and increase resilience in the face of adversity. Both approaches play a critical role in humanitarian settings; however, the rationale for adopting one or the other approach is commonly insufficiently articulated and should be based on a thorough assessment of causal processes at multiple levels of the social ecology. CONCLUSIONS Greater attention to the 'why' of our intervention choices and more explicit articulation of the causal models and theories of change that underlie those decisions (i.e., the 'how'), may strengthen intervention effects and minimise the risk of applying the inappropriate framework and actions to a particular problem.
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Affiliation(s)
| | - M. J. D. Jordans
- War Child Holland, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - W. A. Tol
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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