Developing an integrated intervention to address intimate partner violence and psychological distress in Congolese refugee women in Tanzania
Developing an integrated intervention to address intimate partner violence and psychological distress in Congolese refugee women in Tanzania
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DOI：
10.1186/s13031-019-0222-0
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发表时间：
2019-08-17
影响因子：
3.6
通讯作者：
Tol, Wietse A.
中科院分区：
文献类型：
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作者：
Greene, M. Claire;Rees, Susan;Tol, Wietse A.
长期以来，人们一直建议采取多部门综合干预措施来解决心理健康及其社会决定因素（例如，性别暴力）的情况下，持续的逆境。我们开发了一个综合的健康和保护干预，以减少心理困扰和亲密伴侣暴力（IPV），并测试其交付的外行调解人在低资源的难民环境。形成性研究，以制定干预措施包括一个结构化的案头审查，咨询专家和当地利益相关者（难民激励工作者，人道主义机构的代表，和临床专家），定性访谈（40自由名单访谈难民，15个关键线人访谈）。鉴于人道主义机构为防止这一特定难民营中的性别暴力（包括（潜在）肇事者）所做的现有努力，我们重点关注一项补充努力，即制定一项综合干预措施，有可能减少IPV以及与女性IPV幸存者相关的心理健康影响。我们招募了刚果难民妇女与升高的心理困扰和过去一年的历史IPV（n = 60）谁收到了培训和监督奠定难民调解人提供的干预。通过对参与者的定量和定性访谈，评估了干预的相关性、可行性和可接受性。我们评估了工具重测信度（n = 24），评分者间信度（n = 5次访谈），内部一致性和结构效度（n = 60）。结果我们设计了一个8个疗程的干预，称为Nguvu（“力量”），结合简短的认知处理疗法（专注于帮助客户获得克服消极思想和自我认知的技能，并控制这些对他们生活的影响）和倡导咨询（专注于增加自主权，赋权和加强与社区支持的联系）。平均而言，与会者出席了三分之二的会议。在定性访谈中，参与者建议调整具体的干预措施，并提供有关协调，保留，安全问题和干预参与激励措施的建议。结果工具的性能分析整体显示可接受的可靠性和有效性。结论：我们发现在难民营环境中开发和实施综合的、多部门的心理健康和IPV干预是可行的。确定了执行方面的挑战，这些挑战可能对今后执行和评价针对面临持续逆境人口的多部门战略提供信息。
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.