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

Wietse A Tol,Samuel Likindikoki,Judith K Bass,Jessie K K Mbwambo,M Claire Greene,Ann G Bonz,Peter Ventevogel,Lusia Misinzo

doi:10.1186/s12888-017-1338-7

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 registrationISRCTN65771265, June 27, 2016.

Highlights

Intimate partner violence (IPV) is a critical public health and human rights concern globally, including for refugee women in low-resource settings
Muhimbili University of Health and Allied Sciences is responsible for data collection and management, and the International Rescue Committee coordinates intervention activities. This cluster randomized trial aims to evaluate the impact of a secondary prevention intervention with Congolese refugee women in Nyarugusu refugee camp in Tanzania
Primary outcomes are a reduction in psychological distress, and reduced exposure to intimate partner violence

Summary

Introduction

Intimate partner violence (IPV) is a critical public health and human rights concern globally, including for refugee women in low-resource settings. Intimate partner violence is a widespread and critical concern for human rights and public health globally. Intimate partner violence comprises physical, sexual, psychological, and/ or controlling behaviors, most commonly against women by their current or former male partners [1]. A recent synthesis of data from 141 studies in 81 countries found that globally 30.0% of women aged 15 years and older reported lifetime physical and/ or sexual intimate partner violence [2]. There is strong evidence for links between intimate partner violence and a range of negative outcomes for health and wellbeing in women, including mental health. Researchers have been interested in the role of interpersonal violence as a social determinant of mental health in order to inform public mental health strategies [6, 7]

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