Intimate partner violence comprises physical, sexual, psychological, and/ or controlling behaviors, most commonly against women by their current or former male partners1. 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 violence2. Practitioners and researchers in settings of armed conflict have increasingly emphasized considering the importance of ongoing stressors such as intimate partner violence as determinants of mental health and psychosocial wellbeing, in addition to conflict-related events in the past5-6. At the same time, researchers have been interested in the role of interpersonal violence as a social determinant of mental health in order to inform public mental health strategies7-8.
The aim of this pilot evaluation was to evaluate the feasibility and acceptability of an integrated mental health and advocacy intervention named Nguvu (Swahili for strength) for improving psychosocial health and reducing the recurrence of intimate partner violence among Congolese refugee women in Nyarugusu Refugee Camp, Tanzania. 311 women were recruited through local women’s groups which have on average 16-17 women per group. These women’s groups were organized in the camp by the United Nations High Commissioner for Refugees (UNHCR) implementing partners to provide skills training and an opportunity for women to strengthen their social networks.
This intervention included Cognitive Processing Therapy, a type of cognitive behavioral therapy with a trauma focus, as it was found to be highly effective in Congolese women residing in the DRC in reducing symptoms of depression, anxiety, and posttraumatic stress disorder, as well as in reducing functional impairment9. The intervention was adapted for the Congolese refugee population in Nyarugusu, Tanzania. The project team worked with the lead authors of the three intervention manuals (the 12- and 6-session Cognitive Processing Therapy manuals; the advocacy manual) to develop an 8-session intervention called Nguvu (KiSwahili for strength). The result was an 8-session intervention consisting of one individual initial session, followed by seven group sessions, delivered once per week over 8 weeks in total.
Ten Congolese refugees working as lay psychosocial workers in Nyarugusu camp for the International Rescue Committee (IRC) gender-based violence and women’s empowerment programs were selected as facilitators for the intervention. The facilitators received 9 days of training that covered basic counseling skills, the intervention manual and self-care strategies.Facilitators were expected to deliver 1–5 sessions of the intervention per week depending on the number of active groups (1 session per group per week). A single facilitator delivered individual sessions (Session #1), while a pair of facilitators delivered the group sessions (Sessions #2–8). The facilitators received ongoing support from a psychologist (both remote and on-site supervision). During supervision, complex cases were discussed and the facilitators, together with their supervisors used clinical judgment to determine if certain cases should discontinue participation and whether a referral to other services may be needed.