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Accepted Paper:
Paper short abstract:
The abstract proposes CHANGE, a peer-led intervention, addressing alcohol use disorders and psychological distress among refugees in Uganda. Using a capability framework, a feasibility trial evaluates outcomes including alcohol misuse, psychological distress, and wellbeing.
Paper long abstract:
Background: The conflict in South Sudan has displaced millions to Uganda, where research reveals high levels of alcohol use disorders (AUDs) and psychological distress among refugees. Despite MHPSS guidelines urging AUD intervention, such efforts are rare due to various barriers. Existing interventions are ill-suited to the context and lack psychological strategies for AUDs. Low-intensity interventions like PM+ could bridge this gap but currently lack AUD-specific strategies.
Our study uses a capability framework to evaluate the impact of CHANGE: a novel peer-led psychological intervention that builds on PM+. CHANGE aims to improve the mental wellbeing and quality of life of refugees affected by psychological distress and alcohol misuse in humanitarian settings. As part of our intervention development process, we conducted a study to test the acceptability, feasibility of delivery, and perceived impact of the CHANGE intervention, which is described in this paper.
Methods: A feasibility trial was conducted in the Rhino and Imvepi settlements in Uganda. Sixty-six adult male South Sudanese refugees with i) elevated levels of alcohol use; and ii) psychological distress were assigned 1:1 to enhanced usual care (EUC) or CHANGE and EUC. The CHANGE intervention was delivered by non-specialist workers over six weeks. Outcomes were assessed at baseline and 3-months. The primary outcome was percentage of days abstinent, measured by the Timeline Follow Back at 3 months. Secondary outcomes included percent of days abstinent at 3-months and alcohol misuse, psychological distress (i.e., depression, anxiety, posttraumatic stress disorder), functional disability, perpetration of intimate partner violence, subjective wellbeing (measured by OECD wellbeing questions and the EQ-5D), and capabilities-based wellbeing (measured by the Oxford Capabilities Mental Health [OxCAP-MH]) at 3-months.
A mixed methods process evaluation was also carried out to investigate competency, dose, fidelity, feasibility, and acceptability. Qualitative interviews were done with non-specialist workers (N=5), participants (N=10), family members (N=10), outcome assessors (N=5) and supervisors (N=5).
Results: The data of this feasibility trial are currently being analyzed and results are expected by March 2024.
Discussion: Humanitarian guidelines offer limited direction on addressing alcohol misuse and psychological distress in conflict settings, partly due to a lack of evidence-based interventions. The CHANGE intervention aims to fill this gap, addressing neglected issues sensitively. Besides mental health, CHANGE targets capability-based wellbeing, quality of life, and inter-partner violence. The ongoing feasibility trial will inform a larger trial in Uganda. If successful, the intervention manual will be openly accessible, aiding humanitarian service delivery.
Integrating the Capability Approach in Interventions and Evaluations