Impacts of Clean Cookstoves and Empowerment Training on Women's Health in Refugee Settings

Impacts of Clean Cookstoves/Efficient Fuels Uptake and Empowerment Trainings on Women's Health and Well Being in Humanitarian Settings in Rwanda

The main objective of this study is to understand the links and outcomes of adoption of a cleaner cookstove/fuel and exposure to a personal empowerment training on women's health outcomes in a Congolese refugee camp in Rwanda, with a focus on gender-based violence (GBV).

Study Overview

• Status: Completed
• Conditions: Food Insecurity; Mental Health Wellness 1; Adherence; Gender-based Violence; Empowerment; Relationship, Family
• Intervention / Treatment: Device: Inyenyeri clean cookstove and fuel system; Behavioral: I-ACT (Individual, Agency-Centered Training) workshop

Detailed Description

This randomized controlled trial examines the impacts of a phased-in integrated technology -behavior change intervention on women's health with a focus on gender-based violence. In a population of approximately 1500 Congolese households in Kigeme refugee camp in Rwanda, two interventions are randomly deployed in the camp. The first intervention is the Inyenyeri cookstove/pellet fuel system, a Tier 4 clean cookstove system; the second intervention is a behavior change intervention (referred to as I-ACT, Individual-Agency-Centered Training) designed to foster personal agency and empowerment, given to women and, if applicable, their male partner. Analyses will be done with interviews on 1500 women (ages 18-45) from these households that may have received one, both or none of the interventions, either as the full sample or the sub-sample of partnered-only women.

• Study Type: Interventional
• Enrollment (Actual): 1555
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Rwanda
  • Kigali
    • Kacyiru, Kigali, Rwanda, KG 546ST1
      • Plan International, Rwanda

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 45 years (ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Study participants are between the ages of 18 years - 45 years of age
• Reported as currently living in a refugee camp with no intention to relocate
• Has lived in any refugee camp for at least 1 year and can be interviewed in private
• Has the ability to give informed consent

Exclusion Criteria:

• Inability to provide informed consent
• Individuals having evidence of significant illness and/or are not able to engage fully in the surveys
• Women younger than 18 or over 45 years of age
• Those who have not lived continuously in a refugee camp setting for the past 12 months
• If two or more women live in a household, only one of these will be included in the study. The one responsible for fuel purchase/collection will be selected. If more than one woman is responsible for fuel collection, we will randomly choose one woman to participate in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: PREVENTION
• Allocation: RANDOMIZED
• Interventional Model: FACTORIAL
• Masking: NONE

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Inyenyeri clean cookstove/fuel; A tier 4 clean Mimi-moto cookstove/pellet system	Device: Inyenyeri clean cookstove and fuel system; The Inyenyeri cooking systems includes a tier 4 clean cooking system with biomass pellets that are purchased through the unconditional cash transfer program in the refugee camp
EXPERIMENTAL: I-ACT behavioral empowerment intervention; A culturally adapted 2-day personal empowerment workshop (based on the Individual, Agency-Centered Training (I-ACT) to women and modified, condensed 1-day training for their male partners, if applicable	Behavioral: I-ACT (Individual, Agency-Centered Training) workshop; The I-ACT (Individual, Agency-Centered Training) empowerment workshop consists of behavioral exercises drawn primarily from positive psychology, that provide the tools to foster a growth mindset by allowing participants to understand the link between their thoughts, beliefs, and past actions to their future actions. Conducted in a workshop setting, this locally adapted version of the I-ACT curriculum consists of two days for women and a 1 day workshop for their male partners (as applicable)
EXPERIMENTAL: Cookstove and I-ACT empowerment; Access to both the clean cookstove system and I-ACT empowerment training	Device: Inyenyeri clean cookstove and fuel system; The Inyenyeri cooking systems includes a tier 4 clean cooking system with biomass pellets that are purchased through the unconditional cash transfer program in the refugee camp; Behavioral: I-ACT (Individual, Agency-Centered Training) workshop; The I-ACT (Individual, Agency-Centered Training) empowerment workshop consists of behavioral exercises drawn primarily from positive psychology, that provide the tools to foster a growth mindset by allowing participants to understand the link between their thoughts, beliefs, and past actions to their future actions. Conducted in a workshop setting, this locally adapted version of the I-ACT curriculum consists of two days for women and a 1 day workshop for their male partners (as applicable)
OTHER: I-ACT Waitlisted control; These households include those that were offered cookstoves after 6 months (from baseline) and are waitlisted to receive the I-ACT intervention	Device: Inyenyeri clean cookstove and fuel system; The Inyenyeri cooking systems includes a tier 4 clean cooking system with biomass pellets that are purchased through the unconditional cash transfer program in the refugee camp

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rates of gender-based violence	Change in gender-based violence (GBV) over time as assessed through an adapted ASIST-GBV screening tool to identify physical violence, sexual violence, harassment, emotional violence and reproductive coercion between non-partners and intimate partners in humanitarian settings.	6 months
Number of households reporting uptake and consistent use of clean cooking system and fuel	Change in uptake and use of the clean cooking system as measured through pellet purchase and reported pellet use behavior	6 months
Number of participants reporting minor psychiatric disorders	Changes in the number of participants reporting minor psychiatric disorders as determined by the General Health Questionnaire (GHQ-12) as a result of the empowerment intervention.	6 months
Number of participants reporting anxiety and depression	Changes in the number of participants reporting anxiety and depression as determined by the Hopkins Symptom Checklist (HSCL) as a result of the empowerment intervention.	6 months
Number of participants reporting emotional symptoms of trauma	Changes in the number of participants reporting emotional symptoms of trauma as determined by the Harvard Trauma Questionnaire (HTQ) as a result of the empowerment intervention.	6 months
Number of participants reporting increased economic and social empowerment	Change in rates of reported uptake of economic activities (such as small businesses or savings) as well as participation in social groups and local training programs	6 months
Number of participants reporting reduced food insecurity	Change in reported incidence and severity of food insecurity as determined through a culturally adapted modification of the food insecurity experience scale (FIES) associated with food-related distress during the past month	6 months
Number of participants reporting increased self-efficacy	Changes in self-efficacy (as assessed by the New General Self-Efficacy Scale) as a result of the empowerment intervention.	6 months
Number of participants reporting increased grit	Changes in grit (Grit scale (Duckworth, et al)) as a result of the empowerment intervention.	6 months
Number of participants reporting increased social agency	Changes in social agency (as assessed by Ryff's psychological well-being scales) as a result of the empowerment intervention.	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of participants reporting increased quality and quantity of social networks	Changes in quality of social networks in the form of network size, network density and stove homophily resulting from either the empowerment training or the improved cookstove program as determined by reported social ties and characteristics of those social ties.	6 months

Collaborators and Investigators

• Sponsor: Johns Hopkins Bloomberg School of Public Health
• Collaborators: World Bank; Fundacion Plan International Espana; Global Alliance for Clean Cookstoves
• Investigators: Principal Investigator: Anita V Shankar, Ph.D., Johns Hopkins Bloomberg School of Public Health; Principal Investigator: Naira Kalra, Ph.D., Johns Hopkins Bloomberg School of Public Health

Study record dates

Study Major Dates

• Study Start (ACTUAL): August 1, 2018
• Primary Completion (ACTUAL): December 30, 2019
• Study Completion (ACTUAL): December 31, 2020

Study Registration Dates

• First Submitted: August 5, 2019
• First Submitted That Met QC Criteria: September 4, 2019
• First Posted (ACTUAL): September 9, 2019

Study Record Updates

• Last Update Posted (ACTUAL): August 10, 2022
• Last Update Submitted That Met QC Criteria: August 9, 2022
• Last Verified: August 1, 2022

More Information

Terms related to this study

• Keywords: depression; empowerment; food insecurity; gender-based violence; intimate-partner violence; humanitarian settings; fuel use; clean cookstoves
• Other Study ID Numbers: 7806

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified data from this sample on social networks will be shared with colleagues at Boston College
• IPD Sharing Time Frame: August 2019-January 2020
• IPD Sharing Supporting Information Type: ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No