Comic Intervention for Sexual Violence Prevention and Post-rape Care

A Participatory Comic Intervention for Sexual Violence Prevention and Post-rape Care With Refugee Adolescents and Youth in a Humanitarian Setting in Uganda

In humanitarian settings, sexual and gender-based violence disproportionately impacts women and children. However, there continues to be a lack of evidence regarding both sexual violence prevention and post-rape care interventions in low- and middle-income humanitarian contexts, with even less evidence supporting adolescents and youth in these settings. Participatory comics offer a youth-friendly, low-cost, scalable approach for preventing sexual violence and training clinicians in post-rape care in humanitarian settings. This study aims to develop, implement, and evaluate the effectiveness of a comic intervention on preventing sexual violence and improving post-rape care with youth aged 16-24 and health care providers in the Bidi Bidi refugee settlement.

Study Overview

• Status: Completed
• Conditions: Knowledge, Attitudes, Practice; Post-exposure Prophylaxis
• Intervention / Treatment: Behavioral: Participatory Comic Intervention

Detailed Description

Uganda is Sub-Saharan Africa's largest refugee host community; with over 250,000 residents, Bidi Bidi is the largest refugee settlement in Uganda and the second largest globally. In humanitarian settings, sexual and gender-based violence disproportionately impacts women and children. However, there continues to be a lack of evidence regarding both sexual violence prevention and post-rape care interventions in low- and middle-income humanitarian contexts, with even less evidence supporting adolescents and youth in these settings. Stigma directed toward adolescent sexual practices and engagement in sexual and reproductive health services, such as contraception, HIV testing, and post-exposure prophylaxis (PEP), is also associated with social isolation, violence and mental health challenges. Participatory comics offer a youth-friendly, low-cost, scalable approach for preventing sexual violence and training clinicians in post-rape care in humanitarian settings. This study aims to develop, implement, and evaluate the effectiveness of a comic intervention on preventing sexual violence and improving post-rape care with youth aged 16-24 and health care providers in the Bidi Bidi refugee settlement. Participating youth and health care providers will take part in 4-hour peer-facilitated workshops exploring topics of social, sexual, and psychological needs and pro-social interventions (youth) and post-rape care responses and attending to the needs of youth refugees who have experienced sexual violence (health care providers) using comics developed with qualitative data collected from an earlier study phase. Using a pre-test/post-test design, this study will assess changes in participants' PEP knowledge and acceptance, bystander behaviour, and sexual violence stigma.

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M5S1V4
      • Factor-Inwentash Faculty of Social Work, University of Toronto
• Uganda
  • Arua, Uganda
    • Uganda Refugee and Disaster Management Council

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria (Youth):

• Resides in Bidi Bidi Refugee Settlement Zone 3
• Identify as a refugee/displaced person
• Aged 16-24 years
• Speak English, Bari or Arabic

Exclusion Criteria (Youth):

• Does not reside in Bidi Bidi Refugee Settlement Zone 3
• Does not identify as a refugee/displaced person
• Is less than age 16 years or older than age 24 years
• Does not speak English, Bari or Arabic

Inclusion Criteria (Healthcare Provider):

• Provides healthcare services in Bidi Bidi Refugee Settlement and/or Yumbe, Uganda
• Aged greater than or equal to 18 years
• Speak English, Bari or Arabic

Exclusion Criteria (Healthcare Provider):

• Does not provide healthcare services in Bidi Bidi Refugee Settlement and/or Yumbe, Uganda
• Less than age 18 years
• Does not speak English, Bari or Arabic

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Participatory Comic Intervention; This is a pre-test/post-test trial, therefore all participants will participate in the participatory comic intervention.

Behavioral: Participatory Comic Intervention; This participatory comic intervention promotes sexual violence prevention and post-rape care with refugee youth and health care providers. In 4-hour workshops, a customized comic book featuring eight sexual violence scenarios will be distributed. Each 1-page scenario speaks to a unique theme of sexual violence experiences among youth or post-rape care preferences. During the workshop participants will explore social, sexual, and psychological needs of youth in Bidi Bidi and practice ways of developing and maintaining healthy relationships (youth) as well as discuss post-rape care responses that attend to the needs and priorities of young refugees in Bidi Bidi who have experienced sexual violence (health care providers). Each workshop will include 20 participants and will be facilitated by trained staff from Real Medicine, Uganda. Further, each workshop will have at least 2 facilitators who are trained in the bystander model.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in PEP Knowledge & Acceptability	PEP knowledge and acceptability assessed through testing participants on their knowledge of correct PEP use and asked to report on their acceptance towards PEP use and adherence. Scores are binary yes/no.	Time 1 (0-baseline), Time 2 ( 6 hours follow-up), Time 3 (4 week follow-up)
Changes in Bystander Practices	Bystander practices assessed through the Bystander Decision Balance Scale and Slaby Bystander Efficacy Scale (Range 16-64). Higher scores indicate increased bystander practices.	Time 1 (0-baseline), Time 2 ( 6 hours follow-up), Time 3 (4 week follow-up)
Changes in Sexual Violence Stigma	Attitudes and beliefs towards sexual violence will be assessed using the Sexual Violence Stigma scale (Range 17-68). Higher score indicates poorer attitudes and beliefs, and thus greater stigma, towards sexual violence and sexual violence survivors.	Time 1 (0), Time 2 (5hours), Time 3 (4 weeks post-workshop)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in Gender Equitable Norms	Gender Equitable Norms will be assessed using the physical violence subscale (Range 6-18) of the gender equitable men (GEM) scale to measure attitudes towards gender equitable norms considering the prevailing norms in the community concerning physical violence. A higher score indicates positive attitudes towards gender equitable norms.	Time 1 (0-baseline), Time 2 ( 6 hours follow-up), Time 3 (4 week follow-up)
Changes in Depression	Depression outcomes will be assessed using the Patient Health Questionnaire 2-item (PHQ-2) (Range 0-6). Scores of 3 or above signal major depressive disorder.	Time 1 (0-baseline), Time 3 (4 week follow-up)

Collaborators and Investigators

• Sponsor: University of Toronto
• Investigators: Principal Investigator: Carmen H Logie, PhD, University of Toronto, Canada

Publications and helpful links

General Publications

• Logie CH, Okumu M, Loutet M, Berry I, Lukone SO, Kisubi N, Mwima S, Kyambadde P. Mixed-methods findings from the Ngutulu Kagwero (agents of change) participatory comic pilot study on post-rape clinical care and sexual violence prevention with refugee youth in a humanitarian setting in Uganda. Glob Public Health. 2022 Jun 30:1-19. doi: 10.1080/17441692.2022.2092178. Online ahead of print.

Study record dates

Study Major Dates

• Study Start (Actual): November 30, 2020
• Primary Completion (Actual): April 30, 2021
• Study Completion (Actual): April 30, 2021

Study Registration Dates

• First Submitted: November 13, 2020
• First Submitted That Met QC Criteria: November 30, 2020
• First Posted (Actual): December 7, 2020

Study Record Updates

• Last Update Posted (Actual): December 28, 2021
• Last Update Submitted That Met QC Criteria: December 23, 2021
• Last Verified: December 1, 2021

More Information

Terms related to this study

• Keywords: Uganda; Post-exposure prophylaxis; Forcibly displaced youth; Digital health intervention; Bystander practices; Sexual Violence Stigma; Gender based violence
• Other Study ID Numbers: gcc_bidibidi

Drug and device information, study documents

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