Improving Wellbeing and Parenting Practices Among Refugees in Uganda: Effectiveness of the Journey of Life Intervention

Background and purpose: Child safety and wellbeing in refugee settings is a significant public health concern, which is exacerbated by poor caregiver mental health and functioning. However, there are limited studies about effective interventions to improve caregiver mental health in support of child wellbeing. The objective of the Journey of Life study is to evaluate the effectiveness of the intervention on improving caregiver wellbeing and healthy parenting practices in a refugee camp in Western Uganda.

Methods: A waitlist-control quasi-experimental design was implemented in the Kiryandongo refugee settlement (intervention n = 600, control n = 600). Caregiver mental distress, measured using the Kessler-6, was the primary outcome. Secondary outcomes include (a) functioning measured by the World Health Organization Disability Assessment Schedule (WHODAS), (b) social support measured by the Medical Outcomes Study Social Support Survey, and (c) caregiving behaviors according to the Parental Acceptance and Rejection Questionnaire (PARQ) and the Child Protection Index (CPI). Adjusted linear regressions were used to conduct intent-to-treat analysis and Cohen's D estimates were used to examine intervention effects.

Results: At follow-up, the intervention was significantly associated with the primary outcome of improved mental distress (aOR: 1.73; CIs: 1.10 - 2.35; p<0.001). The intervention was also significantly associated with PARQ subscales of acceptance (aOR: 2.20; CIs: 1.69 - 2.71; p<0.001) and rejection (aOR: 0.78; CIs: 0.46 - 1.10; p<0.001), as well as the CPI's subscale of violence (aOR: 1.54; CIs: 1.11 - 1.98; p<0.001). Significant associations were not demonstrated in the fully adjusted intervention models for functioning, social support, nor CPI roles. The intervention demonstrated a small to medium effect for the CPI subscale of violence, the PARQ subscale of rejection, Kessler-6, and WHODAS (Cohen's D of at least 0.2).

Conclusion and implications: This trial adds much-needed evidence for the implementation of programming to improve the mental health of refugee caregivers and the safety and wellbeing of refugee children. The primary goal of the Journey of Life intervention is to support the safety and wellbeing of refugee children and families living in Uganda. Participants demonstrated improved self-care strategies and were better able to promote and improve child wellbeing. Overall, this study supports burgeoning literature about caregiver psychosocial support and child protection programs in humanitarian and low-resourced settings.