Gender Accessibility to Community-Based Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) By Communities Affected by The Post Lord's Resistance Army (LRA) War in Northern Uganda
DOI:
https://doi.org/10.47672/ajp.1580Keywords:
Gender, Accessibility, TF-CBT.Abstract
Purpose: This paper sought to assess gender accessibility to Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) among communities which were affected by LRA insurgency for two decades in Northern Uganda. A pre study had found out that individuals who survived insurgency such as abduction, living in camps and death continuously displayed muted emotions and other symptoms of grief, loss and depression. This called for several interventions, TF-CBT being among them. The potential utilization of TF-CBT as an intervention to address post insurgency trauma requires equal access to the TF-CBT measures taking into account gender sensitivity. This called for assessment of its gender accessibility.
Methodology: The study design was qualitatively phenomenological. Purposive sample size of participants was 419. Data was got through the help of VHTs, TPO social workers, caregivers, health workers, clients and LCs. Interviews, questionnaires and Focus Group Discussions, (FGDs) with clients were tools that aided data collection and analyzed thematically. The Health Belief Model (HBM) was the guiding theory that helped in identifying that much as there was gender inequality, there were instances of equality in accessing TF-CBT with suggested cues to solving gender inequality.
Findings: This paper notes that causes of gender inequality in accessing TF-CBT are; alcoholism among men, limiting number of entrants, negative attitude towards enrolling for TF-CBT, lack of family support from wives, and self-trust among men. This paper proposes that gender inequality in accessing the intervention can be mitigated by both government and other stake holders through affirmative action, mobilizing all sexes, stopping restrictions in recruitment of beneficiaries, use various leaders for sensitization, extending services of TF-CBT in villages and employing more workers amongst others.
Downloads
References
Abraham, C., & Sheeran, P. (2015). The health belief model. Predicting health behaviour: Research and practice with social cognition models, 2, 30-55.
Albizu-Garcia, C.E., Alegria, M. Freeman, D. & Vera, M. (2013). Gender and Health Services
use for a Mental Health Problem. Journal of Soc Sci Med. Vol. 53(7): 865-878.
Al-Dmour, H., Masa'deh, R. E., Salman, A., Al-Dmour, R., & Abuhashesh, M. (2022). The role of mass media interventions on promoting public health knowledge and behavioral social change against COVID-19 Pandemic in Jordan. Sage Open, 12(1), 21582440221082125.
American Psychological Association. (2017). Stress in America: Coping with change.
Amongi, E., Baguma, P., & Nansubuga, F. (2022). Barriers to Accessing Community Based Trauma-focused Cognitive Behavioral Therapy (TF-CBT) for posttraumatic stress disorder (PTSD) Management in Post Conflict Acholi Sub-region. American Journal of Psychology, 4(2), 34-48.
AVSI. 2005. The psychosocial program of AVSI in Uganda: a case study.
Banerjee, S., & Dash, S. K. (2013). Effectiveness of disease awareness advertising in emerging economy: Views of health care professionals of India. Journal of Medical Marketing, 13(4), 231-241.
Bila, B., & Egrot, M. (2009). Gender asymmetry in healthcare-facility attendance of people living with HIV/AIDS in Burkina Faso. Social science & medicine, 69(6), 854-861.
Bromley, A. (2016). The traumatic effect of homicide in mentally disordered offenders and implications for treatment (Doctoral dissertation, University of Nottingham).
Carroll, J. J., & Robinson, B. E. (2000). Depression and parentification among adults as related to parental workaholism and alcoholism. The Family Journal, 8(4), 360-367.
Clarke, J. M., Waring, J., Bishop, S., Hartley, J., Exworthy, M., Fulop, N. J., ... & Roe, B. (2021). The contribution of political skill to the implementation of health services change: a systematic review and narrative synthesis. BMC Health Services Research, 21(1), 1-15.
Cohen, J. A., & Ryan, C. (2021). The trauma-focused CBT and family acceptance Project: an integrated framework for children and youth. Psychiatric Times, 38(6), 15-17.
Connelly, M. P., Li, T. M., MacDonald, M., & Parpart, J. L. (2000). Feminism and development: Theoretical perspectives. Theoretical perspectives on gender and development, 51-159.
Deblinger, E., Mannarino, A. P., Cohen, J. A., & Steer, R. A. (2006). A follow-up study of a multisite, randomized, controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 45(12), 1474-1484.
Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Steer, R. A. (2011). Trauma"focused cognitive behavioral therapy for children: impact of the trauma narrative and treatment length. Depression and anxiety, 28(1), 67-75.
Dierickx, S., O'Neill, S., Gryseels, C., Immaculate Anyango, E., Bannister"Tyrrell, M., Okebe, J., ... & Peeters Grietens, K. (2018). Community sensitization and decision"making for trial participation: a mixed"methods study from the Gambia. Developing world bioethics, 18(4), 406-419.
Furtado, J. V., Moreira, A. C., & Mota, J. (2021). Gender affirmative action and management: A systematic literature review on how diversity and inclusion management affect gender equity in organizations. Behavioral sciences, 11(2), 21.
Gonani, A., & Muula, A. S. (2015). Point of View: The importance of Leadership towards universal health coverage in Low Income Countries. Malawi Medical Journal, 27(1), 34-37.
Hasanica, N., Ramic-Catak, A., Mujezinovic, A., Begagic, S., Galijasevic, K., & Oruc, M. (2020). The effectiveness of leaflets and posters as a health education method. Materia socio-medica, 32(2), 135.
Hu, J., Feng, B., Zhu, Y., Wang, W., Xie, J., & Zheng, X. (2017). Gender differences in PTSD: susceptibility and resilience. Gender differences in different contexts, 21-42.
Jones, C. L., Jensen, J. D., Scherr, C. L., Brown, N. R., Christy, K., & Weaver, J. (2015). The health belief model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation. Health communication, 30(6), 566-576.
Kebede, L (2005). Effectiveness of Health Posters in Awareness Creation and Promoting Behavior Change. A Case Study of UNICEF's Billboards: Addis Ababa.
Kienzler, H., & Pedersen, D. (2012). Strange but common bedfellows: The relationship between humanitarians and the military in developing psychosocial interventions for civilian populations affected by armed conflict. Transcultural Psychiatry, 49(3-4), 492-518.
Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM"IV and DSM"5 criteria. Journal of traumatic stress, 26(5), 537-547.
Kleber, R. J. (2019). Trauma and public mental health: A focused review. Frontiers in psychiatry, 10, 451.
Mediavilla, R., McGreevy, K. R., Felez-Nobrega, M., Monistrol-Mula, A., Bravo-Ortiz, M. F., Bayón, C., ... & RESPOND Consortium. (2022). Effectiveness of a stepped-care programme of internet-based psychological interventions for healthcare workers with psychological distress: Study protocol for the RESPOND healthcare workers randomised controlled trial. Digital Health, 8, 20552076221129084.
Morrison, A. E., Zaccardi, F., Chatterjee, S., Brady, E., Doherty, Y., Robertson, N., ... & Davies, M. J. (2021). Self-compassion, metabolic control and health status in individuals with type 2 diabetes: A UK observational study. Experimental and Clinical Endocrinology & Diabetes, 129(06), 413-419.
O'Callaghan, P., McMullen, J., Shannon, C., Rafferty, H., & Black, A. (2013). A randomized controlled trial of trauma-focused cognitive behavioural therapy for sexually exploited, war-affected Congolese girls. Journal of the American Academy of Child & Adolescent Psychiatry, 52(4), 359-369.
Okello, J., Onen, T. S., & Musisi, S. (2007). Psychiatric disorders among war-abducted and non-abducted adolescents in Gulu district, Uganda: a comparative study. African journal of psychiatry, 10(4), 225-231.
Omoera, O. S., & Aihevba, P. (2012). Broadcast media intervention in mental health challenge in Edo State, Nigeria. Medical Anthropology, 439, 452.
Pieh, C., Altmeppen, J., Neumeier, S., Loew, T., Angerer, M., & Lahmann, C. (2012). Gender differences in outcomes of a multimodal pain management program. Pain, 153(1), 197-202.
Pieh, C., Altmeppen, J., Neumeier, S., Loew, T., Angerer, M., & Lahmann, C. (2012). Gender differences in outcomes of a multimodal pain management program. Pain, 153(1), 197-202.
Rolleri, L. A. (2013). Understanding gender and gender equality. Research fACTs and Findings, 1-7.
Sadock, B. J. (2015). Kaplan & Sadock's synopsis of psychiatry: behavioural sciences/clinical psychiatry (Vol. 2015, pp. 648-655). Philadelphia, PA: Wolters Kluwer.
Steele, P. D. (2019). Looking to the Future with the Burdens of the Past: Exploring the Systems of Mental Health Treatment for War-Affected Youth in Northern Uganda (Doctoral dissertation).
Steele, P. D. (2019). Looking to the Future with the Burdens of the Past: Exploring the Systems of Mental Health Treatment for War-Affected Youth in Northern Uganda (Doctoral dissertation).
Stein, G. L., Lee, C. S., Shi, P., Cook, B. L., Papajorgji-Taylor, D., Carson, N. J., & AlegrÃa, M. (2014). Characteristics of community mental health clinics associated with treatment engagement. Psychiatric Services, 65(8), 1020-1025.
Steudte, S., Kolassa, I. T., Stalder, T., Pfeiffer, A., Kirschbaum, C., & Elbert, T. (2011). Increased cortisol concentrations in hair of severely traumatized Ugandan individuals with PTSD. Psychoneuroendocrinology, 36(8), 1193-1200.
Tapp, C., Milloy, M. J., Kerr, T., Zhang, R., Guillemi, S., Hogg, R. S., ... & Wood, E. (2011). Female gender predicts lower access and adherence to antiretroviral therapy in a setting of free healthcare. BMC infectious diseases, 11, 1-7.
Teddlie, C., & Yu, F. (2007). WITHDRAWN-Mixed Methods Sampling: A Typology With Examples. Journal of Mixed Methods Research
Torre, C. (2019). Psychosocial support (PSS) in war-affected countries: a literature review.
WHO (2021). Promoting person-centered and rights-based approaches.
Wibabara, Y., Lukabwe, I., Kyamwine, I., Kwesiga, B., Ario, A. R., Nabitaka, L., ... & Mudiope, P. (2021). The yield of HIV testing during pregnancy and postnatal period, Uganda, 2015-2018: analysis of surveillance data. AIDS Research and Therapy, 18(1), 35.
Woldetsadik, M. A. (2018). Long-term Effects of Wartime Sexual Violence on Women and Families the Case of Northern Uganda. The Pardee RAND Graduate School.
World Health Organization. (2009). Integrating gender into HIV/AIDS programmes in the health sector: tool to improve responsiveness to women's needs.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Elizabeth Amongi, Prof. Peter Baguma, Assoc. Prof. Consolata Kabonesa, Dr. Otyola Roberts Wandera, Mr. Muwairwa Michael
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
