Refugee caregivers: Associations between psychosocial wellbeing and parenting in Uganda.

Caregivers in humanitarian settings experience compounding stressors that may challenge their ability to provide quality parenting to children in their care. In recognition of this precarity, our analysis examines the linkage between psychosocial wellbeing and parenting behaviours among caregivers in Kiryandongo Settlement, Uganda. Using baseline data from an evaluation of a psychosocial intervention designed to support caregiver wellbeing and engage caregivers to support children in their communities, multi-variable ordinary least square regressions were used to estimate how various measures of psychosocial wellbeing (i.e. psychological distress, social support, and functioning) and parenting attitudes (related to violence against children) are associated with parental warmth and rejection. Profound livelihood challenges were found, as nearly half of the sample (48.20%) indicated cash from INGOs as their income source and/or reported never attending school (46.71%). Increased social support (coef. 0.11; 95% CIs: 0.08-0.15) and positive attitudes (coef. 0.21; 95% CIs: 0.14-0.29) were significantly associated with more desirable parental warmth/affection. Similarly, positive attitudes (coef. 0.16; 95% CIs 0.11-0.20), reduced distress (coef. 0.11; 95% CIs: 0.08-0.14) and increased functioning (coef. 0.03; 95% CIs: 0.01-0.04) were significantly associated with more desirable scores of parental undifferentiated rejection. While further research is needed to examine underlining mechanisms and causal pathways, our findings both link individual wellbeing characteristics with parenting behaviours and suggest further exploration into whether and how broader elements of the ecosystem may influence parenting outcomes.

Protocol for a caregiver psychosocial support intervention for populations affected by displacement in Uganda.

BACKGROUND: Child psychological distress 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 current study is to evaluate the effectiveness and implementation of the Journey of Life (JoL) intervention to improve caregiver mental health in a refugee camp in Western Uganda. METHODS: A waitlist-control quasi-experimental design is being implemented in the Kiryandongo refugee settlement (intervention n = 600, control n = 600). Caregiver mental distress, measured using the Kessler-6, was selected as the primary outcome. Secondary outcomes include (a) functioning measured by the World Health Organization Disability Assessment Schedule, (b) social support measured by the Medical Outcomes Study Social Support Survey, and (c) caregiving behaviors according to the Parental Acceptance and Rejection Questionnaire and the Child Protection Index. The study aims to examine the implementation of the JoL intervention through qualitative assessments of intervention feasibility, adaptations, and reach. DISCUSSION: This trial will add much-needed evidence for the implementation of caregiver psychosocial programming within the humanitarian community. Findings will be disseminated amongst local, regional, and global actors in order to guide potential scale up within humanitarian settings. TRIAL REGISTRATION: Clinical Trials NCT04817098 (Registered: 3/24/21).