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

Figures & data

Figure 1. Example of comic book image from the Ngutulu Kawero post-rape care intervention with refugee youth in a humanitarian setting in Uganda focused on peer support to access post-rape care.

Figure 2. Example of comic book image from the Ngutulu Kawero post-rape care intervention with refugee youth in a humanitarian setting in Uganda focused on reducing sexual violence stigma.

Table 1. Baseline sociodemographic characteristics of refugee youth enrolled in Ngutulu Kagwero, Bidi Bidi, Uganda (n = 120).

	Total	Women	Men	p-Value*
Total, n (%)	120 (100)	60 (50)	60 (50)
Age in years at baseline^$, mean (SD)	19.7 (2.4)	19.0 (2.1)	20.5 (2.4)	0.001
Country of origin^$, n (%)				1.000
Uganda	1 (0.8)	0 (0.0)	1 (1.7)
South Sudan	119 (99.2)	60 (100.0)	59 (98.3)
Education^#, n (%)				0.040
<primary or none	6 (5.2)	5 (8.5)	1 (1.8)
Primary	38 (33.0)	24 (40.7)	14 (25.0)
Secondary or higher	71 (61.7)	30 (50.8)	41 (73.2)
Asset index^#, n (%)				0.921
Q1 (lowest)	40 (34.8)	20 (33.9)	20 (35.7)
Q2	37 (32.2)	20 (33.9)	17 (30.)
Q3 (highest)	38 (33.0)	19 (32.2)	19 (33.9)
Earned money in the past 12 months^#, n (%)				0.007
No	58 (50.4)	37 (62.7)	21 (37.5)
Yes	57 (49.6)	22 (37.3)	35 (62.5)
Parents^#, n (%)				0.090
Either or both parents dead	29 (25.2)	11 (18.6)	18 (32.1)
Both parents alive, but not living with	17 (14.8)	7 (11.9)	10 (17.9)
Both parents alive, only living with father	5 (4.3)	1 (1.7)	4 (7.1)
Both parents alive, only living with mother	21 (18.3)	14 (23.7)	7 (12.5)
Living with both parents	43 (37.4)	26 (44.1)	17 (30.4)
Relationship status^#, n (%)				<0.001
Married	20 (17.4)	6 (10.2)	14 (25.0)
Separated	7 (6.1)	6(10.2)	1 (1.8)
Single, ever had romantic partner	76 (66.1)	46 (78.0)	30 (53.6)
Single, never had romantic partner	12 (10.4)	1 (1.7)	11 (19.6)
Children^$, n (%)				0.195
No	92 (76.7)	43 (71.7)	49 (81.7)
Yes	28 (23.3)	17 (28.3)	11 (18.3)
Experienced physical violence^$, n (%)				0.105
No	34 (28.3)	13 (21.7)	21 (35.0)
Yes	86 (71.7)	47 (78.3)	39 (65.0)
Experienced sexual violence^$, n (%)				<0.001
No	56 (46.7)	14 (23.3)	42 (70.0)
Yes	64 (53.3)	46 (76.7)	18 (30.0)

^$ Measured at baseline (Time 0) among all 120 youth enrolled.

Measured at the eight-week follow-up visit (Time 2) among 115 youth who were followed-up until the end of the study

*P-values from chi-square tests or Fisher’s exact test for proportions or two-sample t-test for means

Figure 3. Flow diagram of refugee youth through the Ngutulu Kawero study from enrolment to the eight-week follow-up visit in a humanitarian setting in Uganda.

Table 2. Distribution of sexual violence prevention and post-rape clinical care outcomes before, directly after and approximately eight weeks after the intervention, among Ngutulu Kagwero participants, Bidi Bidi, Uganda (n = 115).

Outcome	Pre-workshop	Post-workshop	Follow-up
Total (n)	115	115	115
PEP knowledge, n (%)
No	46 (40.0)	1 (0.9)	0 (0.0)
Yes	69 (60.0)	114 (99.1)	115 (100.0)
PEP acceptance, n (%)
No	10 (8.7)	2 (1.7)	0 (0.0)
Yes	105 (91.3)	113 (98.3)	115 (100.0)
Slaby bystander efficacy scale, median (IQR)	29 (27, 33)	33 (28, 35)	31 (29, 32)
Banyard readiness to change scale
Contemplation, mean (SD)	6.8 (1.0)	6.5 (1.2)	6.4 (1.2)
Action stage, mean (SD)	3 (0.8)	3.5 (0.6)	3.4 (0.6)
Sexual violence stigma scale, mean (SD)	2.5 (0.4)	2.4 (0.4)	2.3 (0.4)
Depression,* n (%)
Negative	26 (22.6)	–	77 (67.0)
Positive	89 (77.4)	–	38 (33.0)
Brief resilient coping scale,* mean (SD)	12.9 (1.7)	–	13.4 (3.1)

*The PHQ-2 for depression and brief resilient coping scale were only collected at Time 0 and Time 2.

Table 3. Crude and adjusted models for post-rape clinical care and sexual violence prevention outcomes among Ngutulu Kagwero participants, Bidi Bidi, Uganda (n = 115).

		Unadjusted model			Adjusted model**
Outcome*	Time period	β	95%CI	p-Value	β	95%CI	p-Value
Bystander efficacy
	Before workshop	Ref			Ref
	After workshop	2.1	1.6, 2.6	<.001	2.1	1.6, 2.6	<.001
	Follow-up visit	1.2	0.4, 1.9	.002	1.2	0.4, 1.9	.002
Readiness to change – precontemplation
	Before workshop	Ref			Ref
	After workshop	−0.1	−0.3, 0.1	.401	−0.1	−0.3, 0.1	.401
	Follow-up visit	−1.9	−2.3, −1.4	<.001	−1.9	−2.3, −1.4	<.001
Readiness to change – contemplation
	Before workshop	Ref			Ref
	After workshop	−0.2	−0.5, 0.03	.086	−0.2	−0.5, 0.03	.086
	Follow-up visit	−0.4	−0.7, −0.1	.004	−0.4	−0.7, −0.1	.004
Readiness to change – action
	Before workshop	Ref			Ref
	After workshop	0.4	0.3, 0.6	<.001	0.4	0.3, 0.6	<.001
	Follow-up visit	0.3	0.1, 0.5	<.001	0.3	0.1, 0.5	<.001
Sexual violence stigma
	Before workshop	Ref			Ref
	After workshop	−0.1	−0.2, −0.05	.001	−0.1	−0.2, −0.05	.001
	Follow-up visit	−0.2	−0.3, −0.1	<.001	−0.2	−0.3, −0.1	<.001
Resilience
	Before workshop	Ref			Ref
	Follow-up visit	1.0	0.6, 1.4	<.001	1.0	0.6, 1.4	<.001
			Unadjusted model			Adjusted model**
Depression^^	Time period	Odds ratio (OR)	95%CI	p-Value	Adjusted OR	95%CI	p-Value
	Before workshop		ref			ref
	Follow-up visit	0.1	0.1, 0.2	<.001	0.1	0.1, 0.2	<.001

*A GEE linear regression model was run for each outcome listed.

**Adjusted for gender and age.

^{^} A GEE logistic regression model was run for depressive symptoms.