Impacts of Clean Cookstoves and Empowerment Training on Women's Health in Refugee Settings

Not Applicable

Completed

• Conditions: Gender-based Violence; Adherence; Empowerment; Relationship, Family; Mental Health Wellness 1; Food Insecurity
• Interventions: Behavioral: I-ACT (Individual, Agency-Centered Training) workshop; Device: Inyenyeri clean cookstove and fuel system

• Registration Number: NCT04081441
• Lead Sponsor: Johns Hopkins Bloomberg School of Public Health

Brief Summary

The main objective of this study is to understand the links and outcomes of adoption of a cleaner cookstove/fuel and exposure to a personal empowerment training on women's health outcomes in a Congolese refugee camp in Rwanda, with a focus on gender-based violence (GBV).

Detailed Description

This randomized controlled trial examines the impacts of a phased-in integrated technology -behavior change intervention on women's health with a focus on gender-based violence. In a population of approximately 1500 Congolese households in Kigeme refugee camp in Rwanda, two interventions are randomly deployed in the camp. The first intervention is the Inyenyeri cookstove/pellet fuel system, a Tier 4 clean cookstove system; the second intervention is a behavior change intervention (referred to as I-ACT, Individual-Agency-Centered Training) designed to foster personal agency and empowerment, given to women and, if applicable, their male partner. Analyses will be done with interviews on 1500 women (ages 18-45) from these households that may have received one, both or none of the interventions, either as the full sample or the sub-sample of partnered-only women.

Study Timeline

• Study Start: 2018-08-01
• Study First Submitted: 2019-08-05
• Study First Submitted QC: 2019-09-04
• Study First Posted: 2019-09-09
• Primary Completion: 2019-12-30
• Study Completion: 2020-12-31
• Status Verified: 2022-08
• Last Update Submitted: 2022-08-09
• Last Update Posted: 2022-08-10

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Female
• Target Recruitment: 1555

Inclusion Criteria

• Study participants are between the ages of 18 years - 45 years of age
• Reported as currently living in a refugee camp with no intention to relocate
• Has lived in any refugee camp for at least 1 year and can be interviewed in private
• Has the ability to give informed consent

Exclusion Criteria

• Inability to provide informed consent
• Individuals having evidence of significant illness and/or are not able to engage fully in the surveys
• Women younger than 18 or over 45 years of age
• Those who have not lived continuously in a refugee camp setting for the past 12 months
• If two or more women live in a household, only one of these will be included in the study. The one responsible for fuel purchase/collection will be selected. If more than one woman is responsible for fuel collection, we will randomly choose one woman to participate in the study.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
I-ACT behavioral empowerment intervention	I-ACT (Individual, Agency-Centered Training) workshop	A culturally adapted 2-day personal empowerment workshop (based on the Individual, Agency-Centered Training (I-ACT) to women and modified, condensed 1-day training for their male partners, if applicable
Cookstove and I-ACT empowerment	Inyenyeri clean cookstove and fuel system	Access to both the clean cookstove system and I-ACT empowerment training
Cookstove and I-ACT empowerment	I-ACT (Individual, Agency-Centered Training) workshop	Access to both the clean cookstove system and I-ACT empowerment training
Inyenyeri clean cookstove/fuel	Inyenyeri clean cookstove and fuel system	A tier 4 clean Mimi-moto cookstove/pellet system
I-ACT Waitlisted control	Inyenyeri clean cookstove and fuel system	These households include those that were offered cookstoves after 6 months (from baseline) and are waitlisted to receive the I-ACT intervention

Primary Outcome Measures

Name	Time	Method
Number of participants reporting increased economic and social empowerment	6 months	Change in rates of reported uptake of economic activities (such as small businesses or savings) as well as participation in social groups and local training programs
Number of participants reporting increased self-efficacy	6 months	Changes in self-efficacy (as assessed by the New General Self-Efficacy Scale) as a result of the empowerment intervention.
Number of participants reporting anxiety and depression	6 months	Changes in the number of participants reporting anxiety and depression as determined by the Hopkins Symptom Checklist (HSCL) as a result of the empowerment intervention.
Number of participants reporting reduced food insecurity	6 months	Change in reported incidence and severity of food insecurity as determined through a culturally adapted modification of the food insecurity experience scale (FIES) associated with food-related distress during the past month
Rates of gender-based violence	6 months	Change in gender-based violence (GBV) over time as assessed through an adapted ASIST-GBV screening tool to identify physical violence, sexual violence, harassment, emotional violence and reproductive coercion between non-partners and intimate partners in humanitarian settings.
Number of participants reporting increased social agency	6 months	Changes in social agency (as assessed by Ryff's psychological well-being scales) as a result of the empowerment intervention.
Number of households reporting uptake and consistent use of clean cooking system and fuel	6 months	Change in uptake and use of the clean cooking system as measured through pellet purchase and reported pellet use behavior
Number of participants reporting minor psychiatric disorders	6 months	Changes in the number of participants reporting minor psychiatric disorders as determined by the General Health Questionnaire (GHQ-12) as a result of the empowerment intervention.
Number of participants reporting emotional symptoms of trauma	6 months	Changes in the number of participants reporting emotional symptoms of trauma as determined by the Harvard Trauma Questionnaire (HTQ) as a result of the empowerment intervention.
Number of participants reporting increased grit	6 months	Changes in grit (Grit scale (Duckworth, et al)) as a result of the empowerment intervention.

Secondary Outcome Measures

Name	Time	Method
Number of participants reporting increased quality and quantity of social networks	6 months	Changes in quality of social networks in the form of network size, network density and stove homophily resulting from either the empowerment training or the improved cookstove program as determined by reported social ties and characteristics of those social ties.

Trial Locations

Locations (1)

Plan International, Rwanda; 🇷🇼 Kacyiru, Kigali, Rwanda