A quasi-experimental study design, using before and after evaluation of study participants for a participatory, gender based, community-led Gender Action Learning Systems (GALS) intervention included qualitative and quantitative data collection among the enrolled urban refugees in the SRH study for the period between May 2018 to October 2019. The data were collected in the capital of Uganda Kampala and specifically in the areas of Katwe, Makindye, Masajja and Namuwongo where the refugees reside. The project enrolled 867 participants to train and learn using the GALS empowerment approach in the participants’ neighbourhoods to deliver SRH including family planning services to urban refugees in Kampala between Marc 2018 and September 2019. The training included building sustainable capacity among urban refugees through peer CHWs that contributed to individual reflections about human needs, taking on collective action to solve communal SRH and life challenges, and gender advocacy for change and community awareness. Urban refugees enrolled in GALS were interviewed at the beginning and end of the GALS intervention when both qualitative and quantitative data were collected. Univariate, bivariate, and multivariate analyses were conducted to determine social demographic factors influencing the uptake of SRH services by urban refugees.
Data were collected among urban refugees residing in the Kampala and Wakiso districts who consented to participate in the GALS project. The inclusion criteria focused on refugees who consented to voluntarily participate in the study, aged 15 years and above, and residing in the urban areas of Kampala and parts of Wakiso districts.
During data collection, a list of enrolled study participants and geographical locations where these urban refugees reside was generated. These data included the responses of people from South Sudan, Burundi, Somalia, Rwanda and Congo. Identification of participants was made possible through CHWs who were study contacts and were members themselves of the refugee community they represented.
The measurement for SRH services in this study were Family Planning (FP) use and use of health facilities for STI services.
Data collection procedure
Data were collected by three research assistants who spoke at least one of the refugee languages, including Swahili, French, and Arabic. Structured study questionnaires were used that had been translated into the three major languages. The questionnaire was also translated to local languages and translated back to English by a different person to ensure consistency and accuracy. Data were collected electronically using the programmed Open Data Kit (ODK) tool. This system allowed offline data collection that could be uploaded on the server at the end of every day. Using these mobile data collection tools on Tablets, data were collected at the start of the GALS project and at the end of project implementation one year later. The data collected included demographic information about the participants, data about reproductive health such as, sexually transmitted infections, family planning services and practices and gender justice.
Descriptive summary statistics were conducted for both baseline and endpoint on the characteristics of the study participants. Tests for proportions and chi square tests were used to compare pre and post intervention periods. This was done in order to identify the effect of the intervention for training CHWs to use the GALs approach for reaching urban refugees in an effort to improve utilization of SRH and FP services. Logistic regression analysis was conducted to identify predictors associated with access to SRH services by urban refugees. Multiple regression models were generated in order to explore the effects of different characteristics of the study participants on FP use. A logistic regression model was generated to investigate the effect of gender on FP use, adjusted for age, and vice versa. A model was generated to investigate the effect of religion on FP use adjusted for education level. Additional regression models were generated to investigate the effect of country of origin and education level on FP use and these factors were both adjusted for religion. Finally, in order to control for the confounding effect of multiple variables, all factors gender, religion, country of origin and education level were, all adjusted for age group.
The study ethical clearance and approval was obtained from the Mildmay Uganda Research Ethics committee approval ref number: RECREF # 0206-2018 and then research permit from Uganda National Council for Science and Technology SS4795. The study also received official approvals from the Ministry of Health, Kampala Capital City Authority and Office of the Prime Minister responsible for taking care of refugees in Uganda. During the introduction, the purpose of the study was explained to the participants and written informed consent was received before the commencement of data collection. Confidentiality of the shared information and participants was ensured through using participant unique identifiers and by only designated study personnel accessing and identifying data on the participants. Participation in the study was voluntary and people could withdraw at any time.