Acceptability and feasibility of CHANGE, a non-specialist worker delivered intervention to address alcohol use disorders and psychological distress among conflict-affected populations in Uganda: a qualitative study

Introduction

CHANGE is a psychological intervention designed using a systematic intervention development process for addressing the needs of men with co-existing psychological distress and alcohol use disorders (AUD) in conflict-affected settings. The aim of this study in Uganda was to understand experiences of those who delivered and received the intervention to inform contextually relevant adaptations before testing its cost-effectiveness in a randomised controlled trial.

Methods

The study was implemented in the Rhino Camp refugee settlement in Northern Uganda. We conducted three sequential sets of 10 individual semi-structured in-depth interviews each with (a) adult (≥18 years) men with hazardous/harmful drinking and psychological distress who received the CHANGE intervention, and (b) non-specialist workers (NSWs) who delivered the CHANGE intervention. Thematic analysis was used to analyse the data.

Results

The experiences of the men with hazardous/harmful drinking and NSWs were broadly consistent with each other. The participants found the knowledge and skill acquisition related to alcohol use, and the intervention materials such as handouts useful. Feasibility of the intervention was enhanced by its structured nature with in-built flexibility, and intervention content was perceived as easily comprehensible. On the other hand, the loss of potential earnings due to time spent in the sessions was a barrier to attendance. The intervention was perceived to result in reduced drinking and improvement in related activities such as sleep, appetite, and social relationships. Some of the perceived mechanisms for change included distraction and strengthening of supportive social networks. The day-to-day challenges of life in a refugee camp were a common barrier to changing drinking behaviour despite receiving the intervention.

Conclusion

If proven to be effective, the acceptability and feasibility of CHANGE makes it a potentially scalable intervention in low resource settings with shortage of specialist healthcare professionals. The intervention may have the potential to be integrated with other programmes of care that can address additional adversities that the population may face in the setting.