This case study series documents the experience of R2HC-funded research teams in engaging with people affected by crisis. The full case series can be found here.

STUDY BACKGROUND

Exploring refugee adherence to COVID-19 guidelines in Uganda

Project partners for this study were Gulu University, Uganda, Lutheran World Federation (LWF), Agency for Cooperation in Research and Development, Uganda (ACORD-U), Ministry of Health, Uganda.

A rapid, mixed-methods cross-sectional methodology was used to:

1. assess knowledge, attitudes, practices and perceptions of risk related to COVID-19;
2. describe the implementation of, and feasibility and adherence to, COVID-19 preventative measures; and
3. identify and assess existing community resources, systems and their efficacy in the COVID-19 response.

The study team found that knowledge of COVID-19 was high, but that there were some harmful myths and perceptions of risk. Adherence to preventative measures was also observed to be in decline. The study team was able to use this knowledge to inform policy, raise community awareness and develop behavioural change resources.

This case study draws from discussions with the Refugee Lived Experiences, Knowledge and Thinking (REFLECT) study team.

ENABLERS TO THE ENGAGEMENT OF PEOPLE AFFECTED BY CRISES

Several factors enabled more meaningful participation throughout each stage of the research. These included: intentionality of participation during the design phase, community leadership during research activities, and the importance of adaptation and iterative changes based on initial findings.

“This research positions refugees at the centre, highlighting issues most meaningful and positively transformative for them. We need to listen, learn and then act, acknowledging refugees’ agency and ‘nothing about us without us” – Gloria Seruwagi, PI

DESIGN PHASE

Access to intended participants

Direct access to intended participants was considered essential. The study team partnered with humanitarian organisations to achieve this, as access was otherwise limited via the lead academic institution.

Assumptions: From theory to reality

The study team visited the targeted settlements to ground theoretical aspects, such as the sample size and selection, and whether to use certain methodological approaches such as computer-assisted personal interviewing (CAPI). In doing so, feedback was provided in relation to the structure of households, locations, and other practicalities. This was particularly important due to the absence of comprehensive household lists from which to develop a sampling frame.

“We knew the theoretical aspects, but we had to take our assumptions to the community. We were aware that the community had their own catalogue of experiences, including challenges. We were trying to open up research to them, questioning what was happening and creating something including tools to demystify the research process.”
– Dr Eric Awich Ochen, Co-Investigator

Participation of community members during the study launch

Members of the diverse refugee settlements attended the study launch event in Kampala, along with community leaders. Refugee representative attendance at such events is often rare, given barriers to attendance including distance from the rural settlements and transport costs. The study team were intentional about reducing barriers to attendance by supporting transport and by making space so that community members could meaningfully speak and engage. When some preliminary findings were shared, community members were able to respond to media and other questions, and a vibrant discussion ensued.

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“Representatives’ usually means the leaders – the same faces. We were intentional about community members attending along with leaders of the settlements, and that typically overlooked groups should also be present.”
– Dunstan Paul Ddamulira, Co-Investigator

Direct answers from the community provided an authenticity to the study’s initial findings, and ensured communities were centred in the conversation.

IMPLEMENTATION PHASE

Mapping people and places

Prior to the initiation of data collection, humanitarian partners and community leaders helped the study team to identify relevant systems and structures. Key informants were identified, who helped the study team to map available resources and other people. Of note, 2020 was a political campaign period, which meant that the study team could not readily meet with certain key actors, especially those involved in politics. Nevertheless, community members highlighted the importance of this group and helped to identify individuals.

Community leadership in research activities

Communities led on mobilisation, while the study team remained mindful of the potential for bias, and the need to incorporate community views while ensuring scientific rigor. Community guides – individuals with a strong understanding of the local context and a background in research – led on logistical components alongside humanitarian partners.

“We’ve all had experience conducting research and realising it has been a short extractive visit. In this case, it was different and felt like it was the community leading the study”
– Dr Denis Muhangi, Co-Investigator

A ‘citizen science’ approach was adopted, with community members advising on the feasibility of different aspects. The research team’s approach was ultimately a fusion between citizen science, action research and implementation science.

Humanitarian partners were encouraged to lead on logistical elements, with training and voluntary participation emphasized to ensure communities in the partners’ catchment areas did not feel obliged to participate.

“We bought a few masks to use as a demonstration – we also highlighted that the community had the skills and resources to make their own masks. We discussed proper use of the masks. We wanted to draw on the knowledge and resources within the community. You’ll now go into the community and see lots of masks in beautiful fabrics. Enthusiasm continued to grow as the threat of COVID-19 became more apparent. Local solutions made communities feel validated – and their resources activated – through the research. Let the locals lead the way. If you do that, the key questions will not be a big problem.”
– Andrew Masaba, Co-investigator

Iterative changes from initial study plans

Importantly, as data collection progressed, the study team identified other groups they wanted to approach. For example, children had not originally been incorporated, yet school closures had created several issues, including concerns related to teenage pregnancy. Ethical approval was adapted to support the inclusion of children and young people below the age of 18.

These adaptations were made easier by the rapport that the study team had developed in communities during the design phase. For example, with a better understanding of relationships in the household, researchers were able to ask more readily to speak to children.

POST-IMPLEMENTATION PHASE

Village health teams, leaders, and chairpersons were involved, and they were able to disseminate findings within their communities. This included door-to-door visits, at the gatherings that were permitted at this time, at humanitarian partner offices within the settlements and via radio talk shows.

As actionable changes were identified during the research process, the study team were able to engage in sensitisation during the dissemination and validation stages.

“We wanted to keep the conversation going. We were intentional about using our research as a catalyst to support action that would outlive the research itself. R2HC availed us the opportunity to engage further, based on the gaps identified during the data collection phase. It gave us the opportunity to continue engaging with the community when the COVID-19 trajectory had changed”
Gloria Seruwagi, PI

FIND OUT MORE

To find out more about this research, please see the study profile.

You can also visit the study homepage.

ACKNOWLEDGEMENTS

Thank you to Gloria Seruwagi, Eric Awich Ochen, Dunstan Paul Ddamulira, Denis Muhangi and Andrew Masaba for their expertise and reflections.