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3.66 MB PDF version

Measuring Psychosocial Wellbeing
in Democratic Republic of Congo
Report of a Pilot Study
Working Paper No. 4
April 2014
Rebecca Horn
The International Bank for Reconstruction and Development / The World Bank
1818 H Street, NW
Washington, DC 20433
All rights reserved
First published March 2014
www.logica-wb.net
This Working Papers Series disseminates the findings of work in progress to encourage discussion and
exchange of ideas on gender and conflict related issues in Sub-Saharan Africa. Papers in this series are not
formal publications of the World Bank. The papers carry the names of the authors and should be cited accordingly. The series is edited by the Learning on Gender and Conflict in Africa (LOGiCA) Program of the
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This paper has not undergone the review accorded to official World Bank publications. The findings, interpretations and conclusions herein are those of the author and do not necessarily reflect the views of the
International Bank for Reconstruction and Development/World Bank and its affiliated organizations, its
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To request further information on the series, please contact [email protected] LOGiCA. Papers are also
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Cover and layout design: Duina Reyes
Photos provided by World Bank photo library and United Nations photo library
Measuring Psychosocial Wellbeing
in Democratic Republic of Congo
Rebecca Horn
Working Paper No. 4
April 2014
Table of Contents
Executive Summary.................................................................................... 3
Methodology & Findings............................................................................................................ 3
Conclusions................................................................................................................................ 5
A. Introduction.......................................................................................... 6
Background................................................................................................................................ 6
Objective.................................................................................................................................... 8
Process of developing the assessment tool.................................................................................... 8
B. Phase 1: Qualitative Study..................................................................... 9
Methodology.............................................................................................................................. 9
Analysis of data......................................................................................................................... 11
Review draft interview schedule with key people and revise...................................................... 12
Translation of the interview schedule........................................................................................ 12
C. Phase 2: Informal Testing.................................................................... 14
Description of the draft psychosocial wellbeing tool.................................................................. 14
D. Phase 3: Formal Testing of the Draft Tool to Measure
Psychosocial Wellbeing............................................................................ 16
Assessing validity and reliability of a tool to measure psychosocial wellbeing............................. 16
Description of process............................................................................................................... 17
Ethical issues............................................................................................................................. 17
Description of participants........................................................................................................ 18
Review and revision of items..................................................................................................... 18
E. Summary and Conclusions.................................................................. 22
F. References............................................................................................ 24
Annex 1. Schedule of activities................................................................. 27
Annex 2. Research tools for qualitative study (Phase 1)........................... 29
Annex 3. Policies and Practical Guidelines.............................................. 33
Annex 4. Code of conduct........................................................................ 35
Annex 5. Code of Conduct (French)........................................................ 37
Annex 6. Informed consent for Phase 1................................................... 39
Annex 7. Summary of findings from qualitative study (Phase 1).............. 40
Annex 8. Draft assessment tool for testing............................................... 45
Annex 9. Draft assessment tool for testing (French)................................. 59
Measuring Psychosocial Wellbeing in Democratic Republic of Congo
1
Annex 10. Draft assessment tool for testing (French)............................... 75
Annex 11. Preparation of database........................................................... 83
Annex 12. Review and revision of items................................................... 85
Annex 13. Final version of psychosocial wellbeing assessment
tool (English)........................................................................................... 89
Annex 14. Data entry guide and database preparation........................... 105
2
Executive Summary
S
ince it began operating in the 1990s in
northern Uganda, the LRA has inflicted
enormous suffering on millions of civilians
in several countries of the Great Lakes and Central
African regions. In the 1990s and early 2000s, successive Ugandan People’s Defence Force (UPDF)
operations in northern Uganda largely drove the
LRA into the DRC and what is now South Sudan,
and after 2008, into the CAR.
Armed conflict negatively affects women and men
in different ways and results in gender-specific disadvantages which are not always recognized or addressed in mainstream conflict and reconstruction
programs and policies. The ‘Learning on Gender
and Conflict in Africa’ Program (LOGiCA) aims
to increase gender-specific programming in postconflict Sub-Saharan Africa, with a focus on demobilization and reintegration (D&R) in the
Great Lakes region (GLR), and gender specific
issues arising from armed conflict including psychosocial aspects.
During 2011, a LOGiCA initiative sought to develop tools to measure psychosocial wellbeing for
the specific population of conflict-affected women
in the Acholi sub-region of Northern Uganda. The
initiative served to develop: (i) a measure of psychological wellbeing based on local understandings of psychosocial wellbeing & psychological
distress, (ii) a measure of social connectedness,
(iii) a measure of empowerment, and (iv) various
measures of factors hypothesised to influence the
psychological wellbeing of women in Northern
Uganda. The tools were subsequently piloted and
tested in the context of a pilot project designed
to strengthen women’s economic associations in
Northern Uganda implemented by the Transitional Demobilization and Reintegration Program
(TDRP).
The aim of the current project is to replicate this
work in LRA-affected areas of DRC, by developing locally relevant tools to measure psychosocial
well-being among conflict-affected women in the
Orientale province in DRC
Methodology & Findings
The development of the tool took place in three
phases: (1) a qualitative study designed to develop
the necessary understanding of the concepts to be
included in the tool; (2) an informal testing process; and (3) a formal testing phase.
Six research assistants were recruited and participated in training and data collection throughout
the period of the development of this tool.1
PHASE 1: QUALITATIVE STUDY
Three methods were used to collect the information required to develop the assessment tools, in
addition to a review of the literature and of relevant surveys/ assessment tools developed for the
DRC context:
1) Group discussions (with 2 groups of community members, 2 groups of members of
women’s groups, and 2 groups of community leaders): A group discussion methodology
was used to develop: (a) a list of all the groups
that women can be involved in, as members
and/ or as leaders; (b) a list of all the community activities that women can take part in;
and (c) an understanding of what ‘empowerment’ means for women in this context.
2) Freelisting (52 respondents): the freelisting
methodology (asking people one or more
standardised questions to generate a list) was
used to collect data which would be used to
develop a measure of current events/ circumstances which may contribute to psychological distress.
1 MDF Management and Consultancy partnered with LOGiCA to
manage the data collection in field
3
3) Case study interviews (44 respondents): this
methodology (which involves respondents
telling us about a woman they know who
has suffered emotionally but has recovered,
and another who has suffered emotionally
but has not recovered) was used to develop
a measure of psychological distress and measures of events and circumstances that contribute to psychological distress.
On the basis of these four types of information,
an interview schedule was designed to assess the
key elements of psychosocial wellbeing in this
context, plus some background and contextual
factors. This was translated into French and backtranslated into English and any discrepancies in
the translation were resolved.
In addition, the tool included a number of demographic factors and information about the woman’s economic situation, as well as her experience
of events and situations which may have an impact on psychosocial wellbeing. These include a
checklist of distressing events experienced during
the conflict; experience of displacement; various
aspects of the woman’s current life situation which
may contribute to her psychosocial wellbeing; and
her experience of domestic violence.
PHASE 3: FORMAL TESTING
The six research assistants tested out the interview
schedule informally with five people each. Their
feedback led to further revisions of the tool.
The general aim of the formal testing phase of the
project was to test out the effectiveness of the psychosocial assessment tool and revise it so it could
be used to assess the psychosocial wellbeing of
women living in the eastern part of DRC which is
affected by LRA activity. The specific questions to
be addressed included:
The draft version of the tool which was produced
at the end of this process consisted of:
• Are the items appropriate/ readily understood?
(Acceptability/ usability)
• Four measures of social connectedness:
2) Involvement in community activities
over the previous one month (9 items)
• Does the psychological distress scale distinguish between those who are psychologically
distressed and those who are not, as identified
by key community members? (Discriminant
validity)
3) Confidence that one could get help from
others in a crisis (3 items)
• Are the various scales internally consistent?
(Internal reliability)
4) A measure of various forms of support
received from others over the last one
month (12 items)
• Do people respond consistently to the measure as a whole? (Test-retest reliability)
PHASE 2: INFORMAL TESTING
1) Involvement in community groups
• One 19-item measure of psychological distress.
• Three measures of empowerment:
1) Leadership roles held
2) A measure of a number of behaviours
which indicate empowerment for women
(7 items)
3) A measure of the woman’s power/ influ-
4
ence within the marriage relationship (9
items)
In order to test the reliability and validity of the
psychological distress and the social connectedness
parts of the interview schedule, these sections were
administered to a sample of 100 women from the
Dungu area.
These women had previously been identified by
community leaders as either showing signs of psychosocial distress (N=50) or showing no signs of
psychosocial distress (N=50), with their categorisation being confirmed by the data collection team
leader and a psychologist from Caritas. The aim
was to find out whether the psychological distress
section of the interview was able to distinguish between these groups of women. This is an accepted
way of assessing validity, in the absence of a ‘gold
standard’ (professional diagnosis of psychological
problems).
The interviews were conducted either in French or
in Lingala, without the research assistant knowing
how the respondent had been categorised. Twenty-two respondents were chosen at random for reinterview 2-3 days after the first visit, to assess the
test-retest reliability of the tool.
The analysis of data enabled the psychometric
properties of items and scales to be reviewed, and
revisions to be made. The psychometric properties
of the revised scales were then assessed:
• The revised version of the psychological distress scale was found to have acceptable internal consistency and was able to distinguish
between women identified as having psychosocial problems and those identified as having
no such problems. Therefore, it is possible to
have some confidence in the scale as a measure
of psychological distress with this population.
• The measures of social connectedness were related to each other in predictable ways, other
than the measure of ‘confidence in a crisis’.
There is good evidence that the measures of
involvement in social networks and community activities, along with the measure of supportive relationships, are tapping into a single
underlying concept, which can be called social connectedness. There is less evidence for
the validity of the measure of ‘confidence in
a crisis’.
• There is no relationship between the three
measures of empowerment, which suggests
they are measuring different aspects of women’s lives. However, those who are less empowered in their marriage were also found to
experience higher levels of domestic violence,
which is an indication that they are measuring
a common factor. The three measures were
found to be internally consistent. It seems
that they are measuring different aspects of
women’s lives, which all contribute to empowerment but do not form a single underlying
concept. However, all three appear to be reliable measures in themselves.
The majority of sections had very good levels of
test-retest reliability. The high level of stability in
responses to the questions in these sections over
time indicates that the respondents understood
the questions they were asked and responded in a
consistent way. This increases confidence that the
interview schedule will provide reliable information about these aspects of psychosocial wellbeing.
The exception to this is the measure of psychological distress, which has poor test-retest reliability,
and that of the domestic violence scale is also relatively low.
Conclusions
The results of the pilot study indicate that the psychosocial assessment tool has good reliability and
validity with this population, although there are
some concerns about two sub-scales: the ‘psychological distress’ measure and the ‘confidence in a
crisis’ measure. Since even these two scales demonstrated good psychometric properties in all but
one aspect, it is not recommended to remove them
at this stage. However, they should be used tentatively, and ideally a qualitative study would be
conducted to explore the reasons for the poor testretest reliability of the psychological distress scale,
and the lack of relationship between the ‘confidence in a crisis’ measure and the other measures
of social connectedness.
It is also recommended that the lack of relationship
between the ‘empowerment’ sub-scales is explored
further. Each ‘empowerment’ measure has good
psychometric properties, but they were expected
to be related in some way, and this was found not
to be the case.
In summary, the tool can be recommended for use
as a measure of psychosocial wellbeing of women
in the north-eastern part of DRC, but the properties of the sub-scales identified above should continue to be explored.
5
A. INTRODUCTION
Background
Since it began operating in the 1990s in northern
Uganda, the LRA has inflicted enormous suffering
on millions of civilians in several countries of the
Great Lakes and Central African regions. In the
1990s and early 2000s, successive Ugandan People’s Defense Force (UPDF) operations in northern Uganda largely drove the LRA into the DRC
and what is now South Sudan, and after 2008,
into the CAR. Several initiatives were undertaken
to peacefully resolve the conflict, including efforts
to facilitate a negotiated settlement between 2006
and 2008.
In March 2008, after months of intensive efforts
by regional and international stakeholders to bring
the conflict to an end, representatives of the Government of Uganda and the LRA finalised the
Peace Agreement. However, LRA leader Joseph
Kony refused to sign the Agreement and in December 2008, Uganda and the DRC launched
joint military operations (Operation Lightning
Thunder) against the armed group. While these
operations dislodged the LRA from several parts
of the DRC, they also had severe humanitarian
consequences and many of the civilians affected
remain displaced.
Following these military operations, which officially ended in March 2009, the LRA is believed to
have fragmented into several highly-mobile groups
operating across a wide area, from Aba in Haut
Uele district across to Ango in Bas Uele district in
the DRC; from Birao in Vakaga prefecture to Obo
in Haut Mbomou prefecture in the CAR; and into
Western Equatoria and occasionally Western Bahr
el Ghazal states in South Sudan.
Following Operation Lightning Thunder, the national security forces of the DRC, the CAR and
South Sudan have continued to conduct military
6
operations against the LRA in the affected areas of
their respective countries. In particular, the UPDF,
with the agreement of the relevant Governments
and with logistical support from the United States
of America, has conducted joint military operations in the CAR, the DRC and South Sudan.
These operations have significantly reduced the
strength and operational capacity of the LRA over
the past three years. Despite the relative success
of the military operations, the group continues to
pose a serious security threat to civilians, as the capacity of the national security forces in the affected
countries is limited.
The LRA’s indiscriminate attacks on civilians constitute serious violations of international humanitarian and human rights law and have caused a
serious humanitarian crisis in the affected countries. An estimated 2.5 million people have been
displaced by the LRA, either internally or across
borders, in Uganda, South Sudan, DRC and CAR
over the last 30 years. As of June 2013, more than
440,000 persons were displaced in the central African region due to the LRA; 319,000 were displaced in the DRC alone (Titeca, Vlassenroot &
Wissing, 2013).
LRA attacks, committed with impunity, have typically included killings, abductions (especially of
children and women), recruitment of and use of
boys and girls as combatants and in other roles,
sexual violence including rape and sexual slavery,
forced marriage, mutilations, looting, and the destruction of property. Many women who were abducted and used as sex slaves face stigmatization
and great difficulties in reintegrating in their communities of origin.
Armed conflict negatively affects women and men
in different ways and results in gender-specific disadvantages which are not always recognised or addressed in mainstream conflict and reconstruction
programs and policies. The ‘Learning on Gender and Conflict in Africa’ Program (LOGiCA)
aims to increase gender-specific programming
in post-conflict Sub-Saharan Africa, with a focus
on demobilisation and reintegration (D&R) in
the Great Lakes region, and gender specific issues
arising from armed conflict including psychosocial
aspects.
Psychosocial considerations in conflict-affected
contexts
Prolonged conflict and displacement such as that
experienced in the LRA-affected area erodes normally protective supports, and increases the risk of
diverse psychosocial problems. The Psychosocial
Working Group (2003) has identified three key
domains through which these effects can be understood. Firstly, human capacity may be reduced
when people become depressed, withdraw from
social life or become physically disabled; and the
feeling of having less control over events and circumstances may contribute to people feeling less
able to meet the challenges they face. Secondly,
conflict often leads to disruption of the social ecology of a community, where relations between families and peers change, or where religious and civic
organisations find it difficult to function. Thirdly,
the culture and values of communities may be disrupted when common values are challenged and
human rights are violated. It may become more
difficult for people to follow cultural traditions
that have previously provided a sense of unity and
identity to communities. The loss of material and
economic resources of households, the disruption
of infrastructure at local and regional levels, and
the degradation of the environment all have an
important impact on psychosocial well-being.
Women’s experiences of conflict differ qualitatively
from that of men. To some extent, this is a function of their experience of the conflict itself, which
can include not only being targets and victims of
armed groups in communities, but also serving as
combatants, in supportive and domestic roles, and
as sexual slaves and ‘wives’ (Annan & Brier, 2010).
Women and girls are at increased risk of sexual and
gender based violence (SGBV) during and after a
war, but conflict also impacts on women differently to men due to their social position and role,
and dominant gender discourses (Sideris, 2003;
Deacon & Sullivan, 2010). In many communities, women’s relative lack of power limits their
access to protective social and material resources,
so ‘the emotional response and loss of social belonging/identity, will be felt differently by men
and women’ (Sideris, 2003: 722). In some conflict and post-conflict settings (e.g. Afghanistan,
Lopes Cardozo et al, 2005; Sudan, Roberts et al,
2010), women have been found to report higher
rates of mental illness and psychological distress
than men.
In the LRA-affected area, there have been a range
of crimes committed against women, girls and
children by perpetrators of the war such as rebels, paramilitary groups, and some male relatives
among others. These crimes include abductions,
killings, mutilations, rape, torture, sexual slavery
and domestic violence.
There are, however, significant gaps in locally
appropriate, culturally sensitive techniques to
measure psychosocial well-being among specific
populations and within specific localities of the
LRA-affected area. During 2011, a LOGiCA initiative sought to develop such tools for the specific population of conflict-affected women in the
Acholi sub-region of Northern Uganda. The initiative served to develop: (i) a measure of psychological wellbeing based on local understandings of
psychosocial wellbeing & psychological distress,
(ii) a measure of social connectedness, (iii) a measure of empowerment, and (iv) various measures
of factors hypothesised to influence the psychological wellbeing of women in Northern Uganda.
The tools were subsequently piloted and tested in
the context of a pilot project desgined to strengthen women’s economic associations in Northern
Uganda implemented by the Transitional Demobilization and Reintegration Program (TDRP).
The aim of the current project is to replicate this
work in DRC.
Context in DRC
The LRA’s presence in north-eastern DRC has
been concentrated in the districts of Haut-Uele
and Bas-Uele, which make up two of the four
7
districts of Orientale province. LRA attacks in
DRC have been reported mainly in Haut Uele,
but also in Bas Uele, particularly north of Ango.
These have included large-scale massacres, such as
in December 2008 when reports indicated that
over 700 people were killed in Faradje, Duru and
Doruma, and in December 2009 when more than
300 persons were reportedly killed in Makombo
and 206 abducted including at least 80 children.
In January and February 2014 there were 32 LRA
incidents in Dungu (where the study reported
here took place), including looting of food and
non-food items, and kidnap.
Since 2011, LRA attacks in the districts of Haut
and Bas-Uele have decreased significantly, but the
displacement caused by previous attacks, and the
fear of new ones, remains high. The history of
LRA attacks in DRC’s Orientale province has created far higher levels of fear and psychosocial distress than in other areas. Orientale province hosts
the largest number of people displaced due to LRA
activity, with an estimated 320,000 IDPs in 2013
(Titeca, Vlassenroot & Wissing, 2013). The arrival of IDPs increases pressure on already scarce
resources, and IDPs face particular challenges in
8
accessing education, health care and land, partly
due to financial constraints but also due to tensions with host communities. About 85 per cent
of the IDPs stay with host families that are already
extremely poor, and the remainder live in spontaneous IDP settlements in Dungu and Irumu territories.
Objective
The overall aim of this project is to develop locally
relevant tools to measure psychosocial well-being
among conflict-affected women in the Orientale
province in DRC.
Process of developing the assessment
tool
The development of the tool took place in three
phases: (1) a qualitative study designed to develop
the necessary understanding of the concepts to be
included in the tool; (2) an informal testing process; and (3) a formal testing phase. The schedule
of activities is outlined in Annex 1.
B. PHASE 1: QUALITATIVE STUDY
The aim of this phase was to collect the information needed in order to:
• A list of all the community activities that
women can take part in.
• develop a measure of psychosocial wellbeing based on local understandings of
wellbeing and distress
• An understanding of what ‘empowerment’ means for women in this context,
particularly what opportunities there are
for women to exercise control within
their own lives, and to have influence in
public life.
• develop a measure of social connectedness appropriate for the DRC context
• identify experiences believed to contribute to psychological distress, especially
conflict related experiences
• develop a measure of relevant war experiences and environmental/ daily stressors
salient in this context.
Methodology
Three methods were used to collect the information required to develop the assessment tools, in
addition to a review of the literature and of relevant surveys/ assessment tools developed for the
DRC context:
1) Group discussions (with community
leaders, general community members,
and members of women’s groups)
2) Freelisting
3) Case study interviews
1. Group discussions (with community leaders, general community members, and members
of women’s groups)
A group discussion methodology was used to develop:
• A list of all the groups that women can be
involved in, as members and/ or as leaders.
The discussions were free-flowing and issues were
explored as they came up, but were loosely based
on discussion guides which can be found in Annex 2.
2. Freelisting
Paul Bolton and his colleagues (Bass et al., 2006)
have created a number of locally relevant instruments to measure mental health problems in Africa using the freelisting process (see, for example,
Wilk and Bolton, 2002; Bolton, 2001b). Freelisting interviews involve asking local people one or
more standardised questions in order to generate a
list of what they perceive as the major problems affecting their community (for example). The problems identified during the freelisting interviews are
collapsed into a composite list of the major problems from the community’s perspective, including
mental and emotional disorders, and how highly
the community prioritises them. This list is used
to create an instrument designed to measure the
extent to which people are affected by the psychological/ emotional problems they listed. Bolton
and his colleagues (Bolton et al., 2007) describe
the use of an instrument developed in this way
(the Acholi Psychosocial Assessment Instrument)
in Northern Uganda. The instrument was found
to be internally reliable, and to distinguish between
youth who were said by themselves and others to
suffer from depression-like syndromes, and youth
who were said not to suffer from such syndromes.
9
In the development of the psychosocial assessment
tool for use in DRC, the freelisting methodology
was used to collect data to develop a measure of
current events or circumstances which may contribute to psychological distress. The structured
question used was: ‘What are the kinds of things
that worry women in this community?’ (see Annex 2 for a copy of the freelisting data collection
form).
3. Case study interviews
Jon Hubbard and the Center for Victims of Torture
(CVT) developed a means of assessing children’s
wellbeing, using locally relevant criteria (Hart et
al., 2007). Members of the target group/ community are asked to think of a child they know
who, in their view, is doing well, and then list the
things about this child that indicate to them that
he or she is doing well. The characteristics that
emerge from this process can then be used as indicators of wellbeing, which can be used to assess
individual children. Since participants are asked
to describe the characteristics of real children, the
indicators are likely to be attainable and realistic,
rather than abstract ideals. This method has since
been adapted for use with adults, and has been
widely used as the first stage of developing culturally valid measures of psychosocial wellbeing (e.g.
Fernando, 2008). For example, Miller et al (2006)
used individual interviews based on this methodology to identify salient traumatic experiences in
Afghanistan, as well as other types of stressors and
indicators of psychological distress. They used this
information to develop items for a questionnaire
which was later validated.
In the development of the psychosocial assessment
tool for use in DRC, this methodology (called
here ‘case study interviews’) was used to develop a
measure of psychological distress and measures of
events and circumstances that contribute to psychological distress. The methodology was based
on that used by Miller et al (2006) and involved
asking the respondent to think of two women
they know personally, both of whom have suffered
emotionally because of difficult life experiences:
• One woman should be someone who has
10
recovered and is now functioning well
despite the hardships she has endured
• The other woman should be someone
who has continued to suffer despite the
passing of time
The respondent is then asked to tell the interviewer about the two people in detail, focusing particularly on:
• The difficult life events they have experienced
• How they have been affected (thoughts,
feelings, behaviour)
• Signs that indicate that the woman is still
suffering
• Signs that indicate that the woman has
now recovered
• Why they think the first woman recovered, and the second is still having difficulties
The data collection form for the case study interviews can be found in Annex 2.
Recruitment and training of research assistants
Prior to the start of the study, six research assistants (three male and three female) were recruited in Dungu by LOGiCA’s field data collection
partner. Following a call for applications, field assistants were interviewed and recruited based on
their experience in the psychosocial field.
All six research assistants participated in three days’
training in the two interview methods (freelisting
and case-study interviews) prior to the data collection phase. The research also addressed ethical
issues associated with the research, and explored
how the study had the potential to cause harm,
and how this potential could be minimised. The
research reviewed and revised the ‘Policies and
practical guidelines’ and ‘Code of Conduct’ to ensure that they were appropriate for the DRC context (see Annex 3 and 4 for the final versions), and
all research assistants signed a French version of
the Code of Conduct (see Annex 5).
Procedure
Between 29th August and 1st September 2013,
the research team visited four locations within
Haut-Uele district: Dungu, (in quarter Mussa),
Kiliwa, Li-May.
Individual interviews
A total of 52 freelisting interviews were conducted
over this four-day period, and 44 case study interviews.
Table 1. Summary of individual interviews
conducted
LOCATION
data collection team leader, with the assistance of
a translator who had participated in the research
assistants’ training so had a good understanding of
the aims and objectives of the discussions.
Discussions were conducted with two groups of
community members (Dungu, N=10; Mussa,
N=13); two groups of community leaders (Li-May,
N=13; Dungu, N=7); and three women’s groups
(Li-May, N=15; Kiliwa, N=11; Mussa, N=9). A
total of 20 community leaders participated in
group discussions (19 men and one woman); 23
community members (13 men and 10 women);
and 35 members of women’s groups. The community leaders who participated in the discussions
included church leaders, health care staff, town
chiefs, youth leaders, teachers and other professionals.
N. FREELISTING
N. CASE STUDY INTERVIEWS
Dungu
5
3
Kiliwa
17
8
Analysis of data
Li-May
9
13
Freelisting data
Mussa
21
20
Interviewers recorded respondents’ answers to
the standardised question (‘What are the kind of
things that worry women in this community?’) in
the form of lists, with each item on the list being
accompanied by a short description.
Respondents were selected for the individual interviews on an opportunity basis. The research assistants approached them and explained the study,
and what their participation would involve, using
an ‘informed consent’ guidance sheet (see Annex 6). If they agreed to participate, interviews
were conducted in Lingala or French. Research
assistants made notes at the time of the interview,
which they then submitted to the team leader.
These notes were translated into English and typed
up for analysis.
The average (mean) age of respondents was 36
years for the freelisting interviews (minimum age
= 19, maximum = 63), and 38.5 years for the case
study interviews (minimum age = 20, maximum
= 68; missing data for 1 respondent). Freelisting
interviews were conducted with 26 women and 26
men; case study interviews were conducted with
22 women and 22 men.
Group discussions
Seven group discussions were conducted by the
A table was created and each issue raised by a respondent as a worry or concern for women was
recorded on a separate row in that table, along
with its short description. Since the same worries
recurred in several lists, the frequency with which
each worry was stated was recorded, and the description added to those given by other respondents. Whenever new worries (those not mentioned by previous respondents) were stated, they
would be added to the table in a new row.
When all data had been analysed, the table was
reorganised in order of frequency, so that worries
appeared in order of the frequency with which
they were mentioned, indicating their importance
to the respondents. The final stage was to analyse
the descriptions given of each problem to identify
the major themes. Throughout the analysis, links
were identified and recorded between the items
(see Annex 7 for a summary of the findings).
11
Case study interview data
The case study interviews provided information
about respondents’ perceptions of:
• Events which contributed to psychological distress (difficult life experiences)
• Signs (indicators) of psychological distress
• Signs (indicators) of recovery
• Factors that contribute to recovery
The data obtained from the 44 respondents were
typed up and organised into these four themes.
They were then analysed thematically, to identify:
the key events believed to contribute to psychological distress; the signs of psychological distress
and wellbeing; and the factors which contribute to
psychological wellbeing (see Annex 7 for a summary of the findings).
Group discussion data
The content of the group discussions was divided
into the following subjects:
• Leadership roles available to women
• Decision-making carried out by women
• Groups that women can be part of
• Community activities that women participate in
• The signs of an ‘empowered woman’
• Men’s role in women’s empowerment
• Social connectedness (signs of a woman
having a good social network)
The content of each subject was then analysed thematically.
12
psychosocial wellbeing. The sources of information that contributed to each section are outlined
below.
• Background/ demographic information: SWAY survey (Annan et al, 2008),
BRAC Poverty Scorecard, the SF-8 used
by Roberts et al (2010), plus data from
group discussions.
• Social Connectedness: data from group
discussions; items from Pronyk et al’s
(2006) assessment tool; items from the
SWAY survey.
• Empowerment: data from group discussions; items from Pronyk et al’s (2006)
assessment tool.
• Psychological distress: data from case
study interviews; Betancourt et al’s
(2009) APYA;
• Events that may contribute to psychological distress: SWAY survey; data from
case study interviews
• Current circumstances that could contribute to psychological distress: data
from freelisting interviews and case study
interviews; items from the SASA! baseline survey (Abramsky et al, 2010).
Review draft interview schedule with
key people and revise
The draft interview schedule was reviewed by all
members of the research team. Those based in
DRC (specifically an MDF consultant and the
research team leader) identified any aspect of the
draft tool that seemed inappropriate in the DRC
context, or unclear. The interview schedule was
then revised.
Development of first draft of interview schedule
Translation of the interview schedule
The information from group discussions and individual interviews was combined with information
from other studies identified during the development of the Northern Uganda tool to measure
The translation of instruments is a crucial part of
the process; if a translation is inaccurate, both reliability and validity will be low. Items designed to
measure psychosocial concepts such as ‘social con-
nectedness’ can be especially difficult to translate
without changing their meaning because of their
cultural specificity (see Verduin et al, 2010). Hubbard and Miller (2004), amongst others (e.g. Bolton, 2001a) have described a rigorous process for
the translation of psychosocial evaluation tools.
The interview schedule was translated into French,
and back-translated into English by a second translator who had no connection with the project.
This back-translated version was then compared
with the original English, and any discrepancies
identified and corrected.
13
C. PHASE 2: INFORMAL TESTING
T
he six research assistants were trained to administer the draft version of the interview
schedule. They administered the draft assessment tool to five people in their home areas with
the aim of getting feedback on the items, response
formats, and overall content of the interview
schedule. The research assistants recorded their respondents’ feedback on the items and the response
formats, along with their own reflections. These
feedback documents were translated into English
and the interview schedule was revised based on
the research assistants’ experience of administering
it. In addition, issues which should be clarified
during training for administration of the tool and
data entry in future were noted.
Plus: attendance at religious services.
B. Psychological distress
One 19-item measure of psychological distress.
Plus: whether woman takes alcohol
C. Empowerment
There are three measures of empowerment:
1) Leadership roles held
2) A measure of a number of behaviours
which indicate empowerment for women
(7 items)
The revised version of the interview schedule was
translated into French ready for formal testing.
Description of the draft psychosocial
wellbeing tool
MEASURES OF PSYCHOSOCIAL
WELLBEING
The measures of psychosocial wellbeing included
in the draft version of the tool (see Annex 8) are:
Plus: whether the woman is head of her household
share of household income she provides role in
decision-making about economic activities
A. Social connectedness
ASPECTS OF WOMEN’S LIVES WHICH
MAY CONTRIBUTE TO PSYCHOSOCIAL
WELLBEING
There are four measures of social connectedness:
Demographic factors
1) Involvement in community groups
• Age
2) Involvement in community activities
over the previous one month (9 items)
• Marital status
3) Confidence that one could get help from
others in a crisis (3 items)
4) A measure of various forms of support
received from others over the last one
month (12 items)
14
3) A measure of the woman’s power/ influence within the marriage relationship (9
items)
• Level of education and reading ability
• Whether the woman feels part of her community or an outsider
• Whether the woman considers herself to be a
displaced person
• Number of people in household
• Number of biological children
ˏˏ
Whether children live with her
ˏˏ
Whether children’s father(s) are alive
ˏˏ
Whether father(s) help to provide for children’s needs
ˏˏ
Whether anyone else helps to provide for
children’s needs
ˏˏ
Children’s ages
ˏˏ
Number of female/ male children in
school, and reasons for absence from
school
• Number of non-biological children the woman is caretaker for
the month (in debt/ break even/ in credit)
• Whether the woman has received assistance
from an NGO/ CBO
• Distressing events and circumstances
• A checklist of distressing events experienced
during the conflict (33 items)
• Experience of displacement
• Various aspects of the woman’s current life situation which may contribute to her psychosocial wellbeing (identified through qualitative
interviews)
• Experience of domestic violence (16 items)
• Other events that may have an impact on psychosocial wellbeing
• Physical health
• Number of children who died, were miscarried, aborted or stillborn
• Economic situation
• Whether husband gets drunk often
• Number of times woman went to bed hungry
in the last week
• Whether the woman has problems related
to cultivation, and, if so, the reasons for the
problems
• Whether the woman works, and if so what she
does and how much she earned in the past 7
days
• Whether the woman has problems accessing
water
• Financial situation of household at the end of
15
D. PHASE 3: FORMAL TESTING OF THE DRAFT
TOOL TO MEASURE PSYCHOSOCIAL WELLBEING
T
he general aim of the formal testing phase
of the project was to test out the effectiveness of the psychosocial assessment tool and
revise it so it can be used to assess the psychosocial
wellbeing of women living in the eastern part of
DRC which is affected by LRA activity. The specific questions to be addressed include:
• Are the items appropriate/ readily understood?
(Acceptability/ usability)
• Does the psychological distress scale distinguish between those who are psychologically
distressed and those who are not, as identified
by key community members? (Discriminant
validity)
• Are the various scales internally consistent?
(Internal reliability)
• Do people respond consistently to the measure as a whole? (Test-retest reliability)
It would also be desirable to assess the tool’s sensitivity to change, but this was not possible due to
time constraints.
Assessing validity and reliability
of a tool to measure psychosocial
wellbeing
The difficulties of evaluating the validity and reliability of a locally developed instrument to measure psychological/ emotional wellbeing are discussed by Bolton (2001a). The most important
form of validity for cross-cultural work, according
to Bolton, is criterion validity, which is the performance of the instrument against some criterion.
This criterion should be an accepted measure of
the presence of the factor targeted by the new instrument. Ideally, the criterion against which the
new instrument is compared would be a profes-
16
sional diagnosis (if measuring a psychological/
psychiatric problem), or another instrument that
has been validated in the same setting, with the
same population. However, in conflict and postconflict settings it is common for neither of these
criteria to be available, so alternative measures of
criterion validity must be found. Bolton (2001a)
and his colleagues (e.g. Bolton et al, 2004; Bolton
et al, 2007) have addressed this difficulty by using
local input. They ask local people to identify those
in their community who have the psychological/
emotional problem of interest, and also to identify
those who do not have such a problem. Blind interviewing of these groups is carried out, and the
scores of the two groups compared. If the instrument is effective, one would expect those identified as having a psychological/ emotional problem
to score more highly than those without such a
problem.
The identification of those with and without the
psychological problem of interest is not straightforward, and efforts must be made to ensure that the
categorisation is valid. Bolton (2001a) addressed
this by supervisors initially visiting knowledgeable community members to collect the names of
those who currently had and did not have the psychological problem being studied. Interviewers
(who were unaware of the respondent’s reported
status) administered the interview and then asked
respondents themselves if they had the psychological problem of interest. If the knowledgeable
community member and the respondent disagreed
on whether they had the problem, the data from
that interview were not used in the analysis. In
Bolton’s study, this process resulted in 131 interviews being included in the analysis, and 38 being
discarded. However, Bolton notes that it was still
unclear how accurately local people identified the
psychological problem he was interested in.
Description of process
The pilot study took place in Dungu between 16
and 22 March 2014. The data collection team
worked in liaison with community leaders and a
psychologist from Caritas, an organisation which
had been based in the area for some time, to identify suitable respondents.
The research team leader worked with a team of six
research assistants, who participated in two days of
training prior to the data collection phase. Four
of these staff were involved in Phases 1 and 2 of
the project, and two were newly recruited. The
recruitment process involved a call being made
for applications, and interview of qualified candidates.
The research design was to interview 100 women,
half of whom had been identified by community
leaders as having psychosocial problems, and half
of whom were identified by the same community
leaders as not having psychosocial problems. The
research assistants would conduct the assessment
interview without knowing which category their
respondents belonged to. In Dungu, the head
of the village made the initial selection of women
in each category, and the categorisation was confirmed by the research team leader and the Caritas
psychologist .2
The interviews were conducted either in French
(see Annex 9) or in Lingala (see Annex 10 for the
translation developed by research assistants during
their training).
Twenty-two respondents were chosen at random
for re-interview 2-3 days after the first visit. In
some cases, the selected respondent was not avail-
2 The community leaders making the initial selection were told
that they should not base their categorisation on physical wellbeing, or on mental health in terms of psychiatric conditions such as
schizophrenia or psychosis. The women categorised as having good
psychosocial wellbeing might be women who are happy most of the
time, have good relationships with most other people, and behave
well in different contexts. Women categorised as having poor psychosocial wellbeing may have some bad feelings (e.g. sad, frightened,
angry, worried), may have difficult relationships with other people,
or avoid other people, and may behave in ways that seem strange
or unusual.
able, in which case the research assistant would
attempt to arrange another appointment, or an alternative respondent was selected. The data from
the repeat interviews was necessary to assess the
test-retest reliability of the tool.
Ethical issues
A number of ethical issues had the potential to affect this pilot study, and attempts were made to
address these before the study began. The main
issues are summarised below, along with a description of the procedures put in place to minimise any
potential harm to individuals or communities.
1. Discussing Sensitive Issues
The psychosocial wellbeing assessment tool touches on a number of sensitive issues, which could
cause distress. During the training of research
assistants, the team discussed the parts of the interview schedule likely to be particularly sensitive,
and how the research assistants should manage any
distress (see Policies and Practical Guidelines, Annex 3).
2. Informed Consent
To enable respondents to make a considered decision about whether to participate or not, they were
provided with information about the research and
what the interview would involve. The informed
consent form can be found in Annex 8 (and the
French version in Annex 9).
3. Confidentiality
Sensitive information (names, incidents, locations, details, violations witnessed or suffered by
respondents, etc.) collected during the assessment
were kept confidential, except where the respondent gave permission for her case to be referred for
further assistance.
Research assistants were given guidance on confidentiality during the training (see Annex 3) and
procedures were put in place to ensure that the data
collection forms were stored in such a way that the
identities of the respondents were protected.
4. Ensuring the Welfare of Respondents
17
Where a research assistant had concerns about the
welfare of a respondent, she or he would first ask
the respondent if she wanted help with the issue.
If she did, the research assistant could refer her to
the Caritas psychologist. This was necessary in
two cases during the pilot study.
5. Code of Conduct
All the research assistants were required to sign a
Code of Conduct (see Annex 4 and 5), following
explanation and discussion during the training period.
Compensation
All respondents, and the leaders who assisted with
the selection of respondents, were compensated
for the time they spent participating in this study
with a bag of salt (costing locally around 250 Congolese Francs, or $0.27).
Description of participants
Interviews were conducted with 100 women in
seven quartiers of Dungu: Eti (3), Li-lka (7), LiMay (46), Li-Ungwa (2), Ngilima (28), Uye (12).
Of these, 50 women were categorised as having
no psychosocial problems, and 50 as having psychosocial problems. The age of the respondents
ranged from 18 to 76, with a mean of 37.8 (standard deviation = 15.2).
Twenty-three of the women had no education;
the educational level of the others ranged from
P1 right through to S6, with one woman having
tertiary education. Sixteen respondents had secondary education, and the median stage at which
respondents’ education ended was P4.
The women’s marital status is described below:
• Married: 36
• Co-habiting: 9
• Widowed: 20
• Separated: 31
• Divorced: 4
• Single (never married/ co-habited): 0
18
Review and revision of items
The first stage of the analysis of the pilot study data
was to review responses and identify those items
which did not work well, and should be removed.
This process is described in Annex 12. The revised
version of the psychosocial assessment tool can be
found in Annex 13 (English).
ASSESSMENT OF RELIABILITY AND
VALIDITY
A. Psychological Distress
Cronbach’s alpha for the test version of the psychological distress scale was .63, indicating lower
than expected internal consistency. Review of the
item statistics resulted in the removal of eleven
items; the final 8-item scale has a Cronbach’s alpha
of .65, which is slightly more acceptable, and less
burdensome to complete.
Discriminant validity was evaluated by comparing
the scores on the revised 8-item scale of women
identified as having psychosocial problems, and
those identified as having no such problems. It was
predicted that those identified as having psychosocial problems would score more highly on the
scale than those without. The mean score of those
with psychosocial problems was 14.86 (sd=3.97)
and for those without it was 9.38 (sd=3.46). This
difference was found to be significant 3; therefore
our prediction was supported. The psychological
distress scale was able to distinguish between those
who had psychosocial problems and those who
did not.
3 T (df=98) = 7.36, p<.001
SUMMARY: The revised version of the
psychological distress scale has acceptable internal
consistency and is able to distinguish between
women identified as having psychosocial problems
and those identified as having no such problems.
Therefore, the scale can be used with some
confidence as a measure of psychological distress
with this population.
B. Social Connectedness
Social connectedness was assessed by four separate
measures: two measures of quantity of connections
(involvement in groups and participation in community activities) and two measures of quality of
connections (confidence that people would help
in a crisis, and support received from family and
friends over the previous one month). Assessment
of internal consistency only applied to the two
measures of quality of connections. Cronbach’s alpha for the revised ‘supportive relationships’ scale
was .77, and for the ‘confidence in a crisis’ scale, it
was .72. Both indicate good internal consistency.
It was predicted that involvement in groups and
activities would be related (quantity of social connections) and that experience of supportive relationships and confidence that someone would
help in a crisis would be related (quality of social
connections). Some relationship between quality
and quantity of social connections was also expected, although it was difficult to predict what form
this would take.
The results are summarised below:
• Involvement in groups and community activities were significantly related to each other
(r=.38, p=<.001), as expected.
• Confidence that people would help out in a
crisis was not significantly related to any of the
other measures of social connectedness. This
is surprising; the expectation was that it would
be related to the amount of support received
from others in the last month, if not all three
other measures. This finding reduces confidence in this measure of social connectedness,
and as more data is collected using this tool it
may be decided toremove this measure.
• Both measures of quantity of connections
were related to the support received from others in the last month (Groups, r=.23, p=.02;
Activities, r=.24, p=.01). This is as predicted;
women who are more involved in community
activities and groups would be expected to
have more opportunities to develop supportive relationships.
C. Empowerment
Empowerment was assessed by three measures:
number of leadership positions held ; a measure
of behaviours indicating empowerment; and influence within the marital relationship. Assessment
of internal consistency only applied to the second two. Cronbach’s alpha for the revised 5-item
‘empowered behaviour’ scale was .76, and for the
revised 7-item ‘marital influence’ scale it was .67,
both of which indicated adequate-to-good internal
consistency. As an additional check on the ‘marital
influence’ scale its relationship with the ‘domestic
violence’ scale was explored. Those who are less
empowered in their marriage were expected to report higher levels of domestic violence, and this is,
in fact, what was found4.
The three measures of empowerment (‘empowered
behaviour’, leadership and marital influence) were
expected to be related. In fact, none of these relationships were found to be statistically significant.
The relationship between leadership roles and
other forms of ‘empowered behaviour’ approached
significance5, as did the relationship between leadership roles and marital influence6, but there was
no relationship between marital influence and
‘empowered behaviour’.
4 r=-.31, p=.04
5 r=.19, p=.06
6 r=.29, p=.06
SUMMARY: There is no relationship between the
three measures of empowerment, which suggests
they are measuring different aspects of women’s
lives. Those who are less empowered in their
marriage were also found to report higher levels
of domestic violence. The three measures were
found to be internally consistent. They may be
measuring different aspects of women’s lives,
which all contribute to empowerment but do
not form a single underlying concept. More data
would be needed, and some qualitative study, to
further explore the meaning of these variables.
However, all three appear to be reliable measures
in themselves
19
Table 2. Summary of test-retest data for the Psychosocial Assessment tool.
N
Time 1
Mean (SD)
Time 2
Mean (SD)
Pearson’s
correlation (r)
Significance
(probability)
Social connectedness - Groups
22
2.27 (1.69)
1.91 (2.07)
.68
<.001
Social connectedness Activities
22
3.05 (2.01)
2.73 (1.72)
.80
<.001
Social connectedness Confidence in a crisis
22
1.14 (1.52)
1.0 (1.20)
.66
.001
Social connectedness –
Supportive relationships
22
11.95 (4.50)
11.55 (4.68)
.75
<.001
Empowerment -behaviour
22
4.50 (3.11)
4.45 (2.87)
.63
.002
Empowerment - Marital
influence
10*
11.40 (3.10)
10.20 (4.32)
.68
.03
Empowerment – leadership
roles
22
0.23 (0.61)
0.14 (0.64)
.65
.001
Psychological distress
22
10.45 (4.32)
10.95 (5.02)
.13
.56
War events
22
8.91 (3.46)
8.59 (4.13)
.75
<.001
Domestic violence
10*
6.17 (5.18)
8.18 (4.62)
.60
.05
* The numbers here are lower because these sections only apply to married respondents
D. Test-Retest Stability
If very marked changes in scores were found over a
short period of time, this would suggest problems
with the assessment tool. Twenty-two respondents
were randomly selected to be interviewed for a second time, and were interviewed 2-3 days after the
first interview. The test-retest data for each section
are shown in Table 2.
The majority of sections had very good levels of
test-retest reliability, ranging from .60 to .807. The
high level of stability of responses to the questions
in these sections over time indicates that the interviewees understood the questions they were asked
and responded in a consistent way. This increases
confidence that the interview schedule will provide reliable information about these aspects of
psychosocial wellbeing.
The exception to this is the measure of psycho-
7 The closer the ‘r’ is to 1, the more closely related respondents’
scores are at Time 1 and Time 2.
20
logical distress, which had poor test-retest reliability. The mean score on the scale increased by 0.5
between the first and second interview, and the
reasons for this are unclear. When the individual
items making up the scale were explored, four of
the eight were found not to be correlated at first
and second interview. The four are:
1. Do you cry frequently?
7. Do you often feel afraid?
8. Do you think a lot about bad things that
have happened to you?
19. How much did emotional problems limit
your daily activities?
These items have been found to have good testretest reliability in other settings, so it is difficult
to explain why they did not in this pilot study. It
could be that the translation of the items was unclear, or that they were understood in a way differently to that intended. The fact that women did
not respond consistently to these items suggests
that they were not well understood, or that there
were other factors influencing accurate reporting.
It would be necessary to carry out further study to
understand this, especially since repeat interviews
were only conducted with 22 women. It should be
noted that measures of ‘states’ (i.e. variables which
commonly change over time, such as anxiety) are
commonly found to have lower levels of reliability
than are measures of more stable traits or abilities.
A relatively low test-retest correlation was also
found for the section relating to domestic violence, with mean scores increasing on the second
occasion. Since domestic violence is typically under-reported in surveys such as this, it is likely that
the second time the research assistant met with the
respondent, more incidents of domestic violence
were disclosed, as trust increased.
21
E. SUMMARY AND CONCLUSIONS
The psychometric properties of the psychosocial
assessment tool are considered under the four aims
of the formal testing phase of the project.
Acceptability/ usability
Are the items appropriate/ readily understood?
In general, items were appropriate and readily understood. There were minimal levels of missing
data. The test-retest data raises some doubts about
whether four items from the measure of psychological distress were clearly understood, but the fact
that these items, and the scale as a whole, clearly
distinguishes between respondents categorised
as having good psychosocial wellbeing and those
categorised as having poor psychosocial wellbeing
gives some confidence that they were understood,
and that they measured what they were intended
to measure.
Discriminant validity
Does the psychological distress scale distinguish between those who are psychologically distressed and
those who are not, as identified by key community
members?
Discriminant validity was evaluated by comparing the scores on the psychological distress scale of
women identified by community leaders as having psychosocial problems, and those who had no
such problems. It was predicted that those identified as having psychosocial problems would score
more highly on the scale than those without, and
this was found to be the case. The psychological
distress scale was able to distinguish between those
who have psychosocial problems and those who
do not.
Internal reliability
Are the various scales internally consistent?
22
Internal reliability was assessed for the five scales
included in the psychosocial assessment tool, and
was found to range between .65 and .77 (mean
internal consistency = .71). This finding that the
women interviewed responded consistently to
the questions suggests that they understood them
(random responses would have suggested a lack of
understanding and/ or a lack of engagement with
the process).
Test-retest reliability
Do people respond consistently to the measure as a
whole? (Test-retest reliability)
One scale (psychological distress) had poor testretest reliability (r=.13); the test-retest reliability
of the other nine sections assessed ranged between
.60 and .80 (mean = .69). The high level of stability of responses over time indicates that the interviewees understood the questions they were asked
and responded in a consistent way. This increases
confidence that the interview schedule will provide reliable information about psychosocial wellbeing. The exception to this is the scale measuring
psychological distress. Four items were found to
have poor test-retest reliability, and it is difficult to
explain this without further exploration.
Conclusion
The results of the pilot study indicate that the psychosocial assessment tool has good reliability and
validity with this population, although there are
some concerns about two sub-scales: the ‘psychological distress’ measure and the ‘confidence in a
crisis’ measure. However, even these two scales
demonstrated good psychometric properties in all
but one aspect, so it is not recommended to remove them at this stage. However, they should
be used tentatively, and ideally a qualitative study
would be conducted to explore the reasons for the
poor test-retest reliability of the psychological distress scale, and the lack of relationship between the
‘confidence in a crisis’ measure and the other measures of social connectedness.
It is also recommended that the lack of relationship between the ‘empowerment’ sub-scales is explored further. Each ‘empowerment’ measure has
good psychometric properties, but they would be
expected to be related in some way, and this was
found not to be the case.
In summary, the tool is recommended for use as
a measure of psychosocial wellbeing of women in
the north-eastern part of DRC, but the properties
of the sub-scales identified above should continue
to be explored.
23
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Psychosocial Working Group (2003) Psychosocial Intervention in Complex Emergencies: A Framework
for Practice PWG: Edinburgh
Roberts, B., Damundu, E. Y., Lomoro, O., & Sondorp, E. (2010). The influence of demographic characteristics, living conditions, and trauma exposure on the overall health of a conflict-affected population in Southern Sudan. BMC Public Health, 10.
Sideris, T. (2003). War, gender and culture: Mozambican women refugees. Social Science and Medicine,
56, 713-724.
Titeca,K., Vassenroot,K. & Wissing,M. (2013) A life of fear and flight: The legacy of LRA brutality in
north-eastern Democratic Republic of Congo UNHCR & IDMC/ NRC
Verduin,F.; Scholte,W.; Rutayisire,T. & Richters,A. (2010) How qualitative information helped to shape
quantitative research instruments in Rwanda. Intervention8 (3), 233-244
Wilks, C. M. & Bolton, P. (2002). Local perceptions of the mental health effects of the Uganda acquired
immunodeficiency syndrome epidemic. The Journal Of Nervous And Mental Disease, 190, 394397.
25
H. ANNEXES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
26
Schedule of activities
Research tools for qualitative study (Phase 1)
Policies and practical guidelines
Code of Conduct (English)
Code of Conduct (French)
Informed consent for Phase 1
Summary of findings from the qualitative study (Phase 1)
Draft assessment tool for testing (English)
Draft assessment tool for testing (French)
Draft assessment tool for testing (Lingala)
Preparation of database
Final version of psychosocial wellbeing assessment tool (English)
Data entry and database preparation guide
"
Annex 1
Schedule of activities
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Annex 3
Policies and Practical Guidelines
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*$F$'*&/"&'+"FG11)*.")*"G+A$*T2+$"1$)13$eF"A2B+2.C"'+A"Y$33c%$2+B?":."2F"P2.'3".)"*$F1$&."2+A2P2AG'3F"
'+A"&)TTG+2.2$Fa"'+A".)"'P)2A"%$/'P2)G*a"A*$FFa")*"'..2.GA$F"./'."1$)13$"T'C"*$B'*A"'F"A$T$'+2+B"
)*"2+'11*)1*2'.$?""
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•
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K*$FF"'+A"%$/'P$"2+"Y'CF"./'."'*$"3)&'33C"'11*)1*2'.$?""
M$"'Y'*$")S"'+A"*$F1$&."B$+A$*"+)*TF?""
0P)2A2+B"1'FF2+B"OGABT$+.")+"%$32$SF")*"1*'&.2&$F?""
M$"F$+F2.2P$".)"1$)13$eF"F&/$AG3$?"9*C".)"F&/$AG3$"2+.$*P2$YF"S)*".2T$"./'."'*$"&)+P$+2$+."S)*"
1$)13$?""
0P)2A"1)32.2&'3"A$%'.$Fa"&*2.2&2F2+B")./$*Fa")*"2T1)F2+B"C)G*")Y+"P2$YF?""
:+S)*T$A"7)+F$+.""
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Y2./)G."'+C"+$B'.2P$"&)+F$^G$+&$F?"K$&2F2)+F".)"1'*.2&21'.$"F/)G3A"%$"2+S)*T$A"%C"'+"
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2+S)*T'.2)+"Y233"%$"GF$Aa"'+A"1).$+.2'3"*2FNF"'+A"%$+$S2.F".)"1'*.2&21'+.F?""
J%.'2+2+B"2+S)*T$A"&)+F$+."2F"2+/$*$+.3C"A2SS2&G3."S)*"T'+C"*$'F)+F"FG&/"'F"./$"1)Y$*"2T%'3'+&$"
%$.Y$$+"*$F$'*&/$*F"'+A"1'*.2&21'+.Fa"./$"1$*P'F2P$"$]1$&.'.2)+F"./'."1'*.2&21'.2)+"Y233"%*2+B"
T'.$*2'3"2T1*)P$T$+.F"+)Y")*"FG%F$^G$+.3Ca"./$"1*$P'232+B"+)*TF")S"/)F12.'32.Ca"'+A"./$"
1$*&$1.2)+F")S"3)&'3"1$)13$"'%)G."&)TTG+2.C"3$'A$*Fb"eF"$]1$&.'.2)+Fa"'T)+B")./$*F?":+"T'+C"
F2.G'.2)+Fa")%.'2+2+B"Y*2..$+"&)+F$+."2F"+)."S$'F2%3$"%$&'GF$")S"3)Y"32.$*'&C"3$P$3F"'+A"1*)F1$&.2P$"
1'*.2&21'+.Fe"S$'*F"./'."Y*2..$+"A)&GT$+.F"Y233"%$"GF$A"'B'2+F."./$T?"M$&'GF$")S"./$"S3G2Aa"
G+S)*$F$$'%3$"+'.G*$")S"./$"F2.G'.2)+a"2."2F"2T1)*.'+.".)".*$'."2+S)*T$A"&)+F$+."'F"'+")+B)2+B"
1*)&$FF"*'./$*"./'+"'")+$c)SS"'&.2)+?""
"
"
"
"
33
"
<1$&2S2&"F.$1F".)"2+FG*$"2+S)*T$A"&)+F$+."'*$".)U""
•
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8F$"'"S*2$+A3C"'11*)'&/"2+"$]13'2+2+B"./$"1G*1)F$")S"./$"*$F$'*&/a"Y/'."'+A"/)Y"
2+S)*T'.2)+"Y233"%$"GF$Aa"./$2*"*2B/.".)"F'C"e+)b"Y2./)G."+$B'.2P$"&)+F$^G$+&$Fa"$.&?""
[$"Y233"+)."'FN"2+A2P2AG'3F".)"F2B+".)"2+A2&'.$"&)+F$+.a"AG$".)"3)Y"32.$*'&C"3$P$3F"'+A"S$'*F"
./'."Y*2..$+"A)&GT$+.F"T2B/."%$"GF$A"'B'2+F."./$T?""9/$"*$F$'*&/$*"Y233"2+A2&'.$")+"./$"
S)*T"./'."./$"1'*.2&21'+."/'F"&)+F$+.$A?"
K)"+)."'&&$1."'"&)TTG+2.C"3$'A$*bF"F.'.$T$+."./'."$P$*C)+$"Y233"1'*.2&21'.$"'F"2+S)*T$A"
&)+F$+.?"9/$"1*)&$FF")S")%.'2+2+B"2+S)*T$A"&)+F$+."TGF."%$"2T13$T$+.$A"S)*"$'&/"
2+A2P2AG'3?""
='+'B$"$]1$&.'.2)+F"%C"$]13'2+2+B"2+"F2T13$a"&3$'*"3'+BG'B$"./'."+)"T'.$*2'3"%$+$S2.F"Y233"
&)T$"./*)GB/"1'*.2&21'.2)+"2+"./$"*$F$'*&/?"0AAa"/)Y$P$*a"./'."./$"2+S)*T'.2)+"&)33$&.$A"
Y233"%$"GF$A"%C"./$"[)*3A"M'+N"'+A")./$*")*B'+2F'.2)+F".)"T'N$"FG*$"./'."1*)B*'TT$F"'*$"
/'P2+B"'"1)F2.2P$"$SS$&.")+"1$)13$bF"32P$F?"
7)+S2A$+.2'32.C""
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*$F$'*&/$*F"Y233"+)."F/'*$"1G%32&3C"2+S)*T'.2)+"FG&/"'F"+'T$F"./'."&)G3A"%$"GF$A".)"2A$+.2SC"F1$&2S2&"
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1$)13$"Y$"Y'+.".)"2+.$*P2$Y?""()Y$P$*a"&)T13$.$A"S)*TF"Y233"%$"N$1."2+"'"3)&N$A"S23$"'+A"Y233")+3C"
%$"'&&$FF$A"%C"./$"W$'A"#$F$'*&/$*?""9/$"1'B$"&)+.'2+2+B"./$"+'T$"Y233"%$"A$.'&/$A"S*)T"./$"A'.'"
'+A"N$1."F$1'*'.$3Ca"2+"'"3)&N$A"S23$?"
<1$&2S2&"F.$1F".)"$+FG*$"&)+S2A$+.2'32.C"'*$".)U""
•
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N+)YF"Y/)"$3F$"2F"1*$F$+."'+A"B2P$F"./$2*"2+S)*T$A"&)+F$+.".)"&)+.2+G$?""
k$$1"'+C"*$&)*AF")S"+'T$F"'+A")./$*"2A$+.2SC2+B"2+S)*T'.2)+"2+"'"F'S$a"3)&N$A"13'&$"./'."2F"
+).")1$+"S)*"1G%32&"'&&$FF?""
K)"+)."3$'P$"&)+S2A$+.2'3"1'1$*F"'+CY/$*$?"03Y'CF"1G."./$T")G.")S"1G%32&"'&&$FF"$P$+"2S"C)G"
3$'P$"Y/$*$"C)G"'*$"Y)*N2+B"S)*"'"T2+G.$")*".Y)?""
</'*$"+)+c1$*F)+'3"2+S)*T'.2)+"_2?$?"'%)G."C)G*"$]1$*2$+&$")S"&)+AG&.2+B"./$"2+.$*P2$Ya"%G."
+)."'%)G."./$"&)+.$+.")S"./$"2+.$*P2$Y`"Y2./"T$T%$*F")S"./$"*$F$'*&/".$'T"%G."+)."Y2./"
1$)13$")G.F2A$"./$"*$F$'*&/".$'T?""
()3A"2+"F.*2&."&)+S2A$+&$"2+S)*T'.2)+"'%)G."F1$&2S2&"&'F$F")S"'%GF$a"$]13)2.'.2)+a"P2)3$+&$a"
'+A"+$B3$&.a"F/'*2+B"2+S)*T'.2)+")+3C"Y2./"./$"W$'A"#$F$'*&/$*?""
RFC&/)F)&2'3"<G11)*.""
:."2F"1)FF2%3$"./'."2+"./$"&)G*F$")S"A2F&GFF2)+Fa"'"1'*.2&21'+."T2B/."%$&)T$"G1F$."%$&'GF$"F/$"*$&'33F"
1'2+SG3"$P$+.F?"k$C"F.$1F"2+"1*$P$+.2+B"'+A"/'+A32+B"FG&/"'"F2.G'.2)+"'*$".)U""
•
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"
34
:A$+.2SC"2+"'AP'+&$")S"./$"*$F$'*&/"'"+'.G*'3"/$31$*")*"F)&2'3"Y)*N$*"Y/)"&)G3A"1*)P2A$"
1FC&/)F)&2'3"FG11)*.".)"F)T$)+$"Y/)"2F"A2F.*$FF$A"%C"./$"A2F&GFF2)+F?""
0..$+A".)"1$)13$eF"+)+P$*%'3"*$'&.2)+Fa"'+A"A2F&)+.2+G$"./$"A2F&GFF2)+"2S"./$"1'*.2&21'+."
%$&)T$F"G1F$.?""
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/$*"./$")1.2)+".)"/'P$"'"%*$'N")*"A2F&)+.2+G$"./$"2+.$*P2$Y?"
:S"'"1'*.2&21'+."/'F"%$$+"A2F.*$FF$A"%C"'"A2F&GFF2)+"&)+AG&.$A"'F"1'*.")S"./$"*$F$'*&/a"+).2SC"
./$"+'.G*'3"/$31$*")*"F)&2'3"Y)*N$*"F)"./'."./$C"&'+"1*)P2A$"S)33)Y"G1"FG11)*."S)*"./$"
1'*.2&21'+.?"
!
"
Annex 4
Code of conduct
"
+99.V!Z=!$12.!1I!;192<;/!
"
9)"T'2+.'2+"./$"/2B/$F."F.'+A'*AF")S"&)+AG&.a"'+A".)"$+'%3$"GF".)"&)+AG&."'+"'&&G*'.$"'+A"F$+F2.2P$"
'FF$FFT$+.")S"./$"2FFG$F"'SS$&.2+B"Y)T$+"2+"K#7a"Y$"Y233"'A/$*$".)"./$"S)33)Y2+B"7)A$")S"7)+AG&.?"""
"
:6!%ILIFBFHI!DS!7LMTFO!
0+C"&)A$")S"&)+AG&."2F"%G23.")+"'"S)G+A'.2)+")S"F/'*$A"P'3G$F?"9/$"P'3G$F")S"./2F"'FF$FFT$+."1*)O$&."
2+&3GA$U"
• 033"&/23A*$+"'+A"'AG3.F"'*$")S"$^G'3"P'3G$f"
• :+&3GF2P$+$FF"'+A"F)&2'3"OGF.2&$f"
• #$F1$&."S)*"13G*'32FT"'+A"A2P$*F2.Cf"
• 9*'+F1'*$+&Ca"2+.$B*2.C"'+A"/)+$F.Cf"
• #$F1)+F2%3$"F.$Y'*AF/21")S"*$F)G*&$Ff"'+Aa"
• 7)TT2.T$+.".)"&'**C2+B")G.")G*"*$F1)+F2%232.2$F".)"./$"%$F.")S")G*"'%232.C?"
9/$F$"P'3G$F"/'P$"2+S)*T$A"./$"A$P$3)1T$+.")S"./$"7)A$")S"7)+AG&.?"9/$"7)A$")S"7)+AG&."F/)G3A"
/$31"BG2A$"C)G*"%$/'P2)G*"Y/23F."$+B'B$A")+"./2F"'FF$FFT$+."1*)O$&.?"()Y$P$*a"%$&'GF$"2."2F"+)."
1)FF2%3$".)"F$."S)*./"'+"'33c2+&3GF2P$")*"$]/'GF.2P$"7)A$")S"7)+AG&.a"C)G"'*$"$]1$&.$A".)"GF$"C)G*"
)Y+"B))A"OGABT$+.".)"&)+S)*T".)"./$"2+.$+."'+A"F12*2.")S"9/$"7)A$"2+"'33"T'..$*F"+)."F1$&2S2&'33C"
'AA*$FF$A?"
"
=6!,DTG!'FOCDHOKVKMKIKFO!
•
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9/$"7)A$"2+"%)./"3$..$*"'+A"F12*2.?":B+)*'+&$")S"9/$"7)A$"Y233"+)."$]&GF$"C)G"S*)T"2.F"
*$^G2*$T$+.F?"<$$N"BG2A'+&$"S)*"Y/'.$P$*"^G$F.2)+F"C)G"T'C"/'P$?"
•
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•
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•
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$3F$"F'Ca"v5P$*C%)AC"A)$F"2.aw"vI)")+$"Y233"$P$*"N+)Yaw")*"v:."Y)+b."T'..$*"2+"./$"$+A?w"
9/$F$"'*$"F2B+F".)"F.)1a"./2+N"./2+BF"./*)GB/"'+A"F$$N"BG2A'+&$?"83.2T'.$3Ca"C)G"'*$"
*$F1)+F2%3$"S)*">J8#"'&.2)+F?"
•
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F2.G'.2)+F"Y/$*$"'"FG1$*P2F)*")*"'"&)33$'BG$"'FNF"C)G".)"P2)3'.$"9/$"7)A$?":+"'33"&'F$Fa"./$*$"
Y233"%$"+)"*$.'32'.2)+"S)*"T'N2+B"'+C"*$1)*.Fa"'+A"$P$*C"$SS)*."Y233"%$"T'A$".)"T'2+.'2+"
&)+S2A$+.2'32.C?"
•
>)G"&'+"*$1)*."P2)3'.2)+F")S"9/$"7)A$".)"C)G*"FG1$*P2F)*?"
•
>)G"'*$")%32B$A".)"&))1$*'.$"Y2./"2+P$F.2B'.2)+F"2+.)"P2)3'.2)+F")S"9/$"7)A$"'+A"TGF."
'3Y'CF"%$".*G./SG3"'+A"S)*./&)T2+B"2+"./$"&)G*F$")S"./$F$"2+P$F.2B'.2)+F?"
"
"
"
35
"
>6!-DNF!DS!-DHNTJI!?4QF!-DNF@!
$6!+FGODHLM!-DHNTJI!LHN!+GDSFOOKDHLM!(HIFUGKIW!
=$T%$*F")S"./$"'FF$FFT$+.".$'T"TGF."'&."Y2./"/)+$F.Ca"2+.$B*2.C"'+A")1$++$FF"2+"'33"./$2*"A$'32+BF"
'F"*$1*$F$+.'.2P$F")S"./$"1*)O$&.?"">)G"F/)G3AU"
• 9*$'."&)33$'BG$F"'+A"1'*.2&21'+.F"1*)S$FF2)+'33C"'+A"Y2./"&)G*.$FC"'+A"*$F1$&.f"
• 0P)2A"'+C"'&.2)+"Y/2&/"T'C"%$"P2$Y$A"'F"/'*'FFT$+.a"P$*%'3")*"1/CF2&'3"'%GF$f"
• 0P)2A"%$/'P2)*"./'."T'C"&*$'.$"'+"'.T)F1/$*$")S"/)F.232.C")*"2+.2T2A'.2)+f"
• K)"+)."$+B'B$"2+"'+C"233$B'3"'&.2P2.Cf"
• 0P)2A"./$"'%GF$")S"'3&)/)3")*"&)+.*)33$A"FG%F.'+&$F"Y/23F."$+B'B$A")+"./2F"1*)O$&.?"
"
26!-DHSKNFHIKLMKIW!LHN!NKOJMDOTGF!DS!KHSDGBLIKDH!
• 5+FG*$"./'."1'*.2&21'+.F"B2P$"2+S)*T$A"&)+F$+.".)"./$2*"2+P)3P$T$+."2+"./$"'FF$FFT$+."
• 033"2+S)*T'.2)+"&)33$&.$A"2+"./$"&)G*F$")S"C)G*"Y)*N"TGF."%$"F'S$BG'*A$Aa"'+A"TGF."+)."%$"
F/'*$A"Y2./"'+C%)AC")G.F2A$"./$"1*)O$&.?""
• K)"+)."T'N$"&)12$F")S"'+C")S"./$"A'.'"&)33$&.2)+"S)*TFa")*"N$$1"'+C"*$&)*A")S"./$Ta")./$*"
./'+"./)F$"*$^G2*$A"S)*"./$"*$F$'*&/"1*)O$&.?"
• K)"+)."GF$"&)+S2A$+.2'3"2+S)*T'.2)+".)"'..$T1.".)"2A$+.2SC")*"T'N$"G+'G./)*2F$A"&)+.'&."
Y2./"'+C"2+A2P2AG'3a")*"1*)P2A$"2+S)*T'.2)+".)"'+)./$*"1$*F)+"S)*"./)F$"1G*1)F$F?"
• J%F$*P$"&)+S2A$+.2'32.C"1*)&$AG*$Fa"2+&3GA2+B"2+"&'FG'3"&)+P$*F'.2)+"Y2./")./$*F"2+"./$"
'FF$FFT$+.".$'T?"
"
-6!%FXTLM!LVTOF!LHN!FXCMDKILIKDH!
• 5]&/'+B$")S"T)+$Ca"$T13)CT$+.a"B))AF")*"F$*P2&$F"S)*"F$]a"2+&3GA2+B"F$]G'3"S'P)G*F")*")./$*"
S)*TF")S"/GT232'.2+Ba"A$B*'A2+B")*"$]13)2.'.2P$"%$/'P2)G*"2F"1*)/2%2.$A?""
• <$]G'3"'&.2P2.C"Y2./"&/23A*$+"_1$*F)+F"G+A$*"./$"'B$")S"!Q`"2F"1*)/2%2.$A?""=2F.'N$+"%$32$S"2+"
./$"'B$")S"'"&/23A"2F"+)."'+"$]&GF$?"
"
36!&OF!DS!CGDYFJI!LOOFIO!
• >)G"T'C"+)."GF$"1*)O$&."'FF$.F"S)*"C)G*")Y+"1$*F)+'3"%$+$S2.")*"./$"%$+$S2.")S"'+C)+$")./$*"
./'+"./$"1*)O$&.?"
• >)G"F/)G3A"*$S*'2+"S*)T"A'T'B2+B"1*)O$&."1*)1$*.C")*"GF2+B"2."2+"'+"2+'11*)1*2'.$"T'++$*?"
"
Z6!3KOJKCMKHLGW!$JIKDHO!
9/$"1*)O$&."3$'A$*"Y233".'N$"'11*)1*2'.$"A2F&2132+'*C"'&.2)+"S)*"P2)3'.2)+F")S"9/$"7)A$a"2+&3GA2+B"
.$*T2+'.2)+"Y2./)G."1'CT$+.?"
"
Z6!%KUHLITGF!LHN!$J[HDEMFNUBFHI!
:"&$*.2SC"./'.":"/'P$"*$'A"'+A"G+A$*F.'+A"./$"7)A$")S"7)+AG&."'+A"'B*$$".)"&)T13C"Y2./"2.a"
"
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx"_R*2+.$A"I'T$`"
"
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx"_<2B+'.G*$`""""xxxxxxxxxxxxxx"_K'.$`"
"
36
"
Annex 5
"
Code of Conduct (French)
+99.V![=!$12.!1I!$192<;/!X7D.9;0Y!
-/3#!3#!2/))#!-/)3&(4#!3#!0A#7$0&$4(/)!+%,-./%/-($0#!
"
R)G*"T'2+.$+2*"3$F"+)*T$F"3$F"13GF"y3$Py$F"A$"&)+AG2.$a"$."1)G*"+)GF"1$*T$..*$"A$"1*)&yA$*"z"G+$"
yP'3G'.2)+"1*y&2F$"$."F$+F2%3$"A$F"^G$F.2)+F"^G2".)G&/$+."3$F"S$TT$F"A'+F"3'"*yB2)+"A$"KG+BG"$."
$+P2*)+a"+)GF"'33)+F"*$F1$&.$*"3$"&)A$"A$"&)+AG2.$"FG2P'+.?"
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"
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Annex 6
Informed consent for Phase 1
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39
Annex 7
Summary of findings from qualitative study
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"
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44
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Annex 8
Draft assessment tool for testing
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57
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"
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"
58
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"
Annex 9
+99.V!_=!@DBI/!B::.::K.9/!/113!I1D!/.:/894!X7D.9;0Y!
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W)&'32.yg"
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%2$+c{.*$"1FC&/)cF)&2'3"A'+F"3$F"&)TTG+'G.yF"A'+F"&$..$"*yB2)+?"W$"%G."A$"&$..$"y.GA$"$F."A$".$F.$*"
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AqyP'3G$*"3$"%2$+c{.*$"1FC&/)F)&2'3"A'+F"&$..$"*yB2)+?":3"+qC"'"1'F"A$"%y+yS2&$F"A2*$&.F"'G]"1$*F)++$F"
1'*.2&21'+."z"&$..$"*$&/$*&/$"
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d720!572d%f!0#21%6!>%0!;2%01:7"0!72!#66%1%6!#!1721!$7$%"1&";)GF"1)GP$d"Ay&2A$*"A$"+$"
1'F"*y1)+A*$"z"".)G.$"3q$+^G{.$a")G"P)GF"1)GP$d"+)GF"A2*$"^G'+A"G+$"^G$F.2)+""P)GF"*$+A"T'3"z"
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+$"P'F"1'F"2+S3G$+&$*"3q'2A$"^G$"P)GF")%.$+$d"A$"+q2T1)*.$"^G$33$")*B'+2F'.2)+"
<7"9:3%"1:#>:1%&!9)G.$F"P)F"*y1)+F$F"A$T$G*$*)+."1*2Py$F"$."&)+S2A$+.2$33$Fa"$."3$F"F$G3$F"
1$*F)++$F"^G2"'G*)+."'&&ÇF"z"&$..$"2+S)*T'.2)+"F$*)+."3$F"&/$*&/$G*F"1*2+&21'G]"A$"&$..$"y.GA$?"
<7"1#<1&"<2"P)GF"'P$d"A$F"^G$F.2)+Fa")G"F2"A$F"1*)%3ÇT$F"FG*P2$++$+.a"P)GF"1)GP$d"&)+.'&.$*"
5.2$++$"=%'3$a"3$"1FC&/)3)BG$"A$"7'*2.'Fa")G"1'FF$*"A2*$&.$T$+."'G"%G*$'G"A$"7'*2.'F"z"KG+BG"
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"
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59
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70
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« Membre de la famille » peut inclure n'importe quel membre de la famille élargie de la
répondante. Il n'est pas nécessaire de sonder pour identifier qui il était.
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Notes: Plusieurs de ces points s’appliquent seulement aux répondantes qui étaient avec les
rebelles pour une période. Cependant, vous devez demander toutes les répondantes, car il est
difficile de savoir a qui ils pourraient s’appliquer et a qui pas.
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Vous pouvez sauter cette question si la femme n’était pas violée, mais rassurez vous d’enregistrer ‘0’ ici, pas
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"
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Annex 10
"
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+99.V!M`=!@DBI/!B::.::K.9/!/113!I1D!/.:/894!XP894B3BY!
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E@?=2N)3)"T23$N2a"T).)"T)N)"'3'+A'N2"%2+)"+'"T)1'+B'"_T%$32`".)"$3)N)"T)FGFGh"
E4?M'N'+B'N'"C)+"'"%)3)N)h"
"
80
"
"
"
"
"
"
"
"
"
"
"
EH?M'T$T2F'N'"C)"T2NGT%'"C'"N23)".)")F'3'N'"T2F'3'"+'"T'N'F2h"
EL?M'%$.'N'"T).)".)"%'C)N2F'N'"%'.)"T1'F2")"T2F)"T'"C)h"
E\?M'%)T'N2"T).)")T2F)"T'"C)h"""
EQ?M'.'T%)3'N2"+'"TY'F2"+'"T'N'F2")"T2F)"T'"C)h"
EX?M'%)T'N2"T)%'32"+'"C)h"
E!-?M'%)T'N2"TY'+'".)"%'+'"%'"C)h"
E!!?M'%)T'N2"+A$N)"C'"32%).'"3C'"C)".)"T)+2+B'h"
E!,?='F'F2"$3$3'N2"+B)+B'"+C)F)h"
E!@?M'd)N2F'N2"C)"1).'"T'N'F2"+'"%'.)T%)N2h"
E!4?M'.)T%)N2"%'%).)3'N2"%23)N)"%C'"C)h"
E!H?Jd'3'N2".$T)2+"+'"$F2N'")C)"%'d'3'N2"N)%)T'"%'.)h"
E!L?Jd'3'N2".$T)2+"+'"$F2N'")C)"%'.GT%'N2"%'.)+"'"+A'N)h"
E!\?M'N'+BN2"C)"3)N)3'h"
E!Q?M'N'+B'N2"T)%'32"+'C")".)"'%G+B'h"
E!X?=Y'+'".)"%'+'"%'"C)"%'N'+B'N'"T1$"%'+B)".)"%'%G+B'h"
E,-?M'N'+B'N'"+A$N)"+'C")".)"T)+2+B'"+'"C)h"
"
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kLQHW8HY*W()'+?'*T&/(+?-)(*#&*=(T(=@&*<(+(*"&T'*&)'+?'>*#-@'"(*+?('*=(T(=@&*=(#-**
E,!?IA$N)"+'"C)"'d)N'N'"1).'"T'N'F2"+'"%2.GT%'h"
E,,?M'C'N'"N)C2%'".)"N)%$%2F'"%23)N)"C'"%'.)+"'"T%)N'h"
E,@?M'N'+B'N2"C)+"'"T'N'F2"N)%)T'"%'F)A'"+'"%2.GT%'h"
E,4?M'N'+B'N2"C)+"'"T'N'F2"N)T$3'"%'+B2h"
E,H?M'N'+B'N2"C)+"'"T'N'F2")%$.'".)")N'.'"+A$N)"+'"C)".)"T)+2+B'"+'C")h"
E,L?M'N'+B'N2"C)"+'"T'N'F2")%$.'".)")N'.'"T).)"T)FGFGh"
E,\?"M'N'+B'N2"C)"+'"T'N'F2")%)T'"+A$N)"+'"C)".)"T)+2+B'"+'C")h"
E,Q?"M'N'+B'N2"C)"+'"T'N'F2")%)T'"T).)"T)FGFG")C)"'d'3'N2"+A$N)"+'"C)".$h"
E,X?"M'N'+B'N2"C)"+'"T'N'F2"N)F'+B2F'"+d).)"+'"C)"+'"T)%'32h"
E@-?9'+B)"%'.'T%)3'N2"+'"C)"+'"T'N'F2")T$T'N2"d$T2"T1$")%).'N2"TY'+'h"
E@!?"
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E@@?"='N'T%)"T)FGFG"$d'32")C)".)F)3)32".$h"
E@4?"<)N2"$d'32a"3)%'"
E@H"?JN2T'"T%)N'"+'"C)".$"T1)"+'"%2.GT%'"h"
E@L?"<)N2"+A2C)a")N$+A'N'"+A$"Y'12h"
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""c!!c"
"
"
81
"
"
"
"
Z,\?"I'"F'+d'"$3$N2a"T)%'32"+'"C)"'N'+B'N2"C)"+'"T'N'F2"T1)"+'"N)F'+B2F'"+d).)"'.'"+N)")32+B'N2"
.$h"
Z,Q?"I'"F'+d'"$3$N2a"T)%'32"+'"C)"'N)T'N2"+'"N'+A'"F)N2")F)3)32"+'"T)%'32"T)FGFGh"
Z,X?"I'"F'+d'"$3$N2a"T)%'32"+'"C)"'32+B'N'"N).2'+'"T1)"+'"N)C$%'"Y'12"+A$")d'32"+'"+B)+B'"+C)F)h"
Z@-?"I'"F'+d'"$3$N2a"T)%'32"+'"C)"'T$N'N2"N)1$N2F'"C)")N$+A$"N).'3'"%'+2+B'h"
Z@!?"I'"F'+d'"$3$N2a"T)%'32"+'"C)"'%'+B2F'N2"C)".)"'B'+B$3'N2"C)h"
Z@,?"I'"F'+d'"$3$N2a"T)%'32"+'"C)"'.G+B2F'N2"C)".)"T)FGFG")C)"'S'+A2"$1'2"+'"C)h"
Z@@?"I'"F'+d'"$3$N2aT)%'32"+'"C)"'%)C'N2"N)1$F'"C)"T%)+B)"T1)"+'"32FG+B2"C'"+A'N)"'.'"+N)"'d'3'N2"
+'"T%)+B)"T1)+'"T'N'T%)"T)FGFGh"
Z@4?"I'"F'+d'"$3$N2a"T)%'32"+'"C)a"'dY'N2"$3)N)".)"T%)+B)"+'"C)"'.'"+N)")32+B'N2".$h"
Z@H?"?"I'"F'+d'"$3$N2a")%)T%'N2"T%)+B)"+'C")"+'"F)T)"C'"N)%'+B'"T)%'32"+'"C)"T1)"'dY'".$h"
"
"
82
"
"
"
"
"
"
Annex 11
"
Preparation of database
"
"
"
"
"
+99.V!MM=!HD.JBDB/819!1I!2B/BEB:.!
"
2$-9*'/&)3!7$'($20#%!
7*$'.$"+$Y"P'*2'%3$"S*)T"T'*2.'3"F.'.GF"_M,`".)"2+A2&'.$"Y/$./$*"./$"*$F1)+A$+."2F"Y2./"'"1'*.+$*")*"
+).?"e[2./"1'*.+$*b"_!`"2+&3GA$F"T'**2$A"'+A"&)c/'%2.2+Bf"eY2./)G."1'*.+$*b"_-`"2+&3GA$F"A2P)*&$Aa"
F$1'*'.$Aa"Y2A)Y$A"'+A"F2+B3$?""
#57JK5"^G$F.2)+"'%)G."Y/$./$*"*$F1)+A$+."2F"/$'A")S"/)GF$/)3A"_MQ`".)"2+A2&'.$")+3C"Y/$./$*"./$"
*$F1)+A$+."2F"/$'A")S"/)GF$/)3Aa")*"F)T$)+$"$3F$"2F"/$'A")S"/)GF$/)3A"_.)"2+&3GA$"e/GF%'+Ag"
1'*.+$*ba"'+A"e)./$*b`?"
#57JK5"^G$F.2)+"'%)G."T)+./3C"S2+'+&$F"_M,\`".)"2+A2&'.$"Y/$./$*"'."./$"$+A")S"./$"T)+./"./$"
/)GF$/)3A"2F"GFG'33C"2+"A$%."_.)"2+&3GA$"eGFG'33C"/'P$".)"%)**)Ybf"e*$3C")+"S'T23C"T)+$C".*'+FS$*bf"
GFG'33C"/'P$".)"GF$"1'F."F'P2+BFb`f"%*$'N"$P$+f")*"'*$"2+"&*$A2."_eGFG'33C"/'P$"T)+$C"3$S.")P$*b`?"
7*$'.$"+$Y"P'*2'%3$"_eIZJ"/$31`"%C"FGTT2+B"*$F1)+F$F".)"M@!cM@\a".)"2+A2&'.$"./$"$].$+.".)"Y/2&/"
./$C"/'P$"*$&$2P$A"'FF2F.'+&$"S*)T"IZJFg"7MJF?"
"
%/-($0!)#41/'9%!
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7'3&G3'.$".).'3"e<)&2'3"+$.Y)*NFb"F&)*$"%C"FGTT2+B"*$F1)+A$+.bF"*$&)A$A"F&)*$")+"<)&2'3"I$.Y)*NF"
_'`".)"_+`?""9).'3"F&)*$"&'+"*'+B$"%$.Y$$+"-"'+A"!4?"
7'3&G3'.$"'".).'3"e&)+S2A$+&$"2+"'"&*2F2Fb"S*)T"*$F1)+A$+.bF"F&)*$F")+"./$"./*$$"^G$F.2)+F"'%)G."/)Y"
&)+S2A$+."F/$"Y)G3A"%$"./'."F/$"&)G3A"B$."'FF2F.'+&$"2+"'"&*2F2F"F2.G'.2)+"_7Hc\`?""9).'3"F&)*$"&'+"
*'+B$"S*)T"-cX?"
7'3&G3'.$"'".).'3"e*$3'.2)+F/21b"F&)*$"S*)T"./$"*$F1)+A$+.qF"F&)*$F")+".Y$3P$"^G$F.2)+F"'%)G."./$"
.C1$F")S"FG11)*."F/$"/'F"*$&$2P$A"S*)T")./$*F")P$*"./$"1*$P2)GF"T)+./"_7Qc!X`"_-i+)a"!iF)T$.2T$Fa"
,i)S.$+`?""9).'3"F&)*$"&'+"*'+B$"S*)T"-c,4?"
"
#"+/1#'"#)4!
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T'*2.'3"*$3'.2)+F/21"_+)i!f"C$Fi-`?"
7'3&G3'.$"'".).'3"eT'*2.'3"2+S3G$+&$b"F&)*$"S*)T"*$F1)+A$+.bF"F&)*$F")+"./$"X"2.$TF"*$3'.2+B".)"/$*"
*$3'.2)+F/21"Y2./"/$*"/GF%'+Ag"1'*.+$*"_5Qc!L`?""9).'3"F&)*$"&'+"*'+B$"S*)T"-c!Q?"
#$&)A$"*$F1)+F$F".)"_7!`"<)&2'3"I$.Y)*NF"_'`".)"_+`"F)"./'."I)")*"=$T%$*i-"'+A"W$'A$*i!?""
7'3&G3'.$".).'3"eZ*)G1"3$'A$*b"F&)*$"%C"FGTT2+B"*$F1)+A$+.bF"*$&)A$A"F&)*$")+"_'`".)"_+`?""9).'3"
F&)*$"&'+"*'+B$"%$.Y$$+"-"'+A"!4?""7'3&G3'.$"'".).'3"F&)*$"S)*"7@".)"2+A2&'.$"./$"+GT%$*")S"
3$'A$*F/21"1)F2.2)+F"/$3A?""7'3&G3'.$"'".).'3"eW$'A$*F/21b"F&)*$"%C"FGTT2+B"./$"eZ*)G1"3$'A$*b"'+A"7@"
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"
+%,-./0/*(-$0!3(%4'#%%!
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1FC&/)3)B2&'3"A2F.*$FF"_+)."'."'33i@f"'"32..3$i,f"^G2.$"'"%2.i!f"$].*$T$3Ci-`?"
7'3&G3'.$"'".).'3"e1FC&/)3)B2&'3"A2F.*$FFb"F&)*$"S*)T"*$F1)+A$+.bF"F&)*$F")+"./$"!X"2.$TF"2+"./$"F&'3$?""
9).'3"F&)*$F"&'+"*'+B$"S*)T"-cH\?"
"
"
83
"
"
"
!
#b+#'(#)-#%!+/4#)4($00,!()50&#)-()*!+%,-./%/-($0!1#002#()*!
7)+S32&."*$3'.$A"2FFG$F"
7'3&G3'.$"'".).'3"eY'*"$]1$*2$+&$Fb"F&)*$"S*)T"./$"+GT%$*")S"A2F.*$FF2+B"$]1$*2$+&$F"*$F1)+A$+.F"
F'2A"./$C"/'A"$]1$*2$+&$A"AG*2+B"./$"&)+S32&."_Z!c@@`?""9).'3"F&)*$F"&'+"*'+B$"S*)T"-c@@?"
7'3&G3'.$"./$".).'3"+GT%$*")S"T)+./F"./'."*$F1)+A$+.F"Y$*$"A2F13'&$A"_Z@L`?"
R)F."&)+S32&."&/'33$+B$F"
#57JK5"2.$TF"(Qa"(!Xa"(!H"'+A"(!\"F)"./'."'"/2B/$*"F&)*$"2+A2&'.$F"T)*$"&/'33$+B$F"$]1$*2$+&$A"
_+)i,f"F)T$.2T$Fi!f"C$Fi-`??"
7'3&G3'.$".).'3"eA)T$F.2&"P2)3$+&$b"F&)*$"S*)T"*$F1)+A$+.bF"F&)*$F")+"./$"!L"2.$TF"'%)G."A)T$F.2&"
P2)3$+&$"$]1$*2$+&$F"_(,-c@H`?""9).'3"F&)*$F"&'+"*'+B$"S*)T"-c!L?"
"
"
"
84
"
"
"
"
"
"
"
Annex 12
"
"
"
"
"
"
+99.V!MR=!,.G8.Q!B92!D.G8:819!1I!8/.K:!
"
9/$"S2*F."F.'B$")S"./$"'+'3CF2F")S"./$"123)."F.GAC"A'.'"Y'F".)"*$P2$Y"*$F1)+F$F"'+A"2A$+.2SC"./)F$"
2.$TF"Y/2&/"Y$*$"+)."Y)*N2+B"Y$33a"'+A"F/)G3A"%$"*$T)P$A?""9/2F"F.'B$")S"./$"'+'3CF2F"2+P)3P$A"./$"
S)33)Y2+B"1*)&$AG*$FU"
•
•
•
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0"*$P2$Y")S"./$"T2FF2+B"A'.'"S)*"$'&/"2.$T?""(2B/"3$P$3F")S"T2FF2+B"A'.'"FGBB$F."./'."./$"2.$T"
2F"+)."'1132&'%3$".)"'"3'*B$"1*)1)*.2)+")S"*$F1)+A$+.Fa")*"./$"*$F1)+A$+.F"'*$"A$&32+2+B".)"
'+FY$*"2."%$&'GF$"2."2F"2+'11*)1*2'.$?"
0"&/$&N"S)*"$+A)*F$T$+."S*$^G$+&C")S"2.$TF?"":S"$P$*C)+$"*$F1)+AF"./$"F'T$"Y'C".)"'+"
2.$Ta"2."Y233".$33"GF"P$*C"32..3$"'%)G."&/'+B$?""[/$*$")+$"'3.$*+'.2P$"/'F"'"P$*C"/2B/"_)*"3)Y`"
$+A)*F$T$+."*'.$a"2."2F"*$T)P$A?"
0"&/$&N")+"./$"2+.$*+'3"&)+F2F.$+&C")S"2.$TF"_/)Y"Y$33"$'&/"2.$T"&)**$3'.$F"Y2./")./$*"2.$TF"
'+A"./$".).'3"F&)*$`?"
0"&/$&N")+"./$"A2F&*2T2+'.2)+"'%232.C")S"2.$TF"_Y/2&/"2.$TF"%$F."A2F&*2T2+'.$"%$.Y$$+"
*$F1)+A$+.F"Y/)"F&)*$"'%)P$"./$"T$A2'+")+"./$"F&'3$"'F"'"Y/)3$a"'+A"./)F$"Y/)"F&)*$"
%$3)Y"./$"T$A2'+`?""9/)F$"Y/2&/"A2F&*2T2+'.$"%$F."%$.Y$$+"./$F$".Y)"B*)G1F"'*$"T)*$"
32N$3C".)"%$"F$+F2.2P$".)"&/'+B$?"
:+"F)T$"&'F$Fa"Y/$*$"./$"+GT%$*")S"2.$TF"'+A"*$F1)+A$+.F"'33)Y$Aa"'"S'&.)*"'+'3CF2F"Y'F"
&)+AG&.$A".)"'FF$FF"Y/$./$*"./$"F&'3$"&)+F2F.F")S")+$"F2+B3$"S'&.)*")*"'"+GT%$*")S"S'&.)*F?""
:.$TF"Y/2&/"A)"+)."3)'A")+.)"'+C"S'&.)*"/2B/3C"'*$"*$T)P$A?"
R<>7(JWJZ:70W"K:<9#5<<"
9/2F"!Xc2.$T"F&'3$"Y'F"A$F2B+$A".)"'FF$FF"$T).2)+'3"'+A"1FC&/)3)B2&'3"A2F.*$FF"$]1$*2$+&$A")P$*"./$"
1*$P2)GF")+$"Y$$N?""7*)+%'&/bF"'31/'"S)*"./$"SG33"F&'3$"Y'F"-?L@f"'+"'31/'")S"?\-"2F"B$+$*'33C"
&)+F2A$*$A"'&&$1.'%3$a"F)"./$"2+.$*+'3"&)+F2F.$+&C")S"./2F"F&'3$"Y'F"3)Y$*"./'+"'+.2&21'.$A?""9/$*$"
Y'F"+)"T2FF2+B"A'.'?"
#$P2$Y")S"2.$T"F.'.2F.2&F"2+A2&'.$A"./'."2.$TF",a"4a"La"Xa"!-a"!,a"!@"'+A"!4"_)+"./$")*2B2+'3"P$*F2)+`"A2A"
+)."&)**$3'.$"Y$33"Y2./"./$"F&'3$"'F"'"Y/)3$f"'+A"2.$TF"@a"4a"Xa"!-a"!!a"!@a"!4"'+A"!H"A2A"+)."
A2F&*2T2+'.$"Y$33"%$.Y$$+"./)F$"Y/)"F&)*$A"'%)P$"'+A"%$3)Y"./$"T$A2'+")+"./$"F&'3$?"":.$TF"4"'+A"
H"/'A"P$*C"3)Y"$+A)*F$T$+."*'.$F"_2+A2&'.2+B"./'."'3T)F."$P$*C%)AC"F'2A"./$C"A2A"+)."'113C".)"
./$T`?""0"S'&.)*"'+'3CF2F"2+A2&'.$A"./'."'"F2+B3$"S'&.)*"$]13'2+$A"!Q?@Lã")S"./$"P'*2'+&$"
_$2B$+P'3G$i@?4Xà"'+A"./$"2.$TF"Y/2&/"3)'A$A"T)F."/2B/3C")+"./2F"Y$*$"./)F$"Y/2&/"*$3'.$A".)"
1/CF2&'3"Y$33%$2+B"_!La"!\"'+A"!Q`?""0"F$&)+A"S'&.)*"'&&)G+.$A"S)*"!!?\-ã")S"./$"P'*2'+&$"
_$2B$+P'3G$i,?,,`"'+A"2.$TF"S)&GF2+B")+"1FC&/)3)B2&'3"A2F.*$FF"3)'A$A"/2B/3C")+"./2F"F$&)+A"S'&.)*"
_!a"@a"4a"Qa"!!a"!X`?""0F"'"*$FG3.a"'"A$&2F2)+"Y'F"T'A$"+).".)"2+&3GA$"./$"2.$TF"T$'FG*2+B"1/CF2&'3"
Y$33%$2+B"2+"./$"1FC&/)3)B2&'3"A2F.*$FF"F&'3$a"F2+&$"./$C"F$$T$A".)"%$"T$'FG*2+B"'"A2SS$*$+."
G+A$*3C2+B"S'&.)*?""9/$"2.$TF"S)*"Y/2&/"TG3.213$"1*)%3$TF"Y$*$"2A$+.2S2$A"_,a"4a"Xa"!-a"!,a"!@a"!4`"
Y$*$"'3F)"*$T)P$A"S*)T"./$"F&'3$"
9/$"*$P2F$A"P$*F2)+")S"./$"F&'3$"&)+F2F.F")S"$2B/."2.$TFU"
!?"K)"C)G"&*C"S*$^G$+.3Ch"
@?"K)"C)G"S2+A"C)G"%$&)T$"'+B*C"P$*C"^G2&N3Ch"
H?"K)"C)G"F.'C"'Y'C"S*)T")./$*"1$)13$h"
L?"K)"C)G"'P)2A"&$*.'2+"13'&$F")*"1$)13$"%$&'GF$"./$C"*$T2+A"C)G")S"1'2+SG3"./2+BFh"
\?"K)"C)G")S.$+"S$$3"'S*'2Ah"
Q?"K)"C)G"./2+N"'"3)."'%)G."%'A"./2+BF"./'."/'P$"/'11$+$A".)"C)Gh"
!!?"K)"C)G"/'P$"'"B))A"'11$.2.$"S)*"S))Ah"_.-F-."-*"$&.'+?`"
!X?"()Y"TG&/"A2A"$T).2)+'3"1*)%3$TF"32T2."C)G*"A'23C"'&.2P2.2$Fh"
9/$"7*)+%'&/bF"'31/'")S"./$"*$P2F$A"Qc2.$T"F&'3$"2F"?LHa"Y/2&/"2F"&3)F$*".)"'+"'&&$1.'%3$"3$P$3?"":."
F/)G3A"%$"+).$A"./'."T$'FG*$F")S"eF.'.$Fb"_2?$?"P'*2'%3$F"Y/2&/"&)TT)+3C"&/'+B$")P$*".2T$a"FG&/"'F"
"
"
85
"
"
"
"
'+]2$.C`"'*$"&)TT)+3C"S)G+A".)"/'P$"3)Y$*"3$P$3F")S"*$32'%232.C"./'+"'*$"T$'FG*$F")S"T)*$"F.'%3$"
.*'2.F")*"'%232.2$F?"
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87
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88
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Annex 13
"
Final version of psychosocial
wellbeing assessment tool (English)
"
"
"
"
+99.V!MT=!789B3!G.D:819!1I!J:5;01:1;8B3!Q.33E.894!B::.::K.9/!/113!X"9438:0Y!
"
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104
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Annex 14
Data entry guide and database preparation
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THE WORLD BANK
1818 H, Street N.W.
Washington, D.C. 20433
www.logica-wb.org

3.66 MB PDF version

Transcription

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