C2.01 - Oral: Research for Health Equity: Longitudinal Photovoice with Congolese Refugee Women in Kampala, Uganda

Brief Abstract Summary: There are over 500,000 refugees from the Democratic Republic of Congo in neighboring Uganda with priority health conditions of mental health, parasitic infections, and sexual and gender-based violence. Both women refugees and urban refugees are understudied though evidence shows distinct experiences from male refugees and from those in settlements. Therefore, we conducted longitudinal Photovoice research with 21 urban refugee women in 2023 and 13 of the same group in 2024 to understand changes over time in health and integration. Three themes of improvements, increased needs, and potential for group support emerged. Sub-themes in “improvements” were housing security and livelihood opportunities. Sub-themes in“increased needs” were the impact of premature deaths, ongoing healthcare barriers, and increasing sense of discrimination. Both the methods and findings offer insight for promoting health equity with a population that is often stigmatized, marginalized, and invisible in Uganda.

Detailed abstract description:

Background: The multi-decade conflict in the Democratic Republic of Congo (DRC) is one of the most complex humanitarian crises in the world. By 2023, there were over 500,000 refugees from DRC in neighboring Uganda. Priority health conditions among refugees include mental health challenges, malaria, parasitic infections, and high potential for experience of sexual and gender-based violence. Additionally, there is risk for health inequities due to multiple factors prior to migration during the wars in DRC, during migration and potentially living in settlements, and challenges during resettlement as "foreigners" in Uganda. Further, women refugees are understudied though evidence shows distinct experiences from male refugees. Research with urban refugees is limited, but available evidence suggests urban women refugees experience multiple barriers to integration, health, and healthcare including living without assistance from UNHCR, housing insecurity, uncertain economic opportunities, stigma, discrimination, and lack of legal protection and access to basic healthcare. Urban Congolese women refugees in Uganda, deserve examination of their unique experiences and needs to prevent exacerbation of inequities.

Methods: We conducted longitudinal Photovoice research with urban Congolese refugee women in Kampala to understand changes over time, or lack thereof, in health and integration experiences. Interview, photo, and narrative data were collected over four meetings with 21 adult women in 2023 and three meetings with 13 of the same women in 2024. Maintaining the original goals of Photovoice, strengths and concerns were discussed and public events were held to promote awareness and advocate for change. Analysis included participant choice of photos and collaborative discussion followed by conducting inductive thematic analysis for developing, reviewing, and refining core themes.

Results: Three key themes of: improvements over time, increased needs over time, and potential for group support emerged. Sub-themes within “improvements” included housing security and livelihood opportunities, while sub-themes within “increased needs” included impact of premature death of family and community members, ongoing barriers to healthcare, and increasing sense of discrimination. The third theme of potential for group support included data illustrating support for each other related to past sexual assault and trauma, and discussions about future social support.

Conclusions: Findings revealed strengths for health promoters to build upon while also highlighting crucial needs for prioritization by implementing partners. Both our methods and findings offer insight into promoting health equity for a population that is often stigmatized and invisible in Uganda. This presentation will describe the longitudinal Photovoice methods used and how findings can inform programs and policies to improve health and integration for Congolese refugee women in Uganda.