Accessibility statement

Adapting the Connecting People Intervention to support mental wellbeing of bonded labourers in Nepal

Background

Bonded labour, a form of modern day slavery, is the subject of widespread international concern and action, yet it still persists on an alarming scale, affecting more than 20.9 million people globally. Bonded labour causes significant psychosocial distress, a disintegration of communities and the ways people interact through human contact and trusting relationships. Amid a resource-limited system, there is an urgent call to address the psychosocial needs of individuals, families and communities living in bonded labour in order to help them move sustainably out of exploitation.

This co-produced project with ICMHSR at University of York, UK based charity the Freedom Fund and the Centre for Mental Health and Counselling (CMC) in Nepal, will accelerate the impact of a mental health social intervention aiming to mobilise community-based resources in the provision of mental health support for bonded labourers.

The Connecting People Intervention (CPI) provides a practice framework for non-specialist community-based workers to support people with mental health problems to enhance their social connections by engaging in social activities, building trust with supportive people and drawing upon existing resources in their community.

Aims and objectives

We aim to build upon our initial advances using the CPI approach in the UK and Sierra Leone and co-productively work with local stakeholders in Nepal to adapt a culturally appropriate model and gather outcome data about the likely efficacy of the CPI among bonded labourers. In particular, we seek to answer the following questions:

  • How can the CPI be culturally adapted for the mental health needs of bonded labourers in Nepal?
  • How feasible is it to train community facilitators to deliver the adapted CPI?
  • How acceptable is the adapted CPI to people living in bonded labour and their surrounding communities?
  • How can fidelity to the adapted CPI be measured with good reliability and validity?

The answers to these questions will help us to establish the feasibility, acceptability and indicative effectiveness of the adapted CPI in Nepal.

Methods

WP1 Feasibility and acceptability; intervention model development

Firstly, we will draw upon the network in the region developed by the Freedom Fund and bring together key stakeholders including: bonded labourers and family members, district and primary care service providers, NGO community facilitators (CFs), traditional healers and local community leaders who are highly active in interacting with district officials and advocating for rights. Secondly, we will use ethnographic methods of triangulating interviews, observations and informal discussions to obtain a rich description of the adapted intervention within the community context.

Based upon the intervention model developed in the first phase, we will then co-produce standardised practice guidelines and training materials in manuals. Through ongoing communication between members of the research team, CMC in Nepal, and our partner organisations we will contextualise language, activities and theory to ensure the manuals are culturally sensitive, thus enhancing retention and sustainability. The intervention model will be designed for training-of-trainers (TOT) whereby we will train local NGO staff to deliver the intervention in the bonded labour communities.

WP2 Pilot study

An integrated mixed methods approach will be used in a pre-post pilot. The Theory of Change model guides the design of this study, a structured participatory approach characterised by co-productively evaluating links between changes from exposure to adoption, implementation, and sustainability with local stakeholders.

We will train roughly 60 staff members from partner organisations in south eastern Nepal and recruit 100 bonded labourers (60 intervention group, 40 control group) to participate in the pilot. We will administer measures at baseline, post-training and 6-month follow-up to test the hypothesis that higher fidelity to the adapted CPI will be associated with a reduction in psychiatric symptoms and enhanced quality of life and social relationships for people currently in bonded labour, and increased confidence in skills for NGO staff delivering the intervention. We will also investigate how the various components of the complex intervention interact to inform future iterations of the model and training.

Funding

This project has been funded by the University of York ESRC Impact Acceleration Account and by the Freedom Fund UK.

Output

The findings from this study will be published in an open access peer-reviewed journal after its completion in January 2018 and a briefing report will be available to download from the Freedom Fund and the School for Business and Society web pages, and the Freedom Fund’s monthly Research Digest.