Browsing by Author "Gyawali, Bishal"

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    236 Community engagement in chronic disease research with displaced populations in Uganda
    (Oxford University Press, 2025-12-08) Dricile, Ratib; Gyawali, Bishal; Dræbel, Tania Aase; Nakanjako, Rita; Nanfuka, Esther; Skovdal, Morten
    Background Hypertension and type 2 diabetes are growing health concerns among forcibly displaced persons (FDPs). In Uganda, continuity of care is disrupted by mobility, limited resources, and fragmented services. This study explored factors influencing continuity and discontinuity of care for FDPs with these conditions in Northern Uganda. Methods The study was conducted in Bidibidi Refugee Settlement (Yumbe District) and Nyumanzi Settlement and Reception Centre (Adjumani District) using a community-based participatory design. Four trained peer researchers (two male, two female), Village Health Teams (VHTs), and health facility staff collaborated in data collection. Methods included surveys, point-of-care testing, interviews, and focus group discussions. An advisory board of district health authorities, humanitarian actors, and community representatives guided recruitment, tool adaptation, and referral pathways. Results Community engagement enhanced trust and facilitated culturally relevant tools and participant recruitment. VHTs, following hands-on training, successfully conducted point-of-care testing and data collection. Peer researchers contributed insider perspectives, offering deeper insights into the effects of mobility on care disruption. Key challenges included limited geographic coverage due to financial constraints, language barriers affecting data quality, and the need for extensive training and supervision. Conclusions Participatory approaches involving peer researchers and VHTs are feasible and valuable for chronic disease research in humanitarian settings. However, future studies should invest in sustainable capacity building, language mediation, and adequate resources to strengthen data quality and impact. Findings highlight the importance of embedding community engagement in non-communicable disease (NCD) research and practice to improve continuity of care among displaced populations.
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    Factors associated with continuity of care in hypertension and type 2 diabetes among forcibly displaced persons in the Bidibidi refugee settlement in Uganda: Protocol for a cross-sectional, mixed-methods study
    (Elsevier, 2023-03-02) Gyawali, Bishal; Dricile, Ratib; Dræbel, Tania Aase; Kyaddondo, David; Nakanjako, Rita; Nanfuka, Esther; Bygbjerg, Christian; Meyrowitsch, Dan Wolf; Skovdal, Morten
    Background: Non-communicable diseases in humanitarian settings are generally under-researched, particularly in Africa and have been called a neglected crisis. Little is known about factors affecting access to and (dis)continuity of care for chronic conditions, such as hypertension (HTN) and type 2 diabetes among forcibly displaced persons (FDPs) in Uganda. Aim:To investigate factors affecting access to and (dis)continuity of HTN and/or type 2 diabetes care among FDPs in the Bidibidi refugee settlement, Uganda. Methods: A sequential explanatory mixed-methods design incorporating methodological and investigator triangulation will be conducted. The study aims to employ a community-based participatory research approach to equitably engage community members, researchers, and other stakeholders in the research process, recognising and maximising their diverse contributions. In phase 1, the quantitative arm of the study, 960 FDPs with HTN and/or type 2 diabetes will be interviewed about their sociodemographic characteristics, health status, migration experiences, social capital, and awareness, treatment, and control of these diseases. Participants will be purposively recruited from phase 1 as well as village health teams, healthcare providers, and policymakers to participate in phase 2, the qualitative study, in order to gain more insight into how mobility and social factors affect (dis)continuity of care among FDPs with HTN and/or type 2 diabetes. Discussion: The findings from phase 1 and phase 2 of the study will be integrated through a triangulation process to provide a more holistic and comprehensive insight into the factors affecting access to and (dis)continuity for HTN and/or type 2 diabetes care among FDPs. Understanding these factors is expected to pave the way for conceptualizing health-enabling environments and strengthening health systems for FDPs with chronic conditions. It is anticipated that the study will generate baseline evidence that might be beneficial in developing and implementing HTN and diabetes care models for FDPs in the region.
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    Working through community structures: the role of community health workers in cardio- metabolic disease care in Bidibidi, Uganda
    (Bristol University Press, 2026-02-05) Dræbel, Tania Aase; Gyawali, Bishal; Ratib, Dricile; Nakanjako, Rita; Nanfuka, Esther Kalule; Raju, Emmanuel; Kyanddodo, David; Skovdal, Morten
    This chapter examines how community health workers (CHWs) support refugees with diabetes and hypertension in accessing health services and engaging in self- and social care. Despite limited resources, CHWs perform three critical roles: 1. Relational Work: CHWs connect with the community, facilitate communication with healthcare staff, help patients re- engage with services, advocate for patients, and act as intermediaries. 2. Healthcare Work: CHWs monitor and screen for illnesses, refer complex cases, promote health, deliver medication, monitor adherence, and follow up with patients. 3. Community Engagement Work: CHWs assess community conditions, engage in sensitisation, and mobilise efforts. These three types of work are crucial to maintaining the continuity of care for refugees with chronic conditions. Our findings underscore the importance of CHWs and the need to integrate them into the formal healthcare system.