Trauma-informed Phone Interviews on Sensitive Topics: Learning from the COVID-19 lockdown in Uganda

An interview with Sylvia Namakula and Agnes Grace Nabachwa

Healing and Resilience after Trauma (HaRT) is dedicated to holistic healing among women and girls who have experienced human trafficking and gender based violence. Our HaRT Yoga program uses mindfulness exercises, yoga and other movement activities to support participants in connecting with their inner resilience, building a supportive community, and overcoming the physical and emotional consequences of trauma. We are conducting a mixed-methods evaluation with women and girls in Kampala, Uganda to assess any changes in their overall wellbeing. The project is a collaboration with HaRT (Sylvia Namakula, Agnes Grace Nabachwa and Sophie Namy), the University of Alabama School of Social Work (Catherine Carlson and Violet Nkwanzi) and Willow International (Joylyn Edwards, Lillian Ayella and Kelsey Morgan). All HaRT Yoga participants are currently residing in one of Willow’s shelters, or have recently relocated due to COVID-19.

Uganda has taken a number of measures to contain the COVID-19 pandemic. Until early June, the country was under strict lockdown, including a ban on the use of all public and private transport, the closure of all non-food businesses, and a national curfew. As such, since mid-March it has not been possible to continue with HaRT’s in-person activities, prompting an eventual pivot to virtual methods. Below we interview Sylvia and Agnes—our research team members leading the data collection—to learn more about the transition from in-person to phone-based interviews, and the lessons they learned along the way. 

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Please share a bit about your process and decision to move forward with remote research during this difficult time?

When the lockdown first started, we made the difficult decision to suspend all our research and programming, while things stabilized in the country and for us personally. Even at Willow, they were facing an enormous challenge to ensure all the women and girls participating in their anti-trafficking programming were safe and had a place to live, food to eat, etc.

As time moved on, we had further discussions about the wellbeing of the 21 women and girls who were enrolled in our study and had agreed to participate in the five rounds of planned data collection. We had already gone through two rounds of interviews together, and had asked them sensitive questions about the traumatic events that brought them to live in the shelter, their mental health, physical health, and support networks—so we had developed strong trust and rapport. We wondered how they were doing, and if they might feel we had abandoned them in this difficult moment. We also knew that COVID-19 and the lockdown was likely intensifying the mental health challenges some of the participants had been experiencing previously, or even causing them to relive their past traumas.

After consulting with Willow and the ethical review boards in Uganda and the U.S., we felt that with care and sensitivity, it might be possible to safely continue our research over the phone. Our primary motivations were to sustain our relationships with these women and girls, learn from their experiences during the lockdown, and connect them to further support if needed. For example, we were able to set aside emergency cash disbursements for participants who were having trouble meeting their basic needs. We were further reassured knowing we could tap into referral services at Willow, who had already shifted all their case managers to providing remote support. Before committing to this new protocol, we also set aside time to share knowledge and ideas about how to make phone-based interviewing successful. This really helped us, since this style of interviewing is not the usual, so we had to encourage each other and give each other confidence. Finally thinking about our own wellbeing as researchers, we agreed to daily debriefs and a longer follow-up with a clinical psychologist in Kampala.

What approach did you use when starting the phone interviews?

First, after receiving the contact information from the Willow case managers we made ‘pre-calls’ to each participant to invite them for the interview and set a date and time that was convenient for them. This process was very important, as it gave everyone—interviewer and interviewee—time to prepare, to find a private space, and also to ensure phones were adequately charged. In this way we also knew the interview would take place at a time that was appropriate, comfortable, and safe for the participants to talk. Even for us at home, we had to set up our space so that there would be no disturbances, as we were also under lockdown with our families.

During the call itself, we started off by introducing ourselves again and asking the participant to introduce themselves as well. We would listen in on their voice, to ensure it was the same individual we had spoken with previously. We also had to make a bit of small talk, to help break the ice and feel more connected – ‘How are you? How are things where you are?’ and so forth. This gave participants the opportunity to get into the interview mood.

Next we would go through the consent, really making sure the participant understood all that was required to participate in the interview—such as a private space to talk. We explored this several times during the interview itself, asking if it was still a good place to talk and if there was anyone listening in. Ourselves we would also listen for any background noises. Because the interviews took some time, we made sure to ask, ‘are you sitting down?’ and ‘is the volume okay?’ These steps really laid the ground for us to have a successful interview.

Did you put in place any additional ethical protocols compared to your prior in-person work?

Yes we did. One of the big things we realized is that with face-to-face, it’s usually the interviewer that ensures all ethical principles are followed. But with the phone interview, you have to engage the interviewee themselves. For example, much as we ask about privacy, in the end you have to rely on the participant to assess and ensure the place is private. We also asked them to check if the phone is on speaker, and if so to take it off so no one could overhear. Another thing we added is agreeing on a diversion topic at the beginning, so that if someone came into earshot the participant would change the discussion right away.

We also learned to rely on the tone of voice, and other clues like how long the person is pausing, because we couldn’t see their facial expressions or body position. So when the tone or cadence changes, we might ask something like, ‘Is it okay for us to continue.?’ Or ‘is this still a good environment to talk?’ So at different points we reminded the participants about the conditions we established at the beginning during the consent, including that they were free to skip any question. This helped ensure there was no breach in the ethics.

And finally, we did include the cash disbursements for emergency needs for the women and girls who had shifted out of the shelters during confinement. This was not part of our original plans, but we felt an ethical responsibility given the economic stress and inability of many women to earn money during the lockdown.

Can you share some examples of how you brought a trauma-informed lens to the interviews?

With phone interviews, we really took listening to the next level

We made it a point to listen even more attentively for these non-verbal cues, especially the hesitations, the pauses, and any background noises—so that we were better able to detect the emotional state of the participant. Throughout the survey, we gave the women and girls more time to talk and explain their responses. 

This felt more important on the phone, to really make it clear that we value and care about what they were sharing.

Another principle in trauma-informed research is emphasizing choice and personal agency – which we did by asking participants to choose the time, decide where to sit or have the interview, and make them aware of the option to opt-out entirely or skip any questions. After the first day, we also realized it was important to add a question at the end to help close the conversation when the participant is in a more stable emotional place. So before moving to the referral script, we asked the participant about any ‘bright spots’ in their days during lockdown so that the women and girls did not feel low, especially after having shared their traumatic experiences. Hopefully this left them having positive thoughts, despite the ‘no-contact’ interview.

Is there anything you would like to share about your own experience as interviewers facilitating these discussions during COVID-19?

Overall it was an exciting process. Because when we first talked about phone interviews, we worried about our ability to have the same connection and depth as during in-person discussions. Looking back, we feel confident that a phone interview can be just like a face-to-face conversation, and that it is possible to have trust and openness. So you are not just calling a person to talk—you are taking them through the ethical requirements, and inviting them to participate and play an active part in the safety of the interview.

In terms of our own wellbeing, of course we also had this anxiety- this COVID anxiety. But talking with the participants, we realized they were going through even more uncertainty and difficulties. That was an important perspective. We also supported each other and had internal team debriefs each day, that helped to share and release our feelings. When a person pours out their heart—and you are listening—at this time you keep in mind that at the end of the day, you are not alone . . . when we debrief together, it helps to get the emotions off our chest. We also talked about how to handle ourselves emotionally during hard interviews.

One thing we learned is about our own self-talk as researchers, saying to ourselves, ‘Yes, it is not about me, I am not the cause’—and this really helps. I remember one girl—she was suffering a lot—and I just reminded myself that her situation is not because of me, and that there is a boundary between us. I told myself that this is her life, I am here to listen to what she is saying and support her by making referrals if necessary. Even when the situation is hard, in the end we are supporting this person by connecting them to a case manager. And then as a team we could follow-up, and get the confirmation that the referral took place. Maybe this is why the participants are eager to talk to us. Much as we are doing research, they trust we will do our best to connect them to additional support.

Sometimes we also did these short relaxation exercises that are part of the HaRT Yoga program ourselves. We shared them on WhatsApp, and they were relaxing! By the time you finish, you feel you have forgotten all the stress. It helps you to put aside issues from the interviews, and focus on your muscles, focus on your arms and legs . . . on the now of the present moment rather than worrying.

Overall, what is one takeaway you want to share with others about facilitating these sensitive interviews via phone compared to in-person?

With phone interviews you need to adopt new skills. The interviews are conducted a bit differently. Because with face-to-face, the interviewer covers the ethical processes at the site of the interview, however with the phone interviews, the ethical processes are to be observed and ensured at both end of the call- interviewer and interviewee sites.

During phone interviews, the interviewer also must depend so much on the listening, the tone, pauses in the statements, and anything else happening in the background. You really try to hear their emotions and stability from the tone of their voice and the way they are sharing. In our interviews, we are talking about sensitive experiences. You have to let the person know you are listening to them. You must give them time to talk and also be mindful of the time/length of the interview. By giving this time and attention, it helps the participant realize that we are not just there for the data, to ask questions, get responses and leave—because we also care for their wellbeing.

It is possible to build rapport and connect with participants during phone interviews. We knew each other already, but we worried they might feel a bit distant on the phone. Surprisingly even when we talked to the younger girls, they spoke freely, and you would feel that whatever they are sharing is from their heart. The participants were able to open up, it seems that many were yearning to talk to someone. Maybe this is partly because of the lockdown, we came in to listen at a time so many women and girls are experiencing anxiety and isolation.

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The current HaRT program and learning activities are being supported by the Small Grants Program at University of Alabama and a Rapid Response Grant from Urgent Action Fund-Africa. Please send any enquiries or comments about HaRT or our phone-based research protocol to hartyogakampala@gmail.com.

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