Multifamily Healing Spaces for Family Resilience in Rwanda

NCT07621705 | Completed

• 2 other identifiers: MFHS-CRT-RWA-2023122/RNEC/2023
• Study Type: interventional
• Target: 319
• Locations: 1 country
• Sites: 5

Brief Summary

This cluster-randomized waitlist-control trial evaluated Multifamily Healing Spaces (MFHS), a culturally adapted behavioral family intervention for genocide-affected communities in Rwanda. Community members across five districts were screened through a staged triage process. Individuals with acute or severe clinical concerns were routed to clinical referral, those with individual mental-health needs were prioritized for Resilience-Oriented Therapy, and families were invited to MFHS when at least one screened family member met criteria for family communication difficulties. Twenty eligible clusters were randomly selected and then allocated to MFHS or waitlist control. The baseline cohort included 319 family members aged 12 years or older. The trial tested whether MFHS improved family resilience, parenting, couple and youth family-system outcomes, and secondary mental health, psychosocial, community, and livelihood outcomes from baseline to immediate post-intervention endline.

Conditions

Family Relations; Psychological Trauma; Stress Disorders, Post-Traumatic; Parent-Child Relation

Keywords

Rwanda; post-genocide; societal healing; family resilience; family systems; multifamily therapy; cluster randomized trial; intergenerational trauma

Outcome Measures

Primary Outcomes (4)

• Change in Family Resilience

  Family resilience was measured with the Walsh Family Resilience Questionnaire. The local version included 32 items forming belief systems, organization patterns, and communication/problem solving subscales. Subscale scores range from 1 to 5, with higher scores indicating stronger family resilience processes.

  Baseline to immediate post-intervention endline, up to 5 months

• Change in Parenting Practices

  Parenting practices were measured with the Parenting Practices Questionnaire. The local version included 20 items forming authoritative warmth/involvement, authoritative democratic participation, and authoritarian verbal hostility subscales. Subscale scores range from 1 to 5, with higher scores indicating more of the named parenting behavior.

  Baseline to immediate post-intervention endline, up to 5 months

• Change in Parent Couple Functioning

  Parent couple functioning was measured with parent-only measures of dyadic adjustment, dyadic happiness, sexual relationship decision-making power, and preference for boys over girls. Dyadic adjustment domains range from 0 to 3 and dyadic happiness ranges from 1 to 5, with higher scores indicating better couple functioning. Sexual relationship decision-making power ranges from 1 to 3, with higher scores indicating more respondent decision-making authority. Preference for boys over girls ranges from 1 to 4, with higher scores indicating stronger preference for boys over girls.

  Baseline to immediate post-intervention endline, up to 5 months

• Change in Youth Family-System Functioning

  Youth family-system functioning was measured with youth-only family enmeshment and personal accountability scores. Family enmeshment was measured with seven items ranging from 1 to 5, with higher scores indicating greater over-involvement or lower differentiation. Personal accountability was measured with eight items ranging from 1 to 4, with higher scores indicating greater youth responsibility and accountability.

  Baseline to immediate post-intervention endline, up to 5 months

Secondary Outcomes (6)

• Change in Post-Traumatic Stress Symptoms

  Baseline to immediate post-intervention endline, up to 5 months.

• Change in Borderline Traits

  Baseline to immediate post-intervention endline, up to 5 months.

• Change in Aggression

  Baseline to immediate post-intervention endline, up to 5 months.

• Change in Forgiveness and Community Relations

  Baseline to immediate post-intervention endline, up to 5 months.

• Change in Socioemotional Skills

  Baseline to immediate post-intervention endline, up to 5 months.

Study Arms (2)

Multifamily Healing Spaces

EXPERIMENTAL

Clusters allocated to Multifamily Healing Spaces (MFHS) received the behavioral family intervention during the trial evaluation period. MFHS was delivered to families in group formats using intergenerational, whole-family, parent-only, and youth-only sessions.

Behavioral: Multifamily Healing Spaces

Waitlist Control

NO INTERVENTION

Clusters allocated to waitlist control did not receive MFHS during the baseline-to-endline evaluation period. Families were invited to receive MFHS after the evaluation period.

Interventions

Multifamily Healing Spaces BEHAVIORAL

MFHS is a culturally adapted, group-based family intervention for genocide-affected communities in Rwanda. It includes 18 core 3-hour meeting occasions in intergenerational, whole-family, parent-only, and youth-only formats. Sessions focus on trauma-informed psychoeducation, family communication and problem solving, shared meaning-making, parenting, couple relationships, youth voice, and family and community resilience. Groups were facilitated by trained facilitators, including a therapist and community volunteer, with facilitator training and supervision.

Multifamily Healing Spaces

Eligibility Criteria

• Age: 12 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Member of a family living in or connected to a selected MFHS-eligible cluster/cell in one of the five study districts in Rwanda.
• Aged 12 years or older.
• Family invited because at least one screened family member met the staged MFHS criterion for family communication difficulties after higher-priority clinical and individual mental-health triage.
• Able and willing to participate in baseline assessment and, if allocated to MFHS, family/group sessions.
• Written informed consent, assent, and/or caregiver permission obtained according to age and local ethics requirements.

You may not qualify if:

• Individuals with suicidality, psychosis, or severe substance-use flags were routed for clinical interview or hospital referral rather than MFHS as first-line allocation.
• Individuals meeting higher-priority individual mental-health criteria were routed to Resilience-Oriented Therapy before the MFHS screening stage.
• Individuals or families unable to provide consent/assent or safely participate in group family sessions were not enrolled.
• Remaining individuals with social-conflict indicators after earlier stages were routed to sociotherapy rather than MFHS.

Sponsors & Collaborators

• University of Rwanda: collaborator
• Alexandros Lordos, PhD: lead
• Interpeace: collaborator
• Centre for Sustainable Peace and Democratic Development: collaborator

Study Sites (5)

Community and Health-Centre Settings, Ngoma District

Ngoma, Eastern Province, Rwanda

Location

Community and Health-Centre Settings, Nyagatare District

Nyagatare, Eastern Province, Rwanda

Location

Community and Health-Centre Settings, Musanze District

Ruhengeri, Northern Province, Rwanda

Location

Community and Health-Centre Settings, Nyamagabe District

Nyamagabe, Southern Province, Rwanda

Location

Community and Health-Centre Settings, Nyabihu District

Nyabihu, Western Province, Rwanda

Location

Related Publications (2)

• Lordos, A., Interayamahanga, R., Kayitare, F., Dukuzumuremyi, E., Mahoro, M., Mwiza, J., & Mbanda, J. (2026). Establishing multi-stakeholder alliances to promote societal healing and resilience in post-genocide Rwanda. In S. Clarke-Habibi & C. Reimann (Eds.), The Routledge International Handbook of Trauma-Responsive Peacebuilding (pp. 411-424). Routledge. https://doi.org/10.4324/9781003536970-33

  BACKGROUND

• Nikolaou, K., Lordos, A., Rutembesa, E., Ioannou, M., Dukuzumuremyi, E., Christou, G., Meade, A., Karayianni, E., Anastasiou, E., Guest, A., Sezibera, V., Panayiotou, O., Throstur, B., & Kayitare, F. (2025). Multifamily Healing Spaces: Development of a family-based intervention for recovery and resilience in Rwanda. Intervention, 23(1), 52-62. https://doi.org/10.4103/intv.intv_16_24

  BACKGROUND

MeSH Terms

Conditions

Psychological Trauma; Stress Disorders, Post-Traumatic; Historical Trauma

Condition Hierarchy (Ancestors)

Stress Disorders, Traumatic; Trauma and Stressor Related Disorders; Mental Disorders

Study Officials

• Alexandros Lordos, PhD

  University of Cyprus

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Baseline enumerators and participants were intended to be unaware of condition assignment during baseline outcome measurement. After allocation, masking could not be assured because local implementation required allocation lists before groups could be convened, and endline masking was difficult to maintain because participants could disclose their allocation status.
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Director, Skills and Resilience Lab, Department of Psychology

Model Details: Cluster-randomized parallel-group waitlist-control trial. Twenty eligible community/cell clusters were randomly selected from 56 MFHS-eligible cells and then randomly allocated to MFHS or waitlist control. Outcomes were assessed at baseline and immediate post-intervention endline.

Study Record Dates

• First Submitted: May 20, 2026
• First Posted: June 2, 2026
• Study Start: April 28, 2023
• Primary Completion: September 15, 2023
• Study Completion: September 15, 2023
• Last Updated: June 2, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ANALYTIC CODE
• Time Frame: Available after publication, with no predetermined end date.
• Access Criteria: Researchers must submit a methodologically sound proposal to the first author. Access will be subject to approval by the study team and any applicable ethics, data-protection, and partner-organization requirements. Shared data will be de-identified.

Locations

RW (5)