What works in psychosocial programming in humanitarian contexts in low- and middle-income countries: a systematic review of the evidence

Haroz, Emily E.; Nguyen, Amanda J.; Lee, Catherine I; Tol, Wietse A.; Fine, Shoshanna L.

doi:10.4103/intv.intv_6_19

Cited by 38 publications

(13 citation statements)

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“…A recent systematic review and meta-analysis estimates that 22.1% of people in conflict settings meet criteria for a mental disorder, specifically depression, anxiety, and posttraumatic stress disorder (PTSD; Charlson et al, 2019). In recent years, research has established a growing evidence base for effective mental health and psychosocial support interventions among conflict-affected populations (Bangpan et al, 2019; Haroz et al, 2020; Tol et al, 2011). These interventions typically target a specific mental disorder (e.g., PTSD, major depressive disorder) and are usually delivered in one-on-one individual or group sessions (Purgato et al, 2018).…”

Section: Background and Significancementioning

confidence: 99%

Psychological flexibility in South Sudanese female refugees in Uganda as a mechanism for change within a guided self-help intervention.

Lakin¹,

Cooper²,

Andersen³

et al. 2023

Journal of Consulting and Clinical Psychology

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Objective: To examine the role of psychological flexibility as a potential mediator in the relationship between involvement in a guided self-help intervention, Self-Help Plus, and psychological distress in a sample of South Sudanese refugee women living in northern Uganda. Method: We conducted secondary analysis of data from a cluster randomized controlled trial conducted in 2018. We used multilevel mediation modeling to explore the relationship of psychological flexibility, as measured by the Acceptance and Action Questionnaire (AAQ-II), as a mediating factor in the relationship between Self-Help Plus involvement and general psychological distress as measured by the Kessler Psychological Distress Scale–6 (K6). Results: We found strong multilevel mediation of decreased K6 scores in the treatment group by AAQ-II scores (multilevel b = −3.28). A more pronounced mediation effect was discovered immediately post intervention (b = −1.09) compared to 3-month follow-up (b = −0.84). This is in line with the current literature that demonstrates the role of psychological flexibility as a primary mechanism of change in ACT-based interventions. Conclusions: Psychological flexibility is a contributing component in the theory of change for this ACT-based intervention. Identifying the core components of interventions allows for more effective adaptation and implementation of relevant services, especially in low-resource contexts.

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Section: Background and Significancementioning

confidence: 99%

Psychological flexibility in South Sudanese female refugees in Uganda as a mechanism for change within a guided self-help intervention.

Lakin¹,

Cooper²,

Andersen³

et al. 2023

Journal of Consulting and Clinical Psychology

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“…Migrants and forcibly displaced populations in Latin America face a range of risk factors for mental health problems across the phases of migration, including exposure to potentially traumatic events, discrimination and xenophobia, social isolation, lack of integration and socioeconomic adversity (Keller et al, 2017; Carroll et al, 2020; Mougenot et al, 2021; Morales et al, 2022; Salas-Wright et al, 2022). There is growing evidence supporting the effectiveness of community-based mental health and psychosocial interventions for alleviating symptoms of common mental disorders and psychological distress among displaced populations (Bangpan et al, 2019; Turrini et al, 2019; Barbui et al, 2020; Haroz et al, 2020), including for displaced and emergency-affected populations in Latin America (Bonilla-Escobar et al, 2018; 2023). However, access to and utilization of mental health and psychosocial support services to prevent and treat mental health problems remains limited (Cubides et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Strategies to improve the implementation and effectiveness of community-based psychosocial support interventions for displaced, migrant and host community women in Latin America

Greene,

Wimer,

Larrea

et al. 2024

Camb. prisms Glob. ment. health

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As evidence supporting the effectiveness of mental health and psychosocial interventions grows, more research is needed to understand optimal strategies for improving their implementation in diverse contexts. We conducted a qualitative process evaluation of a multicomponent psychosocial intervention intended to promote well-being among refugee, migrant and host community women in three diverse contexts in Ecuador and Panamá. The objective of this study is to describe the relationships among implementation determinants, strategies and outcomes of this community-based psychosocial intervention. The five implementation strategies used in this study included stakeholder engagement, promoting intervention adaptability, group and community-based delivery format, task sharing and providing incentives. We identified 10 adaptations to the intervention and its implementation, most of which were made during preimplementation. Participants (n = 77) and facilitators (n = 30) who completed qualitative interviews reported that these strategies largely improved the implementation of the intervention across key outcomes and aligned with the study's intervention and implementation theory of change models. Participants and facilitators also proposed additional strategies for improving reach, implementation and maintenance of this community-based psychosocial intervention.

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“…Accordingly, in a recent consensus-based research agendabuilding exercise for psychosocial support (PSS) programming, stakeholders pointed to a particular need for evaluations of community-based programs that integrate delivery of MHPSS into other routine health services (e.g., nutritional support) and that target caregivers to improve child well-being (Lee et al, 2019). In general, there is a relative lack of evidence for more prevention-oriented or low-intensity psychosocial programs aimed at improving or promoting mental health in humanitarian contexts in low-and middle-income countries, as demonstrated by an extensive systematic literature review (Haroz et al, 2020). Yet, few parent-child integrated PSS programs exist that aim to prevent or respond to these issues (Ruel and Alderman, 2013;Surkan et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Psychosocial impacts of Baby Friendly Spaces for Rohingya refugee mothers in Bangladesh: A pragmatic cluster-randomized controlled trial

Nguyen,

Murray,

Rahaman

et al. 2024

Camb. prisms Glob. ment. health

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Background: This study evaluated the effectiveness of Baby Friendly Spaces (BFS), a psychosocial support program for Rohingya refugee mothers of malnourished young children in Bangladesh. Because BFS was already being implemented, we examined the benefit of enhancing implementation supports. Methods: In matched pairs, 10 sites were randomized to provide BFS treatment as usual (BFS-TAU) or to receive enhanced implementation support (BFS-IE). 600 mothers were enrolled and reported on maternal distress, functional impairment, subjective well-being and coping at baseline and 8-week follow-up. Data were analyzed using multilevel linear regression models to account for clustering; sensitivity analyses adjusted for the small number of clusters. Results: Significant within-group improvements in BFSIE were observed for distres (À.48, p = .014), functional impairment (À.30, p = .002) and subjective well-being (.92, p = .011); improvements in BFS-TAU were smaller and not statistically significant. Between-group comparisons favored BFS-IE for distress (β = À.30, p = .058) and well-being (β = .58, p = .038). Sensitivity adjustments produced p-values above .05 for all between-group comparisons. Discussion: Feasible adjustments to implementation can improve program delivery to increase impact on maternal distress and well-being. Although results should be interpreted with caution, study design limitations are common in pragmatic, field-based research. Impact statementAs maternal mental health and child health are clearly linked, supporting maternal mental health and well-being is critical to the promotion of child development and care practices that can ultimately promote positive child health outcomes. Addressing maternal mental health is particularly critical in settings of adversity where exposure to traumatic events, deprivation and ongoing stressors threaten the well-being of both caregivers and child. However, scant research addresses how to support the integration of evidence-based mental health and psychosocial support (MHPSS) services into other care settings, such as child nutrition. Conducting rigorous research to grow this evidence is complicated in real-world humanitarian settings where logistical challenges and ethical constraints render some research designs infeasible. This paper presents a study designed to evaluate the impact of Baby Friendly Spaces (BFS), a psychosocial support program for mothers of malnourished young children, delivered in Rohingya refugee camps in Cox's Bazar, Bangladesh. In this study, mothers and babies participated in BFS as part of a broader package of child nutrition care. Because all operating Integrated Nutrition Centers offered BFS, it was not possible to randomize participants or centers to treatment and control conditions. Instead, we provided additional implementation support in half of the centers to determine the added value of improving existing programming and found that doing so improved the mental health impacts for mothers in the program. This study adds to a growing body...

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What works in psychosocial programming in humanitarian contexts in low- and middle-income countries: a systematic review of the evidence

Cited by 38 publications

References 0 publications

Psychological flexibility in South Sudanese female refugees in Uganda as a mechanism for change within a guided self-help intervention.

Psychological flexibility in South Sudanese female refugees in Uganda as a mechanism for change within a guided self-help intervention.

Strategies to improve the implementation and effectiveness of community-based psychosocial support interventions for displaced, migrant and host community women in Latin America

Psychosocial impacts of Baby Friendly Spaces for Rohingya refugee mothers in Bangladesh: A pragmatic cluster-randomized controlled trial

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