TY - JOUR
T1 - Cultural adaptation of a scalable psychological intervention for Burundian refugee adolescents in Tanzania
T2 - a qualitative study
AU - Singh, Aneeha
AU - Nemiro, Ashley
AU - Malik, Aiysha
AU - Guimond, Marie France
AU - Nduwimana, Estella
AU - Likindikoki, Samuel
AU - Annan, Jeannie
AU - Tol, Wietse A.
N1 - Funding Information:
This research was funded by the Oak Foundation and implemented by the International Rescue Committee in partnership with Johns Hopkins University, the World Health Organization and Muhimbili University. The Oak Foundation was not involved in decisions regarding the research design, data collection, analysis and interpretation or writing of this manuscript.
Funding Information:
The version of EASE adapted for this study is comprised of seven, 90-min group sessions and includes evidence-based techniques: psychoeducation, stress management, behavioural activation, problem solving and relapse prevention. There are also three group sessions (120 min) for caregivers which aim to increase capacity to support a child in distress, which include the following discrete strategies: psychoeducation, active listening, quality time, praise and showing interest in their child, reducing harsh discipline, caregiver self-care (including stress management) and relapse prevention for their child. The involvement of caregivers is supported by the WHO mental health Gap Action Programme (mhGAP) intervention guidelines, which recommend caregiver skills training for emotional and behavioural disorders in children []. Additional materials were developed as part of the EASE package and include a storybook, and workbook with practice exercises for adolescents and posters and handouts for both adolescents and caregivers, to support session delivery.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Background: There is an urgent need for evidence-based, scalable, psychological interventions to improve the mental health of adolescents affected by adversity in low-resource settings. Early Adolescents Skills for Emotions (EASE) was developed by the WHO as a brief, transdiagnostic, group intervention for early adolescents exhibiting internalising problems, delivered by trained and supervised lay providers. This study describes the cultural adaptation of EASE for Burundian adolescents living in Mtendeli refugee camps in Tanzania. Methods: A phased approach to adaptation of the EASE intervention and its implementation, was adopted and comprised of: (1) a desk review to synthesize existing research on mental health issues in conflict-affected Burundian communities, (2) a rapid qualitative assessment involving free listing and key informant interviews with multiple stakeholders, (3) cognitive interviews with end users, and (4) a two-part adaptation workshop involving the implementing partner staff, members of the refugee community and mental health experts. We applied the Bernal framework to systematically document and track adaptations across eight dimensions of the intervention. Results: Problems associated with worry, stress, sadness, shame and fear were identified as amongst the most critical mental health concerns, alongside a range of experiences of different forms of violence (such as gender-based violence, violence when fleeing from their homes) and associated problems. Problems associated with violence that included past experiences of fleeing as well as ongoing problems of gender-based violence in the camp. The most significant adaptations that were required included providing options for low literacy of participants, safety planning to address the high prevalence of sexual violence, simplification of strategies for the benefit of the end users and of lay facilitators, and implementation changes to consider involvement of refugee incentive workers. A majority of changes were across dimensions of language, people, metaphors, content, methods and context, while there were fewer changes regarding the goals and concepts of EASE. Conclusions: The approach to adaptation of a psychological intervention suggested both minor and major required changes. Adaptations based on the findings of this study are anticipated to enhance relevance and acceptability of the EASE intervention and its delivery for camp-residing Burundian refugees in Tanzania.
AB - Background: There is an urgent need for evidence-based, scalable, psychological interventions to improve the mental health of adolescents affected by adversity in low-resource settings. Early Adolescents Skills for Emotions (EASE) was developed by the WHO as a brief, transdiagnostic, group intervention for early adolescents exhibiting internalising problems, delivered by trained and supervised lay providers. This study describes the cultural adaptation of EASE for Burundian adolescents living in Mtendeli refugee camps in Tanzania. Methods: A phased approach to adaptation of the EASE intervention and its implementation, was adopted and comprised of: (1) a desk review to synthesize existing research on mental health issues in conflict-affected Burundian communities, (2) a rapid qualitative assessment involving free listing and key informant interviews with multiple stakeholders, (3) cognitive interviews with end users, and (4) a two-part adaptation workshop involving the implementing partner staff, members of the refugee community and mental health experts. We applied the Bernal framework to systematically document and track adaptations across eight dimensions of the intervention. Results: Problems associated with worry, stress, sadness, shame and fear were identified as amongst the most critical mental health concerns, alongside a range of experiences of different forms of violence (such as gender-based violence, violence when fleeing from their homes) and associated problems. Problems associated with violence that included past experiences of fleeing as well as ongoing problems of gender-based violence in the camp. The most significant adaptations that were required included providing options for low literacy of participants, safety planning to address the high prevalence of sexual violence, simplification of strategies for the benefit of the end users and of lay facilitators, and implementation changes to consider involvement of refugee incentive workers. A majority of changes were across dimensions of language, people, metaphors, content, methods and context, while there were fewer changes regarding the goals and concepts of EASE. Conclusions: The approach to adaptation of a psychological intervention suggested both minor and major required changes. Adaptations based on the findings of this study are anticipated to enhance relevance and acceptability of the EASE intervention and its delivery for camp-residing Burundian refugees in Tanzania.
KW - Adaptation
KW - Adolescents
KW - Psychological distress
KW - Psychological intervention
KW - Refugees
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UR - http://www.scopus.com/inward/citedby.url?scp=85115752638&partnerID=8YFLogxK
U2 - 10.1186/s13031-021-00391-4
DO - 10.1186/s13031-021-00391-4
M3 - Article
C2 - 34579750
AN - SCOPUS:85115752638
VL - 15
JO - Conflict and Health
JF - Conflict and Health
SN - 1752-1505
IS - 1
M1 - 73
ER -