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Abstract
Gaps remain in the evidence base guiding the design and evaluation of culturally appropriate humanitarian mental health and psychosocial support (MHPSS) refugee programmes. The study was embedded in a pilot MHPSS programme initiated by the UNHCR. The research is based on a case study amongst Iraqi refugees in urban Syria. Both the programme and the research were grounded on the tenets of the ADAPT model. The research combines three novel features: developing a culturally relevant measure of psychosocial well-being; using a pragmatic approach to applying the measure in a rapidly changing emergency setting; assessing case-management outcomes.
The specific objectives of the programme of research were to:
Identify expressions and idioms of well-being and distress.
Develop a culture-, context- and theory-guided psychosocial well-being and distress measure.
Apply the measure to assess outcomes of a case-management system.
Use the findings to examine the utility and applicability of principles of the ADAPT model within this context.
To set the stage for the empirical work, a systematic review of relevant literature was undertaken.
The psychosocial well-being measure, PSWDAI, was developed and psychometrically tested through a three-step mixed-method development process. Four Iraqi refugee groups, three of whom participated in the MHPSS programme, completed a survey including the PSWDAI.
The PSWDAI is the first psychosocial measure developed for Iraqi refugees, drawing on a universal theory (ADAPT) but grounding the process in culture and context. Exploratory factor analysis followed by confirmatory factor analysis on a separate sample produced a three-factor model: stability of social environment and survival; personal/psychological/emotional ability and coping; and social support, spirituality and inner peace. The third dimension was identified through additional qualitative research. Improvements in PSWDAI scores among programme participants showed the measure’s sensitivity to the effects of interventions, adding to its validity. The measure’s pragmatic utility was supported by the programme implementers’ capacity to apply it in the routine work of a busy humanitarian assistance programme.
The study illustrates the feasibility and value of developing and applying a theoretically grounded, culturally appropriate measure of psychosocial distress and well-being in parallel with the implementation of a comprehensive MHPSS programme.