Innovative Strategies for Remotely Sampling Hard-to-Reach Populations: Assessing Phone Versus Internet Respondent-Driven Sampling Approaches Among Venezuelan Refugees and Migrants in Colombia.

It is challenging to quantitatively measure the health vulnerability and risk factors of refugees and migrants residing outside of formal settlement settings. For hard-to-reach populations without available sampling frames, researchers have increasingly turned to novel sampling and statistical methods, like respondent-driven sampling (RDS). "Standard" RDS is typically conducted face-to-face at fixed sites. However, during the coronavirus disease 2019 (COVID-19) pandemic, face-to-face survey methods and recruitment approaches posed high potential risk of virus transmission and infection, making remote RDS approaches optimal. In this paper, we explore the feasibility of implementing telephone and Internet RDS strategies to assess challenges faced by Venezuelan refugees and migrants in the city of Bogotá, Colombia's capital, and the department of Norte de Santander, the main Venezuelan-Colombian border crossing site. We describe RDS assumptions, survey design, formative research, and the implementation of both strategies and present diagnostics for determining whether assumptions are met. Phone-based recruitment strategies in both locations and the Internet strategy in Bogotá achieved their calculated sample size; however, the Internet strategy in Norte de Santander did not. Most RDS assumptions were sufficiently met at sites where sample sizes were reached. These surveys provide valuable lessons for implementing innovative remote strategies with which to study hard-to-reach populations such as refugees and migrants.

Assessing the impact of the COVID-19 pandemic among Venezuelan refugees and migrants in Colombia using respondent-driven sampling (RDS).

OBJECTIVES: To determine factors associated with adherence to COVID-19 mitigation measures, related symptoms and testing, as well as pandemic-related income loss among Venezuelan refugee and migrant adults in urban and border areas of Colombia. DESIGN: Phone-based respondent-driven sampling SETTING: Bogotá and Norte de Santander, Colombia. PARTICIPANTS: 605 adult Venezuelan refugees and migrants residing in Bogotá (n=305) and Norte de Santander (n=300), who arrived in Colombia after 2014 and completed the survey in August and September 2020. PRIMARY AND SECONDARY OUTCOME MEASURES: Full COVID-19 compliance (vs incomplete or no compliance), any COVID-19-related symptoms (vs none) and income loss due to isolation measures in Colombia (vs no income change or increase in income). RESULTS: Older age was associated with lower odds of compliance with physical distancing measures (0.94, 0.90-0.99; p=0.01) for those in Bogotá. Nearly 15% of refugees and migrants in both locations (81 of 605) experienced at least one symptom consistent with COVID-19. Having a health condition was associated with higher odds of experiencing COVID-19-related symptoms in Bogotá (4.00, 1.22-13.06; p=0.02) and Norte de Santander (6.99, 1.95-24.99; p=0.003). Around 8% in both locations (48 of 605) were tested for COVID-19. Around 90% in both locations (537 of 605) had trouble earning an income after the introduction of isolation measures, and the median reported monthly income decreased by half in Bogotá and by 30% in Norte de Santander. A higher level of education (3.46, 1.02-11.75; p=0.05) was associated with higher odds of income loss among participants in Norte de Santander. CONCLUSIONS: Results indicate high compliance with COVID-19 mitigation measures, low testing rates and high pandemic-related income loss among Venezuelan refugees and migrants in Colombia. This study provides insights into a hard-to-reach refugee and migrant population in Colombia; additional study on the effects of the pandemic on hidden populations is warranted.

Alternate delivery platforms and implementation models for bringing evidence-based behavioral interventions to scale for youth facing adversity: a case study in West Africa.

BACKGROUND: Youth Functioning and Organizational Success for West African Regional Development (Youth FORWARD) was launched as an implementation science collaboration focused on scaling out evidence-based mental health interventions for youth exposed to war and other adversities through novel delivery platforms. This implementation science case study examines the use of a collaborative team approach (CTA) as a scale-out strategy to foster the integration of an evidence-based group mental health intervention, the Youth Readiness Intervention, into youth employment programs tied to regional economic development in Sierra Leone. METHODS: A case study methodology is used to explore the feasibility and acceptability of integrating an evidence-based intervention, the Youth Readiness Intervention (YRI), into youth entrepreneurship programs (ENTR) in Sierra Leone, facilitated by the CTA. The authors analyzed field notes logged during program implementation, 8 weeks of supervision notes, 20 interviews with agency leaders and front-line staff delivering the YRI within this alternate delivery platform. Quantitative dissemination and implementation interviews administered to youth, facilitators, and agency leaders were analyzed using descriptive statistics and mixed linear models. A linked Hybrid Type II effectiveness-implementation cluster randomized trial is evaluating the clinical effectiveness of the YRI within this delivery platform. RESULTS: Extant data indicate the strong feasibility and acceptability of integrating the YRI into the ENTR program. Facilitators of integration of the YRI into the ENTR include mission alignment of the organizations with the delivery of psychosocial interventions, shared commitment to serving vulnerable youth, support from local District Youth Councils, and high interest from the youth served. Barriers include perceived competition between frontline organizations seeking funding for psychosocial interventions, and challenges in flexibility between donors and implementation partners operating in a fragile/post-conflict setting. The CTA was a feasible and acceptable strategy to support fidelity and quality improvement while scaling out the YRI. CONCLUSIONS: Youth entrepreneurship and livelihood programs offer a promising mechanism for expanding the reach of evidence-based interventions to youth in fragile and post-conflict settings. Quality improvement and sustainment of evidence-based interventions are novel concepts in such settings. The CTA strategy institutionalizes the integration of an evidence-based intervention into youth entrepreneurship programs. TRIAL REGISTRATION: NCT03603613 (phase 1 pilot, registered May 18, 2018) and NCT03542500 (phase 2 scale-out study, registered May 18, 2018).

The intergenerational impact of war on mental health and psychosocial wellbeing: lessons from the longitudinal study of war-affected youth in Sierra Leone.

BACKGROUND: Globally, one in four children lives in a country affected by armed conflict or disaster often accompanied by exposure to a range of adversities including violent trauma and loss. Children involved with armed groups (often referred to as "child soldiers") typically exhibit high levels of mental health needs linked to their experiences. The Longitudinal Study of War-Affected Youth (LSWAY) in Sierra Leone is a seventeen-year prospective longitudinal study of the long-term effects of children's experiences in the country's eleven-year (1991-2002) civil war on their adult mental health and functioning in addition to exploring the potential mechanisms by which intergenerational transmission of emotional and behavioral disruptions due to war trauma may operate. LSWAY illuminates how war-related and post-conflict experiences shape long-term adult functioning, family dynamics, and developmental outcomes in offspring. DISCUSSION: The LSWAY study utilizes mixed methodologies that incorporate qualitative and quantitative data to unpack risk and protective factors involved in social reintegration, psychosocial adjustment, parenting, and interpersonal relationships. To date, study findings demonstrate striking levels of persistent mental health problems among former child soldiers as adults with consequences for their families, but also risk and protective patterns that involve family- and community-level factors. This case study examines the course of LSWAY from inception through implementation and dissemination, including building on the study results to design and evaluate several intervention models. CONCLUSION: The case study offers a unique perspective on challenges and field realities of health research in a fragile, post-conflict setting common in the context of humanitarian emergencies. LSWAY findings along with lessons learned from the field can inform future research as well as intervention research and implementation science to address the mental health and development of war-affected young people. With four waves of data collection and a planned fifth wave, LSWAY also provides rare insights into the intergenerational effects of humanitarian crises on children, youth, and families across generations.