Ecological Networks and Community Attachment and Support Among Recently Resettled Refugees.

Interventions aimed at enhancing mental health are increasingly centered around promoting community attachment and support. However, few have examined and tested the specific ecological factors that give rise to these key community processes. Drawing from insights from the ecological network perspective, we tested whether spatial and social overlap in routine activity settings (e.g., work, school, childcare) with fellow ethnic community members is associated with individuals' attachment to their ethnic communities and access to social resources embedded in their communities. Data on routine activity locations drawn from the Refugee Well-Being Project (based in a city in the Southwestern United States) were used to reconstruct the ecological networks of recently resettled refugee communities, which were two-mode networks that comprise individuals and their routine activity locations. Results indicated that respondents' community attachment and support increased with their ecological network extensity-which taps the extent to which respondents share routine activity locations with other community members. Our study highlights a key ecological process that potentially enhances individuals' ethnic community attachment that extends beyond residential neighborhoods.

Challenges and Innovations in a Community-Based Participatory Randomized Controlled Trial.

Randomized controlled trials (RCTs) are a long-standing and important design for conducting rigorous tests of the effectiveness of health interventions. However, many questions have been raised about the external validity of RCTs, their utility in explicating mechanisms of intervention and participants' intervention experiences, and their feasibility and acceptability. In the current mixed-methods study, academic and community partners developed and implemented an RCT to test the effectiveness of a collaboratively developed community-based advocacy, learning, and social support intervention. The goals of the intervention were to address social determinants of health and build trust and connections with other mental health services in order to reduce mental health disparities among Afghan, Great Lakes Region African, and Iraqi refugee adults and to engage and retain refugees in trauma-focused treatment, if needed. Two cohorts completed the intervention between 2013 and 2015. Ninety-three adult refugees were randomly assigned to intervention or control group and completed four research interviews (pre-, mid-, and postintervention, and follow-up). Several challenges to conducting a community-based RCT emerged, including issues related to interviewer intervention to assist participants in the control group, diffusion of intervention resources throughout the small refugee communities, and staff and community concerns about the RCT design and what evidence is meaningful to demonstrate intervention effectiveness. These findings highlight important epistemological, methodological, and ethical challenges that should be considered when conducting community-based RCTs and interpreting results from them. In addition, several innovations were developed to address these challenges, which may be useful for other community-academic partnerships engaged in RCTs.