Barriers and Facilitators to Implementing a Community-Based Psychosocial Support Intervention Conducted In-Person and Remotely: A Qualitative Study in Quibdó, Colombia.

Community-based psychosocial support group (CB-PSS) interventions using task-shifting approaches are well suited to provide culturally appropriate services in low- and middle-income countries. However, contextual barriers and facilitators must be considered to tailor interventions effectively, particularly considering the challenges introduced by the COVID-19 pandemic. We explore the barriers, facilitators, and psychosocial changes associated with implementing a CB-PSS group intervention delivered by local lay providers to conflict-affected adults in Quibdó, Colombia, using both in-person and remote modalities. Data were analyzed from 25 individual interviews with participants and a focus group discussion involving staff members, including 7 community psychosocial agent facilitators and 2 mental health professional supervisors. The analysis used a thematic approach grounded in a descriptive phenomenology to explore the lived experiences of participants and staff members during implementation. Participant attendance in the in-person modality was compromised by factors such as competing work and family responsibilities and disruption caused by the COVID-19 pandemic. Participants in the remote modality faced challenges concerning unstable Internet connectivity, recurrent power outages caused by heavy rain, distractions, interruptions, and threats to confidentiality by family and coworkers. Despite these challenges, data revealed key contextual facilitators, including the community-based knowledge of facilitators and integration of traditional practices, such as the comadreo (informal talks and gatherings). Respondents shared that the CB-PSS groups promoted stronger community relationships and created opportunities for participants to exchange peer support, practice leadership skills, develop problem-solving skills based on peers' experiences, and enhance emotional regulation skills. Differences and similarities across in-person and remote modalities are discussed, as are key considerations for practitioners and policymakers.

Piloting a community-based psychosocial group intervention designed to reduce distress among conflict-affected adults in Colombia: a mixed-method study of remote, hybrid, and in-person modalities during the COVID-19 pandemic.

BACKGROUND: Community members in Quibdó (Choco, Colombia) are highly vulnerable to psychosocial problems associated with the internal armed conflict, poverty, and insufficient public services, and exacerbated by the COVID-19 pandemic. A pilot study was conducted with conflict-affected adults in Quibdó to assess feasibility and outcomes of a community-based psychosocial support group intervention using three different intervention modalities: in-person, remote (conducted online), and hybrid (half of sessions in-person, half-remote). This group model integrated problem-solving and culturally based expressive activities and was facilitated by local community members with supervision by mental health professionals. METHODS: This study utilized a mixed-explanatory sequential design (a quantitative phase deriving in a qualitative phase) with 39 participants and 8 staff members. Participants completed quantitative interviews before and after an eight-week group intervention. A subset of 17 participants also completed in-depth qualitative interviews and a focus group discussion was conducted with staff at post-intervention. RESULTS: From pre- to post-intervention, participants in all modalities demonstrated improved wellbeing and reduced symptoms of generalized distress, anxiety, depression, and posttraumatic stress. Use of coping skills varied across modalities, with remote groups associated with a decrease in some forms of coping, including use of social support. In qualitative interviews and the focus group discussion, participants and staff described logistical challenges and successes, as well as facilitators of change such as problem resolution, emotional regulation and social support with variations across modalities, such that remote groups provided fewer opportunities for social support and cohesion. CONCLUSIONS: Results offer preliminary evidence that this model can address psychosocial difficulties across the three modalities, while also identifying potential risks and challenges, therefore providing useful guidance for service delivery in conflict-affected settings during the COVID-19 pandemic and other challenging contexts. Implications of this study for subsequent implementation of a Randomized Control Trial (RCT) are discussed.

Development and Testing of a Community-Based Intervention to Address Intimate Partner Violence among Rohingya and Syrian Refugees: A Social Norms-Based Mental Health-Integrated Approach.

Intimate partner violence (IPV) is the leading form of gender-based violence globally and increases during times of conflict and displacement. To reduce IPV and encourage help-seeking, a two-phase community-based intervention was co-designed with Rohingya in Malaysia and Syrians in Lebanon. Three day workshops, utilizing a social norms-based mental health-integrated approach, were implemented for women and men in each country (n = 148). Pre- to post-measures indicated reductions in beliefs about acceptability of violence and rigid gender norms, and improvements in mental health, functioning, coping, and self-efficacy for women and men following workshop participation. Workshop participation was also associated with increased help-seeking intent, for both mental health and IPV (victims and perpetrators). Workshops included community design of poster campaigns to address IPV, which were then tested in each setting using a randomized controlled trial in Malaysia (n = 240) and a matched cluster comparison in Lebanon (n = 260). Women in both settings found IPV less acceptable in the poster condition. Help-seeking preferences were also influenced by the poster for women and men in both countries. This participatory intervention research can provide a roadmap for use in other settings, emphasizing the value of community-generated solutions to IPV among displaced populations.

Integrating mental health and disaster preparedness in intervention: a randomized controlled trial with earthquake and flood-affected communities in Haiti.

BACKGROUND: Given the frequency of natural hazards in Haiti, disaster risk reduction is crucial. However, evidence suggests that many people exposed to prior disasters do not engage in disaster preparedness, even when they receive training and have adequate resources. This may be partially explained by a link between mental health symptoms and preparedness; however, these components are typically not integrated in intervention. METHODS: The current study assesses effectiveness of an integrated mental health and disaster preparedness intervention. This group-based model was tested in three earthquake-exposed and flood-prone communities (N = 480), across three time points, using a randomized controlled trial design. The 3-day community-based intervention was culturally-adapted, facilitated by trained Haitian lay mental health workers, and focused on enhancing disaster preparedness, reducing mental health symptoms, and fostering community cohesion. RESULTS: Consistent with hypotheses, the intervention increased disaster preparedness, reduced symptoms associated with depression, post-traumatic stress disorder, anxiety, and functional impairment, and increased peer-based help-giving and help-seeking. Mediation models indicated support for the underlying theoretical model, such that the effect of the intervention on preparedness was mediated by mental health, and that effects on mental health were likewise mediated by preparedness. CONCLUSIONS: The community-based mental health-integrated disaster preparedness intervention is effective in improving mental health and preparedness among community members in Haiti vulnerable to natural hazards. This brief intervention has the potential to be scaled up for use with other communities vulnerable to earthquakes, seasonal flooding, and other natural hazards.

An integrated approach to mental health and disaster preparedness: a cluster comparison with earthquake affected communities in Nepal.

BACKGROUND: On 25th April 2015, Nepal experienced a 7.8 magnitude earthquake, followed by countless aftershocks. Nearly 9000 people were killed and over 600,000 homes destroyed. Given the high frequency of earthquake and other natural hazards in Nepal, disaster preparedness is crucial. However, evidence suggests that some people exposed to prior disasters do not engage in risk reduction, even when they receive training and have adequate resources. Mental health symptoms, including those associated with prior disaster exposure, may influence engagement in preparedness. Perceived preparedness for future disasters may in turn influence mental health. Social cohesion may influence both mental health and preparedness. METHODS: We developed and tested a hybrid mental health and disaster preparedness intervention in two earthquake-affected communities in Nepal (N = 240), about 2.5 months after the April 25th, 2015 earthquake. The 3-day intervention was culturally adapted, facilitated by trained Nepalese clinicians and focused on enhancing disaster preparedness, mental health, and community cohesion. Communities were selected based on earthquake impacts and matched on demographic variables. The intervention was administered initially to one community, followed by the other receiving the intervention shortly thereafter. Survey data was collected across three time points. Focus groups were also conducted to examine intervention impact. RESULTS: At pre-intervention baseline, greater depression symptoms and lower social cohesion were associated with less disaster preparedness. Depression and PTSD were associated with lower social cohesion. Participation in the intervention increased disaster preparedness, decreased depression- and PTSD-related symptoms, and increased social cohesion. Mediation models indicated that the effect of intervention on depression was partially explained by preparedness. The effect of the intervention on disaster preparedness was partially explained by social cohesion, and the effect of intervention on depression and on PTSD was also partially explained by social cohesion. Data from focus groups illuminate participant perspectives on components of the intervention associated with preparedness, mental health and social cohesion. CONCLUSIONS: This mental health integrated disaster preparedness intervention is effective in enhancing resilience among earthquake-affected communities in Nepal. This brief, cost-effective group intervention has the potential to be scaled up for use with other communities vulnerable to earthquakes and other natural hazards. TRIAL REGISTRATION: Clinical Trials Registry-India, National Institute of Medical Statistics. Registration number: CTRI/2018/02/011688. http://ctri.nic.in/Clinicaltrials/login.php Retrospectively registered February 5th, 2018. First participant enrolled July 2015.

A mixed-methods assessment of the experiences of lay mental health workers in postearthquake Haiti.

A mixed-methodological study conducted in the aftermath of the 2010 Haiti earthquake assessed experiences of 8 lay mental health workers (earthquake survivors themselves) implementing a psychosocial intervention for residents of camps for displaced people in Port-au-Prince. Quantitative results revealed decreased posttraumatic stress disorder symptoms, consistently high compassion satisfaction, low burnout, moderate secondary trauma, and high levels of posttraumatic growth measured over 18 months. Qualitative accounts from lay mental health workers revealed enhanced sense of self-worth, purpose, social connection, and satisfaction associated with helping others. Results support the viability of utilizing local lay disaster survivors as implementers of psychosocial intervention.

Lay mental health in the aftermath of disaster: preliminary evaluation of an intervention for Haiti earthquake survivors.

In the year following the 2010 Haiti earthquake, local earthquake survivors trained as lay mental health workers implemented a culturally-adapted, psychosocial and trauma-focused group intervention for residents of camps for internally displaced peoples (IDPs). Analysis of evaluation data collected at three Port-au-Prince IDP camps revealed decreased self-reported posttraumatic distress (measured using the Harvard Trauma Questionnaire) associated with participation in this intervention. Improvement occurred across all three PTSD symptom clusters (re-experiencing, avoidance, and hyperarousal). Female participants reported higher baseline distress, were more likely to participate in the intervention, and benefitted more than did men. Results provide initial support for the effectiveness of train-the-trainer interventions utilizing local lay disaster survivors.