Integrating mental health and psychosocial support into economic inclusion programming for displaced families in Ecuador.

IF 3.1 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Conflict and Health Pub Date : 2024-11-06 DOI:10.1186/s13031-024-00629-x
Arianna Moyano, Daniela Vergara, Amaleah Mirti, Annie G Bonz, Adriana Monar, Efrén Astudillo, Sara Vaca, Karen Cordova, Andrea Armijos, Adrian Barroso, Cesar Cherrez, Jennie Cottle, Aimée DuBois, Isabella Fernandez Capriles, Jean Pierre Grandes, Matias Irarrazaval, Belen Jaramillo, Jeremy C Kane, Carmen Martinez-Viciana, Franco Mascayano, Yescárleth Rodríguez, Matthew Schojan, Kathleen Sikkema, Ezra Susser, Peter Ventevogel, Mike Wessells, Aaron Zambrano López, Kathryn L Lovero, M Claire Greene
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Abstract

Background: Poverty is a key social determinant of mental health among forcibly displaced persons. This study aimed to design and pilot test a strategy to integrate existing mental health and economic inclusion interventions for displaced families in Ecuador.

Methods: We conducted a series of qualitative interviews (n = 30), focus groups (n = 6), and workshops (n = 3) to develop a set of strategies for integrating cross-cutting and focused mental health and psychosocial support (MHPSS) strategies into an existing economic inclusion program for displaced families in Quito. We non-randomly assigned two field offices in Quito to (1) integrate cross-cutting strategies focused on improving economic outcomes or (2) integrate both those cross-cutting strategies plus focused MHPSS strategies into an economic inclusion program. We measured site-level implementation outcomes (adoption, appropriateness, acceptability, feasibility, fidelity, reach, retention, usability) and participant-level psychosocial (wellbeing, depressive symptoms, anxiety symptoms, functioning) and economic inclusion outcomes (financial resources, diet diversity, social capital/networks, self-reliance) over six months. We conducted a mixed-methods analysis to explore the acceptability and feasibility of the integration strategies and the ability to evaluate their effects in a future cluster randomized trial.

Results: We developed a toolkit that included 10 strategies for integrating MHPSS into economic inclusion interventions. Fifty displaced persons participating in an existing economic inclusion program (25 per study condition) were enrolled and 88% remained in the study through the six-month follow-up. Participants and implementers reported that the integration strategy was appropriate, acceptable, feasible, and usable. Implementers, including people without prior experience in delivering mental health services, were able to deliver the intervention with high fidelity. Integration of focused MHPSS intervention components into an economic inclusion program appeared to improve MHPSS outcomes, the strength of social capital and networks, and engagement in economic and other programs.

Conclusions: This study provides preliminary evidence of the acceptability and feasibility of integrating MHPSS into economic inclusion programs for displaced people. We found evidence supporting evaluation methods that can be employed in a future study to definitively test the added value of integrated approaches to mental health and economic wellbeing for displaced persons.

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将心理健康和社会心理支持纳入厄瓜多尔流离失所家庭的经济融入计划。
背景:贫困是影响被迫流离失所者心理健康的一个重要社会决定因素。本研究旨在为厄瓜多尔的流离失所家庭设计并试点测试一项整合现有心理健康和经济融入干预措施的战略:我们进行了一系列定性访谈(n = 30)、焦点小组(n = 6)和研讨会(n = 3),以制定一套战略,将横向和重点突出的心理健康与社会心理支持(MHPSS)战略整合到基多现有的流离失所家庭经济融入计划中。我们以非随机方式指定基多的两个总部外办事处:(1)整合以改善经济成果为重点的横向战略,或(2)将这些横向战略和重点心理健康和社会心理支持战略整合到经济融入计划中。我们测量了 6 个月内现场层面的实施结果(采用、适当性、可接受性、可行性、忠实性、覆盖面、保留率、可用性)以及参与者层面的社会心理(幸福感、抑郁症状、焦虑症状、功能)和经济融入结果(财务资源、饮食多样性、社会资本/网络、自力更生)。我们进行了一项混合方法分析,以探讨融合策略的可接受性和可行性,以及在未来的分组随机试验中评估其效果的能力:结果:我们开发了一个工具包,其中包括将 MHPSS 纳入经济融入干预措施的 10 项策略。参加现有经济融入计划的 50 名流离失所者(每个研究条件 25 人)被纳入其中,88% 的人在 6 个月的随访中仍留在研究中。参与者和实施者都表示,整合策略是适当的、可接受的、可行的和可用的。实施者,包括之前没有心理健康服务经验的人,都能很好地实施干预。将精神健康和心理健康服务的重点干预内容整合到经济融入项目中,似乎可以改善精神健康和心理健康服务的成果、社会资本和网络的强度,以及参与经济和其他项目的情况:本研究提供了初步证据,证明将 MHPSS 纳入流离失所者经济融入计划的可接受性和可行性。我们发现了一些支持评估方法的证据,这些方法可以在未来的研究中使用,以明确检验针对流离失所者的心理健康和经济福利综合方法的附加价值。
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来源期刊
Conflict and Health
Conflict and Health Medicine-Public Health, Environmental and Occupational Health
CiteScore
6.10
自引率
5.60%
发文量
57
审稿时长
18 weeks
期刊介绍: Conflict and Health is a highly-accessed, open access journal providing a global platform to disseminate insightful and impactful studies documenting the public health impacts and responses related to armed conflict, humanitarian crises, and forced migration.
期刊最新文献
Exploring relationships between conflict intensity, forced displacement, and healthcare attacks: a retrospective analysis from Syria, 2016-2022. Feasibility and challenges in sustaining a community based surveillance system in post-Ebola Sierra Leone. Integrating mental health and psychosocial support into economic inclusion programming for displaced families in Ecuador. Maternal and newborn health prioritization in Yobe State, Nigeria: analysis of stakeholders' perspective. War-related trauma and posttraumatic stress disorder in refugees, displaced, and nondisplaced people during armed conflict in Sudan: a cross-sectional study.
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