Translation, adaptation, and pilot of a guided self-help intervention to reduce psychological distress in South Sudanese refugees in Uganda

Abstract

Background.In this period of unprecedented levels of displacement, scalable interventions are needed to address mental health concerns of forced migrants in low-resource settings. This paper describes the adaptation and piloting of a guided, multi-media, self-help intervention, Self-Help Plus (SH+), which was developed to reduce psychological distress in large groups of people affected by adversity.Methods.Using a phased approach that included community consultations, cognitive interviewing, facilitator training, pilot implementation, and a qualitative process evaluation, we adapted SH+ for use among South Sudanese refugees in a refugee settlement in northern Uganda.Results.The SH+ materials, including audio-recorded sessions and an accompanying illustrated manual, were translated into Juba Arabic. Cognitive interviewing primarily resulted in adaptations to language with some minor adaptations to content. Facilitator training and supervision led to further suggested changes to delivery methods. An uncontrolled pilot study (n = 65) identified changes in the expected direction on measures of psychological distress, functional impairment, depression, wellbeing, and psychological flexibility. The process evaluation resulted in further adaptations to intervention materials and the decision to focus future effectiveness evaluations of the intervention in its current form on South Sudanese female refugees.Conclusions.We found that this potentially scalable, guided self-help intervention could be adapted for and feasibly implemented among female South Sudanese refugees in northern Uganda. These findings lay the groundwork for a future rigorous evaluation of SH+ in this context.

Cultural Adaptation of Scalable Psychological Interventions: A New Conceptual Framework

“…As another example, Tol et al (2018) argued that for people in humanitarian settings who suffer from a broad range of symptoms related to psychological distress that cannot be easily categorized as a mental disorder (e.g., nonpathological anxiety, grief reactions, and demoralization), general stress management techniques might be more relevant than disorder-specific treatments. Stress management techniques that focus on dealing with negative emotions such as anger, sadness, or nervousness, might be more relevant in such contexts (Hinton et al, 2012;Tol et al, 2018). b. Nonspecific elements (common factors).…”

Self Help Plus: study protocol for a cluster-randomised controlled trial of guided self-help with South Sudanese refugee women in Uganda

“…In the completed small feasibility cRCT in this population, <20% attrition was observed (Tol et al . 2018 a ).…”

“…In line with this framework, we conducted two preliminary studies: (1) an uncontrolled pilot of SH+ with one group of men and one group of women (Tol et al . 2018 a ); and (2) a feasibility cluster-randomised controlled trial (cRCT) with one group of women in the intervention condition, and one group of women in the control condition (Tol et al . 2018 b ).…”

“…Additional details on the translation, adaptation and initial uncontrolled piloting can be found in this volume (Tol et al . 2018 a ).…”

The Cultural and Contextual Adaptation Process of an Intervention to Reduce Psychological Distress in Young Adolescents Living in Lebanon

“…Each session was role-played, followed by a discussion of comprehensibility, acceptance, completeness, and relevance. This was an addition to the WHO guidance, and recommended based on field experiences indicating that this would provide substantive suggestions for changes (34).…”