Abstract:This study explores the mental health difficulties associated with severe trauma as experienced by refugees and asylum seekers, and issues related to psychological treatments. An evaluation was conducted of a culturally adapted cognitive therapy group programme for Tamil refugees and asylum seekers in the Wandsworth IAPT (Improving Access to Psychological Therapies) service. Data were examined from 16 Tamil participants who accessed the service between 2014 and 2015 and subsequently engaged in the group progra… Show more
“…Twenty‐two articles were identified, with 20 articles using qualitative methods and two mixed methods (Bahu, 2019; Foy et al, 2019). Data collection was carried out at varying time points following the end‐of‐treatment via different methods (semistructured interviews; n = 19); focus group and semistructured interviews ( n = 1; Holst et al, 2017), online questionnaire ( n = 1; Foy et al, 2019), and verbal qualitative feedback ( n = 1; Bahu, 2019). Qualitative analyses used a variety of methods: thematic analysis ( n = 8), interpretative phenomenological analysis ( n = 5), framework analyses ( n = 2), both thematic analysis and grounded theory ( n = 2), Foucauldian disclosure analysis ( n = 1), qualitative content analysis ( n = 1), constant comparative method ( n = 1), systematic text condensation ( n = 1), and one study used an unspecified method (Rogers et al, 2004).…”
Section: Resultsmentioning
confidence: 99%
“…Stigma was mentioned in ~50% of articles. Self‐stigma and social stigma were described as hindering help‐seeking and willingness to share difficulties with others (Allen et al, 2009; Amos et al, 2019; Bahu, 2019; Christodoulou et al, 2018; Foy et al, 2019; Millett et al, 2018; Newbold et al, 2013): …five of the twelve women felt the stigma of seeking help made it difficult to access support due to: “Feeling that you should cope … so I should not need to ask for help”. (Millett et al, 2018)Most participants described negative experiences of being misunderstood, judged and stigmatised because of their depression.…”
Section: Resultsmentioning
confidence: 99%
“…Self‐help was seen as moving from a state of passivity to one of activity (Lillevoll et al, 2013). Some components were identified as problematic by some, for example, the ‘completion of outcome measures, was perceived as a waste of time’ and impersonal (Rushton et al, 2020), irrelevant, or difficult to complete (Bahu, 2019; Mackinnon & Murphy, 2016) but also helpful in order to monitor personal progress (Rushton et al, 2020) and recognise level of distress and risk‐related issues (Bahu, 2019). The experience of outcome measures also impacted service users' view of their mental health and self‐help as a treatment (Bendelin et al, 2011; Mackinnon & Murphy, 2016): Mental health was understood as a measurable entity in which recovery was framed in terms of a reducing score.…”
Section: Resultsmentioning
confidence: 99%
“…Nearly all articles highlighted the importance of practitioners' qualities and skills (Amos et al, 2019; Bahu, 2019; Christodoulou et al, 2018; Doukani et al, 2020; Farrand et al, 2018; Foy et al, 2019; Goldman et al, 2016; Hadfield et al, 2019; Haller et al, 2019; Leonidaki et al, 2016; Lillevoll et al, 2013; Mackinnon & Murphy, 2016; McElvaney & Timulak, 2013; Millett et al, 2018; Rushton et al, 2020). Across studies, perception of therapists' qualities such as ‘humanity’ and ‘responsiveness’, ‘being warm’, ‘considerate’, ‘empathic’, ‘attentive’, ‘genuine’, ‘honest’, ‘non‐judgemental’, or ‘open and accepting’ were valued and considered the most important facilitators for building the therapeutic alliance.…”
Section: Resultsmentioning
confidence: 99%
“…Participants felt that pervasive stigmatizing attitudes or stereotypes attached to LGBQ identities may make it harder for therapists to treat certain groups. (Foy et al, 2019) In some cases, psychoeducation reduced the stigma experienced by service users and facilitated discussions with other individuals in the absence of shame (Bahu, 2019).…”
Primary care mental health services play a crucial role in public mental health by providing local and accessible psychological interventions that meet individuals' needs. Despite growing research investigating service users' perspectives of psychological interventions, a qualitative systematic review in this context is not available. The present meta-synthesis collates the existing articles and gives a thematic synthesis of qualitative studies on service users' experience of psychological interventions in primary care. Multiple databases (CINAHL, EMBASE, PsychINFO, MEDLINE, and Cochrane Library) were searched for published qualitative studies of service users' experiences of psychological interventions delivered in primary care. Articles were included if they met inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme tool. All types of psychological interventions were considered across model and delivery format (e.g., face-to-face, computerised programmes, and group). NVIVO was used to code the dataset and themes were extracted following thematic synthesis. Twenty-two studies were included. Four analytical themes and 10 subthemes emerged. The identified themes were as follows: (1) 'Access and Acceptability: facilitators and barriers', (2) 'Structural aspects'; (3) 'Therapeutic process' and (4) 'Outcomes'. A model of interrelationships between themes is proposed. Findings suggest several 'essential ingredients' across psychological interventions and modalities. The crucial role of relational factors, the importance of assessing service users' perceptions of treatment features (e.g., remote delivery) and of tailoring the intervention to their needs were emphasised. Results also suggest involving service users more in discussions and decisions about psychological interventions offered might enhance access, acceptability, and engagement. Recommendations for practice and research are provided.
“…Twenty‐two articles were identified, with 20 articles using qualitative methods and two mixed methods (Bahu, 2019; Foy et al, 2019). Data collection was carried out at varying time points following the end‐of‐treatment via different methods (semistructured interviews; n = 19); focus group and semistructured interviews ( n = 1; Holst et al, 2017), online questionnaire ( n = 1; Foy et al, 2019), and verbal qualitative feedback ( n = 1; Bahu, 2019). Qualitative analyses used a variety of methods: thematic analysis ( n = 8), interpretative phenomenological analysis ( n = 5), framework analyses ( n = 2), both thematic analysis and grounded theory ( n = 2), Foucauldian disclosure analysis ( n = 1), qualitative content analysis ( n = 1), constant comparative method ( n = 1), systematic text condensation ( n = 1), and one study used an unspecified method (Rogers et al, 2004).…”
Section: Resultsmentioning
confidence: 99%
“…Stigma was mentioned in ~50% of articles. Self‐stigma and social stigma were described as hindering help‐seeking and willingness to share difficulties with others (Allen et al, 2009; Amos et al, 2019; Bahu, 2019; Christodoulou et al, 2018; Foy et al, 2019; Millett et al, 2018; Newbold et al, 2013): …five of the twelve women felt the stigma of seeking help made it difficult to access support due to: “Feeling that you should cope … so I should not need to ask for help”. (Millett et al, 2018)Most participants described negative experiences of being misunderstood, judged and stigmatised because of their depression.…”
Section: Resultsmentioning
confidence: 99%
“…Self‐help was seen as moving from a state of passivity to one of activity (Lillevoll et al, 2013). Some components were identified as problematic by some, for example, the ‘completion of outcome measures, was perceived as a waste of time’ and impersonal (Rushton et al, 2020), irrelevant, or difficult to complete (Bahu, 2019; Mackinnon & Murphy, 2016) but also helpful in order to monitor personal progress (Rushton et al, 2020) and recognise level of distress and risk‐related issues (Bahu, 2019). The experience of outcome measures also impacted service users' view of their mental health and self‐help as a treatment (Bendelin et al, 2011; Mackinnon & Murphy, 2016): Mental health was understood as a measurable entity in which recovery was framed in terms of a reducing score.…”
Section: Resultsmentioning
confidence: 99%
“…Nearly all articles highlighted the importance of practitioners' qualities and skills (Amos et al, 2019; Bahu, 2019; Christodoulou et al, 2018; Doukani et al, 2020; Farrand et al, 2018; Foy et al, 2019; Goldman et al, 2016; Hadfield et al, 2019; Haller et al, 2019; Leonidaki et al, 2016; Lillevoll et al, 2013; Mackinnon & Murphy, 2016; McElvaney & Timulak, 2013; Millett et al, 2018; Rushton et al, 2020). Across studies, perception of therapists' qualities such as ‘humanity’ and ‘responsiveness’, ‘being warm’, ‘considerate’, ‘empathic’, ‘attentive’, ‘genuine’, ‘honest’, ‘non‐judgemental’, or ‘open and accepting’ were valued and considered the most important facilitators for building the therapeutic alliance.…”
Section: Resultsmentioning
confidence: 99%
“…Participants felt that pervasive stigmatizing attitudes or stereotypes attached to LGBQ identities may make it harder for therapists to treat certain groups. (Foy et al, 2019) In some cases, psychoeducation reduced the stigma experienced by service users and facilitated discussions with other individuals in the absence of shame (Bahu, 2019).…”
Primary care mental health services play a crucial role in public mental health by providing local and accessible psychological interventions that meet individuals' needs. Despite growing research investigating service users' perspectives of psychological interventions, a qualitative systematic review in this context is not available. The present meta-synthesis collates the existing articles and gives a thematic synthesis of qualitative studies on service users' experience of psychological interventions in primary care. Multiple databases (CINAHL, EMBASE, PsychINFO, MEDLINE, and Cochrane Library) were searched for published qualitative studies of service users' experiences of psychological interventions delivered in primary care. Articles were included if they met inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme tool. All types of psychological interventions were considered across model and delivery format (e.g., face-to-face, computerised programmes, and group). NVIVO was used to code the dataset and themes were extracted following thematic synthesis. Twenty-two studies were included. Four analytical themes and 10 subthemes emerged. The identified themes were as follows: (1) 'Access and Acceptability: facilitators and barriers', (2) 'Structural aspects'; (3) 'Therapeutic process' and (4) 'Outcomes'. A model of interrelationships between themes is proposed. Findings suggest several 'essential ingredients' across psychological interventions and modalities. The crucial role of relational factors, the importance of assessing service users' perceptions of treatment features (e.g., remote delivery) and of tailoring the intervention to their needs were emphasised. Results also suggest involving service users more in discussions and decisions about psychological interventions offered might enhance access, acceptability, and engagement. Recommendations for practice and research are provided.
Academic literature supports cultural adaptation (CA) of evidence‐informed interventions to increase accessibility and effectiveness of behavioral health treatment to meet the needs of a culturally diverse society. While several meta‐analyses have shown positive outcomes of CA mental health interventions, there is a need for more information about how theoretical CA models have been applied in practice to meet the cultural and contextual needs of specific groups. This scoping review was conducted to understand how CA models have been applied to adapt evidence‐informed behavioral health interventions for people with refugee backgrounds in resettlement. Eighteen manuscripts were identified and analyzed, resulting in five categories: Reasons for Engaging in CA, Processes of CA, Types of CAs, Resources Needed to Support CA, and Evaluating Adaptation Choices. Only four studies utilized any existing model to guide their adaptation efforts, three of which used CA models. Level of detail regarding CA processes and justification for choices varied considerably among articles. Significant gaps were identified, posing challenges for replication. Although articles reported that adapted interventions were effective, it is unclear which, if any, CA choices contributed to the successful outcomes. Findings indicate a need for emphasis on clear and thorough documentation of CA processes and more rigorous assessment of the impact of adaptation choices.
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