A community-based qualitative study of intergenerational resilience with Palestinian refugee families facing structural violence and historical trauma

The Experiences of People From Arab Countries in Coping with Trauma Resulting From War and Conflict in the Middle East: A Systematic Review and Meta-synthesis of Qualitative Studies

The Middle East region has been an area of war and political conflict for several decades. There is currently limited research on the experiences of war and conflict among the individuals from Arab countries in the Middle East. The aim of this review was to systematically review and meta-synthesize qualitative literature on the experiences of individuals from Arab countries in the Middle East of going through and coping with war and political conflict. We systematically searched for relevant literature through MEDLINE, PsycINFO, CINAHL, Google Scholar, EThOS, OpenGrey, and The Arab Journal of Psychiatry. Studies selected needed to have a qualitative design reporting on the war and conflict experiences of participants aged 18 years or older from Arab countries in the Middle East. The review protocol was preregistered with PROSPERO (Ref: CRD42022314108). We identified 27 studies to be included in the final review. Four overarching themes were included in the meta-synthesis: War and conflict as life-defining experiences, experiences of hardship, coping with war and conflict, and positives out of a painful experience. Participants in the included studies reported significant distress and losing their sense of self, as well as resilience and positive growth. This review and meta-synthesis revealed the particular culturally informed experiences of individuals from Arab countries in the Middle East in processing their conflict experiences. These experiences highlight the need for culturally sensitive interventions for a population that has been under significant war-related stressors.

Counter-narratives against hardships among Syrian refugee youth and parents

The conventional literature and popular media describe the challenges of (Syrian) refugees in terms of their being victims who need to deal with the traumatic events they experienced before and during their flight. Their lack of seeking professional psychosocial help to improve their mental wellbeing is often explained by migrants' supposed fear of stigmatization. Using in-depth interviews with 10 Syrian refugees in the Netherlands, we show that their main struggle concerns their identity fragmentation as a result of both their displacement and the stereotypical discourses of Muslim/Syrian people as victims or terrorists. In this article, we explore how Syrian refugee youths use strategic forgetting and remembering of both positive and negative memories to reconstruct their (collective) identity. Our finding that Syrian refugee youths use counter-narratives of being strong and competent to deal with their experience of identity fragmentation offers an alternative explanation for refugees not seeking professional help in dealing with their hardships.

Transgenerational trauma and collective resilience: A qualitative analysis of the experiences of settler-colonial violence among three generations of Palestinian refugees

BACKGROUND

Palestinian people have endured collective dispossession and social suffering for 74 years from the so-called Al-Nakba (Palestinian catastrophe).

AIMS

The present exploratory work sought to analyze experiences of settler-colonial violence over three generations of Palestinian refugees.

METHODS

Forty-five participants (Mage = 44.45; range 13-85) were recruited via snowball sampling and interviewed to explore their understanding of transgenerational and collective trauma. Interviews were analyzed through thematic content analysis, resulting in four emerging themes distributed among the three generations.

RESULTS

The four themes encompassed (1) The impact of Al-Nakba, (2) Hardships, challenges, and quality of life, (3) Coping strategies, and (4) Dreams and hopes for the future. The results have been discussed using local idioms of distress and resilience.

CONCLUSIONS

The Palestinian experience of transgenerational trauma and resilience depicts a portrait of extreme trauma and endurance that cannot be reduced to the mere nosographic collection of Western-informed psychiatric symptoms. Instead, a human rights approach to Palestinian social suffering is most recommended.

Multisystemic Resilience and Psychosocial Wellbeing among Older Refugees: A Systematic Review with Implications for Mental Health and Psychosocial Support (MHPSS)

Older refugees experience poor mental and emotional health outcomes compared to younger counterparts. Although older adults are instrumental in family/community adjustment in postmigration settings, little is known about how to enhance psychosocial resilience in this population. The aim of this systematic review is to glean deeper insight into the protective factors and processes associated with older refugees' resilience and positive psychosocial health in postmigration settings. We searched eight electronic health and social science databases. Twenty-three articles met the criteria for inclusion; we analyzed these using a multisystemic resilience lens. Studies spanned 1991 to 2022; importantly, 15 of the 23 articles were published in the past decade, indicating growing attention to the mental and psychosocial health of older refugees. Only six of the included articles focused on older refugees living in low- and middle-income countries, revealing a contrast between where most of the world's refugees reside and where the majority of mental health and psychosocial support (MHPSS) research is conducted. We found tremendous variation in determinants of psychosocial resilience based on the politico-historical contexts of migration; sociocultural backgrounds of refugees; and distinct postmigration needs, resources, and settings. Broadly, macrosystem determinants of resilience included security, access to basic services, and maintenance of culture and spirituality. Mesosystem factors were related to social support from families, ethnic communities, religious networks, and host country nationals. Finally, microsystem determinants of older refugees' resilience included language acquisition, cognitive reappraisal, and sense of optimism. Our findings suggest the importance of interdisciplinary, multilevel research designs to highlight how multiple ecosystems interact to promote psychosocial resilience among older refugees. Taken together, this systematic review offers important insight into multilevel protective factors and processes to enhance culturally and contextually meaningful MHPSS for older refugees.

Seeking utopia: Psychologies' waves toward decoloniality

This paper provides a review of empirical studies published with a decolonial epistemic approach in psychology. Our goal was to better understand how decolonial approaches are being practiced empirically in psychology, with an emphasis on community-social psychology. We first discuss the context of colonization and coloniality in the research process as orienting information. We identified 17 peer-reviewed empirical articles with a decolonial approach to psychology scholarship and discerned four waves that characterize the articles: relationally-based research to transgress fixed hierarchies and unsettle power, research from the heart, sociohistorical intersectional consciousness, and desire-based future-oriented research to rehumanize and seek utopia. Community-social psychology research with a decolonial approach has the potential to remember grassroots efforts, decolonizing our world.

Psychosocial concerns in a context of prolonged political oppression: Gaza mental health providers' perceptions

In this qualitative exploratory study, we investigated the perspectives of mental health providers in Gaza, Palestine, regarding the primary concerns of their clients who are exposed to low-intensity warfare and structural violence. We conducted qualitative interviews with 30 psychologists, social workers, psychiatric nurses, and psychiatrists providing services to communities in Gaza. Participants were asked to discuss their clients' most commonly occurring mental health problems, diagnoses, and psychosocial conditions. Thematic analysis identified one superordinate theme (Impact of the Blockade on Mental Health and Quality of Life) and four second-order themes (Concerns about Social Problems, General Concerns about Quality of Life, Concerns about the Mental Health of the Community, and Concerns Related to Children's Mental Health). Participants indicated that the social and political dimensions of mental health and the economic, educational, and health-related consequences of the ongoing blockade of Gaza were the main determinants of psychological burden among their clients. Findings demonstrated the importance of adopting an approach to mental health that includes understanding psychological indicators in a broader framework informed by human rights and social justice. Implications for research and clinical work are discussed, including the role of investments in social capital that may provide individuals with access to resources such as social support, which may in turn promote overall mental health.

When Agency Turns Into a Risk Factor: A Literature Review of the Negative Consequences of Children's Agentic Behaviors on Their Physical and Psychological Well-Being

Background: Research has widely documented how, even in conditions of extreme poverty, deprivation, or oppression, children are competent and situated actors, capable of actively mobilizing internal, external, or social resources to protect themselves from their environments and safeguard their everyday lives. Yet, the ways in which their agency might support their well-being or instead increase their own vulnerability has remained underexplored. Aims: The present study aims to provide an assessment of all those contributions which, over the past 20 years, have focused on both the positive and negative consequences of children's actionability, revealing children's self-destructive acts alongside their self-empowering and protective ones. In the process, it highlights several major theoretical breakthroughs and findings in this area of research. Method: We provide an assessment of peer-reviewed studies that have focused on both positive and negative consequences of children's actionability, through a qualitative narrative literature review. Results: Of the 168 studies identified from online searches of the literature and the three additional sources gathered through bibliography mining, 76 qualified for full review, with 12 studies included in the final synthesis. Overall, the literature explored the different conditions in which children's agentic practices expose them to trauma symptoms and to dangerous or self-harmful situations, thereby failing to safeguard their health and overall well-being. Conclusion: The review highlights the need to focus on the dangerous effect of the agentic practices activated by children in terms of their physical and psychological health.

A history of collective resilience and collective victimhood: Two sides of the same coin that explain Black Americans' present-day responses to oppression

Collective victimhood and collective resilience are two sides of the same coin. However, most literature to date has focused on the experiences and consequences of collective victimhood. In the present research, we focused on the experiences of Black Americans, a group that has a legacy of victimization and resilience. As a part of Black Americans' collective memory, we explored the nature of historical collective resilience and examined its role in explaining collective responses to present-day oppression, over and above any effect of historical collective victimhood. When they were asked to reflect on their group's history, across Studies 1 (N = 272) and 2 (N = 294), we found that Black Americans generated narratives of collective resilience. In both studies, we also found evidence that perceived historical collective resilience was linked to a greater sense of collective continuity, which, in turn, explained greater support for the ongoing Black Lives Matter movement. Our findings underscore the importance of considering narratives of resilience in a group's history and point to the way such collective resilience narratives can serve as a resource for the group in the present.

Community Health Worker Program Outcomes for Diabetes and Hypertension Control in West Bank Refugee Camps: A Retrospective Matched Cohort Study

INTRODUCTION

Community health worker (CHW) programs have proven effective in improving diabetes control in many locations and settings, but data on feasibility and efficacy are lacking in the Middle East and settings of chronic violence. A Palestinian CHW program, Health for Palestine (H4P), addresses chronic diseases in West Bank refugee camps. Our study assesses the feasibility and effectiveness of the program's diabetes and hypertension interventions.

METHODS

Data on home visits, patient retention, and blood pressure were extracted from the CHW records and analyzed. To assess diabetic patient progress, we conducted a retrospective matched cohort study using data obtained from a United Nations (UN) clinical database to analyze the trajectory of hemoglobin A1c (A1c) values. Thirty of the 47 diabetic patients in the H4P CHW program met study inclusion criteria and were each matched with 3 patients from the Bethlehem UN clinic (n=120). We tested for significance using multivariable linear regression with robust standard errors.

RESULTS

The average number of home visits per patient per month was 7.3 (standard deviation=4.1), and the patient retention rate was 100% over an average of 11.2 months. For hypertension patients in the CHW program (n=33), mean systolic blood pressure decreased by 7.3 mmHg (95% confidence interval [CI]=1.93, 12.25; P=.009) and mean diastolic blood pressure by 4.3 mmHg (95% CI=0.80, 7.91; P=.018) from March 2018 to November 2019. On average, diabetic patients within the CHW group experienced a 1.4 point greater decline in A1c per year compared to those in the non-CHW group, after adjusting for potential confounders (95% CI=-0.66, -2.1; P<.001).

DISCUSSION

The results suggest that CHW accompaniment may be an effective model for improving diabetes and hypertension control in refugee camps experiencing direct violence and extreme adversity. A low exclusion cut-off for A1c (≤6.4%) may underestimate the program's impact.

Gender-based violence experiences among Palestinian women during the COVID-19 pandemic: mental health professionals' perceptions and concerns

Background

In a geopolitically at-risk environment, such as Palestine, gender-based violence (GBV) is still a crucial problem rooted in discriminatory laws and traditional habits exacerbated by the ongoing Israeli military occupation. Moreover, the lack of updated data makes it difficult to grasp the magnitude of the phenomenon entirely; the purpose of the current study was to explore mental health professionals’ perceptions and concerns on GBV among Palestinian women during the COVID-19 pandemic.

Methods

Participants in the study were 30 Mental Health Professionals (MHP) selected using convenience and snowball sampling techniques from among MHP in northern West Bank, Palestine.

Results

A thematic content analysis revealed seven main themes of GBV during the pandemic. Palestinian MHP reported that the increased number of GBV cases among women during the COVID-19, quarantine, physical distancing measures, and closure of non-essential services significantly heightened the risks of GBV among Palestinian women. Moreover, Palestinian women involved with or married to older men or married at a very young age were at risk of GBV more than others. Results of qualitative analysis also showed that Israeli occupation and the political violence characterizing the area for decades (including restriction of movement, house demolitions, separation of family members, etc.) have also exacerbated and increased GBV in the occupied Palestinian territories.

Conclusions

Improving intervention skills and supervision services among Palestinian MHP to help women who face GBV is recommended. Moreover, additional research should be conducted to explore the risk and potential factors of GBV, agency, and coping strategies to deal with GBV.

The Multidimensional Taxonomy of Individual Resilience

Theoretical work in resilience has continuously evolved to inform and respond to advances in empirical work. In order to further scientific inquiry, it must continue to do so. This narrative overview of the field of resilience science focuses on contemporary challenges confronted by theoretical models of individual resilience and proposes a taxonomic structure for resilience-the multidimensional taxonomy of individual resilience (MTIR). The goal of the MTIR is to articulate a systematic framework within which extant theoretical and empirical work can be nested. Consistent with existing work, the MTIR organizes resilience into two primary branches-manifested resilience and generative resilience. These two components are then organized into subdomains that demonstrate evidence of conceptual distinctiveness. The specification of the subdomains in the MTIR draws support from a diverse body of work on resilience across disciplines and in multiple global contexts. The MTIR makes several critical advances, including expanding and refining the definitions and components of resilience in psychology, providing a clearer framework for conceptualizing mixed profiles of resilience, and tempering assumptions regarding the relational dependencies across domains of resilience. Finally, the utility of the MTIR in organizing research in resilience and advancing theory-testing and development is discussed.

Alternative Ways of Capturing the Legacies of Traumatic Events: A Literature Review of Agency of Children Living in Countries Affected by Political Violence and Armed Conflicts

BACKGROUND

It has been revealed that the construct of agency plays a crucial role in contributing to children's positive functioning and well-being despite their traumatic contexts. Yet there is little agreement within the literature about the definition of agency, how agency is displayed by children, or how it should be investigated.

AIMS

This study provides a synthetic overview of studies that have analyzed the agency of children living in contexts affected by political violence and armed conflict. In the process, it highlights major theoretical breakthroughs and findings in this area of research. The aim was to review research investigating the different ways in which children's agency manifests itself within their everyday lives, as well as possible policy implications.

METHOD

We identified published peer-reviewed studies relating to children's agency in conflict-affected environments through a narrative literature review. An ecological framework was used to organize studies according to the different settings (personal, familial, cultural, or contextual) within which the children's agency was displayed.

RESULTS

Of 682 studies identified from online searches of the literature and the three additional sources gathered through bibliography mining, 63 qualified for full review, with 15 studies included in the final synthesis. Overall, the literature focused mostly on the ways in which children's ability to mobilize resources emerged in order to cope with their challenging contexts.

CONCLUSION

Scholars advocated for community-oriented and child-centered programs that are aimed not only at promoting recovery from symptoms but also at fostering advocacy and a sense of agency in children.

Well-being and Life Satisfaction in Children Living in Contexts of Political Violence: A Narrative Literature Review

Background

Children and youth growing up in contexts characterized by political violence are at high risk of developing mental health impairments. In recent years, a growing interest has been directed to the study of children’s well-being after being exposed to political violence in order to develop interventions aimed at preserving and enhancing it.

Objective

This study provides a synthetic overview of studies that have explored or implemented interventions aimed at improving well-being and life satisfaction in conflict-affected children.

Methods

We identified peer-reviewed studies relating to children’s well-being in conflict-affected environments through a narrative literature review. An ecological framework was used to organize the studies in relation to the individual, family, social and community factors playing a role in promoting and preserving participants’ well-being. Implications for practices, policies and research were summarized to highlight areas in which they need strengthening.

Results

Of 1221 unique studies returned from online searches of the literature, 70 qualified for full review, with a total of 22 peer-reviewed studies included in the final synthesis. Results indicate a range of domains and dimensions that mutually interact to either enhance or diminish children’s well-being and life satisfaction. Four studies explicitly focused on assessing the effectiveness of interventions aimed at promoting and assessing children’s well-being and health.

Conclusions

Researchers were able to identify several dimensions that were contributing to the children’s well-being in situations of significant adversity. The concept of well-being emerged as a combination of personal resources and supportive contexts—such as family, peers, and community—that vary over time or across contexts. Well-being and life satisfaction in children living in contexts of political violence: a narrative literature review.

The Comprehensive Communal Trauma Intervention Model (CCTIM), an Innovative Transdisciplinary Population-Level Model for Treating Trauma-Induced Illness and Mental Health in Global Vulnerable Communities: Palestine, a Case Study

This paper explores how Western medicine may not fully understand and address post-traumatic stress disorder (PTSD) and other trauma-induced illnesses in a culturally appropriate manner in marginalized communities and offers a theoretical framework to develop comprehensive, effective, and sustainable solutions that comprehensively address and treat the trauma on both a collective and individual level. Focused on Palestinians, this paper discusses the collective trauma Palestinians experienced and how it manifests in transgenerational effects on the body and mind that may be post-traumatic stress disorder (PTSD) or perhaps another distinct condition that is yet to be codified in the Western medical lexicon. It describes local alternatives to Western medical diagnostic tools like the "ease to disease" diagnostic scale and the sociopolitical context-in this case, the Palestinian fight for karamah, or dignity-from which such alternatives arise. Based on these findings, a novel theoretical framework, the comprehensive communal trauma intervention model (CCTIM), a truly transdisciplinary population-level model for treating mental health in vulnerable communities globally, is proposed. It articulates the need to address the root cause of collective trauma, make modifications to the healthcare system, and cultivate strategic equity-oriented and research-based partnerships.

A multidimensional model of resilience: Family, community, national, global and intergenerational resilience

This paper aims to unpack the empirical and theoretical complexity that surrounds 'resilience', with particular attention to its application to war-affected children and youth. We expand current conceptual frameworks to adopt a more inclusive and intergenerational approach that accounts for the added layers of national, global and intergenerational resilience, arguing for greater recognition of the shared or relational nature of resilience. We introduce a multidimensional model of resilience that integrates the macro- and micro-level to include resilience-enabling systems at the family, community, national, global and intergenerational levels. The purpose of this conceptual framework is to provide a more holistic and integrative model that combines both bottom-up and top-down approaches to cultivating resilience, highlighting the power of interconnections across interrelated systems and social structures. Using the case example of post-genocide Rwanda and the experiences of children born of genocidal rape, we apply our multidimensional model to illustrate concrete examples of resilience-enabling systems at the family, community, national, global and intergenerational levels. Our proposed multidimensional model as applied to youth born of genocidal rape in Rwanda reveals key gaps in their surrounding social ecological systems, highlighting the importance of coordinated and mutually-reinforcing efforts to engender resilience across all dimensions concurrently. We conclude with a set of policy and practice implications, directions for future research, and lessons-learned on how best to champion the resilience of this unique and important population of children.

Promotion of Resilience in Migrants: A Systematic Review of Study and Psychosocial Intervention

This systematic review aimed to contribute to a better and more focused understanding of the link between the concept of resilience and psychosocial interventions in the migrant population. The research questions concerned the type of population involved, definition of resilience, methodological choices and which intervention programmes were targeted at migrants. In the 90 articles included, an heterogeneity in defining resilience or not well specified definition resulted. Different migratory experiences were not adequately considered in the selection of participants. Few resilience interventions on migrants were resulted. A lack of procedure’s descriptions that keep in account specific migrants’ life-experiences and efficacy’s measures were highlighted.

Culturally sensitive conceptualization of resilience: A multidimensional model of Chinese resilience

Cultural sensitivity is missing in the widely researched construct of resilience. The assumption that resilience takes the same form in all cultures fails to acknowledge that culture shapes the interpretation and instantiation of resilience. Examining how suffering and adversity are perceived and dealt with in Chinese contexts, can identify cultural concepts related to resilience. In this paper, we examine the ways in which Confucianism, Buddhism, and Taoism, the three main belief systems that have influenced Chinese people's perception of the nature of life, can serve as sources of strength to individuals facing adversity. We summarise three culturally inflected elements of dealing with adversities and compare them with existing, widely researched notions of resilience. Taking a socio-ecological perspective to explore resilience, this paper proposes a multidimensional model that can improve understanding of culturally embedded resilience.

Refugee mental health and human rights: A challenge for global mental health

This article introduces a thematic issue of Transcultural Psychiatry that presents recent work that deepens our understanding of the refugee experience-from the forces of displacement, through the trajectory of migration, to the challenges of resettlement. Mental health research on refugees and asylum seekers has burgeoned over the past two decades with epidemiological studies, accounts of the lived experience, new conceptual frameworks, and advances in understanding of effective treatment and intervention. However, there are substantial gaps in available research, and important ethical and methodological challenges. These include: the need to adopt decolonizing, participatory methods that amplify refugee voices; the further development of frameworks for studying the broad impacts of forced migration that go beyond posttraumatic stress disorder; and more translational research informed by longitudinal studies of the course of refugee adaptation. Keeping a human rights advocacy perspective front and center will allow researchers to work in collaborative ways with both refugee communities and receiving societies to develop innovative mental health policy and practice to meet the urgent need for a global response to the challenge of forced migration, which is likely to grow dramatically in the coming years as a result of the impacts of climate change.

Adaptive coping during protracted political conflict, war and military blockade in Gaza

Identifying culturally-relevant concepts and coping mechanisms can help protect civilian wellbeing. This study explores how seven professional Palestinian university graduates in the Gaza Strip (occupied Palestinian territories) cope with war, military occupation, military blockade and the challenges of living in a conflict-affected area. Participants were interviewed to determine whether culturally specific modes of coping were used. Thematic analysis was applied. The use of resistance and more specifically sumud, ¹ being steadfast and persevering, were identified alongside the motivation to persevere and other adaptive responses to living conditions. Coping strategies identified in this study include adapting, problem-solving, accepting reality, exercising patience, utilising social support, and faith in God (iman) and religion. The implications of this study and the relevance of the findings to mental health and disaster relief are considered.

Culturally informed resilience in conflict settings: a literature review of Sumud in the occupied Palestinian territories

Investigating culturally specific views and experiences of trauma and resilience can offer new insights that can aid distress management, meaning making, coping and resilience in adverse conditions, and inform emergency and disaster responses. Sumud is a Palestinian cultural construct and component of resilience in the occupied Palestinian territories (oPt). Sumud in Arabic refers to steadfastness or perseverance. This literature review focuses on research studies on Sumud in the oPt, with particular attention to the meaning and manifestations of Sumud, the role of non-violent resistance, and how Sumud and non-violent resistance informs resilience and coping in the context of a military occupation, protracted political conflict, and chronic adversity. The peer-reviewed literature was surveyed using the PubMed and PsycINFO databases. The findings indicate how Sumud is a central component of resilience and provides a meta-cognitive framework which Palestinians use to interpret, cope and respond to ongoing injustice and traumatic experiences, engendering a sense of purpose and meaning. It is both a value and an action that manifests via individual and collective action to protect family and community survival, wellbeing, dignity, Palestinian identity and culture, and a determination to remain on the land. The implications of this study and the relevance of the findings to mental health and disaster relief are considered.

Survival and Resilience Among Palestinian Women: A Qualitative Analysis Using Individual and Collective Life Events Calendars

Responding to the need for more information concerning the mental health and psychological well-being of women living amid political oppression and war, this study aimed to explore specific factors that contribute to women's individual and collective perceptions about war and the associated traumatic life events that occurred during their lives. Moving from a socioecological and culture-informed perspective, we used narrative timelines elicited from 21 Palestinian women in Gaza, both individually and collectively, as a tool for both data collection and intervention. A deductive, top-down, thematic content analysis procedure was used to categorize data. The main events outlined by the women in their historical accounts, both individual and collective, were linked to political events in and surrounding Palestine. The life events' calendars reflect a constant attempt in balancing and compensating traumatic events with sources of well-being related to social support and family. Individual and collective narrative activities contributed to generate a significant reframing in the attribution of meaning and emotional perceptions of the participants. Women articulated how they build resilience through transgenerational and daily practices of resistance that encompass indigenous strategies of coping and skills of survival.

Essential Care Needs for Patients' Family Members at the Intensive Care Units in Palestine

Background:

Understanding the needs of families of hospital patients, especially those in intensive care units is key to providing comprehensive, effective support. The aim of this study is to determine the needs of families of Intensive Care Unit (ICU) patients in four Palestinian hospitals.

Materials and Methods:

This was a cross-sectional, analytic study including 240 participants selected using convenience sampling. Data was obtained from participants from September 2016 to April 2018. The Critical Care Family Needs Inventory (CCFNI) was distributed to examine their needs. Descriptive analysis, t-tests, and Analysis of Variance (ANOVA) were conducted to analyze relationships between demographic characteristics of respondents and their needs. Differences were considered significant at p < 0.05.

Results:

The results revealed that the assurance domain was the most important, but participants had some unmet needs from the support domain. Parents reported higher levels of importance of all needs than other types of relatives of patients. In addition, participants with a higher level of education reported a significantly higher level of importance in the dimensions of assurance (F_3,236= 2.85, p = 0.038), proximity (F_3,236= 4.36, p = 0.006), and support (F_3,236= 4.13, p = 0.007). Also, married participants had a higher need for all dimensions. Family members of patients who stayed more than 7 days had higher needs for support (F_2,237= 3.39, p = 0.035) and comfort (F_2,237= 3.92, p = 0.021).

Conclusions:

Family members of ICU patients have certain unmet needs, which require attention from healthcare professionals and administration in Palestinian hospitals. In addition, sociodemographic variables influence family member needs.

Growing intergenerational resilience for Indigenous food sovereignty through home gardening

As a community-based participatory research project designed to promote health and wellbeing, Growing Resilience supports home gardens for 96 primarily Eastern Shoshone and Northern Arapaho families in the Wind River Reservation, located in Wyoming. Through analysis of data from two years of qualitative fieldwork, including stories told by 53 gardeners and members of the project's community advisory board in talking circles and through our novel sovereign storytelling method, we investigated if and how these participants employ relationships, knowledge, and practices across generations through home gardening. We find that participants describe home gardening within present, past, future, and cross-generational frames, rooted in family relationships and knowledge shared across generations. Our analysis of these themes suggests that gardening provides families a means to transmit resilience across generations or, as we call it here, intergenerational resilience. We conclude by discussing intergenerational resilience as a culturally specific mechanism of social-ecological community resilience that may be particularly relevant in Indigenous movements for food sovereignty.

"We are children like others": Pathways to mental health and healing for children born of genocidal rape in Rwanda

Despite the well-documented prevalence of rape as a strategy of war, little is known about the specific psychological consequences to children born of conflict-related sexual violence. The results of data analysis of 7 focus groups and 60 in-depth interviews with children born of genocidal rape in Rwanda indicated that they are carrying the trauma of their own stigmatization and marginalization, are burdened with their mothers' trauma, and, we conclude, symbolize unresolved collective trauma for the society. Analysis also reveals that healing for these young adults requires interpersonal and intrapersonal compassion and acceptance, a meaningful connection with a peer group, societal recognition, and empowerment to help contribute to and transform their lives and societies. Each of these pathways to healing-intrapersonal, interpersonal, and social-is contingent upon the other, and none can be considered in isolation. To support this largely invisible population striving to fulfill their potential, opportunities need to be created for self-acceptance and acceptance by mothers, families, and communities; sharing and building emotional and social bonds with their cohort group; formal recognition; official social rituals to validate their experiences and those of the mother-child dyad in the context of culture and community; and for socioeconomic opportunities to enable them to fully participate in building the future of Rwanda.

Place as a Social Determinant of Health: Narratives of Trauma and Homeland among Palestinian Women

Despite calls for greater social work attention to the centrality of place in human life, the profession has yet to hone frameworks that fully capture the role of place in individual-collective identity and well-being. To move this agenda forward, this article draws on data from a series of focus groups to explore the placed experiences of women in Palestine. Analytically, it is informed by critical place inquiry, which emphasises the deeply interactional relationships between people and places, views place-centred practice and research as catalysts for active responses to the spatialised nature of power and injustice, and focuses centrally on the geographic and spatial dynamics of colonisation, and particularly settler colonialism, as key determinants of individual and collective well-being. Women's spatial narratives revolved around individual-collective identity and sovereignty, focusing in particular on three interdependent factors: freedom of movement; possession and dispossession; and continuity of place. Findings also illuminated spatial practices of resistance by which women defend and promote identity and sovereignty. We conclude with recommendations for more explicit, critically informed attention to place in social work practice, education and research.

Centering at the Margins: Critical Community Resilience Praxis

Aims: This article aims to reframe resilience for use in community research and action in conditions of adversity marked by increasing natural disasters and by social inequities rooted in the coloniality of power, such as in Chile. Method: We review international resilience literature that explores responses to complex adversities, evaluating three “waves” of resilience research, including (1) “bouncing back,” which frames resilience as protecting functioning; (2) “bouncing forward,” understanding resilience as adaptation; and (3) what we are calling, the “centering at the margins” wave, which explicitly incorporates liberation psychology and decolonial, critical race theories to the study and promotion of resilience. Results: Building off “third wave” thinking, this article attempts to improve the social justice ethics within which research on resilience is completed by introducing a critical community resilience praxis. Conclusions: Critical community resilience praxis can aid the study of resilience by illuminating ways to avoid the reinforcement of social hierarchies and interlocking systems of oppression relevant to the work of disaster risk reduction investigators, psychologists, and differently positioned stakeholders engaged in resilience research and practice in complex settings internationally marked by histories of colonialism, consequences of climate change, and continual social inequities.

The impact of school principals on implementing effective teaching and learning practices

Purpose

The purpose of this paper is to identify limitations in managing the implementation of effective teaching and learning in township ECD centres.

Design/methodology/approach

This research was grounded in a community-based participatory research approach. A qualitative research design was utilised because phenomena could be studied in terms of the meanings of people. Elements of grounded theory, situational analysis and community-based participatory research were blended. The qualitative research design involved semi-structured face-to-face interviews with teachers in township ECD centres.

Findings

The findings from this research made it evident that principals of ECD centres were often absent; had not been trained to manage an ECD centre; had limited skills to manage finances; did not communicate with parents or teachers; and did not motivate teachers to achieve goals or to improve their qualifications.

Practical implications

Challenges that could impede the effective implementation of an intervention programme should be identified and addressed. Principals of ECD centres should be empowered to manage their centres effectively. A training programme aimed at empowering principals of ECD centres has been developed and will be implemented after consultation with the gatekeeper and principals of the ECD centres.

Originality/value

The findings of this research could be used by principals and researchers to reflect on management practices in ECD centres. A challenge for principals is to acknowledge the principles of effective management and to close the gap between current practices and effective management practices. Interventions from academics are essential to enhance the quality of teaching and learning in ECD centres.

"As Natural as the Air Around Us": On the Origin and Development of the Concept of Structural Violence in Health Research

This article examines the concept of "structural violence." Originating in the work of Johan Galtung in 1969 and popularized by Paul Farmer, structural violence is increasingly invoked in health literature. It is a complex concept - rich in its explanatory potential but vague in its operational definition and arguably limited in its theoretical precision. Its potential lies in the focus it gives to the deep structural roots of health inequities; in contrast to the more passive term "social determinants of health," structural violence explicitly identifies social, economic, and political systems as the causes of the causes of poor health. It is also evocative in its framing of health inequities as an act of violence. Yet the formulation of structure used in this literature is largely atheoretical and, by extension, apolitical. Development of the concept hinges on clarifying the precise aspects of structure it points to (perhaps through using the concept in conjunction with larger theoretical frameworks) as well as improving operational definitions to enable its use in quantitative social epidemiology. We argue that the concept of structural violence can provide a useful lens for understanding health inequities, but its full potential is only realized when combined with larger theoretical frameworks.

Coping with trauma and adversity among Palestinians in the Gaza Strip: A qualitative, culture-informed analysis

In this article, we propose that coping is not only an individual property but also a structural feature. Coping shapes what is referred to in social network theory as multiplex networks, which are based on relations with multiple functions, values and meanings. Focus groups with adult Palestinians were held and content analysed. Five main coping strategies were identified: (a) creating cultural and religious meaning; (b) individualism to collectivism; (c) normalization and habituation; (d) belonging, acceptance, expectation and readiness; and (e) social support. Participants also reported culture-specific expressions for indicating psychological distress. Implications for cultural informed clinical work are then discussed.

Engaging critical community resilience praxis: A qualitative study with Mapuche communities in Chile facing structural racism and disasters

Mapuche are the largest indigenous group in Chile and have survived histories of colonialism, socionatural disasters, and more recently, increasing conflicts with the Chilean state. This study aimed to engage critical theories and examine resilience processes from indigenous perspectives while exploring the impact of racism, intersecting adversities, and ongoing decolonial struggles in Mapuche communities. Decolonial qualitative methods, situational analysis, and community-engaged participatory approaches were utilized in application of a critical community resilience praxis (CCRP). First, an interagency collaborative entitled Mapuche Equipo Colaborativo para la Investigación de la Resiliencia (MECIR) was established. MECIR involved partnerships between a Chilean national research center for disasters, a nongovernmental organization of indigenous advocates/researchers, and a Mapuche community health center. MECIR completed semistructured interviews with 10 participants (N = 10) in addition to ethnographic observations. Four themes of resilience emerged: newen, "strength and spiritual life-nature force"; azmapu, "ancestral systems of social organization and tribal law"; nietun, "cultural revitalization"; and marichiweu, "resistance." Findings contribute to reconceptualizations of resilience from Mapuche perspectives while identifying culturally meaningful strategies for promoting racial justice and mental health equity. Results show benefits of CCRP in community psychology research in an international setting.