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El Masri R, Chaar S, Elias J, Meksassi B, Ali R, Roberts B, Brown FL, Asmar MK, McKee M, El Chammay R, Singh NS. Barriers, facilitators and proposed solutions to equitable mental health financing and service delivery for the Lebanese populations and displaced Syrians in Lebanon: Findings from a qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003318. [PMID: 38941293 PMCID: PMC11213328 DOI: 10.1371/journal.pgph.0003318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/15/2024] [Indexed: 06/30/2024]
Abstract
Forcibly displaced populations experience an increased burden of mental illness. Scaling up mental health (MH) services places new resource demands on health systems in crises-affected settings and raises questions about how to provide equitable MH services for refugee and host populations. Our study investigates barriers, facilitators, and proposed solutions to MH financing and access for Lebanese populations and Syrian refugees in Lebanon, a protracted crisis setting. We collected qualitative data via 73 interviews and 3 focus group discussions. Participants were purposively selected from: (i) national, United Nations and NGO stakeholders; (ii) frontline MH service providers; (iii) insurance company representatives; (iv) Lebanese and Syrian adults and parents of children aged 12-17 years using MH services. Data were analysed using inductive and deductive approaches. Our results highlight challenges facing Lebanon's system of financing MH care in the face of ongoing multiple crises, including inequitable coverage, dependence on external humanitarian funds, and risks associated with short-term funding and their impact on sustainability of services. The built environment presents additional challenges to individuals trying to navigate, access and use existing MH services, and the social environment and service provider factors enable or hinder individuals accessing MH care. Registered Syrian refugees have better financial coverage to secondary MH care than Lebanese populations. However, given the economic crisis, both populations are facing similar challenges in paying for and accessing MH care at primary health care (PHC) level. Multiple crises in Lebanon have exacerbated challenges in financing MH care, dependence on external humanitarian funds, and risks and sustainability issues associated with short-term funding. Urgent reforms are needed to Lebanon's health financing system, working with government and external donors to equitably and efficiently finance and scale up MH care with a focus on PHC, and to reduce inequities in MH service coverage between Lebanese and Syrian refugee populations.
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Affiliation(s)
- Rozane El Masri
- Research and Development Department, War Child Holland, Beirut, Lebanon
| | - Sandy Chaar
- Research and Development Department, War Child Holland, Beirut, Lebanon
| | - Joseph Elias
- Research and Development Department, War Child Holland, Beirut, Lebanon
| | - Bassel Meksassi
- Research and Development Department, War Child Holland, Beirut, Lebanon
| | - Rayane Ali
- Research and Development Department, War Child Holland, Beirut, Lebanon
| | - Bayard Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Felicity L. Brown
- Research and Development Department, War Child Holland, Beirut, Lebanon
| | | | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rabih El Chammay
- Department of Psychiatry, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
- National Mental Health Programme, Ministry of Public Health, Beirut, Lebanon
| | - Neha S. Singh
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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2
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Wimer G, Larrea M, Streeter J, Hassan A, Angulo A, Armijos A, Bonz A, Tol WA, Greene MC. Accessibility and Perceived Impact of a Group Psychosocial Intervention for Women in Ecuador: A Comparative Analysis by Migration Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:380. [PMID: 38673293 PMCID: PMC11049989 DOI: 10.3390/ijerph21040380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
There is increasing guidance promoting the provision of mental health and psychosocial support programs to both migrant and host community members in humanitarian settings. However, there is a lack of information on the respective experiences and benefits for migrant and host community members who are participating in mental health and psychosocial support programming. We evaluated a community-based psychosocial program for migrant and host community women, Entre Nosotras, which was implemented with an international non-governmental organization in Ecuador in 2021. Data on participant characteristics and psychosocial wellbeing were collected via pre/post surveys with 143 participants, and qualitative interviews were conducted with a subset (n = 61) of participants. All quantitative analyses were conducted in STATA, and qualitative analysis was done in NVivo. Attendance was higher for host community members. Specifically, 71.4% of host community members attended 4-5 sessions, whereas only 37.4% of migrants attended 4-5 sessions (p = 0.004). Qualitative analysis shows that the intervention was less accessible for migrants due to a variety of structural barriers. However, this analysis also demonstrated that both groups of women felt a greater sense of social connectedness after participating in the program and expressed gratitude for the bonds they formed with other women. Some migrant women described negative experiences with the host community because they felt as though they could not confide in host community women and speak freely in front of them. These results underscore how the migratory context influences the implementation of mental health and psychosocial support (MHPSS) programs. As humanitarian guidelines continue to emphasize the integration of host community members and displaced persons, it is critical to account for how the same intervention may impact these populations differently.
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Affiliation(s)
- Gabrielle Wimer
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA;
| | | | | | - Amir Hassan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA;
| | | | - Andrea Armijos
- HIAS, Silver Spring, MD 62471, USA; (A.A.); (A.A.); (A.B.)
| | - Annie Bonz
- HIAS, Silver Spring, MD 62471, USA; (A.A.); (A.A.); (A.B.)
| | - Wietse A. Tol
- Department of Public Health, University of Copenhagen, 1172 Copenhagen, Denmark;
| | - M. Claire Greene
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA;
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Ching BCF, Badaoui A, Abou Seif N, Al Hallal R, Bundies GL, Campbell A, Rafie A, Song-Chase A, Hahn JS, Billings J. 'The phoenix that always rises from the ashes': an exploratory qualitative study of the experiences of an initiative informed by principles of psychological first aid following the Beirut blast. Eur J Psychotraumatol 2023; 14:2263146. [PMID: 37796664 PMCID: PMC10557531 DOI: 10.1080/20008066.2023.2263146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/11/2023] [Indexed: 10/07/2023] Open
Abstract
Background: On 4 August 2020, an explosion occurred in Beirut, Lebanon. Hundreds of people were killed, thousands injured and displaced. An initiative was rapidly initiated to provide remote support informed by psychological first aid for the mental health of Lebanese young adults affected by the blast. However, little is known about recipients' experiences of such initiatives.Objective: This study aimed to qualitatively explore the experiences of supporters and recipients in the community-led initiative following the blast.Method: We recruited a diverse sample of four supporters and four Lebanese recipients who took part in the Beirut initiative. Semi-structured interviews were conducted with participants. Reflexive thematic analysis was used to analyse the qualitative data.Results: We developed five themes from the qualitative interviews, which highlighted ideas around accessibility, alienation, the relationship, elements of the safe space created by the initiative, and unmet needs and areas for improvement. Recipients described the detrimental impact of the blast on their mental health within the Lebanese context and beyond. Recipients and supporters elucidated complex experiences of the support and its impact.Conclusions: Our findings suggest remote support has the potential to be acceptable for young adults in Lebanon. Further research into support informed by psychological first aid after similar crisis events is warranted.
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Affiliation(s)
- Brian Chi Fung Ching
- Division of Psychiatry, University College London, London, UK
- Beirut Initiative, London, UK
| | - Alexandra Badaoui
- Division of Psychiatry, University College London, London, UK
- Beirut Initiative, London, UK
| | - Nada Abou Seif
- Division of Psychiatry, University College London, London, UK
- Beirut Initiative, London, UK
| | | | - Gabriel Luiz Bundies
- Division of Psychiatry, University College London, London, UK
- Beirut Initiative, London, UK
| | - Amy Campbell
- Division of Psychiatry, University College London, London, UK
- Beirut Initiative, London, UK
| | | | - Angela Song-Chase
- Division of Psychiatry, University College London, London, UK
- Beirut Initiative, London, UK
| | - Jane Sungmin Hahn
- Division of Psychiatry, University College London, London, UK
- Beirut Initiative, London, UK
| | - Jo Billings
- Division of Psychiatry, University College London, London, UK
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van den Akker A, Fabbri A, Alardah DI, Gilmore AB, Rutter H. The use of participatory systems mapping as a research method in the context of non-communicable diseases and risk factors: a scoping review. Health Res Policy Syst 2023; 21:69. [PMID: 37415182 DOI: 10.1186/s12961-023-01020-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
CONTEXT Participatory systems mapping is increasingly used to gain insight into the complex systems surrounding non-communicable diseases (NCDs) and their risk factors. OBJECTIVES To identify and synthesize studies that used participatory systems mapping in the context of non-communicable diseases. DESIGN Scoping review. ELIGIBILITY CRITERIA Peer-reviewed studies published between 2000 and 2022. STUDY SELECTION Studies that focused on NCDs and/or related risk factors, and included participants at any stage of their system's mapping process, were included. CATEGORIES FOR ANALYSIS The main categories for analysis were: (1) problem definition and goal-setting, (2) participant involvement, (3) structure of the mapping process, (4) validation of the systems map, and (5) evaluation of the mapping process. RESULTS We identified 57 studies that used participatory systems mapping for a variety of purposes, including to inform or evaluate policies or interventions and to identify potential leverage points within a system. The number of participants ranged from 6 to 590. While policymakers and professionals were the stakeholder groups most often included, some studies described significant added value from including marginalized communities. There was a general lack of formal evaluation in most studies. However, reported benefits related mostly to individual and group learning, whereas limitations described included a lack of concrete actions following from systems mapping exercises. CONCLUSIONS Based on the findings of this review, we argue that research using participatory systems mapping would benefit from considering three different but intertwined actions: explicitly considering how different participants and the power imbalances between them may influence the participatory process, considering how the results from a systems mapping exercise may effectively inform policy or translate into action, and including and reporting on evaluation and outcomes of the process, wherever possible.
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Diaconu K, Witter S, Dakessian A, Loffreda G, Ager A. Fragile, handle with care: refining a key concept for global health and development. BMJ Glob Health 2023; 8:e012956. [PMID: 37380366 PMCID: PMC10439341 DOI: 10.1136/bmjgh-2023-012956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- Karin Diaconu
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Arek Dakessian
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Giulia Loffreda
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Edinburgh, UK
- Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
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Prusaczyk A, Bogdan M, Vinker S, Gujski M, Żuk P, Kowalska-Bobko I, Karczmarz S, Oberska J, Lewtak K. Health Care Organization in Poland in Light of the Refugee Crisis Related to the Military Conflict in Ukraine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3831. [PMID: 36900836 PMCID: PMC10001563 DOI: 10.3390/ijerph20053831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Poland is witnessing a migration crisis caused by the ongoing military conflict in Ukraine. In addition to housing and necessities, 1.8 million Ukrainians that had taken refuge in Poland must have access to medical care. We aim to propose a strategy for implementing the changes in the Polish health care system in response to the Ukrainian refugee crisis. METHODS A literature review on organizational changes in the functioning of health care systems during the migration crises worldwide in recent years and brainstorming in order to develop a strategy for implementing changes in the Polish health care system in response to the Ukrainian refugee crisis. RESULTS The proposed strategy for implementing the changes in the Polish health care system is based on building health care resilience and adaptation to different crises. The operational objectives of organization-related activities are: (1) preparation of medical facilities to provide help for refugees, (2) development and implementation of the communication system, (3) implementation of available digital solutions, (4) organization of the diagnostic and medical services, (5) and implementation of changes in the management of medical facilities. CONCLUSIONS Urgent reorganization is required to respond to an unavoidable increase in the demand for health care services.
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Affiliation(s)
| | - Magdalena Bogdan
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Mariusz Gujski
- Department of Public Health, Medical University of Warsaw, 00-097 Warsaw, Poland
| | - Paweł Żuk
- Medical and Diagnostic Center, 08-110 Siedlce, Poland
| | - Iwona Kowalska-Bobko
- Institute of Public Health, Faculty of Health Science, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | | | - Joanna Oberska
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland
| | - Katarzyna Lewtak
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland
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Felmingham T, Backholer K, Hoban E, Brown AD, Nagorcka-Smith P, Allender S. Success of community-based system dynamics in prevention interventions: A systematic review of the literature. Front Public Health 2023; 11:1103834. [PMID: 37033017 PMCID: PMC10080052 DOI: 10.3389/fpubh.2023.1103834] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Systems thinking approaches are increasingly being used to help communities understand and develop responses to preventing complex health problems. Less is known about how success is characterized and what influences success in these approaches. We present a systematic review of how concepts of success are understood and evaluated in the peer reviewed literature of studies using systems thinking in community prevention. We searched five databases for peer-reviewed literature published between 2000 and 2022, with search terms related to systems thinking, prevention and community. Studies were included if they; reported using community-based systems thinking to prevent a public health problem; described the engagement and empowerment of community members to address a public health issue; and, were published in English. Thirty-four articles were identified from 10 countries. Twenty-one aimed to prevent a chronic disease (e.g., obesity) and 16 measured success using specific tools, 10 of which used semi-structured interviews or surveys. Measures of success included implementation processes, cultural appropriateness, the number or type of actions implemented, effectiveness of community action, and changes in individual thinking or mental models, population health outcomes, data collected, or systems level measures. Implementation factors influencing success included the capacity to engage participants, composition and experience of facilitators, strength of coordination teams, allocation of resources, adaptation to participant feedback, use of multiple systems approaches, workshop process providing time and methods to allow new insights, flexible delivery, and diversity of perspectives. Findings from each of the articles indicated that approaches increased a range of outcomes including community action, strategic thinking, future planning and evaluation, community buy-in, community voice, contribution and leadership, in addition to developing shared visions and goals and creating new, ongoing collaborations, among many others. Measures of success varied, suggesting more empirical reporting of proposed outcomes of system science in communities would be valuable. While the measurement of success in the use of systems thinking in community-based prevention efforts is limited, there are helpful examples we can look to for future measurement of success.
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Affiliation(s)
- Tiana Felmingham
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
- *Correspondence: Tiana Felmingham,
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Elizabeth Hoban
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Andrew D. Brown
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Phoebe Nagorcka-Smith
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
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Farran N. Mental health in Lebanon: Tomorrow's silent epidemic. MENTAL HEALTH & PREVENTION 2021; 24:200218. [PMID: 34660191 PMCID: PMC8503814 DOI: 10.1016/j.mhp.2021.200218] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 09/05/2021] [Indexed: 12/14/2022]
Abstract
Lebanon is a middle-income country that has been recently crippled by several tragedies including the economic collapse, COVID-19, and the fourth of August Beirut port explosion, the world's most powerful non-nuclear explosion of the twenty-first century. Recent data on mental health from Lebanon is summarised, and other topics such as the psychological impact of cumulative adversities and the role of international support in Lebanon are examined. Data from Lebanon shows severe levels of distress among the people, in a country with minimal resources. Given current adversities in Lebanon, recent data in the country, and the literature on adversity and mental health outcomes of man-made disasters, Lebanon is most likely going to face an epidemic in poor mental health. A call is made for the wider scientific community and international organizations to support the mental health field in the country and help prevent further negative mental health outcomes. Understanding how to better navigate mental health in places with extreme adversity and emergencies can be beneficial to other communities which might face similar challenges.
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Affiliation(s)
- Natali Farran
- Institute of Psychiatry, Psychology, and Neuroscience. King's College London, 16 De Crespigny Park, Camberwell, London SE5 8AB, UK
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Gyawali B, Harasym MC, Hassan S, Cooper K, Boschma A, Bird M, Konradsen F, Raju E, Tellier S. Not an 'either/or': Integrating mental health and psychosocial support within non-communicable disease prevention and care in humanitarian response. J Glob Health 2021; 11:03119. [PMID: 34804510 PMCID: PMC8590828 DOI: 10.7189/jogh.11.03119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Bishal Gyawali
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mary C Harasym
- IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | | | - Katy Cooper
- IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Anouk Boschma
- IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Martha Bird
- IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Flemming Konradsen
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emmanuel Raju
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Centre for Disaster Research, University of Copenhagen, Denmark
| | - Siri Tellier
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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