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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Greene MC, Wimer G, Larrea M, Mejia Jimenez I, Armijos A, Angulo A, Guevara ME, Vega C, Heard EW, Demis L, Benavides L, Corrales C, de la Cruz A, Lopez MJ, Moyano A, Murcia A, Noboa MJ, Rodriguez A, Solis J, Vergara D, Andersen LS, Cristobal M, Wainberg M, Bonz AG, Tol W. Strategies to improve the implementation and effectiveness of community-based psychosocial support interventions for displaced, migrant and host community women in Latin America. Glob Ment Health (Camb) 2024; 11:e32. [PMID: 38572247 PMCID: PMC10988141 DOI: 10.1017/gmh.2024.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/16/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024] Open
Abstract
As evidence supporting the effectiveness of mental health and psychosocial interventions grows, more research is needed to understand optimal strategies for improving their implementation in diverse contexts. We conducted a qualitative process evaluation of a multicomponent psychosocial intervention intended to promote well-being among refugee, migrant and host community women in three diverse contexts in Ecuador and Panamá. The objective of this study is to describe the relationships among implementation determinants, strategies and outcomes of this community-based psychosocial intervention. The five implementation strategies used in this study included stakeholder engagement, promoting intervention adaptability, group and community-based delivery format, task sharing and providing incentives. We identified 10 adaptations to the intervention and its implementation, most of which were made during pre-implementation. Participants (n = 77) and facilitators (n = 30) who completed qualitative interviews reported that these strategies largely improved the implementation of the intervention across key outcomes and aligned with the study's intervention and implementation theory of change models. Participants and facilitators also proposed additional strategies for improving reach, implementation and maintenance of this community-based psychosocial intervention.
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Affiliation(s)
- M. Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Gabrielle Wimer
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Maria Larrea
- Hunter College, City University of New York, New York, NY, USA
| | - Ingrid Mejia Jimenez
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | | | - Carolina Vega
- HIAS Ecuador, Quito, Ecuador
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emily W. Heard
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lina Demis
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | | - Lena S. Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Milton Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons/New York State Psychiatric Institute, New York, NY, USA
| | | | - Wietse Tol
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Dunleavy S, Edelman DS, Wimer G, Karelas G, Hassan A, Clarke CD, Canfield SM, Lebwohl B, Lypson ML, Moise N. Implementing Public Health Modules as an Approach to Improve Knowledge and Attitudes of Medical Students: A Student-Led, Multi-Year Study. Acad Med 2024:00001888-990000000-00746. [PMID: 38266203 DOI: 10.1097/acm.0000000000005646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
PURPOSE Public health is a necessary focus of modern medical education. However, while numerous studies demonstrate benefits of public health education during medical school among self-selected students (i.e., those interested in public health), there are few educational models shown to be effective across the general medical student population. This study examined the effect of a multi-year, case-based, longitudinal online public health curriculum required for all medical students at an urban, research-focused U.S. medical school. METHOD The authors created 11 short public health modules to supplement a year-long, organ-based preclerkship course at Columbia University Vagelos College of Physicians and Surgeons. Beginning in 2020, all students were required to complete these modules, with repeated surveys to assess changes in attitudes and knowledge of public health over time. The authors compared responses for these domains before and after each module, across multiple time points throughout the year, and cross-sectionally to a 2019 cohort of students who were not provided the modules. RESULTS Across 3 cohorts, 405 of 420 (96.4%) of students provided responses and were included in subsequent analyses. After completing the modules, students reported perceiving a greater importance of public health to nearly every medical specialty (P < .001), more positive attitudes toward public health broadly (P < .001), and increased knowledge of public health content (P < .001). These findings were consistent across longitudinal analysis of students throughout the year-long course and when compared to the cohort who did not complete the modules. CONCLUSIONS Case-based, interactive, and longitudinal public health content can be effectively integrated into the required undergraduate medical education curriculum to improve all medical students' knowledge and perceptions of public health. Incorporating evidence-based public health education into medical training may help future physicians to better address the needs of the communities and populations in which they practice.
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Affiliation(s)
- Spencer Dunleavy
- S. Dunleavy is a family medicine resident, University of Pennsylvania, Philadelphia, Pennsylvania. https://orcid.org/0000-0002-0196-2143
| | - David S Edelman
- D.S. Edelman is chief resident, primary care and social internal medicine, Montefiore Medical Center, New York, New York. ORCID: https://orcid.org/0000-0003-3627-9149
| | - Gabrielle Wimer
- G. Wimer is a medical student, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Gregory Karelas
- G. Karelas is a pediatrics resident, New York Presbyterian - Columbia University, New York, New York
| | - Amir Hassan
- A. Hassan is a medical student, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Cameron D Clarke
- C.D. Clarke is a medical student, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Stephen M Canfield
- S.M. Canfield is associate professor of immunology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Benjamin Lebwohl
- B. Lebwohl is associate professor of gastroenterology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Monica L Lypson
- M.L. Lypson is vice dean for education, Columbia University Vagelos College of Physicians and Surgeons, and professor, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Nathalie Moise
- N. Moise is associate professor, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Matsumoto M, Wimer G, Sethi A. Health needs of refugees: port of arrival versus permanent camp settings. East Mediterr Health J 2019; 25:306-314. [PMID: 31364755 DOI: 10.26719/emhj.18.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 10/22/2017] [Indexed: 11/09/2022]
Abstract
Background The world's refugee population has surpassed 21 million, the large majority of which resides in developing countries. Refugees have relatively high rates of healthcare utilization for management of both long-term needs, such as diabetes, and acute conditions, such as scabies. Aims Using interviews of stakeholders in disparate healthcare settings, we aim to elucidate both common themes and areas of difference that should be recognized and addressed as the refugee crisis continues. Methods This qualitative interview study compares and contrasts two settings for healthcare provision for refugees: the permanent setting of Za'atari, a camp in Jordan, versus the transitory arrival location of Lampedusa, Italy. Results We present data from 12 semi-structured interviews with experts in refugee healthcare that have experience in these two locations. We focus on issues of disease burden and health screening, organizational structures and services, cultural competency, and international response. Conclusions We compiled recommendations to improve healthcare for refugees include recognizing differing health needs of refugees in Za'atari and Lampedusa, training providers in culturally-competent care, screening for and treating psychiatric disorders, and prioritizing agency coordination, documentation, and advocacy.
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Affiliation(s)
- Monica Matsumoto
- Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, United States of America
| | | | - Aisha Sethi
- Department of Dermatology, Yale University, New Haven, United States of America
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