None listed
Conditions
Brief summary
Providing effective mental health interventions for refugees is a critical priority for global public health. However, meeting this priority is challenging, as 99% of the world's refugees reside in low- and middle-income countries (LMICs) where access to psychological treatment is extremely limited. In an attempt to meet this challenge, the World Health Organisation recently developed a set of low-intensity scalable mental health interventions, including Doing What Matters in Times of Stress (DWM). These interventions are ideally suited to LMICs as they teach psychological skills via lay facilitators and self-help methods (thus requiring fewer resources). To enhance the accessibility and reach of the DWM program, this intervention has recently been adapted for remote and individual delivery, where participants receive a workbook and audio files alongside 5-weekly calls from a trained facilitator. To date, however, a comprehensive evaluation of the remote version of DWM has not been conducted. The rationale of the study is to evaluate the efficacy of, and mechanisms underpinning, the DWM intervention for adult refugees in Indonesia. A single-blind randomised controlled trial comparing DWM with a repeated assessment control will be conducted.
Interventions
The intervention used in this trial will be Doing What Matters in Times of Stress (DWM). DWM is a brief, self-help intervention developed by the World Health Organisation (WHO). It is an illustrated guide of an existing intervention called Self-Help Plus (SH+). The DWM manual was released by the WHO in 2020 to support the remote delivery of SH+, considering the COVID-19 pandemic and a growing need for online/remotely delivered interventions. DWM materials used in this trial are readily available
The intervention used in this trial will be Doing What Matters in Times of Stress (DWM). DWM is a brief, self-help intervention developed by the World Health Organisation (WHO). It is an illustrated guide of an existing intervention called Self-Help Plus (SH+). The DWM manual was released by the WHO in 2020 to support the remote delivery of SH+, considering the COVID-19 pandemic and a growing need for online/remotely delivered interventions. DWM materials used in this trial are readily available from WHO (https://www.who.int/publications/i/item/9789240003927) and have not been altered. DWM is: based on Acceptance and Commitment Therapy and adapted for many settings; intended as an intervention for managing stress and coping with adversity; relevant for anyone above the age of 18; designed to be completed over a short period of time; practical so that participants can practice skills regularly on their own; and illustrated, with accompanying audio recordings to support regular practice. The manual involves the following empirically supported elements: psychoeducation, grounding, cognitive defusion, mindfulness exercises, values clarification, and compassion exercises. DWM can be delivered in a variety of formats (e.g., unguided self-paced, guided individual treatment, guided group-based treatment). For the current trial, we are testing the guided individual version of DWM. This means that participants in the active treatment condition will receive: 1. The DWM illustrated workbook that contains five ‘lessons’. The five lesson topics are: Grounding, Unhooking, Acting on Your Values, Being Kind, and Making Room. 2. Accompanying audio files that provide guided scripts for practicing the strategies taught in the workbook. Participant receive a link to the study site where the audio files can be downloaded. 3. Five weekly one-on-one calls (via phone or Zoom) from a trained facilitator, who will help participants to practice the therapeutic techniques. We anticipate these weekly facilitator calls will range from 20-50 minutes. Facilitators are local workers who speak the same language as trial participants and who have experience working with people from refugee backgrounds. Protocol adherence will be ensured by regular clinical supervision of the facilitators and treatment fidelity checks using a checklist. Facilitators will receive at least 28 hours of face-to-face training, at least 1 month prior to the first participant enrolment. The duration of the study for any participant will conclude after the final post-intervention assessment, resulting in a participation duration of 9 weeks.
Sponsors
University of New South Wales
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Inclusion criteria for participants taking part in this study include: (a) 18+ years, (b) from a refugee background, (c) able to speak and read Farsi, and (d) experiencing elevated levels of psychological distress (K10 > 19.9).
Exclusion criteria
Exclusion criteria for those who are not eligible to participate in the study include: (a) participants that do not meet the above inclusion criteria, (b) acute medical conditions, (c) imminent suicide risk or with expressed acute needs/protection risks (e.g., a woman who reports that she is at acute risk of domestic and/or sexual violence), (d) severe mental disorder (psychotic disorders, substance-dependence), (e) severe cognitive impairment (e.g., severe intellectual disability or dementia), and/or (f) concurrent psychological treatment (e.g., currently receiving psychological services from a psychologist, counsellor or mental health-focused program), (g) no access to a smart phone and internet connection.
Outcome results
None listed