Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden

Aniek Woodward; Sebastian Burchert; Alexandra S. Barry; Jacqueline E.W. Broerse; Egbert Sondorp; Anoushka Bold; Alexander Ruberl; Jonas M. Hessling; Christine Knaevelsrud; Bayard Roberts; Daniela C. Fuhr; Peter Ventevogel; Nadine Hosny; Tomas Lindegaard; Shervin Shahnavaz; Marit Sijbrandij; Pim Cuijpers; Martin McKee; Marjolein A. Dieleman

SSM - Mental Health (Dec 2023)

Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden

Aniek Woodward,
Sebastian Burchert,
Alexandra S. Barry,
Jacqueline E.W. Broerse,
Egbert Sondorp,
Anoushka Bold,
Alexander Ruberl,
Jonas M. Hessling,
Christine Knaevelsrud,
Bayard Roberts,
Daniela C. Fuhr,
Peter Ventevogel,
Nadine Hosny,
Tomas Lindegaard,
Shervin Shahnavaz,
Marit Sijbrandij,
Pim Cuijpers,
Martin McKee,
Marjolein A. Dieleman

Affiliations

Aniek Woodward: KIT Royal Tropical Institute, KIT Health, Mauritskade 64, 1092 AD, Amsterdam, the Netherlands; Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands; Corresponding author.
Sebastian Burchert: Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Habelschwerdter Allee 45,14195, Berlin, Germany
Alexandra S. Barry: KIT Royal Tropical Institute, KIT Health, Mauritskade 64, 1092 AD, Amsterdam, the Netherlands; NHS England, 133-155 Waterloo Rd, SE1 8UG, London, UK
Jacqueline E.W. Broerse: Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands
Egbert Sondorp: KIT Royal Tropical Institute, KIT Health, Mauritskade 64, 1092 AD, Amsterdam, the Netherlands
Anoushka Bold: KIT Royal Tropical Institute, KIT Health, Mauritskade 64, 1092 AD, Amsterdam, the Netherlands; Inuka Coaching, Amsterdam, the Netherlands
Alexander Ruberl: Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Habelschwerdter Allee 45,14195, Berlin, Germany
Jonas M. Hessling: Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Habelschwerdter Allee 45,14195, Berlin, Germany
Christine Knaevelsrud: Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Habelschwerdter Allee 45,14195, Berlin, Germany
Bayard Roberts: Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
Daniela C. Fuhr: Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK; Leibniz Institute for Prevention Research and Epidemiology-BIPS, Department of Prevention and Evaluation, Achterstraße 30, 28359, Bremen, Germany; University of Bremen, Health Sciences, Bibliothekstrasse 1, 28359, Bremen, Germany
Peter Ventevogel: Public Health Section, Division of Resilience and Solutions, United Nations High Commissioner for Refugees, Rue de Montbrillant 94, 1202, Geneva, Switzerland
Nadine Hosny: Institute of Psychology, University of Lausanne, 1015, Lausanne, Switzerland
Tomas Lindegaard: Department of Behavioural Sciences and Learning, Linköping University, 581 83, Linköping, Sweden
Shervin Shahnavaz: Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7 B plan 5, 117 63, Stockholm, Sweden
Marit Sijbrandij: Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands
Pim Cuijpers: Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, 37 Republicii Street, Cluj-Napoca, Romania
Martin McKee: Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
Marjolein A. Dieleman: KIT Royal Tropical Institute, KIT Health, Mauritskade 64, 1092 AD, Amsterdam, the Netherlands; Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands

Journal volume & issue: Vol. 4
p. 100231

Abstract

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E-mental health interventions may offer innovative means to increase access to psychological support and improve the mental health of refugees. However, there is limited knowledge about how these innovations can be scaled up and integrated sustainably into routine services. This study examined the scalability of a digital psychological intervention called Step-by-Step (SbS) for refugees in Egypt, Germany, and Sweden. We conducted semi-structured interviews (n = 88) with Syrian refugees, and experts in SbS or refugee' mental health systems in the three countries. Data collection and analysis were guided by a system innovation perspective. Interviewees identified three contextual factors that influenced scalability of SbS in each country: increasing use of e-health, the COVID-19 pandemic, and political instability. Nine factors lay at the interface between the innovation and potential delivery systems, and these were categorised by culture (ways of thinking), structure (ways of organising), and practice (ways of doing). Factors related to culture included: perceived need and acceptability of the innovation. Acceptability was influenced by mental health stigma and awareness, digital trust, perceived novelty of self-help interventions, and attitudes towards non-specialist (e-helper) support. Factors related to structure included financing, regulations, accessibility, competencies of e-helpers, and quality control. Factors related to practice were barriers in the initial and continued engagement of end-users. Many actors with a potential stake in the integration of SbS across the three countries were identified, with nineteen stakeholders deemed most powerful. Several context-specific integration scenarios were developed, which need to be tested. We conclude that integrating novel e-mental health interventions for refugees into routine services will be a complex task due to the many interrelated factors and actors involved. Multi-stakeholder collaboration, including the involvement of end-users, will be essential.

Published in SSM - Mental Health

ISSN: 2666-5603 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Other systems of medicine: Mental healing; Medicine: Public aspects of medicine
Website: https://www.journals.elsevier.com/ssm-mental-health

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