Table 2.

Summary of the mixed-methods studies investigating psychosocial support programmes

Author (year) Methods used Location	Study aims	Intervention Who delivers the intervention (n) Intervention duration	Setting (n) Population (n)	Language Culture Migration status	Outcomes considered	Results	Comments
Blignault et al. (2022) Pre-post measures and qualitative interviews Australia	To implement and evaluate a community-based group mindfulness programme delivered to Arabic and Bangla-speaking communities. An overall programme aim was to address barriers to mental health care through supporting de-stigmatisation, assisting with coping, and facilitating access to professional care when needed	CALD Mindfulness Programme: signs of stress, helpful and unhelpful stress responses, stress management skills, breathing exercises, loving kindness, self-compassion A bilingual mental health clinician (psychologist) with support from a bilingual community worker (98)b Four weeks	Online Arabic and/or Bangla speakers (44 women enrolled, 35 completed the programme)a	Arabic and Bangla Arabic and Bengali Migrants—most were relative newcomers under the skilled migration programme	Pre-post measures Psychological distress: K10+ Overall experience with the program: “Overall, how would you rate your experience of the program?”, with participants reporting their responses on a 5-point Likert Scale Skills transfer: “Over the past four weeks, have you shared your mindfulness skills with anyone? If yes, who?” Qualitative interview data	Pre-post measures K10+ scores showed improvement post-programme (p = < 0.001). 85% of participants indicated that the effect on their overall wellbeing was ‘very good’ or ‘excellent’ and 97% rated their experience of the programme as ‘very good’ or ‘excellent’. 65.7% and 54.3% shared the acquired skills with family and friends, respectively. Qualitative interviews Feedback from participants: “I am very happy to have found this programme in my language and culture. I am able to better understand and relate to the topics”.	The programme adopted a stepped-care model for primary mental health care and a collaborative regional approach. Programme was modified in response to the COVID-19 pandemic.
Budosan et al. (2016) Survey, in-depth interviews with members of NGOs and focus groups with refugees who participated in the survey Turkey	To conduct a needs assessment of Syrian refugees in order to inform development of mental health and psychological support (MHPSS) interventions	MHPSS: vocational activities, psychological first aid and family support, social and community events, formal and informal education of Syrian children, distribution of non-food items (e.g. clothes, shoes). Psychologists, social workers and community workers (NR)b NR	Community Syrian refugees (381 survey respondents; MHPSS participants—NR)	Arabic Syrian Refugees	Surveys Humanitarian Emergency Settings Perceived Needs: includes a range of social, psychological and physical problem areas In-depth interview and focus groups data	Survey On average, participants rated 5.6 problem areas as serious. The lowest number was 0 and the highest was 21. 74% of surveyed participants rated income or livelihood as one of their three priorities. In-depth interviews and focus groups A ‘place to live in’ was a serious problem because the town is overpopulated with Syrian refugees and rents were high. Inability to acquire or pay for medication, education for children and access to drinking water were also discussed as major issues.	Other priorities included ‘clothes, shoes, bedding or blankets (24.9%)’, unequal aid distribution (24.7%) and ‘being displaced from home’ (24.1%). Implications included advocacy of temporary work permits for Syrian refugees, rent regulation, cash assistance for the most vulnerable, criteria for the distribution of humanitarian aid and establishment of a transparent and centralised information system on humanitarian aid availability.
Chemali et al. (2017) Assessment of longitudinal data, qualitative surveys Lebanon	To assess the feasibility and acceptability of an adapted version of the SMART-3RP (Stress Management Relaxation Response Resilience Training) to address the emotional and physical burden on the humanitarian field	The SMART-3RP teaches self-care strategies to protect against the negative effects of stress and improve coping skills. A Lebanese-born and Arabic speaking neuropsychiatrist (1)b Four sessions	NR Social and fieldworkers (100)	Arabic Lebanese NR	Longitudinal data (baseline and quarterly follow-ups) Stress: Symptom Checklist-90-Revised (SCL-90) Blood pressure Pulse Qualitative survey data	Longitudinal data (baseline and quarterly follow-ups) Mean SCL-90 score decreased by 14.7 ± 29.8 points (p < 0.0001) from baseline to follow-up 4. Mean systolic blood pressure decreased by 11.9 ± 18.4 units (p < 0.0001), mean diastolic blood pressure decreased by 6.4 ± 10.1 units (p < 0.0001) and pulse decreased by an average of 8.3 ± 15.9 units (p < 0.0016). Qualitative survey data Participants discussed the effect of the SMART-3RP training on stress and positivity. Many described an amelioration of anger and irritability due to mindfulness exercises, which gave them more control over stressful situations and assisted with problem-solving.	Only 52 workers completed the course. Human resources were scarce—aid workers did not have guaranteed or protected time to participate, and were often forced to choose between attending training sessions and distributing resources to refugees. Many participants voiced wishes to continue this training, and the need for mindfulness practices in their cultural context.
El-Khani et al. (2021) Quantitative measurements, interviews Serbia	Aim 1 To evaluate delivery and feasibility of and any potential impact of the Strong Families programme (SF) with refugees. Aim 2 To assess potential benefits of SF for families, in improving family functioning, children’s psychological wellbeing and its cultural appropriateness	SF: group intervention for primary caregivers and their children that seeks to improve positive communication, ability to enforce limits, encourage good behaviour and discourage misbehaviour Facilitators who had direct access to caregivers and their children and social workers (20, of which 5 were social workers) 5 h over 3 weeks	Reception centres (3) 25 families	Serbian or Dari Afghan Refugees	Quantitative measurements Emotional and behavioural difficulties: Strengths and difficulties questionnaire (SDQ) Parent practices, risk and parental emotional adjustment and quality of family: Parenting and Family Adjustment Scales (PAFAS) Qualitative interview data	Quantitative measurements Emotional and behavioural difficulties: SDQ scores significantly reduced before and after the programme (t1–t2; p = 0.004; t3, p = 0.002). Parent practices, risk and parental emotional adjustment and quality of family: For families who scored over the 70th percentile on each PAFAS subscale at baseline, there was a significant reduction in scores on all parenting subscales, except for parental teamwork. Qualitative interview data Themes included (i) perceived improvements in parenting practices, (ii) improved parent-child and inter-couple communication, and (iii) culturally appropriate engagement and satisfaction with SF (caregivers did not want the programme to end).	The intervention led to parents’ subjective report on reductions in child behavioural and emotional difficulties, supporting the idea that even very light touch interventions can bring about change to families in low resource challenging settings
Fine et al. (2021) Feasibility cluster randomised controlled trial (comparator: enhanced treatment as usual [ETAU] consisted of a joint adolescent and care psychoeducation session), qualitative interviews Tanzania	To evaluate the feasibility, acceptability, relevance and safety of Early Adolescent Skills for Emotions (EASE) amongst Burundian refugee young adolescents and their caregivers. Prior to implementation, EASE was adapted for use with this population to improve cultural and contextual appropriateness and acceptability	EASE contained 2 arms: (1) for adolescents—psychoeducation, stress management, behavioural activation, problem-solving and relapse prevention; (2) for caregivers—psychoeducation, active listening, slow breathing, positive parenting strategies, caregiver self-care and relapse prevention Refugees, non-specialist facilitators (5)b 7 weekly group sessions (90-min each) + 2-h group session for caregivers	Refugee camp (1) 86 adolescents and 68 caregivers (numbers are discordant due to the presence of siblings in the study)	Kirundi Burundi Refugees	RCT Adolescent-focused measures Psychological distress: African Youth Psychosocial Assessment (AYPA) PTSD symptoms: Child PTSD Symptom Scale (CPSS) Mental well-being: Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) Traumatic exposures: Child Trauma Questionnaire (CTQ) Caregiver focused measures Psychological distress: 6-item Kessler Qualitative interviews	RCT Adolescent-focused measures Psychological distress significantly decreased in both the EASE group (mean change = − 6.7, p < 0.001) and the ETAU group (mean change = − 4.3, p = 0.02). There were no other statistically significant differences within groups. Caregiver focused measures Psychological distress decreased significantly in the EASE group (mean change = − 4.0, p < 0.001); there was no change in the ETAU group. Qualitative interviews Most adolescents and caregivers gave positive feedback on the length and frequency of EASE sessions, although several suggested that they would have benefited from more and/or longer sessions. There was a general consensus amongst participants, facilitators and school staff that EASE materials were relevant and appropriate. Most adolescents reported using strategies learned during EASE to cope with issues at home. Caregivers mentioned changes in their children, including increased initiative at home, greater discipline, feelings of wellbeing and the use of breathing exercises to feel calm. A number of caregivers also reported changes in themselves, including improved relationships with their children	Recommendations to a larger trial included (but were not limited to) targeted selection and validation of a screening tool capturing general psychological distress in this population; simplification of EASE materials to address challenges with literacy and better coordination of EASE with schools. As the authors had difficulties retaining facilitators, they highlighted the importance of monetary support and non-financial incentives (e.g. further professional development) to increase motivation and job satisfaction amongst non-specialist providers, both of which are crucial to ensuring the sustainability and scalability of task-shifting interventions
Greene et al. (2019) Desk review, consultation with key stakeholders, examination of outcome measures, interviews Tanzania	To develop an integrated health and protection intervention to reduce psychological distress and intimate partner violence (IPV), examine its relevance, acceptability and feasibility and prepare and evaluate the outcome assessment tools and research procedures	Nguvu: skills to overcome negative thoughts and self-perceptions, focussing on increasing autonomy, empowerment and strengthening linkages to community supports. Lay facilitators (2) 8 weekly sessions (2 hours each)	Refugee camp (1) Females who reported IPV (60). 40 key informants and 17 females participated in the consultation and interviews, respectively	Swahili Congolese Refugees	Desk review Summary of empirical studies on mental health in the context of gender-based violence amongst Congolese women. Consultation Perspectives of stakeholders on the most common problems affecting Congolese women who experience IPV, and on available services and support. Outcome measures IPV: Abuse Assessment Screen Psychological distress: Hopkins Symptom Checklist Anxiety and depression: Harvard Trauma Questionnaire Qualitative interview data	Desk review and consultation Both confirmed that IPV was prevalent amongst Congolese women, but very few interventions have been evaluated to address mental health and IPV in this population. Outcome measures Overall, outcome measures revealed good test-retest reliability and internal consistency. Some items were weakly correlated with the remaining items and perhaps unrelated to functioning (e.g. farming, trading and other income-generating activities). Qualitative interview data The intervention was thought to be relevant and helpful. The most difficult parts of Nguvu to understand were the ABCs (becoming aware of the connection between an event, the resulting thought and how this thought makes the person feel) and changing thoughts.	Participants recommended that the age composition of intervention groups be homogenized to avoid having relatives of different generations within the same group, which can result in relational power dynamics that may inhibit group discussion
Jacquez et al. (2019) Pre-post measurements, field notes United States	To identify stressors experienced by Latino immigrants and goals of stress reduction identified by them. To determine if a Community-based participatory research (CBPR) stress intervention delivered by peers could engage Latinx immigrants and improve stress management and perceived support	CBPR (active listening, identify strategies to cope with stress, promote SMART goal setting) Co-researchers (17)b Three weekly sessions (1st session—88 min; 2nd session—64 min and 3rd session 67 min)	NR Latinx immigrants (116)	Spanish Latinx Immigrants in new migration cities, with a large majority of participants (81%) being undocumented	Pre-post measurements Perceived stress: Perceived stress scale Social support: 8-item measures from PROMIS, PROMIS Emotional support and PROMIS informational support Stress management: Patient Activation measure Psychological resilience: Brief resilience scale Qualitative data from field notes Stressors and goals: documented on field notes	Pre-post measurements Emotional Support t(111) = − 2.44, p = 0.016, informational support t(110) = − 3.023, p = 0.003, and stress management t(110) = − 5.966, p = 0.000 improved significantly. Resilience and perceived stress did not change. Stressors and goals: Family, children, work, health, immigration and spouse were the most commonly reported stressors. Goals were mostly related to spending time with family and friends, exercising, walking, listening to music and eating healthy	Most (76%) of the sample did not graduate from high school and 81% reported household incomes under $25,000. Traditional stress reduction programmes tend to focus on cognitive strategies or relaxation, yet 78% of Latinx immigrants chose to engage in physical activities, such as taking a walk or exercising for stress reduction.

^aAlthough the paper focuses on the evaluation of the online group programmes rolled out during the pandemic, this programme has attracted a total of 489 participants between March 2017 and September 2021.

^bThe people who delivered the intervention had the same cultural background and/or linguistic background as clients.

DACA deferred action for childhood arrivals, NGOs non-governmental organization, SMART specific, measurable, achievable, relevant and time-bound.