Table 3.

Summary of qualitative studies investigating psychosocial support programmes

Author (year) Study Design Location	Study aims	Intervention Who delivers the intervention (n) Intervention duration	Setting Population (n)	Language Culture Migration status	Study findings	Comments
Amodeo et al. (2004) Programme evaluation drawing on case examples and questionnaires United States	To describe the culturally specific programme elements, early accomplishments, barriers and changes to goals and objectives of the intervention: Project Sangkim	Assessment and weekly treatment services for substance abuse for Cambodian adults including counselling, home visits and family involvement, acupuncture and coordination with community services A co-therapy team including an English-speaking social worker (1) and Cambodian non-clinician substance abuse case manager (1) Varied	Mental Health Centre Cambodian adults with alcoholism (n = ‘small client base’)	Khmer Khmer Migrants and Refugees	1. Education on addiction as a treatable illness is needed; 2. Treatment programmes should be situated in non-stigmatizing settings; 3. Addiction and domestic violence treatment should be combined; 4. Clients with chronic substance abuse will likely be the first referred; 5. Full-time programmes are preferred due to severity and clients’ auxiliary needs; 6. Dual diagnoses of substance abuse and other mental disorders (e.g. PTSD) are common; 7. Subcontracts with other refugee support organisations can support referrals; 8. Nonverbal treatments (e.g. acupuncture) should be considered; 9. Capacity building of refugee community members should be prioritised; 10. Culturally appropriate alternatives to in-patient residential treatment should be considered	Providing Project Sangkim through a mental health centre increased connotations to stigma, posing a barrier to uptake Limited budgets often limit a programme’s capacity to document their approach. Documentation, research and evaluation are necessary to support knowledge development of what approaches work
Barudy (1989) Programme model explication Belgium	To describe the central ideas that support a medical-psychosocial support programme for Latin American Political Refugees	Latin American Collective of Psychosocial Work (COLAT; 1976–1985) and EXIL for refugees outside of Latin America (from 1985) Clinicians (psychologists and social workers) and community allies (inferred) Ongoing (inferred)	Mental health programme Political Refugees (4315)	Spanish, Portuguese & other (inferred) Mainly Chilean, Latin American Refugees	Identity challenges are central to being a political refugee, being exiled from one’s country due to acts of political resistance. Community action is central to addressing such identity challenges. Thus, their programme includes 1. Self-help groups to denounce political violence, create new rituals and community; 2. Clinical support: a quick diagnoses followed by the care required, ranging from medical assistance, to family therapy, psychotherapy, group therapy, and hospitalisation; 3. Support to facilitate reintegration into work and society.	Community is positioned as essential to countering the trauma experienced by political refugees. Reconstructing a sense of community is necessary to identity reconstruction. Limited detail on the programme is provided; the role of community allies is not clear
Behnia (2007) Descriptive exploratory drawing on questionnaires Canada, USA, Australia and England	To identify challenges that organizations face in recruiting and retaining befrienders; to learn strategies used to overcome barriers	Befriending programmes 25 organisations Varied	Communities Volunteer befrienders of refugees	Varied (Befriender: English, French, other) (Befriender: Western, refugee background) Refugees (Befriender: Citizens)	Befrienders are mainly educated white women, who assist with advocacy and activities of daily life (e.g. shopping, computer skills, job seeking, refugee hearings). Recruiting a more gender and ethnically diverse pool of befriender volunteers was said to be difficult. Key barriers to recruitment included limited resources preventing broader advertising or capacity to convert voluntary to paid arrangements; liability of professionals working as volunteers; time constraints of work and family; negative stereotypes about refugees; perception of the volunteer work’s effectiveness; fear of the daunting nature of the work. Key challenges to retention included: limited resources, seasonal fluctuation in volunteers’ availability, cultural, political and language differences between refugees and volunteers, reluctance to trust amongst some refugees. Targeted advertising and public presentations were used to overcome recruitment challenges. Training, support, following-up and matching volunteers and refugees based on gender, age and interests were key strategies for overcoming retention barriers	The authors recommend involving refugees and befrienders in the planning and overseeing of befriending programmes; investigating both refugees’ and befrienders’ perceptions of their experiences, and collecting socio-demographic data on refugees and volunteers.
Burns et al. (2019) Programme review United States	To understand the transformation of the programme from an academic-community partnership to a community-led programme, and review the parent education programme for immigrant families from Mexico	Safe, Secure and Loved (SSL): a mindfulness-based, trauma-informed parent education programme delivered by promotoras to Latino communities to support early childhood resilience and nurturing parenting (e.g. mindfulness and self-compassion exercises) Promotoras (female volunteer paraprofessional health and education advisors) Varied	Community, with support from a large non-profit multiservice agency (10 groups for parents of babies in year 5; 12 in year 6) Economically disadvantaged Latino families in San Jose, California (< 100 families in year 5 of the programme; 150 families in year 6)	Mainly Spanish (inferred) Latinx; Mexican Immigrant families	Drawing on online surveys and in-person interviews with the academic researcher, agency education director, agency staff and promotoras from the community workforce, authors identified a process of 1. identifying shared goals across the researcher and director before exploring a researcher partnership and laying the conceptual groundwork; 2. Exploring resourcing options and fielding interest preceding promotoras experiences of connection and personalisation, which were central to the installation phase; 3. Implementing feedback loops and leadership—sustained through mutuality and trust—to address challenges; 4. Reinforcing feedback loops and coaching to manage change and growth, supported by promotion of a staff member to lead the community workforce. Authors attribute their success to the high value of the topic of healthy parenting; the success of mindfulness and trauma-based approaches at addressing stressors related to poverty; the importance of the community workforce in culturally contextualising the learning.	Rigorous research is needed to (1) demonstrate the benefits of such programmes to, potentially, reducing child abuse and neglect and reorienting protective systems towards initiative supported by a community workforce; (2) explore the impact of the community work on promotora, allowing for a better understanding of what motivates them towards this community engagement
Fietz and Stupp (2019) Evaluation: content analysis of 2 focus groups with Turkish seniors Germany	To assess whether native language groups promote social participation of Turkish seniors	Native language groups hosted by a German organisation Community organisation: ZWAR (NR) NR	Community-based organisations Turkish seniors	Turkish Turkish Migrants	Social participation of Turkish seniors was improved through regular meetings with other Turkish seniors, shared understanding, mutual emotional support and further opportunities to participate in community events. Turkish seniors described improved comfort in socialising and increased self-confidence	The organisation of inter-ethnic cultural events fostered a unifying group identity amongst Turkish seniors and followed a strengths-based approach. Traditional gender roles were described as a barrier to equal participation
Hassan (2013) Personal Reflection Syria	To describe the experience of a Syrian psychologist supervising an outreach programme as part of the UN Refugee Agency in Syria	Psychosocial Outreach Volunteer Project, with weekly activities Peer volunteers NR	Refugee camp in Syria NR	Arabic Iraqi Refugee	The psychosocial outreach volunteer programme draws volunteers from the local refugee community with relevant professional training or skills (e.g. social work or yoga). The volunteers are provided with training. Services include those aimed at providing psychosocial support and community activities: drama, art, sewing, music, cooking, yoga, first aid, coffee, peer support and education. Participants and volunteers all benefit. The activities create meaning, self-worth and relationship building	Key challenges are the cost of support activities and access. Many refugees experiencing mental health disorders refuse support
Im and Rosenberg (2016) Qualitative evaluation United States	To assess the impact of a pilot peer-led community health workshop for Bhutanese refugees	Peer-led community health workshops on healthy eating, resettlement stressors, coping, psychological distress and mental health Peer community health worker, after 4 days of training 8 sessions over 2 months	Community Bhutanese adults (27)	Nepali Bhutanese Refugees	Drawing on focus group discussions, health promotion outcomes, health practices, emotional health, sense of community and belonging were all found to improve following the intervention	The peer-led community health workshops facilitated social capital development
Khalsa et al. (2020) Semi-structured interviews, informed by phenomenological approach United states	To explore the experiences of service providers who work with refugee communities in the Northern Colorado area, especially related to acculturation, compassion fatigue and burnout	Refugee service organisation provides support with education (e.g. on culture and language), programme administration (e.g. programme design, staffing, management), and community navigation (e.g. accessing healthcare, education, housing, employment training) Educators, administrators and community navigators, with the latter being members of the community they serve 3 months	In-person (inferred) Refugees living in Northern Colorado (360)	Varied Central America, Middle East, Africa, Southeast Asia Refugees	Drawing on analysis of 60-minute interviews with seven service providers, service providers reported that clients often feel there are cultural and language walls that inhibit their access to services and the broader community. Compassion fatigue and vicarious trauma are common in this work, but limited time and support for self-care were exacerbated by the energy administrators expended on seeking further funding for the service. For community navigators (who were from the communities they serve), boundaries between work and home were difficult to maintain, further limiting time for self-care	The political climate in the US in 2019–2020 was noted as being less hospitable to refugees and immigrants, culminating in reduced funding and job security, placing further strain on financial and emotional resources. Large variations in education—with refugees ranging from having advanced tertiary qualifications to illiterate—also posed challenges
Makhoul et al. (2012) Qualitative Interviews Lebanon	To describe the experience of and assess the benefits to Youth Mentors supporting the Qaderoon mental health intervention for youths in a Palestinian refugee camp in Lebanon	Qaderoon—a theory-based youth mental health intervention project for 10–14-year-olds within a Palestinian refugee camp—involved 45 skill-building sessions in communication, problem-solving, self-esteem and self-responsibility 6 university level facilitators with experience working with youth; 23 17–25-year-old Palestinian Youth Mentors living in or near the refugee camp 1 year: 2008–2009	Refugee camp Youths (18) and their family and friends (10) within a 1.6 km2 refugee camp containing 14,000 to 18,000 residents	Arabic (inferred) Palestinian Refugees	Findings draw on thematic analysis of interviews with Youth Mentors and their family and friends. Incentives for joining included the income, exposure to social and community work, and the opportunity to interact with Palestinian children. Reasons for continuing with the programme included the sense of accomplishment and importance to the programme, as well the programme’s impact on their skill development. Several noted their improved confidence in speaking with more educated individuals, and emotion regulation in managing anger	Recency effect and desirability bias could have influenced interviews, with youth mentors and families emphasising the positive influence of the programme out of a desire for the programme to continue
McFarlane and Fehir (1994) Documentation of MM programme using qualitative interviews and descriptive data United States	To examine the programme Madres a Madres (MM) and report feedback results	MM seeks to increase access to prenatal care by providing information regarding healthcare, shelter, food, child care, legal aid and employment to pregnant women. Volunteer mothers (NR) NR	Community At the Fifth year of the programme, 551 pregnant women were given information about various issues (e.g. prenatal care, housing, food pantries)	Spanish Hispanic NR	Drawing on broad informal qualitative interview data with stakeholders and extensive interviews with 5 MM volunteers, the programme was found to improve communication amongst community residents, form coalitions to solve the community’s problems, increase personal development of programme’s staff and volunteers. Women reported that the programme enhanced their quality of life, self-esteem and increased a sense of unity	The MM programme emphasizes health as a continuous process rather than a terminal event which patriarchal models cast as a “goal.”; Rather than a hierarchical power structure where responsibilities are subdivided and difficult to identify, women in the MM programme enjoy the “power of unity”: the group shares responsibility for decisions and action in the community
Msengi et al. (2015) Descriptive case study using focus groups, observations and evaluation forms United States	To describe the Women of Care Project	A single multicultural women’s programme facilitated in the Midwest state of Iowa including a support group, conversational partner matching, home visits and other community events (e.g. International Tea Party) A programme founder of African descent ran the programme with two translators and two university-student interns One meeting per month over one year, plus other activities	Community and home Immigrant women (15 per meeting on average)	Varied Varied Immigrants and refugees	Findings suggest the programme—featuring a support group and activities such as cooking tea socials and stress management sessions—fostered improvement in wellbeing that extended beyond the individual to participants children and extended families. The support helped women to overcome barriers in language, culture, poverty and discrimination and function in their new communities. Connection with others with similar migration histories helped to alleviate isolation	Study limitations not included
Orpinas et al. (2020) Heuristic inquiry of programme outcomes United States	To describe the challenges faced by promotoras and propose solutions	A community-based participatory research programme—Lazos Hispanos—for Latinx community members, aiming to bridge access to social and health care services Promotora volunteers (9), after 78 hours of training One year (inferred)	Community, Southeastern USA Promotoras (5)	Spanish (inferred) Latinx	Drawing on two group interviews, promotoras describe challenges related to competing family and promotora work priorities, gendered power differences in working with men, emotional impact of participants’ problems—especially their lack of hope, English language barriers, ethnocentrism and discrimination amongst some providers, transportation, setting boundaries and the burden of data collection	Nine promotoras were initially involved, but four left the programme at the end of the first year due to family or work commitments
Paloma et al. (2020) Process evaluation drawing on peer support group transcripts, evaluations, online comments and fieldnotes Spain	To analyse refugees’ processes of resilience and empowerment during participation in a community-based intervention	Across two phases of a community-based intervention, refugees first received and received training in delivering group-based peer support, and second delivering peer group support Phase 1: researcher; Phase 2: newly trained cultural peer support group facilitators 2–3 h × 2 session/week over 15 weeks	Community 10 adult refugees (6 men; 4 women)	Spanish, Ukranian, French Varied Refugees	Following training to become peer support group facilitators—in guided relaxation, individual reflection, sharing migrant stories, presenting community resources and identifying personal strengths—participants described increased resilience, empowerment and self-efficacy	First programme to sequentially combine peer support and peer mentoring formats. Participants may not be representative of the wide population, as they were selected for their leadership skills and sensitivity to social engagement
Perez et al. (2015) Photovoice methodology to reflect on factors affecting mental health United States	To describe the perspectives of Latina promotoras and community forum attendees regarding challenges to mental health for Latinas, and potential interventions	Amigas Latinas Motivando el Alma: a community-partnered research project to identify symptoms and improve Latinas’ mental health outcomes through promotoras and advocacy Promotoras NR	Community, North Carolina Promotoras (8) and community members (146)	English and Spanish Latinx (Mexican, South American) Immigrants	From photovoice discussions with promotoras, challenges affecting mental health were identified: isolation of transitioning to life in the US, feeling stretched between wanting to prioritise culture and involvement in parenting and long work hours, structural and social barriers to education for Latinas and children, and discrimination against undocumented migrants related to housing and obtaining a drivers’ licence. Increasing community awareness of the challenges to mental health and information about resources in the community were key recommendations.	Help-seeking was described as a taboo for Latinas Photovoice was found to be an effective tool for including the experiences of Latinas with limited English proficiency in research to inform interventions
Priebe et al. (2012) Expert interviews 14 European countries	To identify good practice in providing mental health care to socially marginalised groups	Strategy for organising the provision of mental health care to socially marginalised groups Clinical and non-clinical staff NR	Community & clinic Experts in psychiatry, psychology, social work, occupational therapy, nursing, medicine, community work, law, social science and social policy (154)	Varied European Citizens, refugees, people seeking asylum and irregular migrants	Drawing on expert interviews, four components of good practice were identified for providing mental health care to the long-term unemployed, street sex workers, homeless, refugees/people seeking asylum, irregular migrants and travelling communities: outreach programmes; access to multifaceted physical and mental health services to reduce referrals; coordination across services; raising awareness of services to marginalised groups and practitioners	Findings may be specific to highly deprived urban areas. Understanding of context-specific factors was limited
Ruiz-Sánchez et al. (2021) Qualitative retrospective interviews United States	To examine the perspectives of participants in De la Mano con la Salud and explore their perceptions of emotional, information and instrumental support provided	De la Mano con la Salud (lend a hand to health): a community-based participatory project offering non-directive social support by helping Latino immigrant men to articulate their goals (using the Wheel of Life) and find solutions to the problems they prioritise, such as connecting to health and social services and the larger community Latino immigrant male promotores (community health workers), with training Monthly in-person meetings, with additional phone meetings, over 6 months	New and emerging Latinx communities in Pennsylvania Latino immigrant men (182)	Spanish (inferred) Latinx (primarily Mexican, 113, but also Central American, 62) Immigrants	Drawing on findings from 23 interviews, Latino men described a need to have their identity recognised through engagement with their ethnic community. They found the intervention effective in addressing their health, legal and work needs, while also promoting a feeling of ‘respaldo’: perceived social support important to health.	Intervention is offered at an individual level, thus cannot resolve issues requiring intervention at a structural level
Quosh (2011) Evaluation, including qualitative and quantitative needs assessment, knowledge tests standardised training evaluation of trainers. Syria	Description and evaluation of a training programme to build capacity in delivering psychosocial support	Takamol (meaning integration in Arabic)—a UNHCR pilot programme aiming to support refugee mental health through (1) capacity building (training) of frontline workers in schools, clinics, humanitarian aid programmes and universities, (2) case management of people most at risk, and (3) an outreach volunteer programme. Psychiatrists and Psychologists deliver the training to frontline workers 170 h of training over 1 year	Community Trainers (44), with 40 completing the training	Arabic, Kurdish (inferred) Iraqi Refugees	All trainers passed the knowledge tests. Standardised training evaluations suggested the training supported high knowledge absorption, strong ability to run training and consistency in delivery. Attendance ranged from 100 to 87.5%. It was predicted that the capacity building would eventually lead to improved access to psychosocial support and wellbeing amongst Iraqi refugees	Findings support the cascade approach. High staff turnover and differences in interagency politics, timelines and incentives posed challenges. Findings were limited to the effectiveness of the training; further research on the impact of the capacity building on service users is needed
Schmid (2019) Interviews with volunteers Germany	To provide a practical and empirical example of a care-oriented approach to integration	Refugee support work guided by an ethics of care approach to integration Female volunteers from the majority population Varied	Community refugee support organisations in two large cities and smaller towns Female refugee support work volunteers (22)	German	Drawing from literature on the ethics of care to interpret findings from interviews with German female refugee support volunteers, their work involved relationship building, attentiveness, responsibility, empathy, respecting difference and respect (to counter power differences). Volunteers saw their work as political and useful in working towards inclusive societal change	Research with service users is needed. It is important to note the inherent possibility of unequal power relations associated with an ethics of care
Wei et al. (2021) Historical case study and interviews Australia	To describe and review the Victorian Foundation for Survivors of Torture Community Liaison Worker (CLW) role in delivering trauma-informed community capacity building	Trauma-informed community capacity building to support: acculturation, social network building, service engagement and the adoption of meaningful roles in Australian society CLWs (7) Intervention is ongoing; research duration: 12 months	Community, Victoria Community members who are survivors of torture (4308)—permanent residents, people seeking asylum or temporary visa holders		Drawing on a thematic analysis of interviews with 7 CLWs, it was found that CLWs have diverse and multifaceted dual roles as community leaders and employees. Their roles involve working with clients to meet short-term goals, while also working to achieve community empowerment. Specifically, this involves (1) supporting refugees by improving their access to services and helping them to develop independence; (2) supporting service providers by improving their cultural capabilities; (3) developing community self-sufficiency through recognising and addressing a community’s needs	Resourcing and awareness raising were identified as barriers, with underfunding and poor recognition of the complexity of the CLW compromising capacity building. Peer support and supervision were identified as key enablers
Wells et al. (2018) Grounded theory, using interviews to inform transactional concepts Jordan	To develop and test an ecological model of adaptation to displacement, relevant to the experiences of Syrian refugees	Psychosocial organisations supporting the Syrian refugee community in Jordan. NR NR	Community, Amman Syrian (many of whom had recently been displaced) and Jordanian key informants (29), working in relevant psychosocial organisations	Arabic (inferred) Syrian Refugees	Findings, based on interviews with key informants, suggest the Arabic concepts of Karama (dignity) and Sudme (emotional impact of the crisis) were central to the adaptation of an ecological model to the Syrian refugee context. Karame was described as central to identity in relation to family, self, social standing and culture. Sudme suggested the emotional responses to potentially traumatic events was normal. Overall, their emotional responses to trauma (sudme) were compounded by the stress of being in a new community, where one’s dignity tied to one’s identity (karame) was displaced	The ecological model—underscoring the importance of environment, and change in environment as central to understanding refugees’ values and behaviours—was found to be appropriately adapted using the Syrian concepts of wellbeing (Karama, Sudme). An intersectional theoretical lens is suggested to further recognise the importance of gender, class, sexuality and ethnicity as intersecting identity positions
Wiles et al. (2019) Qualitative interviews with service users, non-users, volunteers and stakeholders New Zealand	To explore culturally diverse older adults’ attitudes to and experiences of befriending services in Aotearoa (New Zealand)	Age Concern New Zealand ‘Accredited Visiting Service’—a befriending service for older people, that aims to provide supportive contact, and improve health and wellbeing Paid staff (30) and 2600 volunteers 1-hour weekly	Community Culturally diverse older adults (2500)	English, Mandarin, Korean European, Māori, Pacific, Chinese, Korean	Findings are based on thematic analysis of interviews. Befriending services alleviate social isolation and loneliness. Barriers to access include feeling undeserving (others need it more) and knowledge of and appropriateness of service. Ideal befriending services were said to support real and reciprocal relationships, foster access to community and connection to culture, and be reliable	Cultural alignment—through engagement with culturally specific organisations—should be a priority in improving uptake amongst culturally diverse older adults. Service providers were present in some interviews, which may have influenced findings

NR not reported, CLW community Liaison worker