Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden
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 s...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-12-01
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| Series: | SSM - Mental Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666560323000464 |
| _version_ | 1797385048815566848 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Aniek Woodward |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T21:48:30Z |
| format | Article |
| id | doaj.art-dd224e99ba4c49c1b74a9244d8e716f8 |
| institution | Directory Open Access Journal |
| issn | 2666-5603 |
| language | English |
| last_indexed | 2024-03-08T21:48:30Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | SSM - Mental Health |
| spelling | doaj.art-dd224e99ba4c49c1b74a9244d8e716f82023-12-20T07:38:56ZengElsevierSSM - Mental Health2666-56032023-12-014100231Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and SwedenAniek Woodward0Sebastian Burchert1Alexandra S. Barry2Jacqueline E.W. Broerse3Egbert Sondorp4Anoushka Bold5Alexander Ruberl6Jonas M. Hessling7Christine Knaevelsrud8Bayard Roberts9Daniela C. Fuhr10Peter Ventevogel11Nadine Hosny12Tomas Lindegaard13Shervin Shahnavaz14Marit Sijbrandij15Pim Cuijpers16Martin McKee17Marjolein A. Dieleman18KIT 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.Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Habelschwerdter Allee 45,14195, Berlin, GermanyKIT Royal Tropical Institute, KIT Health, Mauritskade 64, 1092 AD, Amsterdam, the Netherlands; NHS England, 133-155 Waterloo Rd, SE1 8UG, London, UKAthena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, the NetherlandsKIT Royal Tropical Institute, KIT Health, Mauritskade 64, 1092 AD, Amsterdam, the NetherlandsKIT Royal Tropical Institute, KIT Health, Mauritskade 64, 1092 AD, Amsterdam, the Netherlands; Inuka Coaching, Amsterdam, the NetherlandsDepartment of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Habelschwerdter Allee 45,14195, Berlin, GermanyDepartment of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Habelschwerdter Allee 45,14195, Berlin, GermanyDepartment of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Habelschwerdter Allee 45,14195, Berlin, GermanyDepartment of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UKDepartment 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, GermanyPublic Health Section, Division of Resilience and Solutions, United Nations High Commissioner for Refugees, Rue de Montbrillant 94, 1202, Geneva, SwitzerlandInstitute of Psychology, University of Lausanne, 1015, Lausanne, SwitzerlandDepartment of Behavioural Sciences and Learning, Linköping University, 581 83, Linköping, SwedenCentre 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, SwedenDepartment 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 NetherlandsDepartment 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, RomaniaDepartment of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UKKIT 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 NetherlandsE-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.http://www.sciencedirect.com/science/article/pii/S2666560323000464Syrian refugeese-mental healthStep-by-StepScalabilityEgyptGermany |
| spellingShingle | 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 Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden SSM - Mental Health Syrian refugees e-mental health Step-by-Step Scalability Egypt Germany |
| title | Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden |
| title_full | Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden |
| title_fullStr | Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden |
| title_full_unstemmed | Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden |
| title_short | Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden |
| title_sort | scalability of digital psychological innovations for refugees a comparative analysis in egypt germany and sweden |
| topic | Syrian refugees e-mental health Step-by-Step Scalability Egypt Germany |
| url | http://www.sciencedirect.com/science/article/pii/S2666560323000464 |
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