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Background: Refugee parents who fled conflicts suffered violence and traumas and face huge challenges in supporting the health and welfare of their children whilst in transit. Aims: To describe the development of a culturally competent and compassionate Training and Support Package (TSP) for nurses, social and health care workers and volunteers, with a focus on parenting needs among unsettled refugees fleeing conflict. Methods: The multi-method approach included: a scoping review covering parenting needs of refugees fleeing conflict zones; collection of stories from refugee parents, healthcare workers and volunteers via a mobile application; discussions between team members; a piloted and evaluated curriculum. Results: High levels of family distress and deterioration of parental identity were identified. Informed by these results, the curriculum is articulated along twenty bite-sized learning units, covering four age stages of childhood as well as targeting adults’ wellbeing. Pilot training was evaluated positively confirming feasibility and usefulness of TSP. Conclusions: Unsettled refugee parents fleeing conflicts face psychosocial and practical difficulties negatively affecting their parenting skills. Care workforce should be trained in order to provide culturally competent and compassionate support to help these families. Open access digital platforms are promising as autodidactic and self-help tools amongst hard-to-reach populations.
Empowering refugee families
in transit: the development of
a culturally competent and
compassionate training and
support package
Irena Papadopoulos
Head of the Research Centre, Department of Mental Health and Social Work, Middlesex University, UK
Runa Lazzarino
Anthropologist, Department of Mental Health and Social Work, Middlesex University, UK
Ourania Sakellaraki
Independent Consultant, Greece
Victor Dada
President, EDUNET Association, Romania
Paraskevi Apostolara
Lecturer, Nursing Department, National and Kapodistrian University of Athens, Greece
Andrea Kuckert-Wo
Lecturer, Nursing Department, Vorarlberg University of Applied Sciences, Austria; Senior Project
Manager, St. Augustinus Gruppe, Germany
Manuela Mauceri
Neuroscientist and Social Psychologist, Department of Medical and Surgical Sciences and Advanced
Technologies, University of Catania, Italy
Christiana Kouta
Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
Corresponding author:
Irena Papadopoulos, Research Centre for Transcultural Studies in Health, Department of Mental Health and Social Work,
School of Health and Education, Middlesex University, The Burroughs, London NW4 4BT, UK.
Journal of Research in Nursing
0(0) 1–15
!The Author(s) 2021
Article reuse guidelines:
DOI: 10.1177/17449871211018736
Background: Refugee parents who fled conflicts suffered violence and traumas and face huge
challenges in supporting the health and welfare of their children while in transit.
Aims: To describe the development of a culturally competent and compassionate training and
support package (TSP) for nurses, social and health care workers and volunteers, with a focus on
parenting needs among unsettled refugees fleeing conflict.
Methods: The multi-method approach included: a scoping review covering parenting needs of
refugees fleeing conflict zones; collection of stories from refugee parents, healthcare workers and
volunteers via a mobile application; discussions between team members; a piloted and evaluated
Results: High levels of family distress and deterioration of parental identity were identified.
Informed by these results, the curriculum is articulated along 20 bite-sized learning units,
covering four age stages of childhood as well as targeting adults’ well-being. Pilot training was
evaluated positively, confirming feasibility and usefulness of the TSP.
Conclusions: Unsettled refugee parents fleeing conflicts face psycho-social and practical difficulties
negatively affecting their parenting skills. The care workforce should be trained in order to provide
culturally competent and compassionate support to help these families. Open access digital
platforms are promising as autodidactic and self-help tools among hard-to-reach populations.
culture, compassionate care, mental health, mobility, multi-methods, parenting/families, practice
development, public and patient involvement, violence
The role of nurses and other health and social care practitioners is crucial for the well-being
of refugee families, who often have specific unmet health needs (Bartelson & Sutherland,
2018; Sackey et al., 2021). Nurses are key because they carry out the first assessment,
screening and referrals procedures for services (Crowley, 2009), if these are available, and,
more broadly, they occupy a unique position not only in improving understanding and
practice in the care of vulnerable migrants, but also in the promotion of their rights
(Shaffer et al., 2019). However, both nursing research and practice with unsettled families
fleeing conflict is hampered by several practical difficulties, such as doing research through
camps, building acceptance and maintaining privacy (Halabi, 2005; Ogunsiji et al., 2018). In
with findings of a recent systematic review (Robertshaw et al., 2017), the International
Council of Nurses found that ‘‘numerous barriers to access to healthcare have been
identified and include legal, health system resource constraints, discrimination,
bureaucracy, fear of deportation, inability to communicate, lack of financial resources,
shame/stigma, and difficulty navigating the healthcare system’’ (International Council of
Nurses, 2018, p. 1). The same document underlines the ‘‘significant role’’ played by nurses
to better help migrants and refugees. Nevertheless, it is also pointed out that caring for these
populations is ‘‘complex, and nurses must be supported through education, ongoing training
and with adequate resources in order to provide high-quality, culturally-competent care’’
(International Council of Nurses, 2018, p. 1; Papadopoulos & Shea, 2018). This is an
emergent speciality and education and training in refugee nursing are still developing
2Journal of Research in Nursing 0(0)
(Evgin & Muz, 2020; Sackey et al., 2021), with promising experimental projects, such as the
creation of the first nursing school in a refugee camp hosting families fleeing long-term
conflict (Martı
´nez-Linares et al., 2019). Overall, many questions are left unanswered
around, for example, how health practitioners can better meet the parenting support
needs of unsettled refugee children and parents.
Refugee parents are central to supporting the health and care needs of their children
(Bryant et al., 2018). Having fled conflicts where they suffered different types of violence
and traumas, both self- and child-care can be unimaginably hard for refugee parents during
the phases leading to resettlement. Post-flight parents’ poor well-being, impaired parenting
and unhappy family environments are high risk factors for developing family conflict,
insecure attachments and mental health distress in children, at least as strongly as pre-
departure and journey-related traumatic events (Miller & Jordans, 2016). Evidence is
available on the negative health consequences of war-related violence and migration
hardship in survivors, in both children and parents (Browne et al., 2017; Charlson et al.,
2019; Dimitry, 2012). The role of post-migration social determinants of conflict-affected
refugees has been shown to have an impact on their mental health (Hou et al., 2020;
Hynie, 2018). Studies have concentrated on the parenting needs among refugee families
while re-settling, for example, on the conflicting tension between refugees own parenting
styles and those of the host country (Deng & Marlowe, 2013). In contrast, there is not an
abundance of evidence around parenting support needs during pre-settlement phases. Those
studies of refugee families fleeing the atrocities of the Syrian conflict found that children
present trauma symptoms, such as bed wetting, fear of loud noises and bright lights, in
addition to increased regressive and violent behaviours and bad parent-child
communication, anxiety and fear (Cartwright et al., 2015; El-Khani et al., 2016).
Advancement in interventions is occurring, and pioneering programmes have been
delivered, which account for the relevance of cultural beliefs and peer support in
parenting (Weine, 2011), maternity (Sioti et al., 2018), and unaccompanied minors
(Sarkadi et al., 2018), and all are yielding promising results. Similarly, interventions for
re-settling war-affected refugee children (e.g., the establishment of child friendly spaces,
Metzler et al., 2019) generally register improvement in behavioural and emotional
symptoms (Pacione et al., 2013). However, interventions with a narrower focus on refugee
parenting support needs during pre-settlement phases remain scant. An exception is the
project in which routine humanitarian deliveries of bread were utilised to distribute
parenting information leaflets and questionnaires to adults looking after children in
conflict zones inside Syria; overall rating of the leaflet was positive in nearly 70% of
responses, indicating the need for immediate parenting support (El-Khani et al., 2016).
Another pilot intervention assessed the feasibility of delivering and evaluating the ‘‘Caring
for Children Through Conflict and Displacement’’ intervention with caregivers in the West
Bank, and preliminary outcome data indicated the potential to both improve family
functioning and reduce children’s problem behaviour (El-Khani et al., 2019). Finally, the
development of the mobile application Vroom is a strategic intervention using digital media
to offer hard-to-reach pre-settled families a self-help tool. Vroom is a parenting mobile
application originally developed by the Centre of the Developing Child at Harvard
University, and recently adapted and piloted with Syrian refugee families in cooperation
with International Rescue Committee. This case study has shown the effectiveness of using
low-cost and easily scalable mobile technology to support hard-to-reach populations (Wilton
et al., 2017).
Papadopoulos et al. 3
Study and aims
This paper discusses the work of the IENE8 Empowering Migrants and Refugee Families with
Parenting Skills project within the framework of the Intercultural Education for Nurses in
Europe (IENE) programme. The IENE8 was funded by the EU ERASMUSþprogramme.
The main objective of the project has been to develop a comprehensive training and support
package (TSP). The target populations of the TSP are frontline nurses and other socio-health
professionals and volunteers with the aim of improving their knowledge and skills in the care of
pre-settled refugee parents and children. The educational resource is also intended as an
autodidactic, self-help and interactive tool for refugees themselves, and other users. The TSP
has fully open access online via the IENE Knowledge Hub (KHub) for IENE8 (https:// which is conceived as a focal point for the exchange of knowledge
and support primarily in relation to vulnerable migrants who arrive in Greece through Turkey
from Syria, Iraq and Afghanistan. Six European countries participated in the IENE8 project:
Cyprus (coordinator), Germany, Greece, Italy, Romania and the UK.
The research questions used as a basis for the development of the TSP were:
(1) What are the basic parenting support needs of refugee families in transit?
(2) What are the basic training needs of nurses and other socio-health professionals and
volunteers working with this population?
A multi-method research approach was used to answer these questions, which included the
following seven actions.
Scoping review. A scoping review was undertaken between 15 November and 15 December
2018 to map the parenting needs of refugee families with children regarding (a) parenting
skills and (b) factors that provide resilience, empowering parents and children. Inspired by
the framework by Arksey and O’Malley (2005), the review was conducted using the
following keywords: migrant/refugee/asylum seekers, parents/parenting skills, refugee
children, child health, health/healthcare needs, psychological support, psychotherapy,
mental health, psychological trauma, well-being, health promotion, psycho-social, cultural
identity, separation, diversity, resilience, empowerment, inequality, education. Four
categories of evidence sources were included, and for each one different data sources were
used: for scientific peer-reviewed literature, we searched EBSCO (CINAHL, MEDLINE,
Pubmed), Google Scholar, Cochrane, PsycINFO, and ScienceDirect; for grey literature,
WorldCat, Bielefeld Academic Engine (BASE), Open Grey, and other national databases
and official websites were interrogated; in relation to mass media and third sector reports,
the search engine Google was employed, in addition to websites of media and third-sector
organisations identified via opportunistic and snowball sampling. Each partner used these
keywords both in English and in their own language, meaning that sources in Greek,
German, Italian and Romanian were also searched. For those included sources in these
languages, partners produced a short summary in English. Only sources dated between
2010 and 2018 were included, given that the Syrian Civil War began in March 2011.
Refugee parents’ and care workers’ stories. Each project partner collected three to five
testimonies of refugee parents’ stories, based on a template developed by the project
4Journal of Research in Nursing 0(0)
partners ( The stories could come from social and health
care workers, or from refugee parents themselves, and were translated in all partners’
languages, plus in Arabic and Farsi. However, two methods were used for the collection
of stories: (a) contacting social and health care workers and refugee parents to provide their
stories using the IENE8 mobile application; (b) the Greek partners interviewed refugee
parents and added their stories through the mobile application. Team members reviewed
the stories for any sensitive information before uploading stories onto the KHub.
This study only required ethical approval for the conduct of interviews with refugee parents
in Greece (Ethics Committee of Doctors of the World/Me
´decins du Monde – Greece-MdM-
Greece, Ref.255, and endorsed by the MdM Board of Directors). All refugees interviewed were
given, and/or read in their native language, an information sheet and a consent form to sign or
approve verbally. These documents explained the study’s details, gave the ethical approval
information and specified that the participation in the study was totally anonymous and
voluntary. The stories independently uploaded by participants onto the project website were
automatically anonymised by the mobile application, and the research team ensured, before
approval, that no personal data were contained in the stories.
Data analysis and identification of themes. Thematic analysis was conducted for both the
evidence gathered by the scoping review and the stories collected (Braun & Clarke, 2006).
The process of analysis entailed a familiarisation with the data, followed by an extrapolation
of key concepts and topics to identify patterns leading to the establishment of themes. Two
team members independently conducted the analysis and frequently had meetings to reach
consensus, until thematic saturation was reached, and final themes defined.
Curriculum model and contents. The curriculum was informed by the following: (a) the original
Papadopoulos, Tilki and Taylor model of cultural competence in nursing (Papadopoulos,
2006; Papadopoulos et al., 1998), and the more recently developed Papadopoulos Model for
Culturally Competent and Compassionate Care (Papadopoulos, 2018); (b) findings of the
aforementioned scoping review; (c) findings from the stories; (d) pre-existing knowledge and
expertise of the team in child development and parent-child relationships.
The development of the curriculum occurred between January and May 2019 and entailed
three consecutive steps:
(a) development of the IENE8 European Model for the Caregivers of Migrant and
Refugee Families in Transit (see Figure 1);
(b) visual systematisation of results of the thematic analysis into a diagram offering a
meaningful and practical synopsis of the main challenges of unsettled refugee families
(see Figure 2);
(c) design of a detailed curriculum content map condensed in an infographic (see Figure
3), which illustrates the topics of the final 20 sub-units of the curriculum.
In line with the curriculum model and themes, contents followed four main age phases of
child development (i.e., 0–24 months, 2–6 years, 6–12 years and 12–18 years), with the
addition of a stream dedicated to adults, both parents and practitioners. During a
transnational meeting in May 2019 in London, themes, curriculum model, content and
structure were discussed and approved by all partners.
Bite-sized learning units. Based on their stronger competences, each partner chose three sub-
units to develop into bite-sized learning units (BSLUs), to be made available on the KHub
Papadopoulos et al. 5
and to be used during the pilot training workshop. The creation of BSLUs is based on a
template developed and tested during previous IENE projects, and combines theory with
activities, reflexivity and extra resources. All BSLUs drafts were shared with the project
partners, revisions were undertaken where needed and subsequently approved by all
partners (
Guide and pilot training. The seventh and last action entailed: a) the compilation of a training
guide, enriched with good practices’ example; b) the delivery of the pilot training to test and
evaluate the TSP developed. For this project, two new evaluation tools were developed
professionals-and-volunteers: (a) a good practice activity using a given template, that all
partners deliver so to assemble a practical compendium of effective training activities; (b) a
post-course reflection activity using a given scenario (Amira’s Story), where participants
provide a self-reflection on their learning and produce an action plan.
Team expertise and discussions. Importantly, frequent international and national team
discussions constituted a relevant methodological tool. Some partners are frontline
Figure 1. European training model for the caregivers of migrant and refugee families in transit. The
development of the curriculum occurred between January and May 2019 and entailed, as a first step, the
development of the IENE8 European model for the caregivers of migrant and refugee families in transit.
6Journal of Research in Nursing 0(0)
practitioners, working with refugee families in camps and shelters, others have long-term
experience in culturally competent and compassionate nursing, also in relation to migrants
and refugees, and others are specialised in education and training. The challenges
experienced by the IENE8 team primarily had to do with the number of translations,
assuring its authenticity and accuracy.
Rigour and trustworthiness were ensured by the combination of methodologies and data sources,
and the involvement of an international multi-disciplinary research team. This study design
entailed a robust triangulation, covering the four main types of: method, data source,
investigator and theory triangulation (Carter et al., 2014). Furthermore, the quality of the
TSP’s delivery was ensured by the production of a training guide, informed both by
innovative educational approaches and the team’s long-term experience. The TSP was piloted
and the evaluation kit consisted of a comprehensive set of tools. All through the project, recurrent
meetings resolved uncertainties and discrepancies to reach consensual decisions.
In total, 124 evidence sources were included in the scoping review and 27 testimonies of
refugee parents’ stories were collected. Detailed documents reporting on the scoping exercise
and the stories collected are available from the project KHub (i.e., IO 1 Mapping National
and International Literature and IO 5 Introduction to KHub Stories, http:// The thematic analysis of the two pieces of research for
this publication led to the identification of four macro-themes, capturing the key challenges
of unsettled refugee families and how to best respond to them. These are presented in Figure
2. The last one, ‘‘Parental Powerlessness’’, results from all the causes of the traumas in the
previous three challenges and contributes to increased risks of self-conflict and loss of
identity as parents. Parents can feel helpless and unable to protect their children during
the journey, when they faced risk of harm or violence at some point (see Figure 4).
Similarities in coping strategies could be identified: mostly seeking services to share
concerns and support their children, trying to be positive and connecting with the
community (see Figure 5). These findings have informed the development of the curriculum
model and its content map, which is detailed in Figure 3.
Each project partner chose three sub-units from the list of 20 to develop into BSLUs. Due
to the COVID-19 pandemic, only one training could be delivered in time to be reported in
this publication, the other seven were postponed. The workshop took place in Limassol,
Cyprus, on 27 February and 5 March 2020 and was attended by 68 undergraduate, senior
year student nurses. For the pre-course self-directed learning, participants were asked to
read and reflect on three BSLUs. The classroom learning agenda revolved around an
overview of IENE projects; the development of the IENE8 curriculum and its KHub; the
presentation of two BSLUs; a workshop on mindfulness and on working together; and a role
play. In the workshop evaluation questionnaire, participants reported that the training, the
material used, the information and knowledge gained were all very helpful and up to date;
they also reported that the workshop improved their skills to understand and empower
unsettled migrant/refugee families on parenting and child-family healthcare needs. In the
impact evaluation questionnaire, participants declared that it was something different from
Papadopoulos et al. 7
Figure 2. Challenges for refugee families in transit. The second step for the development of the curriculum consisted of the visual systematisation of
results of thematic analysis into a diagram offering a meaningful and practical synopsis of the main challenges of unsettled refugee families.
8Journal of Research in Nursing 0(0)
Figure 3. Curriculum content map. The second step for the development of the curriculum consisted of the creation of a detailed curriculum content map
condensed in an infographic.
Papadopoulos et al. 9
what they usually do, and they appreciated that it was not only about theory, but it entailed
the acquisition of skills that can be applied in practice. The activities and presentations
broadened their perception and understanding regarding refugee families, and they asked
for more similar events to be organised.
According to the last report of the United Nations High Commissioner for Refugees, 79.5
million people were forcibly displaced in 2019. Of these, only 107,800 were admitted for
Figure 5. Coping strategies. From the analysis of the parenting stories collected, similarities in coping
strategies could be identified: mostly seeking services to share concerns and support their children, trying to
be positive, and connecting with the community.
Figure 4. Challenges during the journey. From the analysis of the parenting stories collected, it has
emerged that parents can feel helpless and unable to protect their children during the journey, when they
faced risk of harm or violence at some point. PSS: Psycho-Social Support.
10 Journal of Research in Nursing 0(0)
resettlement and 40% were minors (UNHCR, 2020). This implies that the number of
unsettled refugee families around the world is high, yet little research has been conducted
around their parenting support needs, with far more attention given to re-settling contexts.
This study is therefore contributing to filling a considerable gap in refugee studies. It
constitutes an impact-oriented project advancing both knowledge and intervention
programmes in relation to some of the most severe conflict-related refugee crises of our
times (Abbas, 2019), which are having a considerable impact on the humanitarian and
healthcare systems of several host countries (Dumit & Honein-AbouHaidar, 2019).
Our results are in line with available evidence suggesting that the basic parenting support
needs of refugee families in transit are different from those in resettlement contexts,
particularly due to key protective factors lacking for re-settling refugee children. For
example, a stable context with social and parental support, and family cohesion and
friends (Fazel et al. 2012) are not at hand for pre-settling families. Furthermore, as our
study suggests, living in temporary camps and shelters poses specific challenges, such as
environmental and sanitary threats, dearth of services and the sense of an abrupt
discontinuation with socio-cultural practices and network. Among the few studies available
around unsettled families, one showed that disruptions of family structure and parenting
roles, values and practices occur as early as during pre-flight stages, and result in a sense of
parental powerlessness (Williams, 2010). Another study conducted among refugee families
living in caravans in Mexico highlighted how parents’ emotionally distraught state can lead to
over-protectiveness, harshness and reversal of parent-child roles (Browne, 2018). These
parental behaviours can result in both internalising and externalising behaviour problems
in children, as a study pointed out in relation to young refugees from Syria and Iraq re-settling
in Germany (Buchmu
¨ller et al., 2018). Evidence is therefore growing around the importance
of understanding and meeting the family and parenting needs of unsettled refugees fleeing
conflict. The development of the IENE8 TSP has responded to these findings, which suggest
that an adequate response should foster resilience and heal distress in children and parents,
while also aiming at improving the family environment as a whole, targeting environmental,
daily stressors, as others have also recommended (Miller & Jordans, 2016).
The IENE8 TSP advances the limited research on interventions to address refugees’ parenting
needs, making the case for the need to embed socio-cultural and psychological first aid into
programmes in primary health and education for conflict-related displaced families (Fazel &
Betancourt, 2018; Peltonen & Punama
¨ki, 2010). As in other pioneering projects (Wilton et al.,
2017), our study is making use of information and communication technology (ICT), so that it
stands as an open access, self-help tool, which is also interactive, empowering and ultimately peer-
led. This support format can be particularly effective in reaching populations who are on the
move, difficult to access and assist otherwise, and is a promising step in the use of ICT in post-
conflict refugeedom (Bock et al., 2020; Taftaf & Williams, 2020).
The role of frontline nurses and other health and social care professionals is pivotal
during emergencies and crises (Magnaye et al., 2011). As a training tool, the IENE8 TSP
can be used by nurses, healthcare professionals and volunteers, as an autodidactic and train-
the-trainers instrument, to be better equipped to empower the numerous refugee families in
transit around the world. However, preparedness in this sense, and specifically in relation to
parenting needs among refugees in transit, appears to need advancement. The engagement of
this project with nurses advanced awareness on this topic through meetings, newsletters and
social media dissemination. The stories provided by the nurses and other healthcare workers,
as well as the refugee parents, offered a rich source of the knowledge which helped achieve
Papadopoulos et al. 11
some useful skills to support parenting under extreme and unpredictable conditions. This
was corroborated by the participants in the training who expressed that the TSP was both
timely and innovative and of direct practical use responding to their evolving training needs
(Willey et al., 2018).
Furthermore, the TSP is fundamentally informed by the constructs of culturally
competent and compassionate care (Papadopoulos, 2018), which is increasingly
established as a necessary approach to all service users, and arguably even more necessary
when assisting refugee populations (Brennan et al., 2017; Chau, 2020; Mechili et al., 2018).
As also described by the International Council of Nurses (2018), culturally competent care is
essential when caring for refugees, and nurses are called to enhance their cultural competence
to provide ‘‘ethical, respectful, culturally-sensitive’’ and holistic care to displaced people and
their families; (International Council of Nurses, 2018, p. 3).
This study has occurred during the COVID-19 pandemic when in-person meetings were
prevented, while the funding body did not allow the delivery of online training at the time
of writing. This situation resulted in the main limitation of this study, that is that the TSP
could be only partially tested and evaluated, with a reduced sample size of nursing students
only. Additionally, standard limitations of scoping reviews (Sucharew & Sucharew, 2019)
and qualitative research (Doyle et al., 2020) are also present, yet these are outbalanced by the
solid triangulation of the multiple methods employed.
Unsettled refugee families fleeing conflicts face specific psycho-social and practical difficulties
that negatively affect their parenting skills. Nurses, social and healthcare workforces should
be trained in culturally competent and compassionate support, to better help this population
in their unsettled circumstances and make the most of available resources, thereby
maintaining their children’s and their own health and welfare. The use of ICT both for
(self-)training and (self-)support purposes is promising for this hard-to-reach population,
and their health and social care professionals and volunteers.
Key points for policy, practice and/or research
.Innovative research is needed to better understand the training needs of nurses, health
and social care professionals and volunteers in order to better prepare them for the
care of refugee families, while also being able to boost their self-care under extreme
and unique circumstances.
.Evidence-based interventions catering for the specific needs of this population, and
which take into account the family as a whole, as well as the specific needs of parents
and children are necessary; the use of ICT is highly promising as a flexible and
empowering tool among these hard-to-reach groups.
.In front of the ongoing conflict-related ‘refugee crisis’, both in Europe and elsewhere,
policy makers should increase their effort to support rigorous, open-access and self-
directed training for nurses and other healthcare professionals, which is also culturally
competent and compassionate. Appropriate national and international policies should
also facilitate the establishment of standards of nursing care for refugee families.
12 Journal of Research in Nursing 0(0)
We would like to thank all the refugee families, all the nurses, the health and social care professionals
and volunteers who took part in this study, and shared their/a story of refugee parenting on the move.
We would also like to acknowledge the following colleagues for their contribution to this study:
Athena Kalokairinou, Orazio Licciardello, Elena Rousou, Christina Tsorou.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or
publication of this article.
Ethics Statement
Approval was granted from the Ethics Committee of Doctors of the World/Me
´decins du Monde –
Greece-MdM-Greece, Ref.255, and endorsed by the MdM Board of Directors.
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or
publication of this article: This work was supported by the ErasmusþProgramme of the European
Commission [agreement number 2018-1-CY01-KA202-046848].
Irena Papadopoulos
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... Furthermore, mental health programs, group therapy, and psychological assessments should be studied more, reviewing how they can be more refugee-focused, in an attempt to benefit displaced family members and their integration process [42]. It is crucial for community health programs to provide a diverse array of health practitioners from various backgrounds, as a means of helping refugees with potential language and culture barriers to further their belief in their host countries' care system, thus allowing further trust and understanding into their mental well-being and overall quality of life [43]. Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH ("Springer Nature"). ...
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The refugee crisis is spreading rapidly, with the number of global refugees this decade doubling in comparison to the last, leading to further concern regarding asylum policies and their psychological impacts. The aim of this systematic review is to further emphasize the correlation between familial separation and the risk of mental health disorders in refugees. This particular review uses quantitative and qualitative data sourced from a variety of countries to comparatively view the mental health status of approximately 8,737 refugees ages 15 and older. This was done to determine if familial separation could potentially impact their overall quality of life. As a result, separation from one's family was found to be correlated with symptoms of posttraumatic stress disorder, depression, anxiety, adult separation anxiety disorder, intermittent explosive disorder, and more. Studies reported a high variance in the prevalence of mental health disorders when models were adjusted for family separation. Methods to improve asylum procedure and mental health services for refugees is taken into consideration.
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Background: There are a growing number of forced migrants worldwide. Early detection of poor adjustment and interventions to facilitate positive adaptation within these communities is a critical global public health priority. A growing literature points to challenges within the post-migration context as key determents of poor mental health. Aims: The current meta-analysis evaluated the association between daily stressors and poor mental health among these populations. Method: A systematic search in PsycINFO, PubMed, and Web of Science identified relevant studies from inception until the end of 2018. Effect sizes (correlation coefficients) were pooled using Fisher’s Z transformation and reported with 95% confidence intervals. Moderator and mediator analyses were conducted. The protocol is available in PROSPERO [CRD42018081207]. Results: Analysis of 59 eligible studies (n=17,763) revealed that daily stressors were associated with higher psychiatric symptoms (Zr=0.126-0.199, 95% CI=0.084-0.168, 0.151-0.247, p<0.001) and general distress (Zr=0.542, 95% CI=0.332-0.752, p<0.001). Stronger effect sizes were observed for mixed daily stressors relative to subjective, interpersonal, and material daily stressors, and for general distress relative to post-traumatic stress symptoms and general well-being. Effect sizes were also stronger for children and adolescents relative to adults. Daily stressors fully mediated the associations of prior trauma with post-migration anxiety, depressive, and post-traumatic stress disorder symptoms. Conclusions: This meta-analysis provides a synthesis of existing research on the role of unfavorable everyday life experiences and their associations with poor mental health among conflict-affected forced migrants. Routine assessment and intervention to reduce daily stressors can prevent and reduce psychiatric morbidity in these populations.
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Background: Existing WHO estimates of the prevalence of mental disorders in emergency settings are more than a decade old and do not reflect modern methods to gather existing data and derive estimates. We sought to update WHO estimates for the prevalence of mental disorders in conflict-affected settings and calculate the burden per 1000 population. Methods: In this systematic review and meta-analysis, we updated a previous systematic review by searching MEDLINE (PubMed), PsycINFO, and Embase for studies published between Jan 1, 2000, and Aug 9, 2017, on the prevalence of depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, and schizophrenia. We also searched the grey literature, such as government reports, conference proceedings, and dissertations, to source additional data, and we searched datasets from existing literature reviews of the global prevalence of depression and anxiety and reference lists from the studies that were identified. We applied the Guidelines for Accurate and Transparent Health Estimates Reporting and used Bayesian meta-regression techniques that adjust for predictors of mental disorders to calculate new point prevalence estimates with 95% uncertainty intervals (UIs) in settings that had experienced conflict less than 10 years previously. Findings: We estimated that the prevalence of mental disorders (depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia) was 22·1% (95% UI 18·8-25·7) at any point in time in the conflict-affected populations assessed. The mean comorbidity-adjusted, age-standardised point prevalence was 13·0% (95% UI 10·3-16·2) for mild forms of depression, anxiety, and post-traumatic stress disorder and 4·0% (95% UI 2·9-5·5) for moderate forms. The mean comorbidity-adjusted, age-standardised point prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe post-traumatic stress disorder) was 5·1% (95% UI 4·0-6·5). As only two studies provided epidemiological data for psychosis in conflict-affected populations, existing Global Burden of Disease Study estimates for schizophrenia and bipolar disorder were applied in these estimates for conflict-affected populations. Interpretation: The burden of mental disorders is high in conflict-affected populations. Given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden. Funding: WHO; Queensland Department of Health, Australia; and Bill & Melinda Gates Foundation.
People from a refugee background have significant unmet health needs including complex physical and psycho-social presentations. They can experience low trust, unfamiliarity with the health system and reliance on family and friends to access care. To address these needs, Australia has specialised refugee health services in each state and territory. The majority of these services transition patients to primary care, but this transition, although necessary, is difficult. Most primary care and specialised health professionals share a high degree of commitment to refugee patients; however, despite best efforts, there are gaps. More integrated health services can start to address gaps and promote continuity of care. A previous study has described 10 principles that are associated with successful integration; this paper references five of those principles (continuum of care, patient focus, geographic coverage, information systems and governance) to describe and map out the outcomes of an integrated model of care designed to deliver specialist refugee health in primary care. The Co-location Model is a partnership between a refugee health service, Primary Health Networks, a settlement agency and general practices. It has the potential to deliver benefits for patients, greater satisfaction for health professionals and gains for the health system.
Background Nursing students should gain cultural knowledge and skills necessary for providing care to all types of patients. Aim This study aimed to determine problems faced by nursing students who care for refugee patients. Method The study used phenomenological qualitative design. The sample comprised 25 nursing students who cared for refugee patients in a clinic. Data were analysed using Colaizzi’s seven‐step method following focus group interviews. Results Two themes were identified for the interviews: (i) language barrier: insufficient care and (ii) students’ perspectives on being a refugee. Furthermore, three subthemes were also identified by analysis of the interviews: (i) superficial communication and insufficiency in psychological support, (ii) health problems in difficult living conditions and (iii) unchanged basic human needs and unmet care needs. Conclusions Nursing students find it difficult to care for refugee patients, but nursing education programmes based on culture care improve their knowledge and perceptions and the quality of care they provide to patients from different cultures. Implication for nursing and health policy In a multicultural society, nursing students must recognize cultural differences. Consequently, a multicultural education programme helps lay the groundwork for successful integration of nursing students in new cultures.
Employing ICT platforms has the potential to improve efforts to assist displaced people, or to liberate them in being more able to help each other, or both. And while platform development has resulted in a patchwork of initiatives – an electronic version of ‘letting a thousand flowers bloom’ – there are patterns emerging as to which flowers grow and have ‘staying power’ as compared to ones that wilt and die. Using a partial application of grounded theory, we analyze 47 platforms, categorizing the services they provide, the functionalities they use, and the extent to which end users are involved in initial design and ongoing modification. We found that 23% offer one-way communication, 72%, provide two-way communication, 74% involve crowdsourcing and 43% use artificial intelligence. For future developers, we offer a preliminary list of what leads to a successful ICT initiative for refugees and migrants. Finally, we list ethical considerations for all stakeholders.
The years 2014 and 2015 saw a dramatic rise in the number of migrants entering Europe via the Mediterranean. This rise was mostly accounted for by refugees fleeing the civil war in the Syrian Arab Republic. Since that time Europe has been gripped in a political and humanitarian crisis as the incoming numbers overwhelmed individual state and collective European Union ability to respond effectively. In this article, I explore the European Migrant Crisis in geographical, political and humanitarian perspectives, describing and explaining the key events of the crisis. I then go on to a study of the major health issues arising from the crisis in terms of communicable and non-communicable disease, mental health, gender-related health and access to healthcare. Finally, I discuss the global dimensions of the refugee crisis and enter into a discussion of the roles and effectiveness of the UNHCR and the European Union’s response as a whole.
Background Qualitative descriptive designs are common in nursing and healthcare research due to their inherent simplicity, flexibility and utility in diverse healthcare contexts. However, the application of descriptive research is sometimes critiqued in terms of scientific rigor. Inconsistency in decision making within the research process coupled with a lack of transparency has created issues of credibility for this type of approach. It can be difficult to clearly differentiate what constitutes a descriptive research design from the range of other methodologies at the disposal of qualitative researchers. Aims This paper provides an overview of qualitative descriptive research, orientates to the underlying philosophical perspectives and key characteristics that define this approach and identifies the implications for healthcare practice and policy. Methods and results Using real-world examples from healthcare research, the paper provides insight to the practical application of descriptive research at all stages of the design process and identifies the critical elements that should be explicit when applying this approach. Conclusions By adding to the existing knowledge base, this paper enhances the information available to researchers who wish to use the qualitative descriptive approach, influencing the standard of how this approach is employed in healthcare research.
The sudden influx of refugees into countries around the world has caused a complicated, multi-faceted, international refugee crisis. Refugees, whether in camps or urban areas, face a myriad of problems and obstacles, yet one of the most critical issues young refugees face is the lack of educational opportunities and/or resources. United Nations International Children’s Emergency Fund warns that this lack of education could potentially create a “lost generation” which may lead to serious implications, not only for these young refugees but also to surrounding, nearby societies. This paper seeks to understand if and how Information and Communication Technology (ICTs) have been reported in the literature as being used in different contexts to connect young refugees with high quality educational opportunities, and whether the urban or camp contexts impact these opportunities. The results of this review of the literature indicate that a number of different ICTs have successfully been used in a variety of different educational settings and for a variety of purposes. Additionally, where a refugee lives could impact the accessibility and nature of the ICT tools available to provide an education.