Exploring the Effectiveness of Culturally Adapted Psychoeducation for Improving Access and Combating Stigma in Refugees

Purpose:The International Society for Traumatic Stress Studies (ISTSS) recommends the use of psychoeducation in the management of PTSD as it meets the Level A category of evidence of the Agency for Health Care Policy and Research (AHCRP) based on several randomized trials (Foa, 2009). This study further states that “psychosocial rehabilitation techniques are recommended for the treatment of PTSD in traumatized adults with deficits in community functioning. These techniques may be especially relevant to persons who have been multiply traumatized or have had a more chronic course of PTSD” (Foa, 2009, p.589). Research staff and Karen refugee leaders partnered to develop culturally competent, community based psychoeducation groups. The six session curriculum for the groups addressed the unique needs of Karen refugees and fit with the ethnic organization’s existing programming to address education about trauma and coping skills, grief and healing, navigating the health care system, employment, relationships and family.

Methods:This is a waitlist control study of the effectiveness of psychoeducation with 30 Karen refugee trauma survivors.  Participants were identified and referred by the public health screening clinics.  They were assigned to two groups on a first come first serve basis approximately 10 weeks apart.  Participants were asked to complete pre and post group measures assessing PTSD (PDS), depression (Hopkins Symptoms Checklist-25) and a measure of help seeking behavior and mental health stigma developed by the research team. All measures were rigorously translated, back translated and reconciled.  These measures were used to evaluate the appropriateness of participants for group and to evaluate the effectiveness of the psychoeducation intervention in reducing trauma related symptoms.  Fidelity measures were developed and completed by research assistants in each group. Each six week group was conducted by a licensed psychologist from the Center for Victims of Torture and a Karen cultural leader from two immigrant-led community based organizations (CBOs). The groups were held weekly for 90 minutes at the CBOs. 

Results: Findings indicate significant reductions in anxiety (t=2.031, df= 28, p=.052, Cohen's d= .38) and somatic experiencing (t=2.131, df = 27, p=.042, Cohen's d= .40) in post group. Positive coping skills, including both formal and informal help-seeking, were reported after psychoeducation. Increased positive perception on formal help-seeking was related to high PTSD score, which implies that those with higher PTSD symptoms might perceive more potential benefits of formal help (i.e., counseling with professionals). Most refugees requested referrals for individual counseling at the conclusion of the psychoeducation groups, although stigma was also increased (t=4.178, df= 27 p=.000, Cohen's d= .78). The implications of methodological limitations such as small sample size and the potential impact of this finding on access to care will be discussed. 

Implications: Psychoeducation can be effectively delivered to newly arriving refugees in a group format.  The specific benefits for refugees include decreasing isolation, decreasing anxiety and somatic experiencing and improving access to mental health care.  This study also implies effectiveness of psychoeducation in increased help-seeking intention and positive emotional coping skills.  Future research is recommended with larger samples of refugees to validate culturally adapted curriculum with newly arriving refugees.