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