Parenting and mental health in protracted refugee situations: a systematic review.

BACKGROUND: Refugees' parenting behaviour is profoundly influenced by their mental health, which is, in turn, influenced by their situation of displacement. Our research presents the first systematic review on parenting and mental health in protracted refugee situations, where 78% of all refugees reside. METHODS: We pre-registered our protocol and screened documents in 22 languages from 10 electronic databases, reports by 16 international humanitarian organisations and region-specific content from the top 100 websites for each of the 72 countries that 'host' protracted refugees. Our criteria were empirical papers reporting parenting and parental mental health data on refugees who are in a protracted refugee situation. Studies including only internally displaced or stateless persons were excluded. RESULTS: A total of 18,125 documents were screened and 30 studies were included. We identified a universal pathway linking macro-level stressors in protracted refugee situations, such as movement restrictions and documentation issues, to symptoms of depression and anxiety, which, in turn, led to negative parenting practices. Addtionally, culture-specific pathways were observed in the way parental mental health and parenting were expressed. Situational (e.g., overcrowding) and relational factors (e.g., spousal dynamics) modulated both of these pathways. Biases in the research included the over-representation of specific protracted refugee situations, overreliance on self-reported data, and a heavy focus on mothers while neglecting fathers and other caregivers. Longitudinal research is needed to clarify the directionality and causality between specific macro-level stressors in a given protracted refugee situation and parental mental health and practices. Refugees were rarely consulted or involved in the design of research about their parenting and parental mental health. CONCLUSION: In recognising the existing links between protracted refugee situations, parental mental health, and parenting, our systematic review calls for a shift in thinking: from focusing solely on the micro aspects that affect 'refugee parenting' to understanding and tackling the broader macro-level stressors that drive them. We urge for larger and long-term research efforts that consider diverse protracted refugee situations, greater investment in science communication and diplomacy with governments, and stronger implementation of durable solutions by states to alleviate the roots of refugee parents' distress and negative parenting practices.

The role of mind-body interventions in traumatised refugees' primary care: A qualitative exploration of professionals' experiences in a dedicated programme in Geneva.

Post-traumatic physical and psychological symptoms are pervasive among refugees. Primary care staff face numerous challenges and often seek innovative ways of addressing their refugee patients' physical and mental health needs. A nascent body of literature suggests that mind-body interventions (MBIs1) have a positive effect on post-traumatic symptoms in this population. But the quality of evidence is still poor, and little is known about the role MBI could play in the primary care of refugees. Following the implementation of two different kinds of MBI in a dedicated primary care unit, this study aimed to explore staff members' perceptions and prescribing habits for MBI. Given the paucity of information about this topic, we used a qualitative design combining ethnography and discourse analysis providing in-depth insight into professionals' experiences of MBI. Data collected over five-months of non-participative observation and the transcription of twelve interviews were analysed following the Interpretative Phenomenological Analysis method (IPA) yielding four main results: (1) Generally poor initial understanding of MBI; (2) A variety of conditions and situations where MBIs appeared acceptable and helpful; (3) A persistent lack of experience and knowledge about the indications for MBI, hindering prescription; (4) The importance of articulating MBIs with mental health services. These results, in the light of the existing literature, suggest that stronger evidence for MBI efficacy for refugees is required, a key to improving professionals' understanding of MBI, providing them with explicit prescription criteria, and encouraging stakeholders to implement these innovative interventions.

Understanding the Crisis: Prevalence and Key Determinants of Stunting in Children Aged 2 to 5 Years in an Afghan Refugee Camp in Kohat.

BACKGROUND: Stunting, characterized by impaired growth and development due to malnutrition and illness, is a significant public health concern with profound implications for cognitive and physical development. This issue is particularly severe in refugee settings, where food insecurity and limited access to healthcare exacerbate the problem. OBJECTIVE: This study aimed to evaluate the prevalence and determinants of stunting among children aged 2 to 5 years in an Afghan refugee camp in Kohat, Pakistan. METHODS: A cross-sectional observational design was employed, collecting data from children aged 2 to 5 years who had resided in the camp for at least six months. A pre-validated, standardized questionnaire was administered to parents or guardians to gather data on socio-demographic factors, dietary intake, and health history. Stunting was defined as a height-for-age Z-score less than -2 SD from the median of the WHO Child Growth Standards. Anthropometric measurements were taken following WHO guidelines. Bivariate and multivariate logistic regression analyses were conducted to identify predictors of stunting. RESULTS: Out of 384 children, 153 (40%) were found to be stunted. The prevalence was slightly higher among boys (80 out of 153, 52%) compared to girls (73 out of 153, 48%). Significant predictors of stunting included a lack of parental education (adjusted odds ratio (AOR) for fathers 1.8, 95% confidence level (CI) 1.2-2.9; AOR for mothers 2.1, 95% CI 1.3-3.4), a history of infectious diseases (AOR 1.9, 95% CI 1.2-3.0), and low dietary diversity (AOR 2.3, 95% CI 1.4-3.7). CONCLUSION: The study highlights the high prevalence of stunting among children in the refugee camp, underscoring the need for comprehensive interventions targeting healthcare improvement, parental education, economic support, and dietary diversity to reduce stunting rates and improve children's health outcomes.

Secondary traumatization in refugee care-EMDR intervention for interpreters (STEIN): a study protocol for a quasi-randomized controlled trial.

BACKGROUND: By the end of 2022, more than 100 million people worldwide fled their homes. Before, during and after their flight, refugees have high risk of experiencing traumatic events. Accordingly, around every third refugee is affected by posttraumatic stress disorder. For adequate mental health care, the service of interpreters is often urgently needed to overcome existing language barriers. However, repeated exposure with details of traumatic narratives, as experienced by interpreters, can be burdensome and can lead to trauma sequela symptoms in terms of secondary traumatic stress. Only few studies have examined the treatment of secondary traumatic stress to date. Based on the recommendations for the treatment of posttraumatic stress disorder with confrontational methods, this study was designed to evaluate the effectiveness of an eye movement desensitization and reprocessing (EMDR) intervention in a sample of interpreters working in refugee care suffering from secondary traumatic stress symptoms. METHODS: To evaluate the effectiveness of an EMDR intervention for the treatment of secondary traumatic stress symptoms, a quasi-randomized controlled trial using a waiting group design will be performed. Participants will be treated with a maximum of 6 sessions based on EMDR standard protocol. Primary outcome is the symptom load of secondary traumatic stress, assessed with the Questionnaire for Secondary Traumatization, while secondary outcomes comprise further symptom complexes such as PTSD due to self-experienced traumatic events, depression, anxiety, and somatization as well as quality of life, quality of professional life, and psychological wellbeing that will be assessed with the PDS, PHQ-9, GAD-7, SSD-12, SF-12, PROQOL-5, and WHO-5, respectively. DISCUSSION: Our primary interest is to determine the efficacy of an EMDR intervention in interpreters affected by secondary traumatic stress, especially how many sessions are needed for significant symptom reduction. Change of associated symptom complexes and quality of life will be investigated. Reprocessing one's own stressful experiences may also contribute to this, which is not the focus of the treatment but relevant to the EMDR protocol. This study aims to assess if EMDR could be an acceptable, effective, and time-efficient method for reducing work-related secondary traumatization. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00032092, registered 16 June 2023.

Nutrition Knowledge, English Adequacy, Women's Education, and Food Insecurity Among Syrian Refugees in Florida.

Objectives The objective of the study was to measure food security among Syrian refugees residing in urban and rural areas in Florida. Women's education, English proficiency, and nutrition knowledge were assessed to indicate their effects on food security in this population. Methods One-on-one interview questionnaires were administered to Syrian refugee households residing in Florida (n=80: n=43 in rural areas and n=37 in urban areas). The main outcomes were food insecurity, nutrition knowledge, English adequacy, and women's education. Results The main outcome of this study was the food security status among Syrian refugees residing in Florida. Among the total households, 80% were food insecure, and food insecurity was greater in rural areas (60.9%) than in urban areas (39.1%). The majority (57.5%) of participants scored fair nutrition knowledge. One-way frequency analysis showed that 75% of households had inadequate English. Around 23.7% of Syrian refugee women had a high school diploma or higher. Among these women, 68.4% were residing in urban areas. The chi-squared test showed significant differences in women's education in rural and urban areas (p=0.03). Nutrition knowledge was higher in urban areas compared to rural areas. The chi-squared test showed a significant difference in nutrition knowledge in urban and rural areas (p=0.04). The result of the multivariate logistic regression model indicated that the type of residence, rural vs urban areas, had an inverse significant effect on food security after controlling for our variables. Syrian refugees in rural areas had 79.9 greater odds of being food insecure compared with urban areas (odds ratio: 0.201, 95% CI: 0.053-0.758, p=0.01). Conclusions Nutrition knowledge, English adequacy, and women's education may be less important than types of residence. The type of residence is a contributing factor to food insecurity in Syrian refugees residing in Florida. A larger sample size would allow a clearer understanding of the relation of our variables with food insecurity.

[Reducing the impact of COVID-19 in immigrants: a systematic review of the efficacy of interventions]. / Contenimento della diffusione del COVID-19 nella popolazione immigrata: una revisione sistematica dell'efficacia degli interventi.

BACKGROUND: the spread of SARS-CoV-2 in the population has amplified the effects of health inequalities, particularly in the most vulnerable groups such as immigrants and refugees. An assessment of the intervention to contain the COVID-19 in these population groups was essential to define new strategies for more equitable, inclusive, and effective health policies to on health. OBJECTIVES: to provide a systematic synopsis of the impact of interventions to contain the spread of SARS-CoV-2 in immigrants. METHODS: data sources included major bibliographic databases. Using a study protocol, already shared with the international scientific community, two independent researchers reviewed the citations, selected and evaluated the interventions studies. Due to the heterogeneity of the interventions, a narrative synthesis was carried out. RESULTS: three eligible studies were identified. The first study modelled the incidence of the disease in a refugee camp in Greece, based on an intervention of sectorialization of people that accessed to services, the use of masks, the early identification and isolation of cases and their family members, and the limitation of movements within the camp. The second evaluated the impact of preventive pharmacological interventions such as the use of hydroxychloroquine, ivermectin, povidone-iodine, zinc, and vitamin C, in different dosages and combinations, to a group of immigrant workers in a city dormitory in Singapore. The third study evaluated an intervention to increase vaccination coverage within a Latino immigrant community in the United States, moving the location of vaccine supply throughout the most frequented contexts by the immigrant community to access the city services. The results of the first and second studies suggest impacts for some of the proposed interventions even if they have been partially overcome due to the use of mass vaccination. The third showed a reduction in vaccine hesitancy and an increase in vaccination uptake and a snowball effect. CONCLUSIONS: the systematic review identified few heterogeneous studies, preventing any generalization of the results. Probably, the low scientific production does not reflect the successful experiences implemented. In the case of a possible resumption of the epidemic or new emergencies, it will be necessary to rely on indirect evidence and the scientific community should consider more the responsibility to evaluate and make available the experiences gained in the field. A constant monitoring activity of the evidence that will be necessary to updating the results for suggest consolidated prevention measures to for controlling the incidence of COVID-19 in immigrants during a possible resumption of the epidemic and for application in other similarly emergency contexts.

Protective and Promotive Factors in Migrant and Refugee Children Facing Violence: A Systematic Review.

Migrant and refugee children are at risk of experiencing various forms of violence before, during, or after migration. This study systematically identifies, reviews, and synthesizes evidence on protective and promotive factors that contribute to the resilience of migrant and refugee children facing violence. Of the 3,663 articles identified through search in five electronic databases and snowball technique, 31 quantitative or qualitative research studies met the inclusion criteria. To be included in the review, studies had to (1) have been published after 2013; (2) have been published in English; (3) include migrant or refugee children and/or adolescents aged 18 or below at the time of interview or migration; (4) mention some types of maltreatment, peer violence, or community violence faced by the children or adolescents; (5) examine the association between the hypothesized protective or promotive factors and indicators of adaptive functioning; and (6) include outcome measures that assessed adaptive functioning such as well-being or absence or low-levels of internalizing and externalizing problems. Quality assessment did not lead to the exclusion of any studies. Five levels of protective and promotive factors were identified: individual, family, school and peers, community, and spatial dimension, which converged to highlight the importance of regulatory, interpersonal, and meaning-making strengths for these children. Understanding and addressing these protective and promotive factors is crucial for promoting well-being and improving mental health outcomes in migrant and refugee children facing violence. The findings of this review have significant implications for designing intervention programs and public policies that support these children effectively.

Development of a Refugee Health Research Agenda in North America.

The lack of a cohesive, stakeholder-informed refugee health research agenda has been a barrier to promoting, funding, and conducting health research with refugee populations in North America. A cross-sectional study was conducted among individuals working in refugee health in North America (N = 93) to describe major domains within the field of refugee health research and to develop refugee health research priorities. Open-ended survey questions included: (1) What research topics specific to refugee research would you like to see in an international research agenda? (2) Please describe current and important gaps that you believe exist in refugee research and why? Overarching themes focused on the need for the development of research partnerships with refugee communities that are intentional, effective, and driven by the needs of refugee communities. The survey also identified a need for best practices in creating sustainable, community-based research partnerships (effective models and evidence-based strategies) that translate across 12 domains. The refugee health research priorities for North America described in this manuscript should continue to be modified over time as political, economic, social, and medical contexts change.

The Impact of Sexual Violence Victimization on Acculturative Stress and Hazardous Drinking Among North Korean Refugee Women in South Korea.

North Korean refugee women face significant risks of traumatic experiences, including sexual exploitation and violence, both in North Korea and during migration. However, there is limited research on the long-term effects of sexual violence among these women. Using data from 245 North Korean refugee women, collected by the National Human Rights Commission of Korea in 2017, we examined the impact of sexual violence victimization during pre-migration and intermediate stages on acculturative stress and hazardous drinking. Our findings revealed that women who experienced sexual violence during the intermediate stage were more likely to engage in hazardous drinking, though no significant effect was found on acculturative stress. This study provides valuable insights for policymakers aiming to reduce negative psychological outcomes in vulnerable populations.

Exploring the Relationship Between Experiences of Violence and Subjective Wellbeing: A Cross-Sectional Survey Among School Teachers in Nyarugusu Refugee Camp in Tanzania.

Experiences of violence have been reported to be associated with lower levels of subjective wellbeing (SWB). However, little is known about this association in conflict settings and among forcibly displaced populations. In this study we exploit data from a representative sample of refugee teachers from Nyarugusu Refugee Camp collected as part of a larger study, to examine the association between demographic characteristics and SWB, and between experiences of violence and SWB. Three cross-sectional surveys of primary and secondary school teachers were conducted, collecting data on lifetime experience of violence (physical and sexual) and SWB (measured by life satisfaction and current happiness, on 1-5 Likert scales). Linear mixed models were used to estimate the associations between violence and SWB accounting for teacher and school clustering, unadjusted and adjusted for main factors associated with SWB. The 3 surveys included 1,666 responses completed by 885 teachers. Country of origin and number of meals consumed per day were strongly associated with SWB. Individuals who experienced physical violence reported on average, 0.13 lower life satisfaction scores (95% CI [-0.23, -0.02], p = .016) compared to those who did not experience physical violence, while survivors of sexual violence reported on average, 0.24 lower happiness scores ([-0.43, -0.05], p = .014) compared to those who did not experience sexual violence, after adjusting for confounders and clustering. We found an important negative association between past experience of violence and SWB in a refugee camp setting. These findings contribute to the evidence that violent experiences are likely to have a long-lasting impact on people's wellbeing. There is a need for improved mental health and psychosocial support in humanitarian settings.

Refugees in the Global North: dynamics, dilemmas, and constructive engagement.

The movement of refugees across borders has become a persistent feature of contemporary global society. Despite the protections offered by the 1951 Refugee Convention, which has been ratified by some 146 states, countries in the Global North have adopted a variety of contradictory and incoherent policy responses to refugees and migrants. These responses have been influenced by anti-immigrant public sentiment and growing popular demands to restrict and manage cross-border movements. The dynamics and dilemmas of contemporary refugee movements and policy responses create challenges for advocates and practitioners. Refugee policies have been complicated by the phenomenon of 'mixed migration', where migratory patterns reflect the intersection of economic choices and forced migration. Within this context, we propose that policies of many prosperous countries, which thus far focus almost exclusively on restriction, be guided by considerations of shared responsibility and human dignity.

Determinants for the humanitarian workforce in migrant health at the US-Mexico border: optimizing learning from health professionals in Matamoros and Reynosa, Mexico.

Introduction: Shortages of health professionals is a common problem in humanitarian settings, including among migrants and refugees at the US-Mexico border. We aimed to investigate determinants and recruitment recommendations for working with migrants to better understand how to improve health professional participation in humanitarian efforts. Methods: Semi-structured interviews were conducted with health professionals working with migrants at the US-Mexico border in Matamoros and Reynosa, Mexico. The study aimed to identify motivations, facilitators, barriers, and sacrifices to humanitarian work, and recommendations for effective learning approaches to increase participation. Participants included health professionals working within humanitarian organizations to deliver healthcare to migrants living in non-permanent encampments. Interviews lasted approximately 45 min and were analyzed in NVivo14 using a validated codebook and team-based methodology. Results: Among 27 participants, most were female (70%) with median age 32. Health professionals included nurses (41%), physicians (30%), logisticians (11%), social workers (7%), an EMT (4%), and a pharmacist (4%) from the US (59%), Mexico (22%), Cuba (11%), Peru (4%), and Nicaragua (4%) working for four organizations. Participants expressed internal motivations for working with migrants, including a desire to help vulnerable populations (78%), past experiences in humanitarianism (59%), and the need to address human suffering (56%). External facilitators included geographic proximity (33%), employer flexibility (30%), and logistical support (26%). Benefits included improved clinical skills (63%), sociocultural learning (63%), and impact for others (58%). Negative determinants included sacrifices such as career obligations (44%), family commitments (41%), and safety risks (41%), and barriers of limited education (44%) and volunteer opportunities (37%). Participants criticized aspects of humanitarian assistance for lower quality care, feeling useless, and minimizing local capacity. Recommendations to increase the health workforce caring for migrants included integration of humanitarian training for health students (67%), collaborations between health institutions and humanitarian organizations (52%), and improved logistical and mental health support (41%). Conclusion: Health professionals from diverse roles and countries identified common determinants to humanitarian work with migrants. Recommendations for recruitment reflected feasible and collaborative approaches for professionals, organizations, and trainees to pursue humanitarian health. These findings can be helpful in designing interventions to address workforce shortages in humanitarian migrant contexts.

"This is not why we brought our children here!": Tensions and challenges in responding to Adverse Childhood Experiences in African-background refugee families.

BACKGROUND: Refugee-background children face increased risks of Adverse Childhood Experiences (ACEs). However, their access to support services continues to pose significant challenges. A need exists to understand how families and child welfare services respond to ACEs to inform the design of culturally responsive interventions. PURPOSE: Based on a broader qualitative study with parents and practitioners, this article shares the findings on the tensions and challenges of addressing ACEs in African-background refugee families in New South Wales (NSW), Australia. METHODOLOGY: The research employed a qualitative micro-ethnographic approach. The first author interviewed 12 parents and 12 clinical practitioners and conducted two focus group discussions with African community leaders: the first with six and the second with five participants. Transcripts were analysed using reflexive thematic analysis. RESULTS: Three central themes reflected the tensions and challenges associated with responding to ACEs: reliance on informal support, the "messy" child protection services, and gaps in the child protection system. Parents responded to ACEs through various cultural and spiritual practices and by allocating most family resources to the needs of the children directly affected by ACEs. This came at the expense of resources available for the victim's siblings, who were also experiencing ACEs directly or vicariously. Professional responses were reactive, and the experiences taking place before resettlement were overlooked. Interactions between parents and child welfare services were particularly adversarial in the case of child removal from the family. CONCLUSION: Refugee-background families face unique challenges in accessing services, but they also have capacities that can be harnessed in collaborative interventions addressing ACEs. Culturally responsive and trauma-informed support models may assist in improving interventions addressing ACEs.

Firearm-related threats before migrating to the USA from Latin America and the Caribbean.

BACKGROUND: Every year, thousands of people from Latin America and the Caribbean are migrating to the USA. Policy-makers have argued that US firearms are fuelling violence in these countries and are contributing to migration. The objective of this article is to examine the proportion of immigrants from Latin America and the Caribbean arriving at the US border who have previously been threatened with a firearm. This article further explores sociodemographic factors associated with the likelihood of previous firearm-related threats, whether those threats are associated with post-traumatic stress disorder, as well as the reasons behind those threats. METHODS: Data were obtained from a survey of migrants recruited at the southern US border from March 2022 to August 2023. To be selected, respondents had to be 18 years of age or older, had to speak English or Spanish and come from a Latin American or Caribbean country. We used descriptive statistics and a logistic regression. RESULTS: We analysed 321 cases. Roughly, 48% of respondents reported previous firearm-related threats. Males and respondents coming from Honduras, Venezuela and El Salvador were more likely to report previous firearm-related threats. There was a strong association between previous firearm-related threats and signs of post-traumatic stress disorder. Most threats occurred during robberies or extortions, but other threats were perpetrated by authorities, to prevent crime reporting, or by intimate partners. CONCLUSION: Understanding the violence, particularly firearm-related violence, experienced by those migrating to the USA from Latin America and the Caribbean could help guide policy discussion and actions.

Strategies and sacrifices of family caregiving in the Somali-American community: a qualitative study.

BACKGROUND: Among the many pressing concerns of the Somali-American community, and other similar immigrant and refugee communities as they grow in the United States, is the provision of care for older adults and adults with disabilities. The implications of effective caregiving range from the facilitation of community building and place-making to the delivery and management of healthcare on a systemic level. However, little is currently known about Somali-American family caregivers, including their duties and responsibilities, primary concerns, and the impacts of surrounding influences on their ability to fulfill their role. METHODS: Semi-structured interviews were conducted with 10 Somali-American family caregivers in Somali language. The resulting transcripts were translated into English by a professional interpreter and analyzed using an inductive thematic analysis approach. A key informant from the community was additionally consulted for insights regarding cultural nuances and interpretations of idiomatic expressions and concepts. RESULTS: Thematic analysis of the reports revealed the principal themes of visitation, patient accompaniment, and self-sacrifice through acceptance and God-consciousness as pervasive and salient concerns across participants. Furthermore, the heightened stresses of the COVID-19 pandemic revealed just how severe the consequences can be when access to culturally habituated navigational tools and coping mechanisms are restricted. CONCLUSIONS: In light of our findings, the growing concern for discrimination and sociocultural discord in the Somali-American community presents a particularly prescient threat to the well-being and sustainability of family caregivers. Their experiences must be understood and used to promote education and partnership between the healthcare system and the community in order to build trust and ensure a healthy future for this indispensable population.

Digital Migration Infrastructure in return-writing: visualizing the migration landscape of India.

Digitization has carved out the migration patterns of immigrants over the recent years of increased technological interventions in human mobility. Migration infrastructures, which typically refer to the physical, commercial, humanitarian, and governmental modes of operation, are multidimensional in nature. Digital infrastructures are equally important to the physical ones as digital technologies facilitate these migration processes through agents like hardware, software, and mediating actors. Amongst the multiple forms of migration, the concept of return-writing and nostalgia-struck-returnees encompass individuals whose life trajectories run parallel to the homeland. The narrative of return to the homeland emerges aßs a dominant motif in literature due to the rising trends of globalization, the writers' reflection on their own migrant experiences, and publishing trends meeting the demand of the global book market. The objective is to assess the role of digital migration infrastructures in return migrations to India through a close reading of the selected texts and review of postcolonial literary theories by using conditional operation in Python. The study here explores the varied nuances of return migration with a primary focus on the external conditions of travel in migration literature. The paper aims to analyze the genre of return-writing in Indian English literature, through three novels over a period of two decades, i.e., from 2000-2023. The selected texts, beginning with Amit Chaudhuri's A New World (2000), Gun Island (2019) by Amitav Ghosh, and Devika Rege's novel Quarterlife (2023), offer a panoramic view of return migration. These novels are extensive in the time period of technological interventions and in depiction of return migration. The Python code examines the extent of existence of a set of digital migration infrastructure keywords by analyzing the content of the novels and creates bar plots and charts to offer a visual representation of the classification results. The resulting trend traces the increased intervention of Digital Migration Infrastructure in the recent migration literature.

Adult refugees' perspectives on the impact of trauma and post-migration hardships on learning.

Background: Research shows that adult refugees' well-being and future in the reception country heavily depend on successfully learning the host language. However, we know little about how adult learners from refugee backgrounds experience the impact of trauma and adversity on their learning.Objective: The current study aims to investigate the perspectives of adult refugee learners on whether and how trauma and other adversity affect their learning.Methods: We conducted in-depth interviews with 22 adult refugees (10 women) attending the Norwegian Introduction Programme (NIP). The participants came from six Middle Eastern, Central Asian, and African countries. Two questionnaires were included, one about past stressful life events (SLESQ-Revised), and one about mental health symptoms and current psychological distress following potentially traumatic experiences (PCL-5).Results: Participants held varying beliefs about trauma's impact on learning: that it had a constant impact, that it was situational, or that it had no impact. Other aspects they brought up as having an essential effect on learning and school attendance include psychological burdens from past and present school experiences, and post-migration hardships such as loneliness, depression, ongoing violence, and negative social control. Post-migration trauma and hardships exacerbated the burden of previous trauma and were frequently associated with a greater negative influence on learning.Conclusion: This study adds new insights from adult refugee learners themselves into how post-migration hardships as well as trauma can impact their learning, and the importance of recognising their struggles. A safe space is required for refugees to open up about their difficulties in life and with learning. This knowledge can be used to enhance teaching practices, foster better teacher-student relationships, and inform policy-making decisions, ultimately benefiting both individuals and society.

Adult refugee learners' own perspectives on the impact of trauma on learning varied from constant to situational to no impact at all.Other factors identified as impacting learning and school attendance included, amongst others, psychological burdens from past and present school experiences, ongoing violence, forced family separation, and negative social control.Post-migration trauma and hardships were frequently associated with a greater negative influence on learning than the burden of previous trauma.

A qualitative study of negative sociocultural experiences of accessing primary health care services among Africans from refugee backgrounds in Australia: implications for organisational health literacy.

BACKGROUND: Primary health care is the first point of contact for patients from refugee backgrounds in the Australian health system. Sociocultural factors, including beliefs and value systems, are salient determinants of health literacy and access to primary health care services. Although African refugees in Australia have diverse sociocultural backgrounds, little is known about the influence of sociocultural factors on their experiences of accessing primary health care services. Guided by the theoretical framework of access to health care, this study examined from the perspective of African refugees how culturally and religiously conditioned, constructed and bound health beliefs, knowledge and practices influence their experiences of access to, acceptance and use of primary health care services and information in Australia. METHODS: This exploratory, qualitative study involved 19 African refugees from nine countries living in New South Wales, Australia. Semi-structured interviews were conducted and recorded using Zoom software. The interviews were transcribed verbatim and analysed using a bottom-up thematic analytical approach for theme generation. RESULTS: Four main themes were identified. The themes included: participants' experiences of services as inaccessible and monocultural and providing information in a culturally unsafe and insensitive manner; the impact of the clinical care environment; meeting expectations and needs; and overcoming access challenges and reclaiming power and autonomy through familiar means. The findings generally support four dimensions in the access to health care framework, including approachability, acceptability, availability and accommodation and appropriateness. CONCLUSION: African refugees experience significant social and cultural challenges in accessing primary health care services. These challenges could be due to a lack of literacy on the part of health services and their providers in servicing the needs of African refugees. This is an important finding that needs to be addressed by the Australian health care system and services. Enhancing organisational health literacy through evidence-informed strategies in primary health systems and services can help reduce disparities in health access and outcomes that may be exacerbated by cultural, linguistic and religious differences.

The use of creative art therapy to address the mental health of refugee adolescents: a systematic review.

INTRODUCTION: Creative art therapy (CAT) has become increasingly popular as a means of promoting positive mental health among adolescent refugees when accompanied by interdisciplinary interventions that engage families and communities. In this pre-registered systematic review (PROSPERO: CRD42022372538), we evaluated and synthesized the available literature reporting the use of CAT as a diagnostic, treatment and mental health promotion intervention with adolescent refugees, aged 10-24 years. METHODOLOGY: We conducted a systematic search of the grey and black literature published in English and Arabic between 2012 to 2022 on 10 databases. RESULTS: Systematic database searches revealed 397 articles but only 5 met our inclusion criteria. These studies reported some positive outcomes but the evidence supporting the effectiveness of CAT as a diagnostic, treatment and mental health promotion intervention with adolescent refugees, aged 10-24 years is inconclusive. CONCLUSION: The findings of this review point to the need for more methodologically robust studies that describe the intervention, implementation, and therapeutic approaches in greater detail to strengthen the evidence for the use of CAT with adolescent refugees.