Self-efficacy and knowledge to improve sexual reproductive health and wellbeing in humanitarian settings (SEEK)

Principal Investigators: Dr. Shadi Saleh, AUB; Dr. Veloshnee Govender, WHO

Research Snapshot: When self-efficacy and wellbeing shape family planning decisions

This single-blind randomised controlled trial found that community-led programs combining SRH and mental health and psycho-social support (MHPSS) are feasible and acceptable in humanitarian settings.

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What did the study set out to achieve?

Recent evidence shows that refugee women and girls in Lebanon and other humanitarian settings, face limited access to SRH and psychosocial support services. Addressing these gaps requires feasible, acceptable, and effective approaches that strengthen knowledge, skills, and self-efficacy (belief in ones’ capacity to influence ones’ own life). This is the first study in the Middle East to evaluate an integrated SRH and wellbeing intervention for Syrian refugee adolescent girls and young women.

A single-blind randomised controlled trial was conducted in two primary healthcare centers in the Beqaa Valley. Trained female paraprofessionals delivered integrated SRH and psychosocial sessions to married Syrian adolescent girls and young women refugees aged 15-24 years. Outcomes were assessed at baseline, post-intervention, and three months post-intervention using validated tools.

What were the key findings?

The SEEK trial found that community-led programs combining SRH and mental health and psycho-social support (MHPSS) are feasible and acceptable in humanitarian settings. Delivered by trained refugee paraprofessionals, the intervention improved well-being, confidence, and decision-making among women and girls. The study highlights the two factors of self-efficacy and wellbeing as essential drivers of improved family planning decision making, while also showing the challenges that can limit access to and uptake of family planning services and the need for further research in this area.

• The trial showed mixed effects. There was limited impact on the primary outcome of family planning service use, and on fertility intentions and STI symptom reporting. However, meaningful improvements were seen in secondary outcomes: participants reported gains in wellbeing, coping skills, problem-solving self-efficacy, and social support, with benefits in coping and social support sustained three months later.
• Analysis showed that while the intervention alone negatively impacted family planning decision making consensus between women/ girls and male partners, the addition of self-efficacy and wellbeing transforms this effect into a positive one.
• SEEK also improved SRH knowledge, including understanding STI prevention and transmission, and encouraged reliance on professional health sources. Uptake of family planning remained constrained, influenced by male partners and limited-service availability. A process evaluation highlighted both strengths and challenges for implementation.

What does this mean for policymakers and practitioners?

Findings indicate that community-led support combining SRH with psychosocial support is both feasible and acceptable, strengthening psychosocial wellbeing, self-efficacy and decision-making. The study highlights the two factors of self-efficacy and wellbeing as essential drivers of improved family planning decision making.

There may be value in institutionalising SRH–MHPSS integration in policymaking and service delivery. Integrated approaches could strengthen referral pathways, reduce stigma, improve continuity of care, and ensure sustainability beyond short-term projects while supporting resilience among displaced populations. Engaging paraprofessionals and local women’s committees could help reach beyond formal health systems.

However, limited effects on service uptake point to wider health systems constraints. Conflict and escalation of war during implementation may have contributed to shifting priorities toward basic survival and limited access to care. Other systemic and sociocultural factors, including limited engagement of male partners, families, and the wider community, likely also play a role and warrant further research to better understand their influence on family planning use.