Shaping the future: Our strategy for research and innovation in humanitarian response.

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Principal Investigator: Mark Van Ommeren, World Health Organisation

What did this study set out to achieve?

The overall objective of this research was to help improve the evidence base and availability of psychosocial interventions that are scalable and accessible even when humanitarian access is limited, thus overcoming current barriers to implementation of evidence-based support. The study aimed to evaluate the effectiveness of Self Help Plus (SH+) with South Sudanese refugee women. SH+ is an innovative WHO intervention package that;

  • (a) is delivered to affected people via a 5-session guided self-help multimedia course;
  • (b) ensures fidelity to evidence-based techniques via pre-recorded audio visual content and illustration-based self-help book;
  • (c) can be implemented in areas where humanitarian access is limited; and
  • (d) is likely readily scalable.

SH+ is based on acceptance and commitment therapy (ACT), a form of cognitive-behavioural therapy, with distinct features.

The research was successfully undertaken. A cluster randomised controlled trial was conducted among female South Sudanese refugees living in Rhino Camp Refugee Settlement in Northern Uganda. Fourteen villages were included in the definitive cRCT with 694 participants randomised to each condition. Baseline assessment included outcome measures of psychological distress, functional impairment, depression and PTSD symptoms, feelings of anger, interethnic relations, subjective wellbeing, psychological flexibility, as well as moderators (trauma history, adherence, health service use) and cost-benefit indicators. SH+ was provided by trained lay facilitators who had 12-16 years of education (e.g. post-secondary school diploma) but no previous clinical training or experience in providing mental health care. The primary outcome –levels of psychological distress– was measured immediately after SH+ and after 3 months with the Kessler 6 (K6) Scale.

Dr Mark van Ommeren


By targeting psychological distress, regardless of whether people have mental disorders, while reducing reliance on scarce specialists and tripling the number of participants reached per session, guided self-help has enormous potential to improve reach and access to psychological support for people affected by adversity.

Dr Wietse Tol

Johns Hopkins Bloomberg School of Public Health and HealthRight International, USA

SH+ provides strategies for managing distress arising in the context of a range of adversities including interpersonal violence, armed conflict, and chronic poverty. The approach is based on acceptance and commitment therapy, a modern form of cognitive‐behavioural therapy, that focuses on increasing psychological flexibility—primarily through mindfulness exercises—and promotes behaviours that are in line with a person’s values

Dr Claudia Garcia Moreno


There are still critical questions left to answer, including why effect sizes reduce over time; whether benefits can be maintained by integrating SH+ into existing humanitarian programmes related to poverty, gender-based violence, or other community health concerns; and whether this approach is cost-effective compared with established psychological interventions.

What were the key findings?

  • SH+ was shown to be effective and feasible to provide with minimal support / supervision.
  • Among female adult South Sudanese refugees living in a refugee settlement in Northern Uganda, with moderate levels and above of psychological distress, delivery of the SH+ intervention compared with enhanced usual care resulted in clinically significant reductions in general psychological distress as well as secondary outcomes (e.g. functioning, wellbeing) at 3 months.
  • The project also demonstrated the feasibility of delivering SH+ by an NGO suggesting that it can be implemented within existing health and community services. For example, SH+ could be provided at local health centres by community health workers or similar personnel.
  • The study noted a high rate of engagement (83% average across all sessions) which suggests that SH+ might be attractive and meaningful to participants.

What does this mean for policymakers and practitioners?

Final adaptations were made to the SH+ package for South Sudanese populations (available on request from WHO – and SH+ is now included on the MHIN innovations website .

A second trial was funded by R2HC to ensure the results can be replicated with another population in another humanitarian setting. In addition, SH+ was tested in a trial with refugees in six European countries to look at its effects in preventing onset of mental disorder (funded by European Commission Horizons 2020 programme). On the basis of positive results from this research, WHO has now disseminated and published SH+  in 30 languages and as a web app, and has generated new research and innovation on its utility as a guided self-help intervention, including a completed RCT focused on health care workers in crisis settings. SH+ is now being implemented as part of the ongoing Ukrainian response across health, social protection, defence, education and security sectors, and in an increasing number of settings including in Türkiye as well as Uganda.

Dissemination of SH+ is also ongoing in Uganda and South Sudan including implementation research to further understand performance at scale. Elrha’s Humanitarian Innovation Fund has funded SH+ under it’s Journey to Scale programme, more information is available on the project page.

Women in Siripi participate in an SH+ session
The South Sudanese version of the SH+ book
Editing of the SH+ audio in a local studio
Getting ready to facilitate the first course


Impact Case Study Mental Health and Psychosocial Support, Research Uptake

Impact Case Study: Effectiveness of a group-based stress management self-help programme for humanitarian settings

Manual, Tool Mental Health and Psychosocial Support

Doing What Matters in Times of Stress: An Illustrated Guide

Peer Reviewed Mental Health and Psychosocial Support

Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial

Article Mental Health and Psychosocial Support

Scalable psychological interventions for people affected by adversity

Peer Reviewed

Self-Help Plus (SH+): A New WHO Stress Management Package

Article, Peer Reviewed Mental Health and Psychosocial Support

Self Help Plus: study protocol for a cluster-randomised controlled trial of guided self-help with South Sudanese refugee women in Uganda

Article, Peer Reviewed Mental Health and Psychosocial Support

Translation, adaptation, and pilot of a guided self-help intervention to reduce psychological distress in South Sudanese refugees in Uganda

Article, Peer Reviewed Mental Health and Psychosocial Support

Feasibility of a guided self‐help intervention to reduce psychological distress in South Sudanese refugee women in Uganda

Latest Updates

Research Impact Case Study Published

Jul 2023

This study was selected by the R2HC for our Impact Case Study series. The case study is now available to view online.


Peer-reviewed article published in the Lancet Global Health

22 Jan 2020

The study's article 'Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial' is published in the Lancet Global Health.


SH+ trial completed: what are the next steps?

Feb 2018

The Self Help Plus (SH+) Uganda team is pleased to announce that primary data collection for the full-scale clinical trial of SH+ wrapped up with the close of 2017.


Building capacity through research: piloting SH+ with South Sudanese Refugees

Mar 2017

On the 26th and 27th of January, the Self Help Plus (SH+) team met in Uganda to discuss the results from two previous pilot studies: one uncontrolled pilot and one…


The importance of piloting in the development of technology-assisted psychological interventions

Feb 2017

In our last blog, we introduced the SH+ project with South Sudanese refugees in Rhino Camp, Northern Uganda. Here we will discuss the importance of piloting when developing a technology-assisted…


Feasibility and acceptability of a new self-help intervention

May 2016

Filling a research gap in humanitarian settings: A scalable psychosocial support programme to meet the needs of South Sudanese refugees in Uganda After decades of conflict, hostilities re-commenced in South…


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