Principal Investigator: Mark Van Ommeren, World Health Organisation
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.
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.View
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.View
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…View
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…View
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…View
A second trial is now underway to ensure the results can be replicated with another population in another humanitarian setting (See related project below). In addition, SH+ is being tested in a trial with refugees in 6 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 future research, WHO plans to disseminate and publish SH+ in a number of languages and continue to innovate ways to make the package simpler to train and scale (e.g. online training courses).
Dissemination of SH+ is also ongoing in Uganda and South Sudan including implementation research to further understand performance at scale.
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.
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
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.
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