This case study series documents the experience of R2HC-funded research teams in engaging with people affected by crisis. The full case series can be found here.
This study was led by Yale University in partnership with Mercy Corps, Queen Margaret University, Taghyeer, University of Western Ontario and Harvard University.
The study assessed the health impact of a psychosocial intervention (led by Mercy Corps) comprising structured, group-based activities for youth displaced by the conflict. The effectiveness of the intervention was tested with a randomised controlled trial with both Syrian refugee and Jordanian youth This measures the impacts on this intervention on mental health, cognitive skills, physiological responses, and resilience.
The study team found that a structured approach to stress attunement, implemented by trained community workers, can be effective in reducing psychosocial stress and insecurity. This included physiological evidence: cortisol levels, analysed from samples of hair pre/post intervention, showed effective stress regulation.
A cornerstone of this study was to integrate compelling science with community engagement. The study used compelling scientific methods to demonstrate intervention impacts on young people’s mind, body, and brain; notably, young people were eager to engage with the best that science could offer (for example, the demonstration of reduced stress through measuring cortisol levels over time).
Recruitment of researchers from the community was fundamental to the research process. The study team included in-country scholars, humanitarian workers, and community leaders, and Syrian/Jordanian staff supporting recruitment, participation and informed consent.
“Researchers from the local community should be the ones initiating the research question, the research challenge and trying to find ways to understand and analyse and interpret. They know the root causes of the challenges because they know the culture and the context. They can also nuance the questions asked”
– Dr Rana Dajani
Local researchers worked in partnership with the global research team and were encouraged to have confidence in their expertise.
“Have confidence in yourself, you are the expert, you know your community better than anyone else. Involve your local community in the research, trust them, bring them along with you. Let them be your research assistants so that you can build sustainability going forward. Create a good and strong scientific community within your community”
– Dr Rana Dajani
Local research collaborators proved essential as the study team engaged communities on the acceptability of stress biomarkers and the relevance of control groups in a randomized trial. Equitable relationships were developed right at the start, beginning with a R2HC-funded pilot research, which secured informed consent with community members, and helped develop culturally relevant approaches for biomarker, qualitative, and survey data collection.
Local interpretation of data helped to ensure that the results were not ‘lost in translation’.
“Interpreting the data is very contextual – it has a lot of qualitative input to understand what the data means, how it should be interpreted and how it can be used. Without the local context - the local scientists - you could be missing the whole point or even misinterpreting to produce a result that is wrong or misleading”
– Dr Rana Dajani
Fostering a culture of equitable partnerships greatly benefited the research process. For example, the study team incorporated clear community feedback for positive metrics of refugee wellbeing, developing a brief, reliable and culturally relevant resilience scale.
“The whole field team saw themselves as research partners, not assistants. They were able to change the research process, it boils down to clear communication and listening.”
– Dr Catherine Panter-Brick
The research team knew that questions around war-related trauma could be upsetting, and that a random selection of youth into control and intervention groups needed to be implemented in an ethical way. Such issues were approached and resolved with community-led decision-making.
Local researchers not only co-designed, co-implemented, and co-adapted the research, but co-presented the results in the community. This in turn helped to generate greater awareness, and positively influenced engagement with and uptake of the findings. Furthermore, the importance of translation and good quality communication between partners cannot be underestimated, in all phases of the work including dissemination.
A sustained partnership with strong communication and layered conversations between all partners (funders, scholars, humanitarians, community-based organisations, media outreach) was essential to success. This partnership, based in ethical engagement, required constant listening, trust, teamwork and respect. Ethical engagement required the research team to be patient and flexible to allow the research process to take on its own momentum.
To find out more, please see the study profile, project website and award-winning documentary.
Panter-Brick C (2022). Energizing partnerships in research-to-policy projects. American Anthropologist.
Panter-Brick C, Eggerman M, Ager A, Hadfied K, Dajani R (2020). Measuring the psychosocial, biological, and cognitive signatures of profound stress in humanitarian settings: Impacts, challenges, and strategies in the field. Conflict and Health.
Chen A, Panter-Brick C, Hadfield K, Dajani R, Hamoudi A, Sheridan M (2019). Minds under siege: Childhood adversity, inhibitory control, and working memory in refugee and non-refugee adolescents. Child Development.
Panter-Brick C, Wiley K, Sancilio A, Dajani R, Hadfield K (2020). C-reactive protein, Epstein-Barr virus, and cortisol trajectories in war-affected adolescents: Links with stress, mental health, and cognitive function during a randomized controlled trial. Brain Behavior and Immunity.
Panter-Brick C, Kurtz J, Dajani R (2018). What strong partnerships achieve: Innovations in research and practice. Humanitarian Exchange 72:15-19.
Dajani R, Hadfield, K, van Uum, S, Greff, M, Panter-Brick C (2018). Hair cortisol concentrations in war-affected adolescents: A prospective intervention trial. Psychoneuroendocrinology 89:138-146.
With thanks to Dr Rana Dajani and Dr Catherine Panter-Brick for their contributions to this case study, and the study team and participants for their contributions to this research.
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