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      Scaling up task-sharing psychological interventions for refugees in Jordan: a qualitative study on the potential barriers and facilitators

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          Abstract

          Training nonspecialists in providing evidence-based psychological interventions (i.e. task-sharing) can effectively increase community access to psychological support. However, task-sharing interventions for this purpose are rarely used at scale. The aim of this study was to examine the factors influencing the potential for scaling up (i.e. scalability) of a task-sharing psychological intervention called Problem Management Plus (PM+) for Syrian refugees in Jordan. Semi-structured individual ( n = 17) and group interviews ( n = 20) were conducted with stakeholders knowledgeable about PM+ and the mental health system for Syrian refugees in Jordan. Using ‘system innovation perspective’, this study conceptualized the context as landscape developments, and systemic considerations were divided into culture (shared ways of thinking) and structure (ways of organizing). Political momentum was identified as a landscape trend likely facilitating scaling up, while predicted reductions in financial aid was regarded as a constraint. In terms of culture, the medicalized approach to mental health, stigma and gender were reported barriers for scaling up PM+. Using non-stigmatizing language and offering different modalities, childcare options and sessions outside of working hours were suggestions to reduce stigma, accommodate individual preferences and increase the demand for PM+. In relation to structure, the feasibility of scaling up PM+ largely depends on the ability to overcome legal barriers, limitations in human and financial resources and organizational challenges. We recommend sustainable funding to be made available for staff, training, supervision, infrastructure, coordination, expansion and evaluation of ‘actual’ scaling up of PM+. Future research may examine the local feasibility of various funding, training and supervision models. Lessons learned from actual scaling up of PM+ and similar task-sharing approaches need to be widely shared.

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                Author and article information

                Contributors
                On behalf of : On behalf of the STRENGTHS consortium
                Journal
                Health Policy Plan
                Health Policy Plan
                heapol
                Health Policy and Planning
                Oxford University Press (UK )
                0268-1080
                1460-2237
                April 2023
                12 January 2023
                12 January 2023
                : 38
                : 3
                : 310-320
                Affiliations
                KIT Royal Tropical Institute, KIT Health , Mauritskade 64, Amsterdam 1092 AD, The Netherlands
                departmentAthena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam , De Boelelaan 1085, Amsterdam 1081 HV, The Netherlands
                KIT Royal Tropical Institute, KIT Health , Mauritskade 64, Amsterdam 1092 AD, The Netherlands
                KIT Royal Tropical Institute, KIT Health , Mauritskade 64, Amsterdam 1092 AD, The Netherlands
                NHS England , 133-155 Waterloo Road, London SE1 8UG, UK
                KIT Royal Tropical Institute, KIT Health , Mauritskade 64, Amsterdam 1092 AD, The Netherlands
                departmentAthena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam , De Boelelaan 1085, Amsterdam 1081 HV, The Netherlands
                departmentDepartment of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine , Keppel Street, London WC1E 7HT, UK
                departmentDepartment of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS , Achterstraße 30, Bremen 28359, Germany
                University of Bremen, Health Sciences , Bibliothekstrasse 1, Bremen 28359, Germany
                departmentAthena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam , De Boelelaan 1085, Amsterdam 1081 HV, The Netherlands
                departmentSchool of Psychology, University of New South Wales , Kensington, Sydney NSW 2052, Australia
                departmentDivision of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet , Solnavägen 1, Solna 171 77, Sweden
                International Medical Corps , Al Shareef Abd Al Hameed Sharaf St 9, Amman, Jordan
                International Medical Corps , Al Shareef Abd Al Hameed Sharaf St 9, Amman, Jordan
                departmentSchool of Psychology, University of New South Wales , Kensington, Sydney NSW 2052, Australia
                departmentDepartment of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam , De Boelelaan 1105, Amsterdam 1081 HV, The Netherlands
                departmentDepartment of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam , De Boelelaan 1105, Amsterdam 1081 HV, The Netherlands
                departmentInternational Institute for Psychotherapy, Babeș-Bolyai University , 37 Republicii Street, Cluj-Napoca, Romania
                departmentDepartment of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine , Keppel Street, London WC1E 7HT, UK
                Author notes
                *Corresponding author. KIT Royal Tropical Institute, KIT Health, Mauritskade 64, Amsterdam 1092 AD, The Netherlands. E-mail: a.woodward@ 123456kit.nl
                [12]

                On behalf of the STRENGTHS consortium: http://strengths-project.eu/en/strengths-project/partners/ (Accessed 10 January 2023).

                Author information
                https://orcid.org/0000-0002-1560-4208
                https://orcid.org/0000-0002-9607-819X
                Article
                czad003
                10.1093/heapol/czad003
                10019561
                36631951
                3864a055-7730-4763-8d4e-97c8a38d4aa3
                © The Author(s) 2023. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 October 2022
                : 22 December 2022
                : 11 January 2023
                : 09 January 2023
                : 06 February 2023
                Page count
                Pages: 11
                Funding
                Funded by: H2020 Societal Challenges, DOI 10.13039/100010676;
                Award ID: 733337
                Categories
                Original Article
                AcademicSubjects/MED00860

                Social policy & Welfare
                refugees,jordan,syria,mental health,implementation,research to policy,health systems research,qualitative research

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