Browsing by Person "Ager, Alastair"

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10 years of the Syrian conflict: A time to act and not merely to remember [Comment]
(Elsevier, 2021-03-12) Jabbour, Samer; Leaning, Jennifer; Nuwayhid, Iman; Ager, Alastair; Cammett, Melani; Dewachi, Omar; Fouad, Fouad M.; Giacaman, Rita; Sapir, Debarati Guha; Hage, Ghassan; Majed, Ziad; Nasser, Rabie; Sparrow, Annie; Spiegel, Paul; Tarakji, Ahmad; Whitson, Sarah Leah; Yassin, Nasser
A process study of early achievements and challenges in countries engaged with the WHO Special Initiative for Mental Health
(BioMed Central, 2024-10-21) Ager, Alastair; Hermosilla, Sabrina; Schafer, Alison; Kestel, Dévora
Background: There is increasing awareness of the importance of the transformation of mental health systems. Launched in 2019, the WHO Special Initiative for Mental Health seeks to accelerate access to quality and affordable care for mental health conditions as an integral component of Universal Health Coverage. Nine countries are currently engaged with the initiative. Methods: This study reviewed processes of implementation—and progress achieved—across all settings by late 2022. It involved review of 158 documents provided by WHO relating to Special Initiative activities and 42 interviews with country-level stakeholders, WHO Regional and HQ personnel engaged with the initiative, and core donors. Documents were thematically coded using a template based upon the WHO framework of health system building blocks. Responses to structured interviews were coded based on an emergent thematic framework. Results: Documentation reported similar achievements across all domains; however challenges were reported most frequently in relation to service delivery, leadership and governance, and workforce. Issues of financing were notable in being twice as likely to be reported as a challenge than a success. Interviews indicated four major areas of perceived achievement: establishing a platform and profile to address mental health issues; convening a multi-stakeholder, participatory engagement process; new, appropriate services being developed; and key developments in law, policy, or governance around mental health. The planning process followed for the initiative, senior country-level buy-in and the quality of key personnel were the factors considered most influential in driving progress. Ambivalent political commitment and competing priorities were the most frequently cited challenges across all interviewees. Conclusions: The role of the Special Initiative in raising the profile of mental health on national agendas through a participatory and inclusive process has been widely valued, and there are indications of the beginnings of transformational shifts in mental health services. To secure these benefits, findings suggest three strategic priorities: increasing political prioritisation and funding for systems-level change; clearly articulating sustainable, transformed models of care; and promoting feasible and contextualised measures to support accountability and course correction. All are of potential relevance in informing global strategies for mental health systems transformation in other settings.
An analysis of policy and funding priorities of global actors regarding noncommunicable disease in low- and middle-income countries
(BMC, 2021-06-29) Jailobaeva, Kanykey; Falconer, Jennifer; Loffreda, Giulia; Arakelyan, Stella; Witter, Sophie; Ager, Alastair
Background: Noncommunicable diseases (NCDs), including mental health, have become a major concern in low- and middle-income countries. Despite increased attention to them over the past decade, progress toward addressing NCDs has been slow. A lack of bold policy commitments has been suggested as one of the contributors to limited progress in NCD prevention and management. However, the policies of key global actors (bilateral, multilateral, and not-for-profit organisations) have been understudied. Methods: This study aimed to map the key global actors investing in action regarding NCDs and review their policies to examine the articulation of priorities regarding NCDs. Narrative synthesis of 70 documents and 31 policy papers was completed, and related to data collated from the Global Health Data Visualisation Tool. Results: In 2019 41% of development assistance for health committed to NCDs came from private philanthropies, while that for other global health priorities from this source was just 20%. Through a range of channels, bilateral donors were the other major source of NCD funding (contributing 41% of NCD funding). The UK and the US were the largest bilateral investors in NCDs, each contributing 8%. However, NCDs are still under-prioritised within bilateral portfolios – receiving just 0.48% of US funding and 1.66% of the UK. NGOs were the key channels of funding for NCDs, spending 48% of the funds from donors in 2019. The reviewed literature generally focused on NCD policies of WHO, with policies of multilateral and bilateral donors given limited attention. The analysis of policies indicated a limited prioritisation of NCDs in policy documents. NCDs are framed in the policies as a barrier to economic growth, poverty reduction, and health system sustainability. Bilateral donors prioritise prevention, while multilateral actors offer policy options for NCD prevention and care. Even where stated as a priority, however, funding allocations are not aligned. Conclusion: The growing threat of NCDs and their drivers are increasingly recognised. However, global actors’ policy priorities and funding allocations need to align better to address these NCD threats. Given the level of their investment and engagement, more research is needed into the role of private philanthropies and NGOs in this area.
Barriers and Opportunities for WHO ‘Best Buys’ Non-Communicable Disease Policy Adoption and Implementation From a Political Economy Perspective: A Complexity Systematic Review
(Maad Rayan Publishing Company, 2023-12-31) Loffreda, Giulia; Arakelyan, Stella; Bou-Orm, Ibrahim; Holmer, Hampus; Allen, Luke N.; Witter, Sophie; Ager, Alastair; Diaconu, Karin
Background: Improving the adoption and implementation of policies to curb noncommunicable diseases (NCDs) is a major challenge for better global health. The adoption and implementation of such policies remain deficient in various contexts, with limited insights into the facilitating and inhibiting factors. These policies have traditionally been treated as technical solutions, neglecting the critical influence of political economy dynamics. Moreover, the complex nature of these interventions is often not adequately incorporated into evidence for policymakers. This study aims to systematically review and evaluate the factors affecting NCD policy adoption and implementation. Methods: We conducted a complex systematic review of articles discussing the adoption and implementation of WHO's ‘best buys' NCD policies. We identified political economy factors and constructed a causal loop diagram (CLD) program theory to elucidate the interplay between factors influencing NCD policy adoption and implementation. A total of 157 papers met the inclusion criteria. Results: Our CLD highlights a central feedback loop encompassing three vital variables: 1) the ability to define, (re)shape and pass appropriate policy into law; 2) the ability to implement the policy (linked to the enforceability of the policy and to addressing NCD local burden); 3) ability to monitor progress, evaluate and correct the course. Insufficient context-specific data impedes the formulation and enactment of suitable policies, particularly in areas facing multiple disease burdens. Multisectoral collaboration plays a pivotal role in both policy adoption and implementation. Effective monitoring and accountability systems significantly impact policy implementation. The commercial determinants of health (CDoH) serve as a major barrier to defining, adopting, and implementing tobacco, alcohol, and diet-related policies. Conclusion: To advance global efforts, we recommend focusing on the development of robust accountability, monitoring, and evaluation systems, ensuring transparency in private sector engagement, supporting context-specific data collection, and effectively managing the CDoH. A system thinking approach can enhance the implementation of complex public health interventions.
The case for (and challenges of) faith-sensitive psychosocial programming
(Wolters Kluwer - Medknow, 2018-09-29) Ager, Wendy; French, Michael; Fitzgibbon, Atallah; Ager, Alastair
Drawing upon evidence compiled in a recent literature review, we identify five arguments for seeking faith-sensitivity in psychosocial programming: it is indicated by the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support (MHPSS); it is implied by humanitarian law and principles; religion is an active and effective source of coping in many contexts; local faith actors have a ‘comparative advantage’ in humanitarian settings; and engaging with religion is coherent with emerging policy and practice. However, we also identify three major challenges in implementing faith-sensitive programming: religion may be used as a basis for maladaptive coping; religious engagement is considered a threat to impartiality; and practices of engaging with religion are poorly documented, disseminated and developed. This suggests the value of guidance on faith-sensitive psychosocial programming—consistent with the existing IASC MHPSS guidelines—suitable for implementation by both faith-based and non-faith-based actors.
Child friendly spaces impact across five humanitarian settings: A meta-analysis
(BMC, 2019-05-15) Hermosilla, Sabrina; Metzler, Janna; Savage, Kevin; Musa, Miriam; Ager, Alastair
Background: Humanitarian crises present major threats to the wellbeing of children. These threats include risks of violence, abduction and abuse, emotional distress and the disruption of development. Humanitarian response efforts frequently address these threats through psychosocial programming. Systematic reviews have demonstrated the weak evidence-base regarding the impact of such interventions. This analysis assesses the impact of Child Friendly Spaces (CFS), one such commonly implemented intervention after humanitarian emergencies.
Child protection practices and attitudes of faith leaders across Senegal, Uganda, and Guatemala
(Routledge, 2021-03-08) Jailobaeva, Kanykey; Diaconu, Karin; Ager, Alastair; Eyber, Carola
Faith leaders are well-positioned to address violence against children, but the extent to which they do so is unclear. This mixed-method study examined faith leaders’ child protection practices, attitudes towards child rights, and views around physical punishment in Senegal, Uganda, and Guatemala. Child protection practices—specifically listening to children and reporting abuse—were strongest among faith leaders in Uganda, although they also most favored use of physical punishment. Overall, findings documented how faith leaders play an important role in promoting the wellbeing of children in their communities. Building on this contribution, however, requires sensitivity to important contextual differences.
Cholera diagnosis in human stool and detection in water: A systematic review and meta-analysis
(Public Library of Science, 2022-07-06) Falconer, Jennifer; Diaconu, Karin; O’May, Fiona; Gummaraju, Advaith; Victor-Uadiale, Ifeyinwa; Matragrano, Joseph; Njanpop-Lafourcade, Berthe-Marie; Ager, Alastair
Background: Cholera continues to pose a problem for low-resource, fragile and humanitarian contexts. Evidence suggests that 2.86 million cholera cases and 95,000 deaths due to cholera are reported annually. Without quick and effective diagnosis and treatment, case-fatality may be 50%. In line with the priorities of the Global Task Force on Cholera Control, we undertook a systematic review and meta-analysis of diagnostic test accuracy and other test characteristics of current tests for cholera detection in stool and water. Methods: We searched 11 bibliographic and grey literature databases. Data was extracted on test sensitivity, specificity and other product information. Meta-analyses of sensitivity and specificity were conducted for tests reported in three or more studies. Where fewer studies reported a test, estimates were summarised through narrative synthesis. Risk of Bias was assessed using QUADAS-2. Results: Searches identified 6,637 records; 41 studies reporting on 28 tests were included. Twenty-two tests had both sensitivities and specificities reported above 95% by at least one study, but there was, overall, wide variation in reported diagnostic accuracy across studies. For the three tests where meta-analyses were possible the highest sensitivity meta-estimate was found in the Cholera Screen test (98.6%, CI: 94.7%-99.7%) and the highest specificity meta-estimate in the Crystal VC on enriched samples (98.3%, CI: 92.8%-99.6%). There was a general lack of evidence regarding field use of tests, but where presented this indicated trends for lower diagnostic accuracy in field settings, with lesser-trained staff, and without the additional process of sample enrichment. Where reported, mean test turnaround times ranged from over 50% to 130% longer than manufacturer’s specification. Most studies had a low to unclear risk of bias. Conclusions: Currently available Rapid Diagnostic Tests can potentially provide high diagnostic and detection capability for cholera. However, stronger evidence is required regarding the conditions required to secure these levels of accuracy in field use, particularly in low-resource settings. Registration: PROSPERO (CRD42016048428).
Cholera diagnosis in human stool and detection in water: protocol for a systematic review of available technologies
(2018-02-20) Diaconu, Karin; Falconer, Jennifer; O'May, Fiona; Jimenez, Miguel; Matragrano, Joe; Njanpop-Lafourcade, Betty; Ager, Alastair
Background: Cholera is a highly infectious diarrheal disease spread via fecal contamination of water and food sources; it is endemic in parts of Africa and Asia and recent outbreaks have been reported in Haiti, the Zambia and Democratic Republic of the Congo. If left untreated, the disease can be fatal in less than 24 h and result in case fatality ratios of 30 - 50%. Cholera disproportionately affects those living in areas with poor access to water and sanitation: the long-term public health response is focused on improving water and hygiene facilities and access. Short-term measures for infection prevention and control, and disease characterization and surveillance, are impaired by d iagnostic delays: culture methods are slow and rely on the availability of infrastructure and specialist equipment. Rapid diagnostic tests have shown promise under field conditions and further innovations in this area have been proposed. Methods: This paper is the protocol for a systematic review focused on identifying current technologies and methods used for cholera diagnosis in stool, and detection in water. We will synthesize and appraise information on product technical specifications, accuracy and design features in order to inform infection prevention and control and innovation development. Embase, MEDLINE, CINAHL, Proquest, IndMed and the WHO and Campbell libraries will be searched. We will include studies reporting on field evaluations, including within-study comparisons against a reference standard, and laboratory evaluations reporting on product validation against field stool or water samples. We will extract data according to protocol and attempt meta-analyses if appropriate given data availability and quality. Discussion: The systematic review builds on a previous scoping review in this field and expands upon this by synthesising data on both product technical characteristics and design features. The review will be of particular value to stakeholders engaged in diagnostic procuremen t and manufacturers interested in developing cholera or diarrheal disease diagnostics.
Community Contact and Mental Health amongst Socially Isolated Refugees in Edinburgh
(OUP, 2002) Ager, Alastair; Malcolm, M.; Sadollah, S.; O'May, Fiona
The availability of familial and broader social networks has been proposed as a significant influence on mental health outcomes for resettling refugees. This small-scale local study considered the experience and adjustment of 26 refugees and asylum-seekers resettling in Edinburgh who had been identified as at particular risk of social isolation. While 92 per cent of refugees reported having social contact outside the home, only 19 per cent had established contacts outside refugee networks and language classes. 54 per cent of the sample scored at levels on the Hospital Anxiety and Depression Scale (HADS) indicative of a diagnosis of an anxiety disorder, with 42 per cent scoring at levels indicative of a diagnosis of depression. Levels of both anxiety and depression increased with length of time in the UK. Social contacts outside the home were generally infrequent and, while their frequency was not found to be associated with lower levels of mental health symptoms, refugees themselves prioritized increased social contact above assistance with practical issues and the provision of counselling. Particular interest was expressed in contact with local individuals and groups that could serve as a 'bridge' into host country customs and practices. In the context of a growing literature regarding post-migratory adjustment, the study supports the vulnerability of resettling refugees (particularly those who are single) to poor mental health. While the protective influence on mental health of family linkage and wider social support was not demonstrated by findings, refugees' prioritization of needs suggests that refugee settlement following a 'dispersal' strategy should explicitly seek both to facilitate family and wider co-ethnic linkage and to identify mechanisms for 'bridging' support from indigenous, majority populations.
Conselho: psychological healing in displaced communities in Angola
(2002-09-14) Eyber, Carola; Ager, Alastair
Cortisol awakening response over the course of humanitarian aid deployment: A prospective cohort study
(Taylor & Francis, 2020-12-21) Qing, Yulan; van Zuiden, Mirjam; Eriksson, Cynthia; Lopes Cardozo, Barbara; Simon, Winnifred; Ager, Alastair; Snider, Leslie; Lewis Sabin, Miriam; Scholte, Willem; Kaiser, Reinhard; Rijnen, Bas; Olff, Miranda
Background: Internationally deployed humanitarian aid (HA) workers are routinely confronted with potentially traumatic stressors. However, it remains unknown whether HA deployment and related traumatic stress are associated with long-term changes in hypothalamic-pituitary-adrenal (HPA) axis function. Therefore, we investigated whether cortisol awakening response (CAR) decreased upon deployment and whether this was moderated by previous and recent trauma exposure and parallel changes in symptom severity and perceived social support.
Decreased awakening cortisol over the course of humanitarian aid deployment is associated with stress-related symptoms: A prospective cohort study
(Taylor & Francis, 2019-06-10) Qing, Yulan; van Zuiden, Mirjam; Eriksson, Cynthia; Ager, Alastair; Snider, Leslie; Lewis Sabin, Miriam; Scholte, Willem F.; Simon, Winnifred; Kaiser, Reinhard; Lopes Cardoza, Barbara; Olff, Miranda
Background: Internationally deployed humanitarian aid (HA) workers are at risk for traumatic and chronic stress, and consequently stress-related psychopathology. Therefore, HA deployment may lead to long-term changes in neuroendocrine stress reactivity. Objective: We investigated whether awakening cortisol changed upon deployment, and whether this was associated with lifetime childhood and adulthood traumatic stressors, current deployment-related traumatic and chronic stressors and within-person changes in stress-related symptomatology upon deployment. Method: From a prospective study among expatriate HA workers (n = 214) from 19 international NGOs, we included n = 86 participants (68% females, 33 ± 8 years) who completed questionnaires and cortisol assessments at three points: pre-deployment, early post-deployment and 3–6 months post-deployment. At each assessment, cortisol parameters were calculated from two saliva samples: at awakening and 30 minutes post-awakening. Results: Linear mixed models showed significant decreased awakening cortisol over time (bs: −.036 [SE = .011] to −.008 [SE = .003], all ps < .007). Cortisol was significantly predicted by three-way interactions between lifetime stressors, deployment stressors and time, with the smallest decrease over time in those with limited lifetime and current stressors (all ps < .05). The change in cortisol was no longer significant upon inclusion of stress-related symptoms in the model. Moreover, a sharper cortisol decrease was significantly associated with higher anxiety (p = .004) and PTSD symptoms (p = .049) across assessments. Conclusions: This is the first study indicating decreased awakening cortisol after HA deployment. The exact decrease within participants depended on the amount of lifetime and current stressors. Importantly, when taking changes in stress-related symptomatology into account, we found these accounted for the attenuated awakening cortisol.
Developing and validating the Sierra Leone perinatal psychological distress scale through an emic-etic approach
(Elsevier, 2024-11-17) Bah, Abdulai Jawo; Wurie, Haja Ramatulai; Samai, Mohamed; Horn, Rebecca; Ager, Alastair
Background Addressing perinatal psychological distress in Sierra Leone faces challenges due to the lack of culturally appropriate assessment tools, despite recent WHO recommendations for screening during the pre- and postpartum periods. While high-income countries use tools like the Edinburgh Postnatal Depression Scale or Patient Health Questionnaire-9 (PHQ-9), their cross-cultural validity and efficacy in developing countries are uncertain. The aim of this study was to address this gap by developing a functional assessment tool, culturally appropriate screening tool for perinatal psychological distress, and validate it with the PHQ-9. Method Following scale development guidelines, the study encompassed three phases: Item Development, Scale Development, and Scale Evaluation. Data from free listing interviews (n = 96), FGDs (n = 24), and cognitive interviews (n = 8) informed the development of the Sierra Leone Perinatal Psychological Distress Scale (SLPPDS) and a Function scale. Item reduction via exploratory factor analysis (n = 120) and validation (n = 140) were conducted in subsequent phases. Result Two screening instruments were developed: the 10-item SLPPDS and a 5-item Function scale assessing perinatal women's ability to perform daily tasks. Sensitivity/specificity values for the SLPPDS and PHQ-9 were 80.0/85.7 and 73.8/76.2 respectively. Internal consistency reliability was 0.88 for the SLPPDS and 0.81 for the PHQ-9. Confirmatory factor analysis supported a one-factor model with 54.9 % variance explained. ROC/cut-off points for SLPPDS and PHQ-9 were 0.90/0.81 and 8.0/7.0 respectively. Conclusion The PHQ-9 shows validity and reliability as a screening instrument, but the SLPPDS emerges as a potentially more salient alternative for assessing perinatal psychological distress in Sierra Leone. This implies the SLPDDS is particularly relevant, meaningful, and applicable to the specific cultural or community context it was designed for. It suggests that the tool effectively addresses the unique needs, perspectives, and experiences of the perinatal women, making it more likely to resonate with users and stakeholders. This relevance may enhance the tool's acceptance, usability, and overall impact in identifying and addressing perinatal mental health issues in Sierra Leone. These instruments could enable effective evaluation of perinatal mental health initiatives by government agencies, locals, and international NGOs.
Development of the Faith Community Child Protection Scale with Faith Leaders and their Spouses in Senegal, Uganda and Guatemala.
(2022-10-15) Diaconu, Karin; Jailobaeva, Kanykey; Jailobaev, Temirlan; Eyber, Carola; Ager, Alastair
Violence, abuse and neglect constitute major threats to children's health and wellbeing globally. However, until recently, relatively little systematic attention has been paid to the role of faith communities in shaping the protective environment for children. This paper describes the development of a measure to capture child-protective disposition amongst faith communities through field studies with faith leaders and their spouses in Senegal, Uganda and Guatemala. Identifying common factors related to child care and protection practices, orientation to child rights and approaches to discipline, the measure potentially serves to both inform and evaluate interventions seeking to engage with the beliefs and behaviours of faith communities to support children's health and wellbeing. [Abstract copyright: © 2022. The Author(s).]
Editorial: The role of faith in the mental health and integration of forcibly displaced populations
(Frontiers Media S.A., 2025-07-08) Rayes, Diana; Robinson, Courtland; Ahmad, Ayesha; Ager, Alastair
Educational, psychosocial and protection outcomes of child- and youth-focused programming with Somali refugees in Buramino camp, Dollo Ado, Ethiopia
(Overseas Development Institute, 2020-04-09) Metzler, Janna; Jonfa, Mesfin; Savage, Kevin; Ager, Alastair; Aktion Deutschland Hilft
Provision of child- and youth-friendly spaces has become a common feature of emergency humanitarian response. The evidence-base regarding such provision is, however, severely limited. This study reports outcomes of Child and Youth Learning Centres (CYLCs) established in Buramino refugee camp for those fleeing conflict in Somalia. Eighty-five youths completed baseline assessments shortly after arrival at the camp and follow-up assessments between three and six months later. Caregivers of 106 younger children completed similar assessments. Attendances at CYLCs between baseline and follow-up were collated. Baseline and follow-up literacy and numeracy assessments were completed by 693 children attending CYLCs. Those attending CYLCs made major gains in both literacy and numeracy (t=9.06 and t=13.94 for younger children and t=13.87 and t=17.10 for youth respectively, all p<.0001). Children’s CYLC attendance also enhanced perceptions of met needs (t=2.53 amongst caregivers and t=2.57 amongst youth, both p<.05) and, amongst caregivers but not youth, significantly moderated protection concerns amidst increasingly challenging camp conditions (t=2.39, p<0.05, and t=-1.90, p=0.06 respectively). There was general improvement in psychosocial well-being over time for all children; CYLC attendance predicted greater reductions in reported difficulties only amongst younger children (t=2.51, p<.05).
Effect of contributing factors on the incidence of non-communicable diseases among adults with common mental health disorders: a systematic review
(National Institute for Health and Care Research, 2024-05) Jamal, Zeina; Horn, Rebecca; Ager, Alastair
Background Individual, social and environmental factors play a dynamic role in determining mental health outcomes. The linkage between mental health and non-communicable disease is widely noted, but the mechanisms are poorly understood. The current systematic review aims to identify common contributing factors linking mental health to non-communicable disease incidence among adults to inform planned preventive interventions for high-risk non-communicable disease and mental ill-health populations. Methods MEDLINE, PsycINFO, EMBASE and CINAHL were searched from February to August 2019 for case-control and longitudinal studies of adults with common mental health disorders (depression and anxiety) assessing the causal effect of individual, environmental and social factors on the incidence of common non-communicable diseases (cancers, cardiovascular diseases, chronic obstructive pulmonary disease and diabetes mellitus). There were no geographical restrictions for the selected studies and the results were generated utilising a narrative synthesis. Results Of 15,266 unique documents identified by search terms, 419 met criteria for full-text review and 11 studies met inclusion criteria for data extraction. None of the identified studies had the onset of chronic obstructive pulmonary disease as an outcome. The majority of the studies showed a significant effect of depression and/or post-traumatic stress disorder on non-communicable disease incidence. The chronicity of mental health disorders appears to exacerbate their effect on non-communicable disease onset. Older age, higher body mass index, female sex, smoking status and number of cigarettes smoked, low educational attainment and ethnicity were found to exert a significant effect on the association between mental health disorders and non-communicable disease onset. Conclusion Findings from this review provide evidence to guide health practice and policy to reduce the burden of non-communicable diseases and mental health disorders. Interventions targeted towards identifying and treating mental health illnesses and the factors linking mental and physical health lower the burden of mental disorders and prevent the subsequent development of non-communicable diseases. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme (NIHR award ref: 16/136/100). A plain language summary of this research article is available on the NIHR Journals Library Website https://doi.org/10.3310/CTDH4677.
The effect of Psychological First Aid training on knowledge and understanding about psychosocial support principles; a cluster-randomized controlled trial
(MDPI, 2020-01-11) Sijbrandij, Marit; Horn, Rebecca; Esliker, Rebecca; O'May, Fiona; Reiffers, Relinde; Ruttenberg, Leontien; Stam, Kimberly; de Jong, Joop; Ager, Alastair
Psychological First Aid (PFA) is a world-wide implemented approach to helping people affected by an emergency, disaster or other adverse event. Controlled evaluations of PFA’s training effects are lacking. We evaluated the effectiveness of a one-day PFA training on the acquisition and retention of knowledge of appropriate psychosocial responses and skills in the acute aftermath of adversity in Peripheral Health Units (PHUs) in post-Ebola Sierra Leone. Secondary outcomes were professional quality of life, confidence in supporting a distressed person and professional attitude.PHUs in Sierra Leone (N=129) were cluster-randomized across PFA (206 participants) and control (202 participants) in March 2017. Knowledge and understanding of psychosocial support principles and skills were measured with a questionnaire and two patient scenarios to which participants described helpful responses. Professional attitude, confidence, and professional quality of life were assessed using self-report instruments. Assessments took place at baseline and at 3 and 6 months post-baseline. The PFA group had a stronger increase in PFA knowledge and understanding at the post-PFA training assessment (d=0.50; p<0.001) and at follow-up (d=0.43; p=0.001). In addition, the PFA group showed better responses to the scenarios at 6 months follow-up (d=0.38; p=0.0002) but not at the post-assessment (d=0.04; p=0.26). No overall significant differences were found for professional attitude, confidence and professional quality of life. In conclusion, PFA training improved acquisition and retention of knowledge and understanding of appropriate psychosocial responses and skills to individuals exposed to acute adversity. Our data support the use of PFA trainings to strengthen capacity for psychosocial support in contexts of disaster and humanitarian crisis. Future studies should examine the effects of PFA on psychosocial outcomes for people affected by crises. Trial registration: Nederlands Trial Register (NTR6846)
Ensuring standards of intervention in challenging behaviour: a report to the Chief Scientist Office of the Scottish National Health Service Management Executive
(Queen Margaret University College, 1998-05) Ager, Alastair; O'May, Fiona