Browsing by Person "Noubani, Aya"

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A community-based system dynamics approach for understanding factors affecting mental Health and Health seeking behaviors in Beirut and Beqaa regions of Lebanon
(2020-03-30) Noubani, Aya; Diaconu, Karin; Ghandour, Lilian; El Koussa, Maria; Loffreda, Giulia; Saleh, Shadi
Background Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility.
Attitudes towards Depression among Primary Healthcare Providers in Contrasting Fragility Contexts in Lebanon: A Cross Sectional Study [Working paper]
(Queen Margaret University, 2025-07) Noubani, Aya; Diaconu, Karin; Muhheiddine, Dina; Alameddine, Mohammad; Saleh, Shadi
Background: Depression is a leading contributor to global disability, yet significant treatment gaps persist—particularly in fragile and low-resource settings. In Lebanon, efforts such as the WHO’s Mental Health Gap Action Programme (mhGAP) and the National Mental Health Program (NMHP) aim to improve mental health integration within primary care. This study investigates the attitudes of primary healthcare providers (HCPs) toward depression in two contrasting Lebanese contexts—urban Beirut and rural Bekaa—and examines how mhGAP training influences these attitudes. Methods: A cross-sectional survey was conducted in 2020 using the 22-item Revised Depression Attitude Questionnaire (R-DAQ) was administered to 237 HCPs across 11 Ministry of Public Health (MoPH) Primary Healthcare Centers (PHCCs) in Beirut and Bekaa. Data collection included socio-demographics, mental health training background, and clinical experience. Quantitative analysis involved descriptive statistics, t-tests, ANOVA, multiple regression, and exploratory factor analysis. Results: Most participants were female (60.3%) and based in Beirut (59.9%), with nearly half being medical doctors. While 94.4% reported frequent encounters with patients experiencing mental health issues, only 40.7% had received mental health training, and less than half of those were trained on mhGAP. Overall, HCPs held neutral-to-positive attitudes toward depression (mean R-DAQ score = 79 ± 8.08), with the strongest agreement around the need for a generalist approach. Professional confidence was moderate, and therapeutic optimism was mixed, with some respondents endorsing stigmatizing beliefs. Attitudes were significantly more positive among HCPs trained in mhGAP, working in Beirut, having postgraduate education, or regularly encountering mental health patients. Multivariable analysis confirmed that mhGAP training and practice setting were key predictors of more favorable attitudes. Exploratory factor analysis validated the original three-factor structure of the R-DAQ. Conclusion: While primary care providers in Lebanon generally support integrating mental health into routine care, gaps remain in training and confidence—especially in more fragile rural settings. Scaling up evidence-based training such as mhGAP may enhance provider preparedness and reduce stigma toward depression, supporting broader mental health reform efforts in fragile health systems.
Decision-making surrounding distress, depression and suicidal ideation: findings of a vignette study with primary health care practitioners in Lebanon [Working paper]
(Queen Margaret University, 2025-07) Noubani, Aya; Loffreda, Giulia; Diaconu, Karin; Muhheiddine, Dina; Horn, Rebecca; Saleh, Shadi
This working paper presents early findings from a vignette-based study exploring how primary health care (PHC) providers in Lebanon assess and respond to cases of mental ill-health, including distress, depression, and suicidal ideation. Sixty-one healthcare providers from PHC centers in Beirut and the Bekaa participated in the study using an interactive, web-based vignette tool that simulated patient cases. Each participant reviewed three vignettes varying by patient gender, nationality, and mental health severity. Providers assessed symptom severity, selected treatment options, and chose appropriate referrals. Although detailed findings are withheld to preserve the novelty of forthcoming peer-reviewed work, general trends suggest that provider decision-making varies based on professional role, patient profile, and regional context. The study underscores the potential of PHCCs to support early mental health intervention and the feasibility of vignette-based tools for research in fragile settings.
Forced migration and sexual and gender-based violence: findings from the SEREDA project in Scotland
(University of Birmingham, 2022) Phillimore, Jenny; Jamal, Zeina; Noubani, Aya; Hourani, Jeanine; Baillot, Helen
Forced migration is gendered with men and women experiencing displacement in different ways and nearly half of the world’s forced migrants being women and children. All forced migrants are vulnerable to sexual and gender-based violence (SGBV) which includes any form of violence whether physical, emotional, sexual, structural or symbolic which is inflicted on the basis of socially ascribed gender roles. However, women and children are most vulnerable to SGBV. The SEREDA project sought to understand the nature and incidence of SGBV experienced by forced migrants residing in countries of refuge. This report outlines the findings of SEREDA interviews in Scotland focusing on the Scottish policy context and how SGBV survivors might be better protected and supported within this context.
Identifying vulnerabilities in essential health services: Analysing the effects of system shocks on childhood vaccination delivery in Lebanon
(Elsevier, 2024-08-28) Ismail, Sharif A.; Tomoaia-Cotisel, Andrada; Noubani, Aya; Fouad, Fouad M.; Trogrlić, Robert Šakić; Bell, Sadie; Blanchet, Karl; Borghi, Josephine
Shocks effects are under-theorised in the growing literature on health system resilience. Existing work has focused on the effects of single shocks on discrete elements within the health system, typically at national level. Using qualitative system dynamics, we explored how effects of multiple shocks interacted across system levels and combined with existing vulnerabilities to produce effects on essential health services delivery, through the prism of a case study on childhood vaccination in Lebanon. Lebanon has experienced a series of shocks in recent years, including large-scale refugee arrivals from neighbouring Syria, the COVID-19 pandemic and a political-economic crisis. We developed a causal loop diagram (CLD) to explore the effects of each shock individually, and in combination. The CLD was developed and validated using qualitative data from interviews with 38 stakeholders working in Lebanon's vaccination delivery system, in roles ranging from national level policy to facility-level service delivery, conducted between February 2020 and January 2022. We found that each of the shocks had different effects on service demand- and supply-side dynamics. These effects cascaded from national through to local levels. Both Syrian refugee movement and the COVID-19 pandemic primarily exposed vulnerabilities in service demand, mainly through slowly emerging knock-on effects on vaccination uptake behaviour among host communities, and fear of contracting infection in crowded health facilities respectively. The economic crisis exposed wider system vulnerabilities, including demand for vaccination as household income collapsed, and supply-side effects such as reduced clinic time for vaccination, declining workforce retention, and reduced availability of viable vaccine doses, among others. Finally, important pathways of interaction between shocks were identified, particularly affecting the balance between demand for vaccination through publicly supported facilities and private clinics. Future research should incorporate dynamic approaches to identifying within-system vulnerabilities and their potential impacts under different scenarios, as a precursor to improved resilience measurement, system preparedness, and intervention targeting.
Outpatient use patterns and experiences among diabetic and hypertensive patients in fragile settings: A cross-sectional study from Lebanon
(BMJ, 2022-05-23) Saleh, Shadi; Muhieddine, Dina; Hamadeh, Randa S.; Dimassi, Hani; Diaconu, Karin; Noubani, Aya; Arakelyan, Stella; Ager, Alastair; Alameddine, Mohamad
Objectives: Assess and describe the health service use and delivery patterns for non-communicable disease (NCD) services in two contrasting fragility contexts and by other principal equity-related characteristics including gender, nationality and health coverage. Setting: Primary healthcare centres located in the urbanised area of Greater Beirut and the rural area of the Beqaa Valley. Design: This is a cross-sectional study using a structured survey tool between January and September 2020. Participants: 1700 Lebanese and Syrian refugee patients seeking primary care for hypertension and diabetes. Primary and secondary outcomes: The main outcome is the comprehensiveness of service delivery comparing differences in use and service delivery patterns by fragility setting, gender, nationality and health coverage. Results: Compliance with routine NCD care management (eg, counselling, immunisations, diagnostic testing and referral rates) was significantly better in Beirut compared with Beqaa. Women were significantly less likely to be offered lifestyle counselling advice and referral to cardiologists (58.4% vs 68.3% in Beqaa and 58.1% vs 62% in Beirut) and ophthalmologists, compared with men. Across both settings, there was a significant trend for Lebanese patients to receive more services and more advice related to nutrition and diabetes management (89.8% vs 85.2% and 62.4% vs 55.5%, respectively). Similarly, referral rates were higher among Lebanese refugees compared with Syrian refugees. Immunisation and diagnostic testing were significantly higher in Beirut among those who have health coverage compared with Beqaa. Conclusions: The study discovered significant differences in outpatient service use by setting, nationality and gender to differentials. A rigorous and comprehensive appraisal of NCD programmes and services is imperative for providing policy makers with evidence-based recommendations to guide the design, implementation and evaluation of targeted programmes and services necessary to ensure equity in health services delivery to diabetic and hypertensive patients. Such programmes are an ethical imperative considering the protracted crises and compounded fragility.
Readiness to deliver person‐focused care in a fragile situation: The case of Mental Health Services in Lebanon
(BMC, 2021-03-02) Noubani, Aya; Diaconu, Karin; Loffreda, Giulia; Saleh, Shadi
Background: Evidence suggests wide variability in the provision of mental healthcare across countries. Countries experiencing fragility related risks suffer from a high burden of mental-ill health and additionally have limited capacity to scale up mental health services given financial and human resource shortages. Integration of mental health services into routine primary care is one potential strategy for enhancing service availability, however little is known about the experiences of currently active health care providers involved in mental health and psychosocial support service (MHPSS) provision at primary care level. This study aims to determine how healthcare providers offering MHPSS services at primary care levels in Lebanon perceive mental health and the health system’s ability to address the rising mental ill-health burden with a view to identify opportunities for strengthening MHPSS service implementation geared towards integrated person focused care model.
Resilience in childhood vaccination: analysing delivery system responses to shocks in Lebanon.
(2023-11-01) Ismail, Sharif A; Tomoaia-Cotisel, Andrada; Noubani, Aya; Fouad, Fouad M; Bell, Sadie; Borghi, Josephine; Blanchet, Karl
IntroductionDespite rapidly growing academic and policy interest in health system resilience, the empirical literature on this topic remains small and focused on macrolevel effects arising from single shocks. To better understand health system responses to multiple shocks, we conducted an in-depth case study using qualitative system dynamics. We focused on routine childhood vaccination delivery in Lebanon in the context of at least three shocks overlapping to varying degrees in space and time: large-scale refugee arrivals from neighbouring Syria; COVID-19; and an economic crisis.MethodsSemistructured interviews were performed with 38 stakeholders working at different levels in the system. Interview transcripts were analysed using purposive text analysis to generate individual stakeholder causal loop diagrams (CLDs) mapping out relationships between system variables contributing to changes in coverage for routine antigens over time. These were then combined using a stepwise process to produce an aggregated CLD. The aggregated CLD was validated using a reserve set of interview transcripts.ResultsVarious system responses to shocks were identified, including demand promotion measures such as scaling-up community engagement activities and policy changes to reduce the cost of vaccination to service users, and supply side responses including donor funding mobilisation, diversification of service delivery models and cold chain strengthening. Some systemic changes were introduced-particularly in response to refugee arrivals-including task-shifting to nurse-led vaccine administration. Potentially transformative change was seen in the integration of private sector clinics to support vaccination delivery and depended on both demand side and supply side changes. Some resilience-promoting measures introduced following earlier shocks paradoxically increased vulnerability to later ones.ConclusionFlexibility in financing and human resource allocation appear key for system resilience regardless of the shock. System dynamics offers a promising method for ex ante modelling of ostensibly resilience-strengthening interventions under different shock scenarios, to identify-and safeguard against-unintended consequences.