A COMMUNITY-BASED RISK REDUCTION AND RECOVERY PROGRAM; A MODEL FOR THE SYRIAN REFUGEE CRISIS

A COMMUNITY-BASED RISK REDUCTION AND RECOVERY PROGRAM; A MODEL FOR THE SYRIAN REFUGEE CRISIS

Women and children are the primary risk group in terms of secondary mortality and morbidity caused by wars and conflicts. Turkey has hosted the largest population of Syrians since 2011. In this study, it was carried out the investigation to implement a community based, culturally-sensitive risk reduction and recovery program (RRRP) for Syrian refugees who were living outside of the camps in Turkey. Quantitative and qualitative data were used for program evaluation. Antenatal and postnatal care, contraceptive demand, breastfeeding, referred cases, and self-efficacy increased significantly, while mental health symptoms decreased following the intervention (p <0.05). The results of this study indicated that the RRRP was a powerful tool to stimulate hope through the reestablishment of daily routines based on risk reduction, building positive thinking, creating social support, increasing self-efficacy, and decreasing mental health symptoms as a community empowerment program for refugees.

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  • Al-Rousan, T., Schwabkey, Z., Jirmanus, L., Nelson, B. D. 2018. Health needs and priorities of Syrian refugees in camps and urban settings in Jordan: perspectives of refugees and health care providers. East Mediterr Health J, 24(3), 243–253. doi: 10.26719/2018.24.3.243.
  • Aptekman, M., Rashid, M., Wright, V., & Dunn, S. (2014). Unmet contraceptive needs among refugees. Can Fam Physician, 60(12), 613–619.
  • Bartlett, L. A., Jamieson, D. J., Kahn, T., Sultana, M., Wilson, H. G., & Duerr, A. (2002). Maternal mortality among Afghan Refugees in Pakistan, 1999–2000. Lancet, 359, 643–649.
  • Benage, M., Greenough, P. G., Vinck, P., Omeira, N., & Pham, P. (2015). An assessment of antenatal care among Syrian refugees in Lebanon. Confl Health, 9(9), 8. doi: 10.1186/s13031-015-0035-8
  • Benson, J., Phillips, C., Kay, M., Webber, M. T., Ratcliff, A. J., Correa-Velez, I., & Lorimer, M. F. (2013). Low vitamin B12 levels among newly-arrived refugees from Bhutan, Iran and Afghanistan: a multicentre Australian study. PLoS ONE, 8(2), e57998.
  • Bittles, A. H. (2013). Consanguineous marriages and congenital anomalies. The Lancet, 382(9901), 1316–1317. doi: 10.1016/s0140-6736(13)61503-2
  • Calhoun, L. G., Tedeschi, R. G. (Eds.). (2006). Handbook of Posttraumatic Growth: Research and Practice. Mahwah, NJ: Erlbaum.
  • Carta, M. G., Bernal, M., Hardoy, M. C., & Haro-Abad, J. M. (2005). Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1). Clin Pract Epidemiol Ment Health, 1, 13.
  • Crandall, A., Rahim, H. F., & Yount, K. M. (2016). Validation of the general self-efficacy scale among Qatari young women. East Mediterr Health J, 21(12), 891–6.
  • de Jong, J. T., Komproe, I. H., & Van Ommeren, M. (2003). Common mental disorders in postconflict settings. Lancet, 361(9375), 2128–2130.
  • de Vries, D. H., Pool, R. (2017). The influence of community health resources on effectiveness and sustainability of community and lay health worker programs in lower-income countries: A systematic review. PLoS ONE, 12(1), e0170217.
  • du Toit, E., Jordaan. E., Niehaus, D., Koen, L., & Leppanen, J. (2018). Risk factors for unplanned pregnancy in women with mental illness living in a developing country. Arch Womens Ment Health, 21(3), 323–331.
  • Dikmen, Yildiz, P., Ayers, S., Phillips, L. (2017). Factors associated with post-traumatic stress symptoms (PTSS) 4-6 weeks and 6 months after birth: A longitudinal population-based study. J Affect Disord. 15(221), 238–245.
  • Dodgson, J. E., Oneha, M. F., & Choi, M. A. (2014). Socioecological predication model of posttraumatic stress disorder in low-income, high-risk prenatal native Hawaiian/Pacific Islander women. J Midwifery Womens Health, 59(5), 494–502.
  • ECDC. (2009). Migrant health: background note to the ECDC report on migration and infectious diseases in the EU. Stockholm, European Centre for Disease Prevention and Control.
  • el-Rufaie, O. F., & Daradkeh, T. K. (1996). Validation of the Arabic versions of the thirty- and twelve-item general health questionnaires in primary care patients. Br J Psychiatry, 169(5), 662–664.
  • Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet, 365(9467), 1309–1314. doi:10.1016/S0140-6736(05)61027-6
  • Gagnon, A. J., Merry, L., & Robinson, C. (2002). A systematic review of refugee women’s reproductive health. Refugee, 21(1), 6–17.
  • Glanz, K., Rimer, B.K. & Lewis, F.M. (2002). Health Behavior and Health Education. Theory, Research and Practice. San Fransisco: Wiley & Sons.
  • Glenton, C., Lewin, S., & Scheel, I. B. (2011). Still too little qualitative research to shed light on results from reviews of effectiveness trials: A case study of a Cochrane review on the use of lay health workers. Implement Sci, 6, 53.
  • Huffman, S. (2009). Awareness of tuberculosis and access to health services and tuberculosis treatment among Uzbek labor migrants in Kazakhstan. Final report for Project HOPE. Millwood.
  • Jamieson, D. J., Meikle, S. F., Hillis, S. D., Mtsuko, D., Mawji, S., & Duerr, A. (2000). An evaluation of poor pregnancy outcomes among Burundian refugees in Tanzania. JAMA, 283, 397–402.
  • Jayatissa, R., Bekele, A., Piyasena, C. L., & Mahamithawa, S. (2006). Assessment of nutritional status of children under five years of age, pregnant women, and lactating women living in relief camps after the tsunami in Sri Lanka. Food Nutr Bull, 27(2), 144–152.
  • Kastello, J. C., Jacobsen, K. H., Gaffney, K. F., Kodadek. M. P., Bullock, L. C., & Sharps, P. W. (2016). Posttraumatic stress disorder among low-income women exposed to perinatal intimate partner violence: Posttraumatic stress disorder among women exposed to partner violence. Arch Womens Ment Health, 19(3), 521–8.
  • Laverack, G. (2018). Is health promotion culturally competent to work with migrants? Global Health Promotion, 25(2), 3–5.
  • Lewin, S., Munabi-Babigumira, S., Glenton, C., Daniels, K., Bosch-Capblanch, X., VanWyk, B.E, et al. (2010). Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev, 20051–108.
  • Lindert, J., Ehrenstein, O. S., Priebe, S., Mielck, A., & Brahler, E. (2009). Depression and anxiety in labor migrants and refugees--a systematic review and meta-analysis. Soc Sci Med, 69(2), 246–257. doi:10.1016/j.socscimed.2009.04.032
  • Maghsoudlou, S., Cnattingius, S., Aarabi, M., Montgomery, S. M., Semnani, S., Stephansson, O., & Bahmanyar, S. (2015). Consanguineous marriage, prepregnancy maternal characteristics and stillbirth risk: a population-based case-control study. Acta Obstet Gynecol Scand, 94(10), 1095–1101.
  • Maguire, A., Tseliou, F., O'Reilly, D. (2018). Consanguineous marriage and the psychopathology of progeny: A population-wide data linkage study. JAMA Psychiatry, 75(5), 438–446.
  • Mcginn, T. (2000). Reproductive health of war-affected populations: What do we know? International Family Planning Perspectives, 26(4), 174–180.
  • Murray, C., King, G., Lopez, A., Tomijima, N., Krug, E. (2002). Armed conflict as a public health problem. BMJ, 324, 346–349.
  • Oda, A., Hynie, M., Tuck A, Agic B, Roche B, McKenzie, K. (2018). Differences in self-reported health and unmet health needs between government assisted and privately sponsored Syrian refugees: A cross-sectional survey. J Immigr Minor Health. doi: 10.1007/s10903-018-0780-z.
  • Okech, D., Hansen, N, Howard, W., Anarfi, J. K., & Burns, A. C. (2018). Social support, dysfunctional coping, and community reintegration as predictors of PTSD among human trafficking survivors. Behav Med, 44(3), 209–218.
  • Oi, W., Gevonden, M., & Shalev, A. (2016). Prevention of post-traumatic stress disorders after trauma: currents evidence and future directions. Currently Psychiatry Reports, 18(2), 20. doi: 10.1007/s11920-015-0655-0. Review.
  • Olff, M., Langeland, W., Witteveen, A., & Denys, D. (2010). A psychobiological rationale for oxytocin in the treatment of posttraumatic stress disorder. CNS Spectrom, 15(8), 522–530.
  • Patel, V., Weiss, H. A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., et al. (2010). Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet, 376(9758), 2086–95.
  • Posselt, M., Eaton, H., Ferguson, M., Keegan, D., Procter, N. (2018). Enablers of psychological well-being for refugees and asylum seekers living in transitional countries: A systematic review. Health Soc Care Community, doi: 10.1111/hsc.12680.
  • Punka, P., Koskela, K., Mcalister, A., Mayranen, H., Smolander, A., Moisio, S., et al. (1986). Use of lay opinion leaders to promote diffusion of health innovations in a community programme: lessons learned from the North Karelia project. Bulletin of the World Health Organization, 64(3), 437–446.
  • Reese Masterson, A., Usta, J., Gupta, J., & Ettinger, A. S. (2014). Assessment of reproductive health and violence against women among displaced Syrians in Lebanon. BMC Womens Health, 14(1), 25. doi: 10.1186/1472-6874-14-25
  • Robertson, C. L., Savik, K., Mathiason-Moore, M., Mohamed, A., & Hoffman, S. (2016). Modeling psychological functioning in refugees. J Am Psychiatr Nurses Assoc. 22(3), 225–32.
  • Rutter, M. (1999). Resilience concept concepts and findings: implications for family theraphy. J Family Ther, 21, 119–144.
  • Samari, G. (2017). Syrian refugee women's health in Lebanon, Turkey, and Jordan and recommendations for improved practice. World Med Health Policy, 9(2), 255–274. doi: 10.1002/wmh3.231.
  • Torun, P., Mücaz, Karaaslan, M., Sandıklı, B., Acar, C., Shurtleff, E., Dhrolia, S., Herek, B. (2018). Health and health care access for Syrian refugees living in İstanbul. Int J Public Health, 63(5), 601–608. doi: 10.1007/s00038-018-1096-4.
  • Strong, J., Varady, C., Chahda, N., Doocy, S., & Burnham, G. (2015). Health status and health needs of older refugees from Syria in Lebanon. Confl Health, 2015, 9–12.
  • Sierau, S., Schneider, E., Nesterko, Y., Glaesmer, H. (2018). Alone, but protected? Effects of social support on mental health of unaccompanied refugee minors. Eur Child Adolesc Psychiatry, doi: 10.1007/s00787-018-1246-5.
  • Simsek, Z., Kayi, I., Yildirimkaya, G. (2017). Lay health worker training program for Syrian refugees in Turkey. Eur J Pub Health, 27(3), ckx187.256.
  • Simsek, Z., Yentur, Doni, N., Hilali, Gül, N., & Yildirimkaya, G. (2018). A community-based survey on Syrian refugee women’s health and its predictors in Şanliurfa, Turkey. Women Health, 58(6), 617–631.
  • Simsek, Z., Ak, D., Altindag, A. & Günes, M. (2008). Prevalence and predictors of mental disorders among women in Sanliurfa, southeastern Turkey. J Public Health (Oxf) 30(4), 487–93.
  • UNHCR. (2014). Syrian Regional Refugee Response: Inter-agency Information Sharing Portal. In UNHCR (Ed.), Syria Regional Response Plan Strategic Overview: Mid-Year Update. Geneva: UNHCR.
  • Walt, G., Perera, M., Heggenhougen, K. (1989). Are large-scale volunteer community health worker programmes feasible? The case of Sri Lanka. Soc Sci Med, 29: 599–608.
  • Walsh, F. (2007). Traumatic loss and major disasters. Strengthening family and community resilience. Family Process, 46(2), 207–227.
  • Ventevogel, P., van Ommeren, M., Schilperoord, M., & Saxena, S. (2015). Improving mental health care in humanitarian emergencies. Bull World Health Organ, 93(10), 666-666A. doi:10.2471/BLT.15.156919
  • Republic of Turkey Ministry of Interior Directorate General of Migration Management. Migration Data. (Accessed 17 November 2018). http://www.goc.gov.tr/icerik3/gecici-koruma_363_378_4713.
  • Yanik, M., Gurel, M.S., Simsek, Z., & Kati, M. (2004). The psychological impact of cutaneous leishmaniasis. Clin Exp Dermatol, 29(5), 464–7.
  • Yentür, Doni, N., Aksoy, M., Şimşek, Z., Gürses, G., Hilali, N.G., et al. (2016). Investigation of the prevalence of Trichomonas vaginalis among female Syrian refugees with the complaints of vaginitis aged between 15-49 years. Mikrobiyol Bul, 50(4), 590–597.