552 - Exploring the Determinants of Successful Implementation of a Preventive Mental Health and Wellness Intervention for Afghan Refugee Families: A Qualitative Analysis of Stakeholder Perspectives

In 2021, we implemented and demonstrated the preliminary efficacy of an evidence-based preventive mental health and wellness intervention adapted for refugee children and families from Afghanistan.

Objective:

To identify key determinants of successful implementation of the preventive mental health and wellness intervention in preparation for implementation in education settings

Design/Methods:

Our interdisciplinary team developed an interview guide using the Consolidated Framework for Implementation Research (CFIR). We purposively sampled refugee-serving stakeholders and refugee parents whose child(ren) participated in 2021. Zoom interviews included a trilingual Dari/Pashto/English interpreter as needed and were recorded, deidentified, and transcribed. A three-person team applied rapid qualitative analysis techniques to code each transcript according to pre-specified CFIR domains, resolved differences by consensus, and reached consensus on emerging themes with the full study team.

Results:

Six refugee-serving stakeholders (including school teachers, mental health professional, and refugee resettlement agency staff) and five refugee parents participated in interviews.

Five major themes emerged around three CFIR constructs (Table). Themes related to stakeholder needs and resources included (1) discussing emotions requires cultural humility (“you have to be brave, you have to be strong” – Refugee 2); (2) miscommunication and missed communications (“…even with interpretation, [not having] the right language…” – Stakeholder 1); and (3) bridging connections between children and families (“[students] have mentioned lately just how little time their parents have to ask them about their days and how they’re doing” – Stakeholder 3). The fourth theme, “layers of learning,” addressed the relative strength and adaptability construct. Families shared that the concrete activities were the main benefits of the intervention, while stakeholders shared that it opened opportunities for communication. The final theme, “specific cultural considerations,” reflected the intervention complexity construct. Families discussed stressors after the Afghan evacuation, and stakeholders discussed general barriers, including language and transportation.

Conclusion(s):

To implement a preventive mental health and wellness intervention with refugee children and families, practicing cultural humility and sensitivity to cultural context while providing layers of learning may facilitate communication, both between families and program staff as well as between children and parents, and may help overcome barriers to participation.