A Psychosocial Program Impact Evaluation in Jordan

Not Applicable

Completed

• Conditions: Stress, Psychological; Mental Health Impairment
• Interventions: Behavioral: Advancing Adolescents

• Registration Number: NCT03012451
• Lead Sponsor: Yale University

Brief Summary

The study aims to deliver a robust pre-post evaluation of the wellbeing impacts of an innovative, brief, and scalable psychosocial intervention, delivered to refugee youth living in urban settlements in Jordan. The study was conducted using two waves of data collection: the first featured an intervention and a matched control group, the second featured a full randomized control trial.

Detailed Description

This study will provide a robust evaluation of the Mercy Corps 'Advancing Adolescents, No Lost Generation' program that targets stress alleviation in refugee youth (12-18 years) with specific measures of psychosocial stress, biological stress, and cognitive function.

Study Timeline

• Study Start: 2015-04
• Primary Completion: 2016-09
• Study First Submitted: 2016-12-21
• Study First Submitted QC: 2017-01-04
• Study First Posted: 2017-01-06
• Study Completion: 2017-04
• Status Verified: 2021-01
• Last Update Submitted: 2021-01-13
• Last Update Posted: 2021-01-15

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 817

Inclusion Criteria

• Eligible and enrolled in Mercy Corps Advancing Adolescents program
• Syrian refugee and Jordanian host-community youth residing in 4 urban centers in northern Jordan

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Exclusion Criteria

• Not available for study recruitment (started sessions or deferred sessions before study start date).

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Advancing Adolescents	Advancing Adolescents	Received structured eight-week psychosocial sessions

Primary Outcome Measures

Name	Time	Method
Psychosocial Stress (International Measure)	11 weeks	Stress was measured using the Arabic version of the Perceived Stress Scale (Cohen, Karmarck, \& Mermelstein, 1983), validated with a Jordanian sample (Almadi, Cathers, Hamdan Mansour, \& Chow, 2012). This 14-item, 5-point Likert scale measures perceived stress over the last month, with higher scores indicating greater stress. Items include, "How often have you been upset because of something that happened unexpectedly?" and "How often have you been able to control irritations in your life?" (reverse-scored) (1 = Never, 5 = Very often).
Psychosocial Stress: Insecurity (Regional Measure)	11 weeks	Insecurity was measured with The Human Insecurity (HI). This tool was developed for use in the West Bank (Ziadni, Hammoudeh et al. 2011, Hamayel, Ghandour et al. 2014). The 10-item scale is a 5-point Likert scale with scores expressed as percentages on a scale of 0-100. The HI covers issues such as worries regarding inability to obtain daily life necessities, losing a source of income, fears about the future, and family safety.
Psychosocial stress: Distress (Regional Measure)	11 weeks	Distress was measured with the Human Distress scale (Hamayel \& Ghandour, 2014), developed for use with conflict-affected adolescents in the West Bank. The 12-item scale is a 5-point Likert scale with scores expressed as percentages on a scale of 0-100. Sample items include, "To what extent have you felt worried," "To what extent did you feel humiliated," and "To what extent did you feel angry." Scores are presented as percentages (0-100%), with higher scores indicating greater distress.

Secondary Outcome Measures

Name	Time	Method
Prosocial Behavior: International Measure	11 weeks	The Strengths and Difficulties Questionnaire (SDQ) Prosocial Score, which featured 5 items to assess prosociality was used. Items include "I try to be nice to other people. I care about their feelings" and "I am helpful if someone is hurt, upset, or feeling sick" (0 = Not true, 2 = Certainly true). Higher scores indicate greater prosociality.
Resilience: Cross-cultural Measure	11 weeks	Resilience was measured using the CYRM-28 (Liebenberg et al., 2012; Ungar \& Liebenberg, 2011), which had been translated and culturally grounded for use into Arabic. Responses ranged from 1 ("Not at all") to 5 ("A lot"), with higher scores indicating greater resilience.
Biological Stress: Cortisol	11 weeks	Cortisol was obtained from immunoassays of scalp hair cortisol that provide useful measures of the altered activity of the hypothalamic-pituitary-adrenal axis. Scalp hair is collected non-invasively (\~100 strands, 0.5 cm area). This measure indicates chronic stress over the last month, and examined per individual for pre/post intervention levels. These analyses are being undertaken by Professor van Uum at Western Ontario University.
Mental Health Difficulties: Regional Measure	11 weeks	Mental health was assessed using the 21-item Arab Youth Mental Health questionnaire (Mahfoud et al., 2011; Mahkoul et al., 2011). This measure includes questions such as, "During the last week I was upset", "During the last week I was bored and hated my life", and "During the last week, I was having a lot of headaches, stomach-aches, and nausea" (1 = Rarely, 3 = Always). Higher scores indicate more symptoms of anxiety and depression.
Mental Health Difficulties: International Measure	11 weeks	The Arabic version of the Strengths and Difficulties Questionnaire (SDQ), a brief screening tool for psychiatric difficulties (Alyahri \& Goodman, 2006) was used. The 20 items include emotional, conduct, and hyperactivity symptom scores (range 0-40). We summed score of the Arabic version of the SDQ subscales relating to hyperactivity, emotional symptoms, conduct problems, and peer problems (Alyahri \& Goodman, 2006).
Biological Stress: Cell-mediated Immune Function	11 weeks	Cell-mediated immune function was measured in field settings, using systemic suppression of immune function in response to chronic stress is measured via immunoassays for Epstein Barr Virus antibodies, in conjunction with C-Reactive Protein, from dried blood spots collected from pricking the finger with a sterile disposable lancet. Three drops of blood on filter paper are dried at room temperature, then frozen until lab assay. This measure reflects compromised immune response due to psychosocial stress over the past week, and examined per individual for pre/post intervention levels.
Cognitive function	11 weeks	Cognitive function was assessed using tablet-based cognitive skill tasks, testing hippocampal function (long term memory) and prefrontal executive function. Children play short games (1-4 min each) during which they press the tablet in response to geometric shapes. Responses during game play are recorded and used to measure cognitive function.

Trial Locations

Locations (1)

Yale University; 🇺🇸 New Haven, Connecticut, United States