Title: Routes to Wellness: Co-designing Peer Support for Refugee and Asylum Seekers
Funder: Department of Health and Social Care

Abstract: This study aims to support the mental health of asylum seekers and refugees. We will develop and evaluate a peer-support intervention for refugees. We use the term ‘refugee’ to include people seeking asylum and those with leave to remain. Below we use the term ‘model’ to refer to our intervention. This is because the community partners in this study prefer this word._x000D_ _x000D_ BACKGROUND: This proposal was co-produced by refugees, researchers, people from voluntary sector organisations, community health and social care services, and commissioners. In a series of meetings we identified mental health as an important area of unmet need. This is because forced migration is traumatic and in areas of low ethnic diversity, services often lack the skills to meet the needs of refugees. Mental distress can also manifest as a physical health problem, and like members of the majority population, some refugees are unaware of the links between physical and mental health. In addition to this, language, cultural differences, and concern about stigma mean that some refugees are reluctant to use services. This can result in long-term health problems and affect their social, educational, economic and integration prospects. Peer-based approaches have the potential to provide culturally relevant support to refugees in the community._x000D_ _x000D_ DESIGN AND METHODS: We will use a study design called “Experience-Based Co-Design” to develop our peer-support model. In this type of study people’s personal account of having a health condition and using services are analysed to identify emotional ‘touch-points’. ‘Touch-points’ are experiences that bring up positive or negative emotions. In “Experience-Based Co-Design”, touch-points inform how support is designed and delivered. We will interview refugees and service staff, and observe interactions between professionals and refugees. The interviews and observations will be analysed to identify emotional touch-points. These will be further discussed in workshops with refugees and service providers, to inform a model of peer-support. The model, including the training of peer-support workers and how they will work with refugees, will then be refined in a further series of workshops. People with a refugee background in Plymouth and Gloucester will then be trained as peer support workers to provide support within their communities. To evaluate the peer-support model, we will observe and interview peer workers and refugees who have received support. Data collected will be analysed, and then used to refine the model further._x000D_ _x000D_ SERVICE USER INVOLVEMENT: Refugees have been and will continue to be involved in all aspects of the study. We will recruit two refugee peer researchers to be part of the study team. Refugees will be members of our local reference group and national advisory group and will participate in events where we look at our findings and develop the training. Refugees contributing to the study will be paid for their time. _x000D_ _x000D_ DISSEMINATION: We will meet regularly with service planners (commissioners), health and social care professionals and refugees to inform them of study progress. We will also hold community events at different points during the study to share what we are doing and get feedback. We will publish in academic journals and service newsletters. We will engage with refugee organisations and hold public events so that findings reach service users and local, regional and national policy-makers.

Lay abstract: Background: The process of displacement contributes to higher levels of mental distress in refugees. Access to health care is challenging due to language barriers and a lack of understanding of how access help. These factors contribute to adverse health outcomes in refugees as one of the most vulnerable groups within the UK. Our involvement work found that refugees want peer-support to improve their mental health, but there is a lack of research in the UK on how to support refugees using these models in the UK. _x000D_ _x000D_ This study will harness the skills of refugees, researchers, and providers to develop and evaluate a peer-led model for refugees. This approach will use narratives to create a shared language about mental health. Peer-support workers (PSWs) will work with refugees and use this shared language to identify health goals and help them access support._x000D_ _x000D_ Research Aim: Co-design a PSW model and test if it is acceptable to refugees._x000D_ _x000D_ Methods: We will use Experience-based Co-design to develop the model, which will be tested for acceptability in a 9-month trial using qualitative methods in Plymouth and Gloucester. _x000D_ _x000D_ EBCD: A range of qualitative methods will be used to identify key issues known as emotional ‘touchpoints’. These are identified to encapsulate significant service user experiences and health related concerns. Over a series of eight co-design workshops with providers and users, touchpoint data will be used to help shape the PSW model. These workshops will also develop the PSW training and delivery manuals, refugee-facing materials, and help identify outcome to measures for a future trial. A workshop will also help us refine the programme theory of how the approach will work. Data collected and evidence from our literature review will inform this process along with refugee and service involvement during the workshops, which will consist of around 20 people. The outputs from these workshops will be presented at a community event to invite further feedback. _x000D_ _x000D_ Acceptability and feasibility test: Six PSWs will receive training to provide the new support model. The workers will then work with up to 10 refugees each over a 9-month period. Each refugee has up to 19 hours of contact time that can be used flexibly. PSWs will enter into a narrative dialogue with each refugee to help understand what is contributing to their distress and help them identify mental health goals to improve this. They will also help them identify suitable community activities and services to help them achieve their goals. We will interview refugees in contact with PSWs (n-16) at 3 time points to assess their experiences of the PSW model, if it is acceptable, and if and how it has been helpful. PSWs will be interviewed to garner their experiences of delivering the model and what benefits or disbenefits they might have experienced. Data from interviews and focus groups will inform adaptations to the approach. Tests of the PSW model will run in both Plymouth and Gloucester. _x000D_ _x000D_ Impact: Impact is part of the EBCD process through workshops and celebration events in the local community. Refugees will gain support, research and design skills, and PSWs will gain paid employment. Commissioners have helped develop this proposal and will commission it if shown to be acceptable. An advisory panel and local impact group will link the study to wider initiatives and findings will be disseminated through refugee networks, websites, the NHS and academic journals.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH