Alastair Ager | Columbia University (original) (raw)

Research Projects by Alastair Ager

Journal of Global Health, 2021

Background. Over recent decades there has been considerable mental health research in Sierra Leon... more Background. Over recent decades there has been considerable mental health research in Sierra Leone but little on local conceptualisations of mental health conditions. Understanding these is crucial both for identifying the experienced needs of the population and utilising relevant community-based resources to address them. This study took a grounded approach to identify the ways in which adults in Sierra Leone express psychological distress. Methods. Rapid ethnographic methods deployed included 75 case study interviews with community members, 12 key informant (KI) pile sorts and 55 KI interviews. Thematic analysis of data was supported by frequency analysis and multi-dimensional scaling. Results. Thirty signs of distress were identified. The only consistent 'syndrome' identified with respect to these was a general concept of crase, which referred to psychosis-related presentation but also a wide range of other signs of distress. We did not find consensus on locally defined concepts for mild-moderate forms of mental disorder: people use multiple overlapping signs and terms indicating psychological distress. Conclusions. Analysis supports calls to view mental health problems as a 'continuum of distress' rather than as discrete categories. This framing is coherent with opportunities for prevention and response in Sierra Leone which do not focus primarily on formal healthcare service providers but rather involve a range of community-based actors. It also enables attention to be paid to the identification of milder signs of distress with a view to early response and prevention of more severe mental health problems.

Background: There has been an 8-fold increase in use of the term resilience within scientific and... more Background: There has been an 8-fold increase in use of the term resilience within scientific and scholar literature over the last twenty years. The arena of public policy has also seen increasing use made of the concept, both with respect to child well-being and development and wider issues. Method: A focal sample of literature comprising 108 papers addressing public policy implications of work on child resilience was identified by a structured bibliographic search. Results: This literature suggests that current work: is characterized by a breadth of sectoral engagement across the fields of education, social work, and health; demonstrates diversity with regard to the systemic levels – individual (biological and psychological), communal (including systems of faith and cultural identity), institutional and societal – with which it engages; but is based more upon conceptual rather than empirical analysis. Major themes of policy recommendation target strengthened family dynamics, increased capacity for counseling and mental health services, supportive school environments, development of community programs, promotion of socioeconomic improvement and adoption of a more comprehensive conception of resilience. Evaluations of resiliency-informed policy initiatives are limited in number, with greatest rigor in design associated with more discrete programmatic interventions. Conclusion: A number of strategies to strengthen research-policy linkages are identified. These include greater commitment to operationalize indicators of resilience at all levels of analysis; more coherent engagement with the policy making process through explicit knowledge translation initiatives; and developing complex adaptive systems models amenable to exploring policy scenarios .

Background: This paper reports on the use of a " neighborhood method " to measure the nature and ... more Background: This paper reports on the use of a " neighborhood method " to measure the nature and incidence of violence against women and girls in post-conflict Liberia. Methods: The study population comprised females in Montserrado and Nimba counties. Study participants were randomly selected for interviews using multi-stage cluster sampling. 30 clusters of households were sampled in each county. Information on incidents of domestic violence and rape within the preceding 18 months was collected with regard to females of all ages in the respondent's household, and those of her four closest neighbors to make up the full sample.

Recent years have seen significant growth in both the size and profile of the humanitarian sector... more Recent years have seen significant growth in both the size and profile of the humanitarian sector. However, little research has focused upon the constructions of humanitarian practice negotiated by agencies and their workers that serve to sustain engagement in the face personal challenges and critique of the humanitarian enterprise. This study used the public narrative of 129 website postings by humanitarian workers deployed with the health-focused international humanitarian organization M edecins Sans Fronti eres (MSF) to identify recurrent themes in personal, organizationally-condoned, public discourse regarding humanitarian practice. Data represented all eligible postings from a feature on the agency's UK website from May 2002 to April 2012. The text of postings was analysed with respect to emergent themes on an iterative basis. Comprehensive coding of material was achieved through a thematic structure that reflected the core domains of project details, the working environment, characteristics of beneficiaries and recurrent motivational sub-texts. Features of the co-construction of narratives include language serving to neutralize complex political contexts; the specification of barriers as substantive but surmountable; the dominance of the construct of national-international in understanding the operation of teams; intense personal identification with organization values; and the use of resilience as a framing of beneficiary adaptation and perseverance in conditions that e from an external perspective e warrant despair and withdrawal. Recurrent motivational sub-texts include 'making a difference' and contrasts with 'past professional constraints' and 'ordinary life back home.' The prominence of these sub-texts not only highlights key personal agendas but also suggests e notwithstanding policy initiatives regarding stronger contextual rooting and professionalism e continuing organizational emphasis on externality and volunteerism. Overall, postings illustrate a complex co-construction of medical humanitarianism that reflects a negotiated script of personal and organizational understandings adapted to evolving demands of humanitarian engagement.

Deployment of resident female Community Health Extension Workers (CHEWs) to a remote rural commun... more Deployment of resident female Community Health Extension Workers (CHEWs) to a remote rural community led to major and sustained increases in service utilization, including antenatal care and facility-based deliveries. Key components to success: (1) providing an additional rural residence allowance to help recruit and retain CHEWs; (2) posting the female CHEWs in pairs to avoid isolation and provide mutual support; (3) ensuring supplies and transportation means for home visits; and (4) allowing CHEWs to perform deliveries. ABSTRACT Introduction: Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services.

Background: Strengthening health research capacity in low-and middle-income countries remains a m... more Background: Strengthening health research capacity in low-and middle-income countries remains a major policy goal. The Health Research Capacity Strengthening (HRCS) Global Learning (HGL) program of work documented experiences of HRCS across sub-Saharan Africa. Methods: We reviewed findings from HGL case studies and reflective papers regarding the dynamics of HRCS. Analysis was structured with respect to common challenges in such work, identified through a multi-dimensional scaling analysis of responses from 37 participants at the concluding symposium of the program of work. Results: Symposium participants identified 10 distinct clusters of challenges: engaging researchers, policymakers, and donors; securing trust and cooperation; finding common interest; securing long-term funding; establishing sustainable models of capacity strengthening; ensuring Southern ownership; accommodating local health system priorities and constraints; addressing disincentives for academic engagement; establishing and retaining research teams; and sustaining mentorship and institutional support. Analysis links these challenges to three key and potentially competing drivers of the political economy of health research: an enduring model of independent researchers and research leaders, the globalization of knowledge and the linked mobility of (elite) individuals, and institutionalization of research within universities and research centres and, increasingly, national research and development agendas. Conclusions: We identify tensions between efforts to embrace the global 'Community of Science' and the promotion and protection of national and institutional agendas in an unequal global health research environment. A nuanced understanding of the dynamics and implications of the uneven global health research landscape is required, along with a willingness to explore pragmatic models that seek to balance these competing drivers.

The availability of simple, specific, and inexpensive on-site detection methods is of key importa... more The availability of simple, specific, and inexpensive on-site detection methods is of key importance for deployment of pathogen surveillance networks. We developed a nontechnical and highly specific colorimetric assay for detection of pathogen-derived peptides based on Saccharomyces cerevisiae—a genetically tractable model organism and household product. Integrating G protein–coupled receptors with a visible, reagent-free lycopene readout, we demonstrate differential detection of major human, plant, and food fungal pathogens with nano-molar sensitivity. We further optimized a one-step rapid dipstick prototype that can be used in complex samples, including blood, urine, and soil. This modular biosensor can be economically produced at large scale, is not reliant on cold-chain storage, can be detected without additional equipment, and is thus a compelling platform scalable to global surveillance of pathogens.

Background: Gender-based violence (GBV) is a significant problem in conflict-affected settings. U... more Background: Gender-based violence (GBV) is a significant problem in conflict-affected settings. Understanding local constructions of such violence is crucial to developing preventive and responsive interventions to address this issue.

Journal of Global Health, 2021

Journal of Chilld Psychology and Psychiatry, 2021

Background: This paper revisits the themes of an influential 1993 review regarding the factors sh... more Background: This paper revisits the themes of an influential 1993 review regarding the factors shaping the mental health and psychosocial well-being of refugees to take stock of developments in the evidence base and conceptualisation of issues for refugee children over the last 25 years. Methods: The study deployed a systematic search strategy. This initially identified 784 papers, which was reduced to 65 studies following application of inclusion and exclusion criteria. We used a later iteration of Bronfenbrenner's bioecological model of human development-the PPCT model-to consolidate evidence. Results: We identify a range of risk and protective factors operating at individual, familial, community and institutional and policy levels that influence outcomes for refugee children. The dynamics shaping the interaction of these influences are linked to the life course principles of socio-historical time and developmental age, proximal processes and child agency. Conclusions: Actions at individual, familial, community, school, institutional and policy levels all have potential traction on mental health and psychosocial well-being of refugee children. However, evidence suggests that greatest impact will be secured by multilevel interventions addressing synergies between ecological systems, approaches engaging proximal processes (including parenting programmes) and interventions facilitating the agency of the developing refugee child.

In light of the recent Ebola epidemic, Francesco Checchi and colleagues argue that the World Heal... more In light of the recent Ebola epidemic, Francesco Checchi and colleagues argue that the World Health Organization’s response to health emergencies is not fit for purpose and put forward six proposals to reform WHO’s crisis response.

Background: Yobe State has faced severe disruption of its health service as a result of the Boko ... more Background: Yobe State has faced severe disruption of its health service as a result of the Boko Haram insurgency. A systems dynamics analysis was conducted to identify key pathways of threat to provision and emerging pathways of response and adaptation.

Health research policy and systems / BioMed Central, 2015

Abstract BACKGROUND: Strengthening health research capacity in low- and middle-income countries... more Abstract
BACKGROUND:
Strengthening health research capacity in low- and middle-income countries remains a major policy goal. The Health Research Capacity Strengthening (HRCS) Global Learning (HGL) program of work documented experiences of HRCS across sub-Saharan Africa.
METHODS:
We reviewed findings from HGL case studies and reflective papers regarding the dynamics of HRCS. Analysis was structured with respect to common challenges in such work, identified through a multi-dimensional scaling analysis of responses from 37 participants at the concluding symposium of the program of work.
RESULTS:
Symposium participants identified 10 distinct clusters of challenges: engaging researchers, policymakers, and donors; securing trust and cooperation; finding common interest; securing long-term funding; establishing sustainable models of capacity strengthening; ensuring Southern ownership; accommodating local health system priorities and constraints; addressing disincentives for academic engagement; establishing and retaining research teams; and sustaining mentorship and institutional support. Analysis links these challenges to three key and potentially competing drivers of the political economy of health research: an enduring model of independent researchers and research leaders, the globalization of knowledge and the linked mobility of (elite) individuals, and institutionalization of research within universities and research centres and, increasingly, national research and development agendas.
CONCLUSIONS:
We identify tensions between efforts to embrace the global 'Community of Science' and the promotion and protection of national and institutional agendas in an unequal global health research environment. A nuanced understanding of the dynamics and implications of the uneven global health research landscape is required, along with a willingness to explore pragmatic models that seek to balance these competing drivers

Global Health: Science and Practice, Mar 2015

Introduction: Nigeria has one of the highest maternal mortality ratios in the world. Poor health ... more Introduction: Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to
weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state
of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health
Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services.
Methods: Between February and August 2011, a quasi-experimental design compared service utilization in the pilot
community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency
access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding
year in Kadawawa, and also compared service utilization data in Kadawawa from 2008–2010 (before introduction of
the pilot) with data from 2011–2013 (during and after the pilot) to gauge sustainability of the model.
Results: Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates
of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per
100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control
community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up
from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a
skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total,
respectively). There was evidence of sustainability of these changes over the 2 subsequent years.
Conclusion: Community-based service delivery through a resident female community health worker can increase
health service utilization in rural, hard-to-reach areas.

Given the growing scale and complexity of responses to humanitarian crises, it is important to de... more Given the growing scale and complexity of responses to humanitarian crises, it is important to develop a stronger evidence base for health interventions in such contexts. Humanitarian crises present unique challenges to rigorous and effective research, but there are substantial opportunities for scientific advance. Studies need to focus where the translation of evidence from noncrisis scenarios is not viable and on ethical ways of determining what happens in the absence of an intervention. Robust methodologies suited to crisis settings have to be developed and used to assess interventions with potential for delivery at scale. Strengthening research capacity in the low- to middle-income countries that are vulnerable to crises is also crucial.

The field of mental health and psychosocial support (MHPSS) in humanitarian emergencies has shown... more The field of mental health and psychosocial support (MHPSS) in humanitarian emergencies has shown remarkable development over the last two decades.1 Mental health was once a notable omission from the health priorities to be addressed in the context of humanitarian response (Ager 1999 ; PWG 2002 ). Humanitarian work was focused principally on addressing material needs, implicitly judging non-material needs as of lower priority in acute emergencies and more challenging to address, being subject to local cultural variation (Harrell-Bond 1986 ). Now, however, MHPSS has been firmly established— viewed within a broader framing of the psychosocial well-being of communities impacted by crisis— as a key sector of humanitarian response (Mollica et al. 2004 ).

Expatriate humanitarian aid workers are often exposed to traumatic events and human suffering in ... more Expatriate humanitarian aid workers are often exposed to traumatic events and human suffering in the context of their deployments. Internal resources, such as having recourse to a transcendent spiritual framework, may play an important part in creating a meaningful perspective on the work and developing coping strategies to overcome challenging experiences. Aid workers from agencies based in North America and Europe participated in a longitudinal study of stress and mental health between 2005 and 2009 (Lopes Cardozo et al., 2012). Participants completed assessments of spiritual transcendence, trauma exposure, psychiatric distress, and posttraumatic life changes at predeployment (n = 212), postdeployment (n = 170), and a 3- to 6-month follow-up assessment (n = 154). Latent class growth analysis indicated 3 distinct trajectories of spiritual changes across the sample: (1) a group with high spiritual transcendence at predeployment with small, but significant, decreases over time; (2) a group with moderate and stable spiritual transcendence scores; and (3) a group with low and slightly decreasing spiritual transcendence scores over the study period. Participants who reported a religious affiliation were more likely to be in the high spiritual transcendence group, and different trajectories were not associated with likelihood of psychiatric distress at postdeployment or follow-up. However, those reporting higher spiritual transcendence were more likely to report positive life changes following their deployments. Findings suggest that spiritual transcendence was relatively stable in this sample, and that aid workers with greater spiritual transcendence may be more oriented toward personal growth after trauma exposure in their work. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Resilience research with war-affected populations has long conceptualized resilience as the absen... more Resilience research with war-affected populations has long conceptualized resilience as the absence of psychopathology and operationalized it by use of standardized measures. However, literature on resilience increasingly highlights the importance of also including indicators of positively valued functioning as well as contextually sensitive indicators of resilience. This study used a participatory approach to examine the contextual conceptualization of youth resilience in the aftermath of war in northern Uganda, as defined by groups of stakeholders (youths, parents, elders, leaders, teachers) in four communities. The results identify 40 indicators covering a multiplicity of domains of functioning. The rationales behind these indicators were clustered into the broad themes: progress, self-reliance, social connectedness, morality, health, and comfort. The findings suggest that positively and negatively valued aspects of functioning are both key to conceptualizing resilience, and indicate the importance of including contextually distinguished indicators. The findings further point to the role of individual and collective processes in the construction of resilience, and to the need to take into account the contexts wherein resilience is conceptualized and observed. This study generated contextually sensitive indicators of young people's resilience, which can be used, complementary to existing measures of functioning, to provide a more comprehensive and culturally sensitive view of youths' resilience in the wake of war adversity.
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The Partnership for Reviving Routine Immunization in Northern Nigeria - Maternal, Newborn and Chi... more The Partnership for Reviving Routine Immunization in Northern Nigeria - Maternal, Newborn and Child Health initiative supports efforts by the government of Nigeria to bridge primary health care (PHC) policies and services at three levels of government: federal, state and local. The paper suggests that understandings informed by complexity theory and complex adaptive systems have been helpful in shaping policy and programme design across these levels. To illustrate this, three initiatives are explored: Bringing PHC under one roof, enhancing access to funding provided by the Global Alliance for Vaccines and Immunization, and strengthening the midwives service scheme. These initiatives have demonstrated how concepts and experience developed at subnational level can influence national policy and practice, and how work at subnational levels can add value to nationally conceived and nationally driven plans for PHC.

Social Science & Medicine, Nov 2014

Recent years have seen significant growth in both the size and profile of the humanitarian sector... more Recent years have seen significant growth in both the size and profile of the humanitarian sector. However, little research has focused upon the constructions of humanitarian practice negotiated by agencies and their workers that serve to sustain engagement in the face personal challenges and critique of the humanitarian enterprise. This study used the public narrative of 129 website postings by humanitarian workers deployed with the health-focused international humanitarian organization Médecins Sans Frontières (MSF) to identify recurrent themes in personal, organizationally-condoned, public discourse regarding humanitarian practice. Data represented all eligible postings from a feature on the agency's UK website from May 2002 to April 2012. The text of postings was analysed with respect to emergent themes on an iterative basis. Comprehensive coding of material was achieved through a thematic structure that reflected the core domains of project details, the working environment, characteristics of beneficiaries and recurrent motivational sub-texts. Features of the co-construction of narratives include language serving to neutralize complex political contexts; the specification of barriers as substantive but surmountable; the dominance of the construct of national-international in understanding the operation of teams; intense personal identification with organization values; and the use of resilience as a framing of beneficiary adaptation and perseverance in conditions that--from an external perspective--warrant despair and withdrawal. Recurrent motivational sub-texts include 'making a difference' and contrasts with 'past professional constraints' and 'ordinary life back home.' The prominence of these sub-texts not only highlights key personal agendas but also suggests--notwithstanding policy initiatives regarding stronger contextual rooting and professionalism--continuing organizational emphasis on externality and volunteerism. Overall, postings illustrate a complex co-construction of medical humanitarianism that reflects a negotiated script of personal and organizational understandings adapted to evolving demands of humanitarian engagement.

Background This paper reports on the use of a “neighborhood method” to measure the nature and inc... more Background
This paper reports on the use of a “neighborhood method” to measure the nature and incidence of violence against women and girls in post-conflict Liberia.

Methods
The study population comprised females in Montserrado and Nimba counties. Study participants were randomly selected for interviews using multi-stage cluster sampling. 30 clusters of households were sampled in each county. Information on incidents of domestic violence and rape within the preceding 18 months was collected with regard to females of all ages in the respondent’s household, and those of her four closest neighbors to make up the full sample.

Findings
Households in the sample contained 7015 females (1687 girls, 4586 women, 742 age missing) in Montserrado and 6632 (2070 girls, 4167 women, 95 age missing) in Nimba. In the previous 18 months 54.1% (CI 53.1-55.1) and 55.8% (CI 54.8-56.8) of females in Montserrado and Nimba respectively were indicated to have experienced non-sexual domestic abuse; 19.4% (CI 18.6-20.2) and 26.0% (CI 25.1-26.9) of females in Montserrado and Nimba respectively to have been raped outside of marriage; and 72.3% (CI 70.7-73.9) and 73.8% (CI 72.0-75.7) of married or separated women in Montserrado and Nimba respectively to have experienced marital rape. Husbands and boyfriends were reported as the perpetrators of the vast majority of reported violence. Strangers were reported to account for less than 2% of the perpetrators of rape in either county. Incidents were most commonly disclosed to other family members or to friends and neighbors, and less often to formal authorities such as the police, court or community leaders. Incidents were approaching fifty times more likely to be reported to police if perpetrated by strangers rather than intimate partners.

Conclusions
Violence against women and girls is widespread in the areas studied. Programming needs to address the fact that this violence is primarily occurring in the household, where most incidents go unreported outside the immediate family or social circle. Police and hospital reports severely under-represent these known perpetrators. Inter-interviewer variance and differences in reports for self and neighbors for some outcomes caution the precision and validity of some estimates. However, the potential utility of the neighborhood method for estimating prevalence rates with an accuracy suitable for programmatic purposes in conflict-affected and post-conflict settings is noted.

Health Policy and Planning, 2013

Expatriate aid workers (n = 214) representing 19 nongovernmental organizations (NGOs) completed a... more Expatriate aid workers (n = 214) representing 19 nongovernmental organizations (NGOs) completed a redeployment survey, including measures of mental health (depression, anxiety, and posttraumatic stress disorder [PTSD]); risk factors
(childhood trauma, family risk, and adult trauma exposure); and resilience factors (coping, social support, and healthy lifestyle) to assess their baseline mental health during preparation for deployment. Multiple regression analysis indicated that childhood trauma/family risk was not significantly related to depression, anxiety, or PTSD symptoms when controlling for report of prior mental illness; yet, adult trauma exposure was significantly related to all three. Social support contributed significant variance to depression and PTSD. NGOs can help applicants recognize the effects of recent trauma and the resilience provided by a healthy social network.

In the aftermath of the civil war that extended from 1983–2009, humanitarian organizations provid... more In the aftermath of the civil war that extended from 1983–2009, humanitarian organizations provided aid to the conflict-affected population of the Vanni region in northern Sri Lanka. In August, 2010, a needs assessment was conducted to determine the mental-health status of Sri Lankan national humanitarian aid staff working in conditions of stress and hardship, and consider contextual and organizational characteristics influencing such status. A total of 398 staff members from nine organizations working in the Vanni area participated in the survey, which assessed stress, work characteristics, social support, coping styles, and symptoms of psychological distress. Exposure to traumatic, chronic, and secondary stressors was common. Nineteen percent of the population met criteria for posttraumatic stress disorder (PTSD), 53% of participants reported elevated anxiety symptoms, and 58% reported elevated depression symptoms. Those reporting high levels of support from their organizations were less likely to suffer depression and PTSD symptoms than those reporting lower levels of staff support (OR = 0.23, p < .001) and (OR = 0.26, p < .001), respectively. Participants who were age 55 or older were significantly less likely to suffer anxiety symptoms than those who were between 15 and 34 years of age (OR = 0.13, p = .011). Having experienced travel difficulties was significantly associated with more anxiety symptoms (OR = 3.35, p < .001). It was recommended that organizations provide stress-management training and increase support to their staff. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

Journal of child psychology and psychiatry, and allied disciplines, 2013

Background: There has been an 8-fold increase in use of the term resilience within scientific and... more Background: There has been an 8-fold increase in use of the term resilience within scientific and scholar literature over the last twenty years. The arena of public policy has also seen increasing use made of the concept, both with respect to child well-being and development and wider issues.
Method: A focal sample of literature comprising 108 papers addressing public policy implications of work on child resilience was identified by a structured bibliographic search. Results: This literature suggests that current work: is characterized by a breadth of sectoral engagement across the fields of education, social work, and health; demonstrates diversity with regard to the systemic levels – individual (biological and psychological), communal (including systems of faith and cultural identity),
institutional and societal – with which it engages; but is based more upon conceptual rather than empirical analysis. Major themes of policy recommendation target strengthened family dynamics, increased capacity for counseling and mental health services, supportive school environments, development of community programs, promotion of socioeconomic improvement and adoption of a more comprehensive conception of resilience. Evaluations of resiliency-informed policy initiatives are limited
in number, with greatest rigor in design associated with more discrete programmatic interventions. Conclusion: A number of strategies to strengthen research-policy linkages are identified. These include greater commitment to operationalize indicators of resilience at all levels of analysis; more coherent engagement with the policy making process through explicit knowledge translation initiatives;
and developing complex adaptive systems models amenable to exploring policy scenarios. Keywords: Resilience, recommendations, policy, (complex adaptive) systems, knowledge transfer.

Journal of traumatic stress, 2012

This study examined the mental health of national humanitarian aid workers in northern Uganda and... more This study examined the mental health of national humanitarian aid workers in northern Uganda and contextual and organizational factors predicting well-being. A cross-sectional survey was conducted among 376 national staff working for 21 humanitarian aid agencies. Over 50% of workers experienced 5 or more categories of traumatic events. Although, in the absence of clinical interviews, no clinical diagnoses were able to be confirmed, 68%, 53%, and 26% of respondents reported symptom levels associated with high risk for depression, anxiety disorders, and posttraumatic stress disorder (PTSD), respectively. Between one quarter and one half of respondents reported symptom levels associated with high risk regarding measured dimensions of burnout. Female workers reported significantly more symptoms of anxiety, depression, PTSD, and emotional exhaustion than males. Workers with the United Nations and related agencies reported fewest symptoms. Higher levels of social support, stronger team cohesion, and reduced exposure to chronic stressors were associated with improved mental health. National humanitarian staff members in Gulu have high exposure to chronic and traumatic stress and high risk of a range of poor mental health outcomes. Given that work-related factors appear to influence the relationship between the two strategies are suggested to support the well-being of national staff working in such contexts.
Copyright © 2012 International Society for Traumatic Stress Studies.

Abstract OBJECTIVES: To strengthen the evidence-base for policy and practice for support of child... more Abstract
OBJECTIVES:
To strengthen the evidence-base for policy and practice for support of children outside of family care requires effective, efficient and sustainable mechanisms for monitoring and evaluation. Toward that end, two core questions guided a systematic review of evidence: What strategies are appropriate for monitoring the needs and circumstances of children outside of family care? What strategies are suitable for evaluating the impact of the programs intended to serve such children?
METHODS:
A structured document search and review process was implemented within the context of the U.S. Government Evidence Summit on Protecting Children Outside of Family Care of December 2011. Through successive review phases, initially using structured screening criteria, followed by thematic review by an expert panel, 73 documents were identified for analysis.
RESULTS:
Analysis of models and strategies indicates that: (1) tools are available for assessment of children's needs, but require refining to accommodate contextual demands; (2) well-designed evaluations are able to identify the influence of assistance; (3) long-term follow-up is crucial to developing a strong evidence-base on effective strategies; and (4) insights into systems-wide monitoring mechanisms are emerging. In addition to describing key components of monitoring and evaluation strategies, findings draw attention to the evaluation of children's resiliency and protective factors, community based monitoring and the role of caregivers, as well as concerns over the stigmatization of children (through data collection methodologies encouraging the 'labeling' of children) and the importance of children's participation.
CONCLUSIONS:
Fostering a stronger evidence-base to improve protection for vulnerable children requires evaluations that are integrated into program development, use context-appropriate methodologies able to assess intervention scalability and employ more longitudinal designs to explore children's trajectories. Further, future programming will benefit from systems-wide data coordination and international comparisons, research that emphasizes coping and resilience mechanisms, and children's participation in monitoring and evaluation.
Copyright © 2012 Elsevier Ltd. All rights reserved.

The purpose of this research as a mid-term review to determine the strengths, weaknesses, opportu... more The purpose of this research as a mid-term review to determine the strengths, weaknesses, opportunities and threats for the Indigo programme from the perspectives of the partners, students, supervisors and the project management team. This article draws upon the research findings and suggests that the reflections and experiences of a broad range of stakeholders will not only facilitate direct programmatic learning, but also inform models of partnership in health research capacity building more generally. -

If you would like to obtain a copy of this Research Output, please contact Hanlie Baudin at researchoutputs@hsrc.ac.za.

Validated measures are needed for assessing resilience in conflict settings. An Arabic version of... more Validated measures are needed for assessing resilience in conflict settings. An Arabic version of the Child and Youth Resilience Measure (CYRM) was developed and tested in Jordan. Following qualitative work, surveys were implemented with male/female, refugee/nonrefugee samples (N = 603, 11–18 years). Confirmatory factor analyses tested three-factor structures for 28-and 12-item CYRMs and measurement equivalence across groups. CYRM-12 showed measurement reliability and face, content, construct (comparative fit index = .92–.98), and convergent validity. Gender-differentiated item loadings reflected resource access and social responsibilities. Resilience scores were inversely associated with mental health symptoms, and for Syr-ian refugees were unrelated to lifetime trauma exposure. In assessing individual, family, and community-level dimensions of resilience, the CYRM is a useful measure for research and practice with refugee and host-community youth.

There are major challenges of conducting evaluations in humanitarian crises such as natural disas... more There are major challenges of conducting evaluations in humanitarian crises such as natural disasters and armed con icts. However evaluation is a vital tool for improving current psychosocial programs as well as future planning, programming and decision-making. Evaluation provides the means to improve program performance, identify potential unintended negative consequences and build inter-agency consensus on good and promising practices. Essentially, the wider impact of well-documented, reliable evaluations will be the building of a stronger knowledge base for e ective psycho- social practice.

Reflecting on research from a wide range of perspectives and contexts, a number of elements of an... more Reflecting on research from a wide range of perspectives and contexts, a number of elements of an approach founded upon principles of resilience can be identified. In particular, work informed by the perspective of resilience may be characterized by: PRO-CAPACITIES EMPHASIS: An emphasis on strengths, resources, and capacities rather than deficits; PREVENTIVE FOCUS: Anticipation of actions that reduce the impact of adversity; MULTI-LEVEL ANALYSIS: Attention to multiple levels of influence ranging from the structural and cultural through to the community and the individual; and SYSTEMS ORIENTATION: Mapping influences within ecologically-nested systems.

Briefing paper for meeting on lessons for DFID's health response in Syria, 25 February 2016. The ... more Briefing paper for meeting on lessons for DFID's health response in Syria, 25 February 2016. The brief highlights - on the basis of a series of case studies and ongoing work - three observations. (1) participatory Group Model Building (GMB) provides a promising mechanism for local consideration of systems resilience; (2) adversity prompts diverse, contextually-related adaptation strategies in health systems; (3) recurrent systems-level characteristics are best basis for generalization and facilitating local problem-solving regarding resilience.

The case study was conducted principally from the perspective of the International Center for AID... more The case study was conducted principally from the perspective of the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University, an implementing partner funded by Centers for Disease Control and Prevention (CDC) under the U.S. President’s Emergency Plan for Aids Relief (PEPFAR). ICAP provided technical assistance for HIV- related programming to the Ministry of Health during this period. ICAP supported family- focused and multidisciplinary HIV services in health facilities across the country, working to build district capacity for provision of comprehensive HIV services1. These services included: pediatric and adult HIV care and treatment (including provision of ART); integrated tuberculosis/HIV care and treatment; rapid HIV testing for adults and children; diagnostic testing/analysis (including Dried Blood Spot DNA PCR testing for infants); community outreach; HIV support groups; and peer education programs. While the Ministry of Health (MOH) provided salaries to the majority of health facility staff and was also responsible for the procurement of drugs, ICAP provided salary support to some staff at health facility level such as data clerks.

Our research points to numerous examples of contributions best made by local faith communities in... more Our research points to numerous examples of contributions
best made by local faith communities in the context
of humanitarian response. However, challenges to effective
engagement of local capacity and barriers in connecting
local faith community resources to wider humanitarian response
persist in the current response to the Syrian crisis.
We draw from challenges and opportunities identified to
suggest some practical actions for humanitarian agencies
to more effectively partner with religious groups.

Journal of Refugee Studies, Jun 12, 2015

The potential role of local faith communities (LFCs) in promoting resilience in contexts of human... more The potential role of local faith communities (LFCs) in promoting resilience in contexts of humanitarian crisis has, despite recent policy interest, been a neglected area of study. This article reports on a structured review of evidence regarding such contributions based on an analysis of 302 publications and reports, supplemented by 11 written submissions from humanitarian non- governmental organizations (NGOs) and 10 stakeholder interviews. Analysis is structured with respect to three major humanitarian processes—disaster risk reduction; emergency response; and facilitating transitional and durable solutions—relevant to the promotion of resilience in populations that are displaced, at risk of displacement or refugee-impacted. Major themes emerging from the analysis concern: the diversity of stakeholder perspectives on the presence and influence of LFCs on local humanitarian response; the resources—material and non-material—potentially made available through LFCs to crisis-affected communities; and the opportunities—and substantive challenges—for greater LFC partnership with humanitarian organizations.

Evidence Brief created for the World Humanitarian Summit on religious engagement in humanitarian... more Evidence Brief created for the World Humanitarian Summit on religious engagement in humanitarian action in relation to the fifth core responsibility of the UNSG's report "One Humanity, Shared Responsibility."

Evidence Brief created for the World Humanitarian Summit on the religious engagement in humanitar... more Evidence Brief created for the World Humanitarian Summit on the religious engagement in humanitarian action in relation to the fourth core responsibility of the UNSG's report "One Humanity, Shared Responsibility."

Exposure to conflict and natural disasters poses significant risks to the mental health and psych... more Exposure to conflict and natural disasters poses significant risks to the mental health and psychosocial wellbeing of affected populations. Children and adolescents are particularly vulnerable given that humanitarian emergencies often disrupt the very social institutions, community resources, economic livelihoods, and infrastructural supports that children depend on for normal growth and development. Although children can be remarkably resilient and adaptive to change in their environments, such disruption of the social fabric commonly warrants the mobilization of interventions addressing mental health and psychosocial support to further facilitate recovery and growth (Loughrey & Eyber, 2003; Boothby, Wessells & Strang, 2006; Hunter, 2012).

This paper reports findings from a cross-sectional analysis measuring the relationship between ho... more This paper reports findings from a cross-sectional analysis measuring the relationship between household livelihoods and children's well-being and protection in two districts of western Uganda. 246 households completed a household questionnaire measuring income, assets, livelihood activities, and various child outcomes. Multivariate analysis indicated that household asset level and livelihood activity were both positively associated with improved child physical well-being. Households with greater assets reported fewer child protection risks. Findings suggest that although economic strengthening activities may improve the physical well-being of children, there remains a need to integrate psychosocial support to households to complement such provisions in securing child protection and well-being.

Intervention

In war a¡ected populations there is often severe disruption of societal cohesion. Additionally, g... more In war a¡ected populations there is often severe disruption of societal cohesion. Additionally, grief and traumatisation, along with insu⁄cient health services and a lack of security, give rise to an increase of mental health problems. Social capital is potentially a key resource to support post con£ict recovery, and is increasingly considered not merely as a resource supporting economic and social development, but also an important in£uence on population health. However, linkages between social capital and mental health are complex. Therefore, this article begins with an introduction to the construct of social capital, then provides an overview of the main ¢ndings on its relation to health and wellbeing, as well to mental health in general and in post emergency situations. Finally, it explores if social capital may be promoted intentionally, as pursued through a community based sociotherapy programme in Rwanda.While there appears to be a rationale for promoting social capitalwithin...

Civil conflict, natural disasters, pandemic disease and famine continue to place the work of huma... more Civil conflict, natural disasters, pandemic disease and famine continue to place the work of humanitarian assistance high in public consciousness. The last twenty years have seen a concerted attempt by humanitarian agencies – both non-governmental and inter-governmental – to develop best professional practice in their fields of operation. The current work of such agencies bears the clear mark of contribution from many disciplines, ranging from agricultural to management sciences, from macroeconomics to social anthropology, from engineering to medicine. However, the contribution from psychology has, to date, been modest.

There are, however, signs of this circumstance changing, with psychologists beginning to make contributions in a number of areas of activity. The purpose of this paper is to (1) identify the constraints that have limited the previous contribution of psychology in the arena of humanitarian assistance and (2) map areas where contributions have begun to be made, or offer particular potential for future contribution. The broad assertion of the paper is that the obstacles to appropriate application of psychological knowledge in the furtherance of the work of humanitarian assistance agencies are very real but, with due sensitivity, flexibility and breadth of vision, there are many areas of the discipline of psychology – both pure and applied – that can make a meaningful contribution to the conceptualization and implementation of humanitarian assistance.

The government’s strategy for integration sets out how the government can collaborate with other ... more The government’s strategy for integration sets out how the government can collaborate with other stakeholders
to encourage local communities to support refugees, provide access to suitable English language tuition and
promote employment of refugees. The main aims of the strategy are to include refugees as equal members of
society, help refugees develop their potential and facilitate access to the support necessary for integration.
In support of the new strategy, the government has provided three additional funding streams: funding to
refugee organisations, funding to community organisations and funding through the Refugee Integration
Challenge Fund. In addition to these funds, the European Refugee Fund provided funds to be administered by
the UK. The Challenge Fund and the European Refugee Fund provide funding to facilitate integration in areas
such as access to employment, health care and education.
To facilitate the implementation of the refugee integration strategy and to ensure that new policies to promote
integration are based on evidence, the Home Office established a research team to conduct research on
immigration and integration. Whilst a lot is known about how to integrate refugees and other migrants,
further research is required to identify interventions that are effective in the UK context. Additionally, the cost
of different strategies to enhance integration, appropriate measures of outputs and outcomes and the social
and economic impact of integrating refugees and migrants on host communities and services will also need to
be examined. The IRSS/ERA team has therefore planned a research programme to increase our knowledge
about integration, identify and evaluate strategies that are effective and appropriate for use in the UK and to
disseminate that knowledge to policy makers and service providers.
These developments have clear implications for the settlement and integration of refugees. The mechanisms for
social integration are many, ranging from national governments to local governments, to organisations such
as churches, sports clubs, schools, non-governmental organisations (NGO’s) and finally, immigrants, members
of ethnic minority groups and members of host communities. To what extent should these players adapt
themselves to embrace diversity? How should members of the receiving society adapt to such changes? How
do we develop evidence-based policies in integration? What does integration mean for diverse groups?
By bringing together policy makers, academics, NGOs, and refugees at the national integration conference
in Manchester, we aim to address these questions and generate a common understanding of the current
challenges and the policy mechanisms in existence to meet them. The conference will focus principally on the
situation in the UK. This will be supplemented with an overview of the policy and research being conducted in
Canada and Europe.

Final Report on the Advanced Research Training Seminar (ARTS) on Qualitative Research Methods: Ap... more Final Report on the Advanced Research Training Seminar (ARTS) on Qualitative Research Methods: Applications Across Cultures and Ethnic Groups at the University of Ottawa, Canada, 22–25 August 1996

This meeting - which followed on from the 26th International Congress of Psychology in Montreal of 16-21 August 1996- was attended by 19 participants drawn across the globe (including China, India, Bangladesh, Mexico, Brazil, Russia, Belarus, Ukraine, Poland and Croatia.)

Publisher 40% Discount to Feb 15th

Faith, Secularism, and Humanitarian Engagement: Finding the Place of Religion in the Support of D... more Faith, Secularism, and Humanitarian Engagement: Finding the Place of Religion in the Support of Displaced Communities
Ager, A and Ager, J. (2015)
Strengthening local humanitarian engagement demands not only rethinking dominant understandings of religion, but also revisiting the principles and practices of humanitarianism. …
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Journal of Refugee Studies, 2009

The growth of the world's refugee population has been a major phenomenon of the late-20th century... more The growth of the world's refugee population has been a major phenomenon of the late-20th century. This volume brings together senior authors from a range of disciplinary backgrounds to analyze key forces shaping the contemporary experience of forced migration. It considers global, social and personal dimensions of displacement, demonstrating their close interrelationship in forging the experience of refuge. Recurrent themes include the importance of valuing the resources, capacities and meanings indigenous to refugee communities, and the intimate linkage of the personal and political in the lives of refugees. In addition to providing deeper insight into the challenges and tensions of the refugee experience, the text seeks to provide a foundation for more informed debate on refugee assistance and asylum policies and practice.

A Child's Right to a Healthy Environment, 2010

Creating a protective environment is the basis of the United Nations’ strategy for protecting the... more Creating a protective environment is the basis of the United Nations’ strategy for protecting the human rights of children faced with the extreme environmental threats posed by disasters and war. The “Protective Environment Framework” was developed as a basis to identify the key areas, where actions can be taken to increase the protection available to children (Landgren, 2005).

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The application of microcomputers to clinical psychology has existed from the beginning of its in... more The application of microcomputers to clinical psychology has existed from the beginning of its introduction in the early 1980's. Examines the field today as well as its future directions. Topics include: selection and support of microcomputer systems, computer-assisted psychometric, neuropsychological and psychological problem assessment, computer-based psychological treatment and cognitive rehabilitation, applications with children and people with learning difficulties, monitoring and evaluating clinical service delivery, expert systems, and psychological aspects of the new technological age.

Journal of Health Psychology, 1999

... 048 India Printed m the United States of America Library of Congress Cataloging-in-Publicatio... more ... 048 India Printed m the United States of America Library of Congress Cataloging-in-Publication Data Aboud, Frances E. Health psychology in ... 97 Measuring the Magnitude of AIDS and HIV 99 International Prevalence Rates and Patterns 101 Prevention Strategies: Whom and ...

Armed conflict and the mass displacement it can produce brings with it specific dynamics that imp... more Armed conflict and the mass displacement it can produce brings with it specific dynamics that impact on the experiences of poverty, on issues of psychosocial well-being, and on ways in which forced migrants confront the difficulties they face. This chapter focuses on the interrelationship between displacement, poverty and psychological factors in order to gain insight into the daily challenges in the lives of refugees and the internally displaced.

Conflict and Health, 2020

Background Evidence of ‘what works’ in humanitarian programming is important for addressing the d... more Background Evidence of ‘what works’ in humanitarian programming is important for addressing the disruptive consequences of conflict and forced displacement. However, collecting robust scientific evidence, and ensuring contextual relevance, is challenging. We measured the biological, psychosocial, and cognitive impacts of a structured psychosocial intervention, implemented by Mercy Corps with Syrian refugees and Jordanian host-community youth. In this paper, we present a case analysis of this evaluation study and reflect on the scientific contributions of the work, the challenges experienced in its delivery, and the strategies deployed to address them. Discussion We identified challenges with respect to study design, methods, and dissemination: these included the logistics and acceptability of implementing a randomized controlled trial in a humanitarian context, the selection and refinement of culturally-relevant research tools and community-based practices, and the dissemination of ...

Psychological Assessment, 2013

Child Psychiatry & Human Development, Nov 27, 2020

Evidence for a single underlying factor structure of posttraumatic stress disorder (PTSD) in chil... more Evidence for a single underlying factor structure of posttraumatic stress disorder (PTSD) in children remains elusive. We assessed the underlying factor structure of the Child PTSD Symptom Scale through exploratory (EFA) and confirmatory factor analyses (CFA) in 570 survivors of the 2015 Gorkha earthquake in Nepal. The EFA suggests that the three-factor DSM-IV model fit these data best. The CFA suggests that while the DSM-IV model adequately fit these data, the four-factor King model fit them better. There was no evidence of differential item functioning by age or gender, and internal consistency of the scale was high. PTSD (overall or by factor) was not correlated with functional impairment. Inconsistent psychometric results across contexts and methodologies suggest that our current theoretical conceptualizations and empirical models of posttraumatic stress are lacking. Future studies must both document the instrument properties to assure internal validity and cross-study comparisons and, bolstered by increased psychometric data and analyses, rework theoretical models of PTSD with improved cross-cultural validity.

Review of Faith & International Affairs, Jan 2, 2014

sch_iih12pub4232pub

Routledge eBooks, Feb 17, 2015

Intervention, Jul 1, 2014

Frontiers in Public Health, Jul 25, 2022

BMC Psychology

BackgroundStudies of psychological distress in Sierra Leone have typically used measures which we... more BackgroundStudies of psychological distress in Sierra Leone have typically used measures which were developed for use in other contexts, and which often have not been adapted or validated for use in Sierra Leone. This has resulted in a lack of reliable information about the patterns of psychological distress within the population, which is a barrier to the development of effective and appropriate mental health services. The aim of the study was to develop a locally-appropriate measure of psychological distress for Sierra Leone.MethodsThe new measure consists of two instruments: the Sierra Leone Psychological Distress Scale (SLPDS) and a gendered measure of ability to carry out daily tasks—a Function scale—as an indication of the severity of distress. A three-phase mixed methods exploratory sequential study was conducted. Phase 1 was item generation and testing, leading to the development of a set of potential items for both instruments. Phase 2 was a small pilot study (N = 202) lead...

Humanities and Social Sciences Communications

Qualitative comparative analysis (QCA) is a relatively new method that examines causal complexity... more Qualitative comparative analysis (QCA) is a relatively new method that examines causal complexity. Its use in mental health research is nascent. In low-income and fragile settings, with weak mental health service provision, identifying pathways of recovery from psychological distress can inform the appropriate deployment of scarce community and public resources. This paper examines the use of QCA to identify predictors of recovery in Sierra Leone. Our study explored lay perceptions of the signs of recovery from psychological distress caused by such events as the loss of a family member, severe sickness, and loss of a relationship. The data drew upon 75 interviews with women and men, across four districts of Sierra Leone, who described the signs of recovery from psychological distress they have observed in one person known to them. The truth table generated through QCA software indicated two signs of recovery— work/study and healthy relations—to be the most prevalent across different...

The Review of Faith & International Affairs, 2021

Health Systems Resilience: A Systems Analysis is a ReBUILD affiliate research project applying a ... more Health Systems Resilience: A Systems Analysis is a ReBUILD affiliate research project applying a systems dynamics approach to understand, predict and identify mechanisms that influence the resilience of health systems in contexts of adversity. The project is implemented by the Mailman School of Public Health, Columbia University, in collaboration with the School of Public Health, University of Western Cape. Resilience is now a dominant concept underpinning development and humanitarian support in contexts vulnerable to crisis, including conflict. This paper is an analysis of the circumstances in the health sector in Yobe state in northern Nigeria, related, and in response to the Boko Haram insurgency beginning around 2011 and continuing to the present. The paper makes a number of Key Points: Yobe State has faced severe disruption of its health service as a result of the Boko Haram insurgency. •Population migration and transport restrictions have severely impacted access to health pro...

UCL Migration Research Unit, 2017

This report summarises the rich conversations which were had over the course of a two-day worksho... more This report summarises the rich conversations which were
had over the course of a two-day workshop on Local Faith Community
Responses to Displacement, which was held in Beirut on the 17th and 18th July 2017. As well as drawing on research from the Refugee Hosts project, this report points to key issues and themes relating to faith and local communities which require further consideration both within the context of the Middle East and further afield. The report and workshop was made possible by the AHRC, ESRC and the generous support of the UCL Knowledge Exchange Fund.