Ruqayya Sulaiman-Hill - Academia.edu (original) (raw)

Papers by Ruqayya Sulaiman-Hill

International Journal of Environmental Research and Public Health

This paper reports on the development and validation of the COVID Psychosocial Impacts Scale (CPI... more This paper reports on the development and validation of the COVID Psychosocial Impacts Scale (CPIS), a self-report measure that comprehensively examines both positive and negative psychosocial impacts from the COVID-19 pandemic. This is the first part of the program of work in which the CPIS was administered and compared with a measure of psychological distress (Kessler Psychological Distress Scale, K-10) and wellbeing (World Health Organization Well-Being Index, WHO-5). The data were obtained online in 2020 and 2022 at two distinct time points to capture different exposures to the pandemic in the New Zealand population to a non-representative sample of 663 and 687 adults, respectively. Two hundred seventy-one participants took part in both surveys. Findings indicate a unidimensional structure within CPIS subscales and inter-relatedness among CPIS stress-related subscales. The scatter plots and correlation matrix indicate CPIS having a positive moderate correlation with K10 and a ne...

BMJ Open

IntroductionThe COVID-19 pandemic exposed people to significant and prolonged stress. The psychos... more IntroductionThe COVID-19 pandemic exposed people to significant and prolonged stress. The psychosocial impacts of the pandemic have been well recognised and reported in high-income countries (HICs) but it is important to understand the unique challenges posed by COVID-19 in low- and middle-income countries (LMICs) where limited international comparisons have been undertaken. This protocol was therefore devised to study the psychosocial impacts of the COVID-19 pandemic in seven LMICs using scales that had been designed for or translated for this purpose.Methods and analysisThis cross-sectional study uses an online survey to administer a novel COVID Psychosocial Impacts Scale (CPIS) alongside established measures of psychological distress, post-traumatic stress, well-being and post-traumatic growth in the appropriate language. Participants will include adults aged 18 years and above, recruited from Indonesia, Iraq, Iran, Malaysia, Pakistan, Somalia and Turkey, with a pragmatic target ...

Worldwide, conflict situations and the resultant number of refugees continue to increase, with ov... more Worldwide, conflict situations and the resultant number of refugees continue to increase, with over 43 million recorded at the end of 2009. Nearly half of those currently under the protection of the United Nations High Commissioner for Refugees (UNHCR) originally came from Iraq or Afghanistan. Although less than 1% will eventually be resettled in new host nations, their long term health and settlement prospects are a matter of continuing relevance. Since 2000, Australia alone has accepted over 58,000 Afghan refugees, with more than 5000 resettled in New Zealand. Although refugees accepted under humanitarian programs receive state support frequently denied to asylum seekers, they are still vulnerable to acculturative stress. Public attitudes and government policies to immigration in receiving countries inevitably play an important role in resettlement outcomes. The overall aim of this research project was to examine the resettlement experiences of refugees settled in Australia and New Zealand, taking into consideration the different policy and social setting in each location. A mixed methods approach was adopted for this exploratory study, utilising both qualitative and quantitative methods to investigate the social and political environment surrounding refugee issues in the public sphere, as well as assessing the health and wellbeing of former refugee participants. A comparative study of newspaper reporting of refugee issues was conducted to monitor trends in reporting over time, to assess public attitudes in each location, and provide background context to the main study findings. This media study provided insights into the politics of the refugee debate and policy environment in New Zealand and Australia, revealing significant differences in the way refugee issues are portrayed by the media in each location. Compared to New Zealand, newspaper articles in Australia were more politicised, and less likely to portray refugees in a positive manner. Since 2001, political attitudes to asylum seekers hardened, as revealed in Australian coverage, reflecting increasing negativity towards refugees overall. In particular, reporting suggests public attitudes towards refugees and those who are visibly different may be shifting over time. This was followed up by a survey of former refugees from Afghanistan and the Kurdish regions of Iraq and Iran, who were living in Perth, Western Australia and Christchurch, New Zealand at the time of data collection in 2008. A mixed methods approach was used to evaluate the perceived effectiveness of resettlement programs in addressing the psychosocial and health care needs of these groups. For the purposes of the study, it was necessary to define what was meant by 'successful resettlement'. Based on the availability of suitable quantitative instruments this was primarily conceptualised by measuring subjective well being and psychological distress. An iv additional instrument was also included to assess general self efficacy, as this can influence motivation and attitudes to change. Translated and culturally validated Instruments were provided in Farsi (Persian), Arabic and English for self completion during interview. Participants were recruited by a snowball sampling technique, using multiple initial contacts with short chains of contacts within each of the refugee groups to improve representativeness and reduce selection bias. Comparison with census data and community profile maps provided reassurance that this had been achieved. Ascending methods help to overcome some of the sampling challenges encountered with difficult to access and vulnerable populations such as these, accepting that achieving an indicative sample provides valuable information even if not truly representative. Quantitative data collected using individual, questionnaire-based interviews was obtained from 193 participants settled up to 20 years. This assessed key outcome variables using the Kessler-10 Psychological Distress Scale (K10), the Personal Well Being Index (for subjective well being) and the General Perceived Self Efficacy scale. In combination with demographic data, this allowed comparisons across domains based on ethnic group, gender, temporal variables and country of settlement. Qualitative material from open ended questions, presenting the personal perspectives of 124 participants, offered valuable insights into their overall resettlement experiences, quality of life, sources of stress and coping responses. Psychological distress was revealed to be a chronic problem, with 60% of those settled more than 8 years still above the K10 threshold. Despite this, many people were reluctant to seek professional help despite considerable morbidity. Introspection and depression were the main sources of concern for participants at all stages of resettlement, closely followed by separation from family and friends, feeling overwhelmed by the challenges facing them and relationship issues. Unemployment was significantly associated with poor mental health, especially as it often resulted in people sitting at home 'thinking too much'. In addition, the impact of political events and the situation of significant others in their home countries, as reinforced by media reporting of conflicts in Iraq and Afghanistan, was also influential. Women in particular, struggled due to a lack of family support, changing roles and expectations, and social isolation. The perception that public attitudes towards Muslims changed as a result of political events elsewhere, resulted in some people believing that they would never really fit in. This may be linked with the cultural and religious concerns expressed by some participants and reflect wider societal attitudes to refugees in general, or Muslims in particular, especially in Australia. Reality often fell short of expectation as refugees experienced difficulties vi CONTENTS Declaration ii Abstract iii Contents vi List of Tables & Figures x Acknowledgements xi Abbreviations xiii Definitions xv List of included publications xviii Contribution of author and co-authors xix CHAPTER 1 INTRODUCTION & THESIS OVERVIEW 1 1.1 Background 1 1.2 Research problem and objectives 3 1.3 Personal background and reflections 3 1.4 Orientation to the thesis 10 CHAPTER 2 CONTEXT OF THE RESEARCH & RESEARCH PARTICIPANTS 14 2.1 Refugee resettlement: International imperatives 14 2.1.1 Refugee status determination 2.1.2 Durable solutions for refugee populations 2.2 Refugee resettlement: New Zealand Response 17 2.2.1 Quota refugees 2.2.2 Family Reunification 2.2.3 Convention refugees/Asylum seekers 2.2.4 Resettlement support 2.3 Refugee resettlement: Australian Response 24 2.3.1 Humanitarian Program Onshore Protection vii 2.3.2 Humanitarian Program Offshore Resettlement 2.3.3 Family reunification 2.3.4 Resettlement services 2.4 Summary of Australian and New Zealand resettlement policies 2.5 Australian immigration-White Australia Policy 2.6 The politics of asylum in Australia 2.6.1 The Tampa incident 2.6.2 Other high profile incidents 2.6.3 Mandatory detention: national inquiries 2.6.4 International concerns 2.7 Geographical and political background of refugee study populations 2.7.1 Afghanistan 2.7.2 Iran, Iraq and the Kurds 2.8 Community profiles of refugee study populations 2.8.1 Christchurch 2.8.2 Perth 2.9 Refugee Stories 2.9.1 Afghan life story-Ali 2.9.2 Kurdish Life Story-Ahmad 2.9.3 Commonalities and differences 2.10 Summary CHAPTER 3 REVIEW OF LITERATURE 3.1 Migration 3.2 Forced migration and health 3.2.1 Physical health concerns 3.2.2 Common mental health disorders 3.3 Migration phase 3.3.1 Trauma and the refugee experience 3.3.2 Detention of asylum seekers 3.4 Paradigm debates 3.5 Post-migration phase 3.6 Social determinants of health viii 3.6.1 Income 3.6.2 Housing 3.6.3 Employment 3.6.4 Education and Language 3.6.5 Access to information and culturally sensitive services 3.7 Separation from family 3.8 Acculturative stress 3.9 Discrimination and visible difference 3.9.1 Media representations of refugees and minority groups 3.10 Factors influencing post migration adaptation 3.10.1 Coping processes 3.10.2 Belief systems 3.10.3 Social support 3.10.4 Self efficacy 3.11 Subjective well being and quality of life 3.12 Long term settlement trends 3.13 Summary, identified gaps and research questions CHAPTER 4 MEDIA STUDY 4.1 Conceptual framework and study design 4.1.1 Aims of the study 4.1.2 Theoretical and conceptual framework 4.1.3 Study design 4.2 Sample selection 4.3 Data analysis 4.4 Article 1: Changing images of refugees: A comparative analysis of Australian and New Zealand print media 1998-2008 4.5 Summary of media study findings CHAPTER 5 METHODOLOGY FOR REFUGEE STUDY 5.1 Conceptual framework and study design 5.1.1 Theoretical and Conceptual framework 5.1.2 Research paradigms and philosophical debates 5.1.3 Approaches to mixed methods research ix 5.1.4 Design of the study 5.1.5 Research questions 5.2 Language considerations & translation procedure 5.3 Data handling 5.3.1 Data collection 5.3.2 Quantitative data processing 5.3.3 Quantitative data analysis 5.3.4 Analysis of qualitative material 5.3.5 Mixing of data and analysis 5.4 Article 2: Selecting instruments for assessing psychological wellbeing in Afghan and Kurdish refugee groups 5.5 Article 3: Sampling challenges in a study examining refugee resettlement 5.6 Summary CHAPTER 6 RESEARCH FINDINGS 6.1 Introduction 6.2 Article 4: 'Thinking Too Much'-Psychological distress, sources of stress and coping strategies of resettled Afghan and Kurdish refugees 6.3 Article 5: Afghan and Kurdish refugees, 8-20 years after resettlement, still experience psychological distress and challenges to well being 6.4 Article 6: Learning to Fit in: An Exploratory Study of General Perceived Self Efficacy in Selected Refugee Groups

The current study explores the perceived quality of life of Syrian refugees who have entered the ... more The current study explores the perceived quality of life of Syrian refugees who have entered the Kurdistan Region of Iraq. Two hundred and seventy participants residing in refugee camps in the Erbil region in Kurdistan completed the WHOQOL-BREF, which measures Quality of Life (QOL) within four domains; physical, psychological, social relationships and environment. Syrian refugees in Kurdistan scored significantly lower for general population norms on physical health, psychological and environment QOL, and score significantly lower for physical health and psychological QOL for refugees in the Gaza strip. However, respondents in the current sample scored significantly higher on environment QOL compared to refugees in the Gaza strip, and significantly higher on all the QOL domains than those reported for refugees in West Africa. Finally, Syrian refugees in Kurdistan scored significantly higher than general population norms for social relationships QOL. The current findings provide the first report of QOL domain scores among Syrian refugees in the Kurdistan camps and suggest that social relationships and environmental QOL circumstances are relatively satisfactory, and that further investigation might be focused on physical and psychological QOL.

BMJ Open, 2021

IntroductionOn 15 March 2019, a white supremacist gunman opened fire in two mosques in Christchur... more IntroductionOn 15 March 2019, a white supremacist gunman opened fire in two mosques in Christchurch, New Zealand, during Friday prayers, killing 51 people and injuring 40. The event was witnessed by at least 250 survivors and also live streamed on social media, leading to widespread and repeated exposure within the community. It is expected that survivors, families and community members will be at increased risk of developing mental disorders due to the scale and violence of these attacks.This protocol describes the first phase of a proposed longitudinal study to screen and assess the long-term impacts of the terrorist attack on members of the Christchurch Muslim community, to determine clinical need and facilitate access to appropriate interventions and to gain insights into working with such a traumatised, ethnically diverse population. It has been developed in close collaboration with members of that community.Methods and analysisA mixed-method design is described, combining self...

Muslims are everywhere these days, at least that’s the impression you might get from media report... more Muslims are everywhere these days, at least that’s the impression you might get from media reports which regularly seem to focus on the latest scandal, perceived injustice or apparently unreasonable demands of Muslim migrants, sparking calls from ‘mainstream’ Kiwi’s to ‘fit in, or go back home’. The stereotypical image of Muslims portrayed in these articles reflects a common perception that the majority hail from rigidly segregated, paternalistic, Middle Eastern countries whose burqa-clad women are treated as second class citizens. Add to this the ongoing rhetoric of the war against terror where, at least in the eyes of the general public, terrorists (read Muslim) are depicted as ‘hating those who love freedom’ and who are hell bent on imposing their own norms and behaviours onto others. Of course there may be some truth in this perception, but the vast majority of Muslims here are content to just get on with their lives and maintain cordial relations with their fellow New Zealanders.

Journal of Muslim Mental Health, 2012

SAGE Open, 2014

Migrant women are under-represented as users of alcohol and other drug (AOD) services. This study... more Migrant women are under-represented as users of alcohol and other drug (AOD) services. This study examined AOD use by newly arrived women, identifying issues of concern to them. A questionnaire-based survey was conducted with 268 migrant women who had arrived in Perth, Western Australia, within the previous 5 years. Almost half were humanitarian entrants. Most women (76%) reported they did not drink alcohol. Of those who did, 10 were drinking at harmful levels and over half reported changes to their drinking patterns since arrival. One fifth of participants (20%) described distressing incidents related to alcohol or drug use by others. Migrant women are concerned by alcoholand drug-related problems, even if they do not drink themselves. Domestic violence and abuse by strangers were concerns that were aggravated by alcohol and drug use. As new migrants often lack strategies to prevent, or deal with alcohol-related misuse, provision of additional information and support is recommended.

Journal of Immigrant & Refugee Studies, 2011

Journal of Immigrant and Minority Health, 2011

Health Promotion Journal of Australia, 2013

Issues addressedPreferences for topics and means of access to health information among newly arri... more Issues addressedPreferences for topics and means of access to health information among newly arrived, culturally and linguistically diverse women in Perth, Western Australia, were explored.MethodsA mixed‐methods approach was adopted. Qualitative material obtained from focus groups and interviews with 22 service providers and 26 migrant women was used to develop a questionnaire, which was then administered to 268 newly arrived migrant and refugee women from 50 countries. Participants' information and support priorities were ascertained from a ranking exercise conducted in a non‐threatening context. Responses of migrant and refugee women were compared quantitatively.ResultsWomen's top priorities for information and support included employment advice, as well as information regarding mental health issues, women's health, exercise and nutrition, family violence and alcohol and other drug issues. Their preferred methods for receiving information were interactive talks or pres...

BMC International Health and Human Rights, 2014

Background: Although the challenges of working with culturally and linguistically diverse groups ... more Background: Although the challenges of working with culturally and linguistically diverse groups can lead to the exclusion of some communities from research studies, cost effective strategies to encourage access and promote cross-cultural linkages between researchers and ethnic minority participants are essential to ensure their views are heard and their health needs identified. Using bilingual research assistants is one means to achieve this. In a study exploring alcohol and other drug service use by migrant women in Western Australia, bilingual workers were used to assist with participant recruitment and administration of a survey to 268 women who spoke more than 40 different languages. Discussion: Professional interpreters, bilingual students, bilingual overseas-trained health professionals and community sector bilingual workers were used throughout the research project. For the initial qualitative phase, professional interpreters were used to conduct interviews and focus group sessions, however scheduling conflicts, inflexibility, their inability to help with recruitment and the expense prompted exploration of alternative options for interview interpreting in the quantitative component of the study. Bilingual mature-age students on work placement and overseas-trained health professionals provided good entry into their different community networks and successfully recruited and interviewed participants, often in languages with limited interpreter access. Although both groups required training and supervision, overseas-trained health professionals often had existing research skills, as well as understanding of key issues such as confidentiality and referral processes. Strategies to minimise social desirability bias and the need to set boundaries were discussed during regular debriefing sessions. Having a number of workers recruiting participants also helped minimise the potential for selection bias. The practical and educational experience gained by the bilingual workers was regarded as capacity building and a potentially valuable community resource for future health research projects. Summary: The use of bilingual workers was key to the feasibility and success of the project. The most successful outcomes occurred with students and overseas-trained health professionals who had good community networks for recruitment and the required linguistic skills. By describing the advantages and disadvantages encountered when working with bilingual workers, we offer practical insights to assist other researchers working with linguistically diverse groups.

BMC International Health and Human Rights, 2011

Background: As almost half of all refugees currently under United Nations protection are from Afg... more Background: As almost half of all refugees currently under United Nations protection are from Afghanistan or Iraq and significant numbers have already been resettled outside the region of origin, it is likely that future research will examine their resettlement needs. A number of methodological challenges confront researchers working with culturally and linguistically diverse groups; however, few detailed articles are available to inform other studies. The aim of this paper is to outline challenges with sampling and recruitment of socially invisible refugee groups, describing the method adopted for a mixed methods exploratory study assessing mental health, subjective wellbeing and resettlement perspectives of Afghan and Kurdish refugees living in New Zealand and Australia. Sampling strategies used in previous studies with similar refugee groups were considered before determining the approach to recruitment Methods: A snowball approach was adopted for the study, with multiple entry points into the communities being used to choose as wide a range of people as possible to provide further contacts and reduce selection bias. Census data was used to assess the representativeness of the sample. Results: A sample of 193 former refugee participants was recruited in Christchurch (n = 98) and Perth (n = 95), 47% were of Afghan and 53% Kurdish ethnicity. A good gender balance (males 52%, females 48%) was achieved overall, mainly as a result of the sampling method used. Differences in the demographic composition of groups in each location were observed, especially in relation to the length of time spent in a refugee situation and time since arrival, reflecting variations in national humanitarian quota intakes. Although some measures were problematic, Census data comparison to assess reasonable representativeness of the study sample was generally reassuring. Conclusions: Snowball sampling, with multiple initiation points to reduce selection bias, was necessary to locate and identify participants, provide reassurance and break down barriers. Personal contact was critical for both recruitment and data quality, and highlighted the importance of interviewer cultural sensitivity. Cross-national comparative studies, particularly relating to refugee resettlement within different policy environments, also need to take into consideration the differing pre-migration experiences and time since arrival of refugee groups, as these can add additional layers of complexity to study design and interpretation.

Australian and New Zealand Journal of Public Health, 2011

Recruiting participants for research from highly traumatised ethnic and faith communities require... more Recruiting participants for research from highly traumatised ethnic and faith communities requires a participatory and trauma-informed approach that considers logistic barriers, as well as trauma-related and culture-specific issues. Active community engagement through every stage of the project and employing community members in research roles can help build trust, identify and mitigate concerns early, prevent re-traumatization, and ensure that findings will be of value to the community. Some of these research challenges are discussed in the context of the Christchurch mosque terror attacks. These insights may be helpful for researchers and clinicians working in similarly challenging environments.

Australian & New Zealand Journal of Psychiatry, 2021

It is critical to understand the psychosocial impacts of the COVID-19 pandemic on populations aro... more It is critical to understand the psychosocial impacts of the COVID-19 pandemic on populations around the world. In this article, we highlight the key challenges associated with epidemiological psychosocial research in a disaster context and reflect on lessons learned from firsthand experience over the last decade in Christchurch, New Zealand, following the 2010/2011 Canterbury earthquakes and 2019 Mosque attacks. We make recommendations for study design to improve the quality of research evaluating the impacts of the COVID-19 pandemic, the inclusion of positive outcome measures and the need to evaluate a range of cultural contexts. We hope that highlighting these areas will improve research and result in a better understanding of the psychosocial impacts of the pandemic.