A qualitative evaluation of the use of Problem Management Plus (PM plus ) among Arabic-speaking migrants with psychological distress in France - The APEX study

Background: Feasibility studies with non-French speaking migrants in France are needed to inform appropriate adaptation of psychosocial intervention procedures.Objective: To test the WHO Problem Management Plus (PM+) intervention protocol for Arabic-speaking migrants in the Paris metropolitan region.Methods: Between 2019 and 2021 we recruited participants from three accommodation centres receiving asylum seekers or migrants experiencing social and economic difficulties. Participants experiencing psychological distress underwent five PM + sessions with trained helpers. Feasibility was evaluated through 15 interviews with 8 participants, 4 helpers, and 3 study supervisors. Interview topics covered PM + implementation in general and for each component. We also sought to understand problems with delivery and gathered suggestions for improvement. Data were analysed thematically using a deductive approach.Results: We found implementation of PM + to be feasible, with predominantly positive reactions from participants, helpers and study staff. All intervention components were considered beneficial, with breathing exercises considered easy to implement and often sustained. Selection of problems and strategies to address them were described as challenging to execute. Psychosocial support from and rapport with helpers and the use of the native language were considered key strengths of the programme. However, we observed the need for complementary or higher intensity psychological support in some cases. Findings also highlighted the importance of addressing distress among non-specialist helpers delivering PM + . Finally, local guidance to social resources were suggested to be added in the protocol.Conclusion: PM + was well-liked and feasible, with cultural adjustments and increased access to community resources for migrants needed. The World Health Organization Problem Management Plus (PM+) intervention was found to be a feasible and acceptable intervention for Arabic-speaking migrants in the Paris metropolitan region, with participants reporting improved mental health outcomes and satisfaction with the programme.The features of psychosocial support from and rapport with non-specialist helpers delivering PM + and the use of the native language were considered key strengths of the programme.The study documented perceived benefits of expanding PM + in scope and length, suggests the need for additional mental health services for non-specialist helpers, and highlights the importance of considering cultural and linguistic factors when providing mental health services to asylum seekers or migrants experiencing social and economic difficulties. Antecedentes: Se necesitan estudios sobre la viabilidad de procedimientos de intervencion psicologica en inmigrantes no francofonos en Francia que sirvan como antecedente para su adaptacion.Objetivo: Evaluar el protocolo de intervencion del programa Enfrentando Problemas Plus (EP+) de la Organizacion Mundial de la Salud (OMS) en inmigrantes de habla arabe en la region metropolitana de Paris.Metodos: Entre el 2019 y el 2021 se reclutaron participantes de tres centros de acogida para solicitantes de asilo y para migrantes en dificultades sociales y economicas. Los participantes que experimentaron angustia psicologica recibieron cinco sesiones de EP + por parte de facilitadores entrenados. La viabilidad se evaluo mediante 15 entrevistas a 8 participantes, 4 facilitadores y 3 supervisores del estudio. Las entrevistas trataban temas relacionados con la implementacion del EP + de forma general y tambien por cada componente. Asimismo, se busco comprender los problemas asociados con su ejecucion y se recabaron sugerencias de mejora. Se analizo la informacion por temas empleando un enfoque deductivo.Resultados: La implementacion del EP + es factible, con reacciones predominantemente positivas por parte de los participantes, facilitadores y supervisores del estudio. Se estimo como beneficioso a todo componente de la intervencion, considerandose particularmente a los ejercicios de respiracion como faciles de implementar y de generalmente mantenerse en el tiempo. Se describieron como dificiles para ejecutar a la seleccion de problemas y estrategias para abordarlas. Se consideraron como fortalezas del programa al soporte psicosocial y rapport de los facilitadores, ademas de haber usado el idioma materno. Sin embargo, se observo la necesidad de brindar soporte psicosocial complementario o de mayor complejidad en algunos casos y, tambien, la necesidad de abordar la angustia en facilitadores no especialistas que brindan el EP + . Finalmente, se sugirio anadir al protocolo la orientacion hacia recursos sociales locales.Conclusiones: El EP + fue aceptado y considerado viable con ajustes culturales e incrementando el acceso a recursos comunitarios para los inmigrantes que lo necesiten.