Syrian refugee young adults implementing Problem Management Plus (PM+) with adults in their community: Using the Consolidated Framework for Implementation Research (CFIR 2.0) to understand perspectives of the implementation team
1
Department of Global and Community Health, George Mason University, Fairfax, United States
2
Multi-Aid Programs NGO, Multi-Aid Programs NG, Beirut, Lebanon
3
Lebanese National Mental Health Program, Lebanon Ministry of Public Health, Beirut, Lebanon
4
Department of Health Promotion and Community Health,Faculty of Health Sciences,, American University of Beirut, Beirut, Lebanon
5
Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States
Popul. Med. 2026;8(Supplement Supplement 1):A2509
ABSTRACT
BACKGROUND:
Globally, over 123 million people were forcibly displaced in 2024, including 6.7 million Syrian refugees, with over 1.5 million displaced to Lebanon. Refugee youth face heightened vulnerability to mental distress.1 Task-sharing approaches, where trained non-specialists deliver mental health interventions, have emerged as effective strategies to bridge treatment gaps in humanitarian settings.2 This study applied the Consolidated Framework for Implementation Research (CFIR 2.0)3 to examine the barriers and facilitators to implementation of Problem Management Plus (PM+) delivered by Syrian refugee young adults in Lebanon to adults in their community through a community participatory model.
METHODS:
A qualitative evaluation was conducted following completion of a three-arm randomized controlled trial (RCT). Data were drawn from in-depth online interviews with five members of the field implementation team. Interviews were conducted in Arabic, transcribed, translated into English, and coded using CFIR 2.0. Coding reliability was ensured through iterative team consensus meetings, and thematic matrices were developed for each CFIR domain.
RESULTS:
Guided by CFIR 2.0 domains, we summarized determinants influencing the implementation of the intervention. Intervention characteristics; the PM+ was viewed as credible, flexible, and aligned with community values. Youth-led delivery enhanced trust but required adaptation for literacy and gender norms. Outer setting; stigma, economic instability, and unstable political settings hindered effective delivery, yet the implementation team’s strong established trust supported implementation. Inner setting; supportive leadership, collaboration, effective team communication, and supervision fostered cohesion despite limited resources. Individuals; trained youths’ empathy enhanced relevance, but concerns were raised about fatigue, indicating the need for enhanced supervision and peer support. Process; iterative feedback, structured training, and collaborative planning between the implementation team and investigators promoted continuous learning and adaptive measures to ensure the study’s completion amid unique humanitarian challenges.
CONCLUSIONS:
Community-engaged, youth-led implementation of PM+ was feasible, acceptable, and culturally resonant within a fragile humanitarian context.
Globally, over 123 million people were forcibly displaced in 2024, including 6.7 million Syrian refugees, with over 1.5 million displaced to Lebanon. Refugee youth face heightened vulnerability to mental distress.1 Task-sharing approaches, where trained non-specialists deliver mental health interventions, have emerged as effective strategies to bridge treatment gaps in humanitarian settings.2 This study applied the Consolidated Framework for Implementation Research (CFIR 2.0)3 to examine the barriers and facilitators to implementation of Problem Management Plus (PM+) delivered by Syrian refugee young adults in Lebanon to adults in their community through a community participatory model.
METHODS:
A qualitative evaluation was conducted following completion of a three-arm randomized controlled trial (RCT). Data were drawn from in-depth online interviews with five members of the field implementation team. Interviews were conducted in Arabic, transcribed, translated into English, and coded using CFIR 2.0. Coding reliability was ensured through iterative team consensus meetings, and thematic matrices were developed for each CFIR domain.
RESULTS:
Guided by CFIR 2.0 domains, we summarized determinants influencing the implementation of the intervention. Intervention characteristics; the PM+ was viewed as credible, flexible, and aligned with community values. Youth-led delivery enhanced trust but required adaptation for literacy and gender norms. Outer setting; stigma, economic instability, and unstable political settings hindered effective delivery, yet the implementation team’s strong established trust supported implementation. Inner setting; supportive leadership, collaboration, effective team communication, and supervision fostered cohesion despite limited resources. Individuals; trained youths’ empathy enhanced relevance, but concerns were raised about fatigue, indicating the need for enhanced supervision and peer support. Process; iterative feedback, structured training, and collaborative planning between the implementation team and investigators promoted continuous learning and adaptive measures to ensure the study’s completion amid unique humanitarian challenges.
CONCLUSIONS:
Community-engaged, youth-led implementation of PM+ was feasible, acceptable, and culturally resonant within a fragile humanitarian context.
| eISSN: | 2654-1459 |
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