Refugees with prolonged and repeated experience of trauma are subjected to severe levels of stress and stress- related ill health. Posttraumatic stress disorder (PTSD) constitutes a frequently diagnosed disorder in this context. Physical activity (PA) is an established efficient stress reliever and physical inactivity has been examined as an important and reciprocal maintenance factor of PTSD and associated mental and physical distress. The objectives of this currently ongoing project is to examine the cause effect relationship of PA and PTSD among trauma afflicted refugees, to develop a group-based multicomponent PA intervention, and to assess and evaluate the efficacy of such an intervention.
The Intervention Mapping (IM) protocol are systematically being applied in the development and design of the intervention, including several studies with mixed methodology. A needs assessment has been conducted to develop a theoretical framework and identify program goals, on basis of literature reviews, inventory of clinical experience and interviews with patients. The theoretical foundation includes commonly reported domains of ill health and functioning, hypothesized mediating variables, determinants of PA and self-management behavior, performance and change objectives, and relevant outcome measures. Several gaps in the existing knowledge has been identified during the process and supported the design of two ongoing studies; A) an explorative qualitative study with focus group discussions, examining patients' experience of participation in PA as part of their treatment, and B) a survey study examining the relationship between physical activity/inactivity and illness perception, function/participation in daily life activities, perceived social support, mental and physical distress, and health related quality of life. The last steps of the IM protocol, implementation and evaluation, are preliminary designed to be carried out in a randomized controlled trial, on basis of the findings from previous studies, preceding workshops with clinical experts, overseeing the final program model and pre-testing program components with patient feedback.
Progress of the initial steps of the IM protocol has resulted in a preliminary program plan, designed to increase participants' PA level, use of SM strategies and participation in daily life activities, highlighted by behavior change theory, to be delivered by experienced physiotherapist to groups of up to eight individuals, comprising multiple educational and exercise-based components. Targeted determinants and performance objectives has been outlined in various models, to be further elaborated, presently including knowledge, skills, illness perception, fear-avoidance beliefs, emotional and instrumental social support, motivation, self-efficacy, body-awareness and self-regulatory capacities. The preliminary designed evaluation plan includes outcome measures of PTSD, associated mental and physical distress, and health-related quality of life. However, due to our preliminary qualitative data and given the long term impact of mental health on post-migration adoption and adjustment in a new society, interventions aimed at health behavior change may have further reaching implications beyond the clinical settings.
Funding & No Conflicts Declaration
The Swedish Red Cross (SRC) Health Care Unit and the SRC University College. Current applications of PhD student grants. No conflict of interest to declare.