A qualitative evaluation of the use of Problem Management Plus (PM+) 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.

HIGHLIGHTS

• 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.