Research Question:
- What interventions are effective in increasing the health and wellbeing of asylum seekers and refugees in the UK?
A refugee is a person who has been forced to leave their country in order to escape war, violence or persecution. Refugee status is recognised under international law, and refugees in the UK are entitled to the same social and economic rights as any UK citizen – including access to medical treatment, education, benefits, housing and employment. An asylum seeker is a person who has asked the government to recognise their refugee status and is awaiting the outcome of their application.
Asylum seekers and refugees are at risk of a complex range of physical and mental health needs arising from experiences before, during and after migration. Before and during migration, experiences can include the physical effects of war and torture; mental health problems related to trauma, uncertainty and stress; exposure to communicable disease; and malnutrition. Asylum seeker and refugee health is further shaped by post-migration experiences following arrival in the UK. Contributory post-migration socio-environmental factors include, but are not limited to, economic status, living conditions, health care access, language barriers, discrimination and stigma, community integration, and threats to identity.
Post-migration, asylum seekers are more likely to have mental health needs than the general population, but are less likely to receive support. Physical health needs may be related to both non-communicable and communicable diseases; injuries resulting from conflict, abuse and torture; pregnancy and perinatal care; child development and family functioning; sexual and reproductive health; oral and dental health; and general health promotion.
The existing evidence base describes the health and wellbeing needs of asylum seekers and refugees, barriers and facilitators to good health, and a growing understanding of effective interventions, particularly for aspects of mental health. However, due to the challenges of research in this area, there is limited high quality evidence about the effectiveness, efficiency, flexibility, and scalability of population-level interventions to improve the health and wellbeing of asylum seekers and refugees. This restricts the evidence base available for decision-making in policy and practice in the UK. Further research is needed to improve our understanding of how best to support asylum seeker and refugee health and wellbeing.
The Public Health Research (PHR) Programme wishes to commission research on the effectiveness of interventions to support asylum seeker and refugee health and wellbeing. Due to the Programme’s remit in generating evidence to inform delivery of non-NHS interventions in the UK setting, research into the Migration and Economic Development Partnership with Rwanda and other international interventions are not in remit for this call.
Research responding to this call may address one or both groups in question (asylum seekers and refugees), but applicants’ reasoning must be clear, with choices reflected in the intervention and study design – as immigration status will affect the way services are accessed, and health needs may differ between groups. Researchers must ensure an ethical approach that is sensitive and responsive to risk, harm, and power imbalance, that upholds forced migrants’ rights and dignity, and also addresses barriers and concerns associated with participation.
Evaluations should improve understanding of interventions or programmes, such as:
- Timing of intervention post-migration.
- Setting for interventions.
- Who delivers the intervention (including lay and peer supporters).
- How interventions are delivered (e.g. addressing language barriers by making use of interpreters, infographics, animations, or theatre groups).
- Who receives the intervention (including different demographic groups and those with different migration experiences).
Research areas of interest include:
- Evaluations of mental health interventions for asylum seekers and refugees, addressing mental health promotion, common mental health disorders, or children’s mental health.
- Interventions addressing the physical health needs, or a key physical health domain, of asylum seekers and refugees.
- Interventions to support the health and wellbeing of unaccompanied asylum-seeking children and young people.
- Integrated, holistic or whole-person interventions, including strength-based or capability approaches.
- Interventions addressing different stages post-migration, such as stabilisation (creating a sense of belonging, identity and integration) and then growth (including opportunities for recreation and creative expression).
- Interventions at group, family, household, community or other collective levels.
- Interventions informed by models of health arising from different cultures, such as models placing equal value on the mind, body and spirit, or collective approaches to health.
- Interventions addressing the social determinants of asylum seeker and refugee health and wellbeing, including effective support in accessing rights and entitlements.
- Interventions targeting discrimination against asylum seekers and refugees.
- Interventions addressing loneliness and/or isolation.
- Interventions targeting domestic abuse.
- Interventions addressing sexual violence, including sexual violence experienced before or during migration or following arrival in the UK.
- Evaluations of collaborative, multilevel, multicomponent or multiagency programmes.
- Research evaluating the impact of policies shaping asylum seeker and refugee migration including evaluation of the impact of different schemes (such as the Afghan Citizens Resettlement Scheme and Homes for Ukraine) and legislative amendments.
- Evaluation of the scalability and sustainability of existing pilot interventions.
- Interventions to improve data quality (for example, housing records). N.b. the PHR Programme funds non-NHS interventions.
- Interventions to tailor communication (including cross-language and cross-cultural communication and digital inclusion).
- Evidence synthesis for the physical health needs, and/or mental health needs, of asylum seekers and refugees.
A range of study designs and outcome measures can be used. Researchers will need to clearly describe the health and/or wellbeing need targeted, as well as justify their chosen methodological approach. Researchers will also need to specify key outcomes and how these will be measured in the short, medium and long term. Primary outcomes must be health-related. For this call, the PHR Programme will accept other outcomes, as long as the link to health can be justified. Wherever feasible, measures must be validated and appropriate for the groups involved. Researchers are encouraged to incorporate health inequality evaluations. The specific population of interest should be clearly identified in terms of key indicators such as country of birth, ethnicity, migration experience, stage of asylum process, and time spent in the reception country.
Understanding the value of public health interventions – whether the outcomes justify their use of resources – is integral to the PHR Programme, where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. Different approaches to economic evaluation are encouraged as long as they assess the value and distributive impact of interventions. Applications that do not include an economic component should provide appropriate justification.
Researchers must ensure that recommendations on undertaking research with asylum seekers and refugees are followed. This includes addressing known barriers and ensuring interventions are responsive to individual needs, such as those relating to language, culture, gender, and service delivery (including trauma-informed care). Training and support for those involved should be considered.
Researchers must involve asylum seekers and refugees throughout the research process, for example through partnership work, co-production, or participatory research where feasible. Researchers should demonstrate the relevance of their proposed research to decision-makers and those with lived experience, and they might do this through involving them as fully costed members of the research team. Proposals should consider how partnerships with decision-makers could be used, to readily translate findings into practice for maximum impact. Researchers should consider how they will share their findings with stakeholders, including special interest groups and charities, policy makers, and community audiences. Researchers are expected to be aware of other studies in this area and ensure their proposed research is complementary.
For further information on submitting an application to the PHR Programme, please refer to the Stage 1 guidance notes and PHR supporting information. These can be found by clicking on the relevant commissioned call on the main funding opportunities page. This also includes closing dates and details about how to apply.