Before launching the study, a reference group of Syrian refugees with expertise in mental health research, healthcare and/or Arabic language was set up. The group was consulted on cultural aspects of mental ill health, appropriate data collection methods and language issues. Their input informed the implementation of the study and the construction of the questionnaire. The reference group also assisted in a social media campaign to explain the study’s purpose to the target population and served as Arabic speaking contact persons for those invited to the survey.
In 2016, a postal questionnaire in Arabic was distributed to a random sample of 4000 refugees from Syria meeting the inclusion criteria, of which 30.4% (n=1215) chose to participate (the non-response analysis is presented in the results section). Given that the sample frame included 9662 individuals, a minimum of 1000 respondents were deemed adequate, as the sample size then would consist of more than 10% of the individuals included in the total sample frame. The questionnaire included scales and items to measure mental ill health and factors hypothesised to be of particular relevance for refugees’ mental health and socioeconomic integration.
A standard double-blind translation and back-translation procedure was used unless adapted Arabic versions of specific parts of the questionnaire already were available. The entire questionnaire was, however, discussed with community experts in focus groups and individually throughout the translation and adaptation process. Revisions and amendments were done in consensus when such changes were deemed necessary.
Usability of the questionnaire was tested by conducting interviews in a rehabilitation centre for war and torture trauma patients, with 10 patients with Arabic as their mother tongue. The interviewees were instructed to read the questions out loud and to follow a Think-Aloud Protocol (TAP). TAP is a method designed to provide information about difficulties that may arise due to problems with comprehension, memory retrieval, judgement and response formatting.21 (link) On any indication of such difficulties, the target item was further scrutinised by the research group, language and community experts and by examining the psychometrics profile of the item from data compiled from a small pilot study and was thereafter modified if needed.
In 2016, a postal questionnaire in Arabic was distributed to a random sample of 4000 refugees from Syria meeting the inclusion criteria, of which 30.4% (n=1215) chose to participate (the non-response analysis is presented in the results section). Given that the sample frame included 9662 individuals, a minimum of 1000 respondents were deemed adequate, as the sample size then would consist of more than 10% of the individuals included in the total sample frame. The questionnaire included scales and items to measure mental ill health and factors hypothesised to be of particular relevance for refugees’ mental health and socioeconomic integration.
A standard double-blind translation and back-translation procedure was used unless adapted Arabic versions of specific parts of the questionnaire already were available. The entire questionnaire was, however, discussed with community experts in focus groups and individually throughout the translation and adaptation process. Revisions and amendments were done in consensus when such changes were deemed necessary.
Usability of the questionnaire was tested by conducting interviews in a rehabilitation centre for war and torture trauma patients, with 10 patients with Arabic as their mother tongue. The interviewees were instructed to read the questions out loud and to follow a Think-Aloud Protocol (TAP). TAP is a method designed to provide information about difficulties that may arise due to problems with comprehension, memory retrieval, judgement and response formatting.21 (link) On any indication of such difficulties, the target item was further scrutinised by the research group, language and community experts and by examining the psychometrics profile of the item from data compiled from a small pilot study and was thereafter modified if needed.
