Feasibility, Effectiveness and Adoption of Self-Help Plus (SH+) Intervention in Gaza Strip: An Implementation Study.

Self Help Plus (SH+) is a WHO intervention that provides strategies for managing distress arising in the context of a range of adversities including interpersonal violence, armed conflict, and chronic poverty (Epping-Jordan et al. 2016). Several studies that evaluated SH+ showed that it reduces psychological distress and prevents the onset of mental disorders among refugees in Northern Uganda (Tol et al. 2018), Turkey (Acarturk et al. 2022), and several countries in Europe (Purgato et al. 2021). This scalable intervention is available in Arabic and could be an important tool in helping distressed Palestinian people living in Gaza Strip once its effectiveness is proved and the intervention is adopted. The research project aim is to Identify and address challenges, problems related to the implementation of SH+ in Gaza Strip, ensure the intervention is appropriate, feasible, culturally accepted; and evaluate its effectiveness. The Proctor et al model (Proctor et al. 2009) of implementation research will guide the investigators throughout the three-phase protocol proposed:
Phase 1 (Piloting): Pilot the intervention on 6 groups of beneficiaries (15-20 participants each) totaling about 100 people.
Phase 2 (Adaptation): Make the necessary adaptation to the intervention to make it more feasible. This might include revisiting the translated material, adjusting the audio recordings, and overcoming any other issues.
Phase 3 (Implementation): Test the effectiveness and feasibility of the intervention through running 30 groups of beneficiaries totaling 500 people which is the sample size.
Several measures will be used including The Depression, Anxiety and Stress Scale - 21 Items (DASS-21) The WHO-5 Well-Being Index, The World Health Organization Disability Assessment Schedule (WHODAS 2.0), SH+ fidelity tool, Implementation Outcome Measures, and the Gaza Trauma Checklist. Focus group discussions with the facilitators will also be used. The DASS global score will be the clinical primary outcome, while Feasibility of Intervention Measure the main implementability outcome. The adapted intervention is expected to become one of the main tools for scaling up mental health interventions in Gaza Strip.