JMIR Publications

ABSTRACT

Background:

Mental burden among refugees is high, but access to mental healthcare in Germany is hindered by numerous barriers. Digital interventions are being suggested to facilitate access to mental healthcare. For example, the digital sleep intervention Sleep-e has been culturally adapted for refugees in Germany mainly coming from African and Middle East countries. With the increasing number of refugees from Ukraine and the associated diversity of cultural backgrounds among refugees in Germany, it is essential to provide appropriate interventions for this target group as well.

Objective:

The current study aims to investigate the perceived appropriateness of the digital sleep intervention in its original and in the culturally adapted version among refugees in Germany, hereby exploring and possibly contrasting the needs of refugees coming from Ukraine and from other countries of origin.

Methods:

Six refugees from Ukraine and seven refugees from other countries of origin went through at least one module of the digital sleep intervention, either in its version adapted for refugees from African and Middle East countries, or its original version for Germans (five participants tested both versions of the intervention). In a total of 17 semi-structured interviews and 9 Think-Aloud sessions, the perceived cultural appropriateness as well as suggestions for adaptations were explored. Participants’ qualitative feedback was transcribed, summarised in a category system, and analysed using structured qualitative content analysis.

Results:

The perceived appropriateness differed between the participating refugees from Ukraine and from other countries of origin and between the two intervention versions, with identification being extracted as a main influencing factor: Whereas the Ukrainian participants expressed identity conflicts regarding the adapted intervention version in terms of being refugees but not seeing themselves as refugees, no such conflicts were identified among the participants from other countries. In contrast, the Ukrainian participants identified with the European context in the original intervention version, but showed a lack of identification with the problems described, albeit to a lesser extent than the participants from other countries.

Conclusions:

The results of the present study suggest that refugees from diverse countries of origin, including Ukraine, might be reached with the digital sleep intervention. However, for Ukrainian participants in particular, neither the adapted nor the original version of the intervention appears to be fully culturally appropriate, likely due to identification difficulties and an identity conflict regarding the refugee context. This illustrates the relevance of including a target group with diverse socio-cultural backgrounds in the development process of digital interventions to ensure broad identification and, herewith, cultural appropriateness. Clinical Trial: Freiburg Registry of Clinical Studies FRKS004288