Blomenkamp Maja, Kiesel Andrea, Baumeister Harald, Lehr Dirk, Unterrainer Josef, Sander Lasse B, Spanhel Kerstin
Institute of Psychology, University of Freiburg, Freiburg, Germany.
Cognition, Action, and Sustainability Unit, Institute of Psychology, University of Freiburg, Freiburg, Germany.
JMIR Form Res. 2025 Apr 3;9:e65412. doi: 10.2196/65412.
Digital interventions have been suggested to facilitate access to mental health care for refugees, who experience structural, linguistic, and cultural barriers to mental health care. Sleep-e, a digital sleep intervention originally developed for German teachers, 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 assess whether existing digital interventions are culturally appropriate for this target group as well.
The study aimed to investigate the perceived cultural appropriateness of Sleep-e in both its original and culturally adapted versions among refugees in Germany, hereby exploring and possibly contrasting the needs of refugees coming from Ukraine and other countries of origin.
Overall, 13 refugees (6 from Ukraine, 23-66 years old; and 7 from other countries, 26-41 years old) participated in the study. Each participant went through parts of the original or culturally adapted version of the digital sleep intervention, with 5 participants going through both versions. A total of 17 semistructured interviews (11 for the adapted, 6 for the nonadapted intervention version) and 9 think-aloud sessions (6 for the adapted, 3 for the nonadapted intervention version) were conducted to assess cultural appropriateness, suggestions for adaptations, and perceived relevance. Data were transcribed, categorized, and analyzed using structured qualitative content analysis.
The findings showed key differences in the perceived appropriateness and identification between the 2 refugee groups and the 2 intervention versions. Ukrainian participants expressed positive (n=70) and negative (n=56) feedback on the adapted intervention version, which revealed identity conflicts, as the adapted intervention version was targeted at a refugee population with whom they could not fully identify (18 negative feedback quotes concerning the refugee example characters). Whereas they identified with the European context in the original version, they found the problems described less relevant to their experiences. In contrast, participating refugees from other countries found the culturally adapted version more comprehensible and culturally appropriate (55 positive and 5 negative feedback quotes). No significant usability issues were reported, but several participants highlighted the need for an individualization of the intervention content.
Neither the original nor culturally adapted version of the digital sleep intervention fully met the needs of all refugee groups, highlighting the complexity of culturally adapting digital interventions for this population. Particularly, the identity conflict of participating Ukrainian refugees regarding the refugee context suggests that adaptation should go beyond regional considerations and consider the dynamics of social identity. These findings emphasize the relevance of including co-design processes with different refugee populations to ensure broad identification and, herewith, cultural appropriateness of digital interventions.
German Clinical Trials Register DRKS00036484; https://drks.de/search/de/trial/DRKS00036484.
数字干预措施被认为有助于为难民提供心理健康护理，因为他们在获得心理健康护理方面面临结构、语言和文化障碍。Sleep-e是一种最初为德国教师开发的数字睡眠干预措施，已针对德国主要来自非洲和中东国家的难民进行了文化适应性调整。随着来自乌克兰的难民数量增加以及德国难民文化背景的多样性，评估现有的数字干预措施对这一目标群体在文化上是否合适也至关重要。
本研究旨在调查德国难民对Sleep-e原始版本和文化适应性版本在文化上的适宜性认知，从而探索并可能对比来自乌克兰和其他原籍国的难民的需求。
共有13名难民参与了研究（6名来自乌克兰，年龄在23至66岁之间；7名来自其他国家，年龄在26至41岁之间）。每位参与者体验了数字睡眠干预措施的原始版本或文化适应性版本的部分内容，其中5名参与者体验了两个版本。总共进行了17次半结构化访谈（11次针对适应性版本，6次针对非适应性干预版本）和9次出声思考环节（6次针对适应性版本，3次针对非适应性干预版本），以评估文化适宜性、适应性建议和感知相关性。数据通过结构化定性内容分析进行转录、分类和分析。
研究结果显示，两个难民群体与两个干预版本在感知适宜性和认同感方面存在关键差异。乌克兰参与者对适应性干预版本给出了积极（n = 70）和消极（n = 56）的反馈，这揭示了身份冲突问题。因为适应性干预版本针对的是他们无法完全认同的难民群体（18条关于难民示例角色的负面反馈）。虽然他们在原始版本中能认同欧洲背景，但觉得其中描述的问题与他们的经历不太相关。相比之下，来自其他国家的参与难民认为文化适应性版本更易于理解且在文化上更合适（55条积极反馈和5条消极反馈）。未报告重大可用性问题，但有几位参与者强调干预内容需要个性化。
数字睡眠干预措施的原始版本和文化适应性版本都没有完全满足所有难民群体的需求，这凸显了为这一群体进行数字干预文化适应性调整的复杂性。特别是，参与研究的乌克兰难民在难民背景方面的身份冲突表明，适应性调整应超越地域考虑，还要考虑社会身份的动态变化。这些发现强调了与不同难民群体进行共同设计过程以确保广泛认同感以及数字干预措施文化适宜性的重要性。
德国临床试验注册中心DRKS00036484；https://drks.de/search/de/trial/DRKS00036484 。
