Overview
In the spring of 2002, the CRPH implemented the Urban Health Study (UHS) whose main objectives were to provide policy-relevant analysis of the health consequences of population change, economic impoverishment, and social capital and, for intervention purposes, to identify social mechanisms that affect health and well-being.
This study was designed to examine the health of families and, in particular, of adolescents, women and older adults in rapidly changing urban neighborhoods around the capital city, Beirut, and to consequently respond to the emerging issues by planning for community-based intervention studies.
Three communities were selected: Hay el Sellom and Burj el Barajneh Camp, in the southern suburbs of Beirut, and Nabaa, located in the eastern suburb. The neighborhoods were selected on a variety of practical and substantive grounds: dense war-displaced populations, prevailing poverty, rural-urban mobility, and lack of basic infrastructure.
The study was unique as it engaged the communities in the research process from the start; it combined science and action by planning for interventions to create a change; and it involved an inter (multi)-disciplinary team of researchers who combined both quantitative and qualitative approaches to examine the social context of health.
Phase I
A household survey was conducted in 2002, generating data about demographics, education, health, labor force, migration, and other household information such as income, and general housing conditions.
A two-stage cluster sample of 3,300 households in all three communities was selected using area drawings developed specifically for this survey. The target population consisted of those individuals living in housing units within the boundaries of the community.
A separate module in this household survey examined the gender division of domestic labor and involvement in paid work, constituting the Women, Work and Health component of the UHS.
Phase II
Following the main household survey, three separate surveys were undertaken in 2003. All individuals between the ages of 13 and 19 years (inclusive), were interviewed on a new set of questions, constituting the Youth component of the UHS. The Women and Reproductive Health component developed a separate questionnaire on reproductive health and child health and surveyed ever-married women aged 15 to 59 years old inclusively. All individuals, who were 60 years old and above, were also interviewed by another questionnaire, constituting the Older Adults component of the UHS.
All three surveys included 66 items on social capital and women’s autonomy. These comprised: civic engagement, trust, community attachment, safety/victimization, reciprocity, social networks, social support, and cultural capital.
The elderly research component of the
UHS
The elderly part of the UHS, known as
the "Elderly Study" consisted of a sample of 740 older men and
women, aged 60 years and above. These were approached for
face-to-face interviews between December 2002 and May 2003. The
questionnaire, drafted in informal Arabic, assessed the older adult
socio-demographic characteristics, sources of income, economic
activity, financial security, insurance coverage, and retirement
schemes. Also information was collected on physical health,
functional ability, chronic health conditions, chronic disease risk
factors, as well as mental health, life events, and religiosity.
Other themes related to social networks, social support, social
trust, and reciprocity were also measured.
Findings of the study showed high
prevalence rates of probable (43.8%) and definite depression (24%).
These rates are higher than those reported in other Arab countries
in the region and elsewhere. Concerns were raised as to whether
these estimates may have resulted from a measurement bias due to the
use of a non-validated tool. Hence, it was imperative to examine the
psychometric properties of the tools used to detect depressive
symptoms in population based studies. The validity and reliability
of the Arabic version of the GDS-15 and the WHO-5 were consequently
evaluated in a sample of 121 older adults. The Arabic version of the
two tools are available below.
GDS-15-A
WHO-5-A
Phase III
A third phase began in January 2005: the intervention studies. This program of intervention research on the health and well-being of youth and married women builds on the findings of the earlier phases. This phase of the UHS has one overarching goal to undertake community-based intervention studies on priority health issues in the poor suburbs of Beirut.
The Youth Intervention Study
The Youth Intervention Study intends to assess the impact of a social skills and social support intervention on mental health of Palestinian refugee children aged 11-13 years living in Burj Barajneh refugee camp, using a randomized controlled trial design. The intervention is ecologic as it includes activities tailored to youth, their parents, and their teachers. It uses the positive youth development as a conceptual framework. The design, implementation, and evaluation of the intervention is guided and approved by a community based youth committee, thus enhancing relevance, feasibility, and ultimately sustainability if results prove positive. The results of the evaluation will extend the evidence base of mental health promotion interventions to a developing world context, to a refugee setting, and from the school into the community as a setting.
Women and Reproductive Health Intervention Study
The aim of the Women and Reproductive Health intervention study is to assess the impact of a psychosocial intervention on medically unexplained vaginal discharge in a group of married, low-income women aged 18-49 years, suffering from moderate levels of anxiety and depression. Reproductive tract infections will be ruled out by first administering a medical exam. The intervention package will include structured social support group discussions and relaxing exercises over a period of 6 months.
The intervention group will be compared to a control group receiving the usual care using a randomized controlled trial design.
