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Does group size and blending matter? Impact of a digital mental health game implemented with refugees in various settings

Brittany R. Schuler (School of Social Work, Temple University, Philadelphia, Pennsylvania, USA)
Solfrid Raknes (Innovation Norway, Oslo, Norway and Heimstadkjaer i Midsund, Midsund, Norway)

International Journal of Migration, Health and Social Care

ISSN: 1747-9894

Article publication date: 24 February 2022

Issue publication date: 10 March 2022




There is an urgent need to upscale accessible mental health (MH) interventions that address barriers to care among Syrian refugee adolescents. The Happy Helping Hand (HH) is an innovative, cognitive behavioral digital game designed to improve MH for adolescents across digital divides. This study aims to examine the impact of HH implemented among Syrian refugees who varied according to group size and face-to-face (F2F) versus digital contact.


This mixed-methods study took place in Central Beqaa, Lebanon, from September 2020 to February 2021. Nine groups of Syrian displaced adolescents (n = 125) aged 13–17 years (Mage = 13.6 years) were recruited from an education center, two orphanages and one informal settlement to participate in the ten-session HH program. The WHO-Five-Well-being Index (WHO5) is a validated measure used to evaluate HH impact on MH at baseline and directly postintervention.


Significant improvements were seen in WHO5 scores in F2F and digital settings from baseline to follow-up. At baseline, 28% reported normal well-being, which increased to 99% after HH participation. WHO5 scores changed from M = 59.4 at baseline, indicating depression, to M = 77.3 at follow-up, indicating normal well-being. Smaller groups with more F2F contact reported greater improvements in mean WHO5 than larger groups with less F2F contact. The greatest aggregate change in well-being was achieved when HH was implemented digitally in bigger groups.


Study results indicate that the HH game can improve well-being and MH for Syrian refugees. Importantly, results build on the base of evidence on digital MH interventions as promising tools on the way to ensure healthy lives and well-being for all.



The authors would like to thank Innovation Norway for supporting development and proof-of-concept studies of the HH and Heimstadkjær i Midsund, Norway, for covering costs for implementing PSS to adolescents in Lebanon in this study.


Schuler, B.R. and Raknes, S. (2022), "Does group size and blending matter? Impact of a digital mental health game implemented with refugees in various settings", International Journal of Migration, Health and Social Care, Vol. 18 No. 1, pp. 83-94.



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