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Culturally-Appropriate Orientation Increases the Effectiveness of Mental Health First Aid Training for Bhutanese Refugees: Results from a Multi-state Program Evaluation


Poor mental health remains a significant source of morbidity and mortality in the Bhutanese refugee community. Mental Health First Aid (MHFA) is a promising intervention that has been used in other immigrant communities to prepare individuals to recognize and respond to mental health warning signs. This was a non-randomized program evaluation. Using pre- and post-training questionnaires developed for prior evaluations of MHFA, we examined the effectiveness of training offered with and without culturally-appropriate orientation to mental health terminology and concepts (N = 458). Pre- to post-training improvement in ability to recognize schizophrenia, ability to respond to schizophrenia and depression, and the overall mental health literacy was greater for Bhutanese refugees who attended orientation relative to other participants (P < 0.05). In scaling up MHFA training for other immigrant communities, we recommend developing and systematically evaluating culturally-appropriate orientation materials that introduce mental health vocabulary and contextualize mental health concepts.

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We thank Anthony Francis Jorm, and Tomas Matza for their guidance, Keshav Acharya and Asmita Gurung for the data entry, and Bhutanese community leaders in the US for outreach and implementation of the survey. Dr. Yun was supported by NIH Grant 5K23HD082312. Mental Health First Aid training was supported by the Office of Refugee Resettlement and their local partners.

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Corresponding author

Correspondence to Ashok Gurung.

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The authors report no conflict of interest, finance, or otherwise.

Ethical Approval

The intent of this project was to improve the effectiveness of an ongoing program and inform decisions about future program development, this project was found to be a program evaluation rather than human subjects research. While a formal determination that planned activities would not involve human subjects research was not sought, categorization of this project as program evaluation was made with guidance from staff in the Human Research Protection Office (HRPO) at the University of Pittsburgh.

Research Involving Human Participants and/or Animals

The intent of our project is to improve program effectiveness and to inform decisions about future program development using a questionnaire survey tool to check new knowledge and skills learned. Therefore, this study does not include humans’ or animals’ specimens for study.

Informed Consent

All participants were informed verbally and in writing that completing the questionnaires was voluntary and the survey would be used to calculate summary statistics. No identifying details such as names, date of birth, or identity number were collected.

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Gurung, A., Subedi, P., Zhang, M. et al. Culturally-Appropriate Orientation Increases the Effectiveness of Mental Health First Aid Training for Bhutanese Refugees: Results from a Multi-state Program Evaluation. J Immigrant Minority Health 22, 957–964 (2020).

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  • Bhutanese refugees
  • Cultural perspectives
  • Mental health terminology
  • Stigma