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Table of Contents
ARTICLE
Year : 2019  |  Volume : 17  |  Issue : 1  |  Page : 86-95

The impact of psychosocial support on well-being and agency within an inclusive livelihood programme


1 PhD in Social Psychology, Mental Health and Psychosocial Support Specialist at Humanity & Inclusion, Freelance, Belgium
2 MSc in Public Health, Inclusive Livelihood Coordinator at Humanity & Inclusion, Freelance, Belgium
3 MSc Public Health and MBA Political Sciences, Information Management Specialist, Freelance, Belgium

Date of Web Publication28-Jun-2019

Correspondence Address:
Davide Ziveri
Mental Health and Psychosocial Support Specialist, Humanity & Inclusion, Avenue Wolvendael 3/10, 1190 Brussels
Belgium
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INTV.INTV_26_18

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  Abstract 


After 7 years of a multifaceted conflict, effective humanitarian assistance for people living in Syria is vital. This action research explores the extent to which psychosocial support (PSS) impacts the well-being and agency of Syrian farmers benefitting from livelihood. Our methodology used a baseline and endline survey towards a target population of households receiving agricultural inputs, with both an experimental and control group. Five dimensions of well-being were considered: emotional, social, economic, skills and knowledge and overall feeling. The key findings are:

  • A stand-alone livelihood programme does in fact have a positive impact on psychosocial well-being;
  • An integrated PSS and livelihood programme, as expected, has a positive impact on psychosocial well-being;
  • There is larger comparative impact of an integrated PSS-livelihood programme compared to a stand-alone livelihood programme for beneficiaries;
  • We learned that compared to those without disabilities, beneficiaries with disabilities experienced a larger benefit from PSS.

These results strongly suggest that an integrated approach providing PSS alongside livelihood interventions has added-value for vulnerable persons to restore their resilience. The results of this pilot study would need to be confirmed by a larger scale study to validate the findings.



Key implications for practice
  • Measure of the impact of psychosocial interventions in conflict settings.
  • New model of livelihood programme.
  • Focus on people with disabilities in armed conflicts.

Keywords: agency, disability, livelihood, psychosocial support, Syria


How to cite this article:
Ziveri D, Kiani S, Broquet M. The impact of psychosocial support on well-being and agency within an inclusive livelihood programme. Intervention 2019;17:86-95

How to cite this URL:
Ziveri D, Kiani S, Broquet M. The impact of psychosocial support on well-being and agency within an inclusive livelihood programme. Intervention [serial online] 2019 [cited 2019 Sep 19];17:86-95. Available from: http://www.interventionjournal.org/text.asp?2019/17/1/86/250809




  Introduction Top


In this article, we present the results of an action research that explores the extent to which psychosocial support (PSS) impacts the well-being and agency of Syrian farmers benefitting from livelihood aid. This research has moved from the need to improve the quality of services offered to vulnerable populations suffering from conflicts and aims to evaluate the impact of an integrated project with both livelihood and psychosocial aid. Livelihood aid consisted in material and trainings to farmers to keep cultivate their land with winter crops (the annual crops sown in autumn and harvested in spring). PSS entailed a short set of individual sessions based on active listening at household level.

Trying to define livelihood from a sociological perspective, we examine the relationship between human activity and the natural context available where people can survive and live in dignity. Implementing livelihood programmes in so-called fragile and conflict-affected settings is challenging due to the deterioration of physical infrastructures, the fragmentation of community and social networks, and the negative impact of potentially traumatic experiences on the population. All this is to say that we cannot reduce livelihood to a mere ‘bare life’ or that the goal of livelihood should simply be biological existence (Agamben, 1998).

Impact of conflict on livelihood in Syria

After 7 years of a multifaceted conflict, violence in Syria has claimed at least 500,000 lives and resulted in more than 12 million persons displaced (Carpanelli, Li, & Schwarz, 2018). Consequently, livelihoods have exposed to severe stressor (Food and Agriculture Organization of the United Nations (FAO), 2016). In 2015, about 90% of people living in Syria were living under the poverty line (The Humanitarian Forum, 2015).

As mentioned, this situation has had particular impacts on farmers and their families, such as prices hikes, fuel scarcity, agricultural infrastructures being damaged or destroyed, supply chains, that is seeds, fertilizer, herbicides and pesticides, and veterinary drugs, being disrupted, access to agricultural land reduced in areas under military control or contaminated by landmines, explosive remnants of war and improvised explosive devices, and scarce labour market opportunities.

Farming is a key livelihood sector. Pre-conflict, farm ownership was the second most common source of income in Syria (REACH, 2015) and can be considered one of main reasons for households to remain in their area of origin despite armed conflict. To stay put increases the risks of exposure to traumatic incidents as well as to the everyday challenges to implementing livelihood strategies (REACH, 2015).

Impact of conflict on mental health in Syria

According to United Nations, one in five people living in Syria is at risk of developing moderate mental health issues, and one in thirty is at risk of developing severe or acute mental health problems (Office for the Coordination of Humanitarian Affairs (OCHA), 2017).

As with other populations affected by collective violence and displacement, the most prevalent mental health conditions are related to depression, prolonged grief disorder, posttraumatic stress and anxiety disorders (Hassan, Ventevogel, Jefee-Bahloul, Barkil-Oteo, & Kirmayer, 2016). The current protracted crisis with the lack of options for livelihood promotes a pervasive sense of hopelessness. Such continuous exposure to the conflict erodes the resilience of Syrians who try to deal with daily difficulties to survive using negative coping strategies (United Nations High Commissioner for Refugees (UNHCR), 2015). Witnessing or having direct exposure to violence can diminish the capacity of individuals and communities to take full advantage of economic opportunities (Kumar & Willman, 2016). Many scholars have demonstrated the impact of stress on psychological dimensions (e.g. memory, decision-making, concentration, emotional regulation, self-esteem, perseverance and future planning) and on labour market outcomes over the lifetime (Kumar & Willman, 2016).

Furthermore, considering how much Syrian communities in neighbouring countries are dependent on external support (Agency for Technical Cooperation & Development (ACTED), 2013), we can deduce that such dependency affects people’s dignity and sense of agency (UNHCR, 2015). Agency can help development and humanitarian practitioners to widening the lens on livelihood work (Rogers, 2014).

Livelihood, household and gender

As the goal of the livelihood intervention was food production for the households themselves, households became our unit of study. In addition to being economical entities, households are also the social units who preserve the cultural identity of their area (United Nations Economic Commission for Europe (UNECE), 2007, p. 161). The PSS addressed the heads of household, who are, by definition, in charge of determining the family’s livelihood strategies and often also has the decision-making authority in their unit. According to previous studies in Syria and neighbouring countries, men were found to be mainly responsible for providing income for the household (78%), whereas females were mostly responsible for taking care of children and household work. Of course, there are exceptions to this and pockets in Syria where women were more economically active, and we are careful not to make generalizations (Buecher & Aniyamuzaala, 2016). Women’s economic participation was relatively low at 22% in 2010 (Agency For Technical Cooperation & Development (ACTED), 2013), with legal barriers, sociocultural norms and the status quo limiting women’s roles, and responsibilities inside and outside the home. As a result of the crisis, Syrian women and men feel that their roles and responsibilities have shifted significantly, whereas women increasingly participate in decision-making on income generation and expenditures and assume responsibilities outside the home, men have slowly lost their traditional role as sole breadwinner, and sole decision-maker (Buecher & Aniyamuzaala, 2016).

The psychosocial dimension of livelihood

Poverty today is understood as a more multifaceted concept than ‘a mere lack of economic resources, including […] opportunities to decide over one’s life’ (Petersen & Pedersen, 2010, p. 3). A person’s capability to decide and act is called ‘agency’. People’s agency, that is the choices people make in developing their livelihood strategies, are determined by factors such as psychosocial status (stress and emotional status), functional family and social networks, and ultimately, by the locus of control and hope. Hopelessness comes from the perception that external factors control one’s life (Brackney & Westman, 1992). As assessed in research among Rohingya refugees in Malaysia (Wake & Cheung, 2016) and according to the testimonies of beneficiaries of international non-governmental organizations, livelihood is a key factor to nourish hope (Solidarites International, 2016). Despite all this, a relationship among livelihood, agency and hope is still missing in programming. Livelihood assistance tries to decrease negative and harmful coping strategies of household (Save the Children, 2015). Recognizing the social nature of coping that implies the notion of responsibility (Valach, 1995) and considering the attribution of responsibility a key function of sense of agency (Frith, 2014) we can start to glimpse this relationship. In addition, there is a cyclical link between disability and poverty. People who are poor may be more exposed to risks/injuries (e.g. during an informal economical activities) which may lead to disability. At the same time, poverty is a consequence of disability due to the reduced access to education, health services and income generating opportunities (Handicap International, 2010).

The experience of agency is not a mere reflection of reality (Moore, 2016). Therefore, a space to build a sense of agency is crucial to raise awareness about opportunities and hope. We focused on the individual level of agency − the ability to respond to daily environment. Of course rural livelihoods systems are vulnerable to socio-natural changes. In a war-torn context, these changes are characterized by extreme violence, as well as the associated material and human losses. A livelihood approach has to include the capacity to cope and recover from losses, stresses and shocks (Chambers & Conway, 1991). ‘Resilience to shocks includes protecting, restoring and improving livelihood systems in the face of threats that impact agriculture, food and nutrition in situations such as the protracted crisis in Syria’ (FAO, 2016, p. 4). The World Bank has openly invited economic and humanitarian actors to focus on these ‘invisible wounds’ improving the PSS programmes. This is because people function as a hub point where external vulnerability factors interact with individual capacities and specific opportunities, allowing a specific spectrum of choice to transform the situation (World Bank, 2014).

Psychosocial support within livelihood interventions

PSS can become a buzzword that can encompass many different approaches, from recreational activities to counselling. In this study, we define PSS from the same person-centred framework described for a livelihood approach. In line with this framework, the core of PSS in this study is active listening and dialogue. Based on a meta-analysis of 23 high-quality studies, Mollica, Cardozo, Osofsky, Raphael, Ager and Salama (2004) showed there is strong evidence for the protective effect of employment on depression and general mental health, and work is a therapeutic factor. However, research of Kumar and Willman (2016) also suggests that livelihood assistance cannot determine alone an improvement in the global well-being. In our opinion, work can have therapeutic effects only if it is felt to be meaningful for the person doing it, and that was the main goal of our PSS intervention. Building meaning is catalysed by the relationship the PSS worker facilitates between the person and their environment.

In our study, we chose a psychosocial approach, closer to a clinical sociology perspective (de Gaulejac & Coquelle, 2017), as it
  • Aims to ‘facilitate resilience within individuals, families and communities enabling families to bounce back from the impact of crises’ (Red Cross, 2010, p. 25);
  • Is based on active listening methods that start with seeking information and exploring meaning for a person, rather than defining a situation according to an external point of view as is the case with the mental health approach;
  • Is tailored and intends to only include the subjective experience of distress.


Our PSS was based on the maieutic pedagogy (from the Greek ‘act as a midwife’) based on a Socratic method of questioning which is used to clarify meanings, feelings related to them, the consequences of livelihood, and the absence or presence of material aid. Maieutic pedagogy was an intervention that blossomed in post-war rural Italy by Dolci (1981), an Italian sociologist and nonviolent social activist. Translating this approach to our PSS intervention, we have considered awareness of stress factors and coping opportunities;
  • Creation of a space to carefully explore the perspectives of beneficiaries and their families about the impact of violence;
  • Exploration of local narratives on how material aid is provided;
  • Exploration of the unintended consequences of receiving aid for a person, such as ‘aid dependency’. Thinking critically about the meaning of being a recipient of external aid and how aid can be used to promote agency in beneficiaries;
  • How exploratory dialogue could help the beneficiaries to prioritize and analyse their surroundings for resources (Petersen & Pedersen, 2010);
  • Promotion of participation, because it is proven to increase motivation which then leads to a better performance (Heller, 2003).


Experience demonstrates that incorporating psychosocial well-being into the humanitarian response can have positive lasting effects on the target population. For example, the Red Cross (2010, p. 143) quotes a specific experience in food distributions where beneficiaries ‘felt like a pack of animals, fighting to survive. After the psychosocial intervention, beneficiaries reported they felt they were being treated with respect and humanity’. A secondary benefit of ‘dignifying’ the aid relationship, which by design is asymmetric in power, could be an increase in social capital of International Non-Governmental Organizations (INGOs) within the local population.

Inclusive livelihood

Inclusion is a human right; the United Nations Division for Social Policy and Development Disability (2006) states in its Article 27 (called ‘Work and employment’) that ‘States Parties recognize the right of persons with disabilities to work, on an equal basis with others; this includes the right to the opportunity to gain a living by work freely chosen or accepted in a labour market and work environment that is open, inclusive and accessible to persons with disabilities’.

Pragmatic approaches to inclusion are adapting farming tools, modifying agricultural environments and work methods of persons with impairments, so that they can increasingly participate and are not sitting on the sidelines. An important precursor to inclusion approaches is correct identification of persons with disabilities (PWD). We have encouraged the use of a well-researched set of questions, called the Washington Group questions and we used the short set. These questions approximate disability prevalence in communities by asking about an individual’s functional difficulties and can easily be administered by any community worker.

Objective

The project’s primary objectives were humanitarian: to improve the psychosocial resilience of Syrian people by offering an integrated PSS livelihood intervention. We built an action-research to study the broader project objectives. The goal of the research was to explore the extent to which PSS impacts the well-being and agency of Syrian farmers who benefitted from livelihood support. In an emergency context, action-research is considered the best way to offer an answer to urgent needs as soon as possible, to continue improving the quality of the service delivered.

The starting questions we wanted to answer in this study:
  • Does a stand-alone livelihood programme in fact have a positive impact on psychosocial well-being?
  • Second, does an integrated PSS-livelihood programme have a positive impact on psychosocial well-being?
  • Third, what is the comparative impact of a stand-alone livelihood programme as opposed to an integrated PSS-livelihood programme, that is general psychosocial indicators as well as perceptions towards livelihood participation?
  • What are the experienced benefits of PSS by PWD compared to those without disabilities?



  Materials and methods Top


Target population for livelihood

The target population for this study and our integrated intervention were selected as follows:

The livelihood aid focused on a winter farming project (seed-distribution of native varieties as legumes, wheat for bakeries, and barley to feed livestock, as well as planning and training on farming best practices) with the following three selection criteria for geographic areas in Syria:
  • Annual rainfall areas (200–350 mL)
  • Rain-fed agricultural areas
  • Rural communities


Second, the following selection criteria for participants were applied:
  • Households interested in agriculture and where farming is the main income source
  • Farmers planning to plant strategic crop
  • Household with rain-fed land (from 2 to 5 ha) and who do not possess agricultural machines and tools and who do not own cars
  • Households who are permanent residents in selected villages
  • Household who have not receive any agriculture assistant before.


Communities targeted by this project were located in Syria. The changing borders at the time of the project characterized an unstable setting. Because the sample of the study were farmers and land access was an inclusion criteria, all participants were residents in their own community and no internally displaced people were included in the target.

Psychosocial support intervention provided

The local team was composed of three males and one female who received short training on PSS. After an initial meeting with the community to explain the nature of the intervention, two teams of two workers each went on to offer one PSS session per week for three weeks to the target population. All sessions were conducted in a home-visit setting.
  • The goal of the first session was to meet the entire family, open a discussion on the topic of livelihood in their specific situation, while at the same time building rapport and trust. The aim was to open a space to express needs and related feelings among families visited and to help normalise stress reactions and strengthen coping strategies of the household.
  • The second session was dedicated to the head of the household in a more private setting, to explore the stressors reported in the baseline that was likened to an assessment of the psychosocial situation of the beneficiary.
  • The last session was intended to uncover needs and explore the future of livelihood strategies for families once the current aid programme would come to an end. This session was meant to increase personal awareness of participation in aid delivery, reframing expectations to avoid dependency and to promote autonomy in livelihood strategies.


Study sample for action research

Following selection of areas and participants who met criteria explained above, 140 households were selected to be part of the winter farming project to receive the integrated intervention (refer to the socio-demographic data overview in [Table 1]).
Table 1 Socio-demographic data overview of 143 participants

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And so (refer to [Table 2]), we randomly selected ten villages where 140 households could be assessed and treated. Beneficiaries of the integrated PSS-livelihood project and action research were randomly divided into two groups of seventy household each, an experimental group and a control group. Both the groups received the PSS intervention, the control group after the research phase ended. That is, the experimental group did the endline survey one week after their last PSS session, whereas the control group, completed the endline survey at the end of the research phase.
Table 2 Sequence of the intervention

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Given the sensitive impact of the violence during an active conflict, ethical issues were given particular consideration in the design of the study to avoid causing respondents unnecessary distress in communities living in an ongoing conflict. Randomization occurred at the village level (clusters of households), rather than at the household level. Experimental and control villages were in close proximity to ensure comparability in demographics and geographic status. Following ‘do no harm’ principles and recognizing that the control group needed psychological support, the beneficiaries living in villages in the control group received PSS after the data collection was completed. The study took place from April to August 2017. The baseline surveys were conducted in April 2017. The endline surveys were conducted intermittently between May and August 2017. The control group, subsequently, received PSS intervention from September to November 2017 after the endline survey was finished.

Survey tool

Many actors in humanitarian aid have developed their own tools to assess the impacts of disasters on people’s livelihoods and the capacities and opportunities for recovery. However, many of these tools do not take into consideration the impact of livelihood on well-being. Therefore, for this study, we adapted an existing psychosocial assessment tool or survey already used in Middle East within the humanitarian organization involved in the project. The tool covers the subjective perceptions of stress in five main dimensions, each of these five sub-scales being subdivided into different items. Each item used a four-point answer scale: four for total difficulty, three for a lot of difficulty, two for some difficulty, and one for no difficulty.
  • Skills and knowledge:
    • Communication skills
    • Decision-making skills
    • Coping mechanisms/self-care
    • Knowledge
  • Social well-being:
    • Being part of cultural activities
    • Capacity to socialize/trust others
    • Getting social support
  • Emotional well-being:
    • Safeness
    • Emotional balance
    • Self-worth
    • Hope
  • Economic well-being:
    • Feeling competent in farming task
    • Motivation to work and complete livelihood
    • Belief livelihood is helpful to improve life
    • Ability to ask for help for livelihood
  • Overall feeling:
    • Level of burden
    • Ability to carry out daily activities
    • Perception of benefit of PSS intervention.



  Results Top


Overview of results

Reviewing the outcomes of the baseline, we note that scores of the experimental and control group are very similar (refer to [Table 3]).
Table 3 Average score of baseline and endline survey for experimental and control groups in each dimension

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We first looked at the percentage of beneficiaries who showed a decrease in their scores, from the baseline compared to endline. We compared this for both experimental and control groups and for each of the five sub-scales. And so
  • approximately half of the beneficiaries of the control group reported less distress at endline, ranging from 44% to 57% over the five dimensions; and
  • the proportion of beneficiaries in the experimental group reporting less distress at endline was even larger, ranging from 56% to 89% over the five dimensions.


According to outputs of our sample, the percentage of beneficiaries who received PSS and showed an improvement in their psychosocial status is higher than the percentage of people who improved in the control group as seen in [Figure 1].
Figure 1 Percentage of beneficiaries who show any improvement in each subscale

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The percentage we report is calculated by taking the percentage change in score in relation to their score at baseline. It means that we measure the percentage of improved feeling compared to baseline.

‘Score improvement’ means a reduction in the score on our survey scale which shows reduced distress and improved in psychosocial well-being, that is moving from score of two to score one, shows improved psychosocial well-being. Looking at the percentage of score improvement, participants in the experimental group showed higher score improvements in all subscales of well-being (from 25% to 46%), whereas the score improvement reaches a maximum of 13% in the control group. There was a larger difference in improvement seen especially in the ‘overall feeling’, emotional well-being and social well-being categories, which were the main targeted areas of the psychosocial intervention [Figure 2].
Figure 2 Percentage of score improvement for the experimental and control groups in each subscale

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Skills and knowledge

We saw an improvement in all items of this sub-scale; however, the two most pertinent items of interest relating to livelihood are decision-making and social well-being.

People who received PSS showed a +39% in their decision-making skills (vs. −2% in control group) and +31% in coping mechanism/self-care (vs. −13% in control group) [Figure 3].
Figure 3 Percentage of score improvement for the experimental and control groups in each items of the skills and knowledge subscale

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Social well-being

Both groups (+42% in experimental group and +32% in control group) said that they faced less difficulties to participate in social activities in their community.

It is interesting to note that the capacity for socialization and trust in others (+26% in experimental group vs. −15% in control group), as well as the ability to get social support (+9% in experimental group vs. −14% in control group), shows a negative outcome in the control group [Figure 4].
Figure 4 Percentage of score improvement for the experimental and control groups in each items of the social well-being sub-scale

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Emotional well-being

The score improvement is higher in the experimental group than in the control group for the four items of emotional well-being. The item of ‘hope’ is the one for which the largest difference between both the groups is observed (+50% for people who received PSS vs. +25% in the control group).

Regarding the ‘self-worth’ item, the beneficiaries of the PSS intervention reported an improvement of +38%; meanwhile, the control group reported an improvement of only 11%.

The improved outcome in safeness (feeling safe) was +35% of improvement for the experimental group, whereas it improved by +11% of improvement on the control group [Figure 5].
Figure 5 Percentage of score improvement for the experimental and control groups in each items of the emotional well-being subscale

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Economic well-being

A sensitive association for PSS is seen in the motivation to work (+36% in experimental group vs. 4% in control group) [Figure 6].
Figure 6 Percentage of score improvement for the experimental and control groups in each items of the economic well-being subscale

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Overall well-being

Lastly, the level of burden was felt to be alleviated in both groups, with more alleviation in the group who received PSS (+44% of experimental group vs. +10% of control group). [Figure 7] shows the reduction of perceived level of burden that corresponds to an improvement in the score of the questionnaire.
Figure 7 Percentage of score improvement for the experimental and control groups in each items of the overall well-being subscale

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There is a huge gain in ‘ability to carry out daily activities’ in experimental group (+41% vs. +5% in control group).

Sex-disaggregated findings

In line with the inclusive approach, we analysed the sex-disaggregated data. We noted that in the majority of subscales (16 out of 17), women on the control group reported a greater improvement in their scores compared to men on the control group (refer to [Table 4].
Table 4 Average score on baseline and endline survey by sex, for experimental and control groups in each dimension

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We also noted that women in the experimental group reported a greater improvement in their scores compared to men in the experimental group, in 12 out of 17 subscales.

Differences have been recorded in
  • Self-worth: 90% score improvement among women vs. 34% among men;
  • Safeness: 44% among women vs. 25% among men;
  • Being part of cultural activities 50% among women vs. 32% among men; and
  • Knowledge: 40% among women vs. 23% among men [Figure 8].
    Figure 8 Score improvement by sex for the experimental group

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Disability-disaggregated findings

As a reminder, 46% of our random sample reported having a disability as per the definition taken according to the Washington Group questions.

First, PWD who received PSS show a better improvement than PWD on the control group (refer to [Table 5].
Table 5 Average score of baseline and endline for persons with and without disabilities, by experimental and control groups in each dimension

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Second, we have analysed the different impact of the psychosocial intervention among PWD and people without disabilities. PWD show a better score improvement in 16 out of 17 subscales compared to the persons without disability. However, PWD who benefited from psychosocial interventions show a lower score just in the item ‘Capacity to socialize/trust in others’.

Finally, we disaggregated data by disability and sex for those who received PSS. Generally speaking, women with disabilities who received PSS reported a better score improvement than men with disabilities who received PSS, in 14 out of 17 subscales [Figure 9].
Figure 9 Disability-disaggregated findings: percentage of improvement in the experimental group

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  Discussion Top


Survey limitations

Due to the nature of action-research, prior to the study, many limitations which could not be mitigated were acknowledged:
  • Due to the tool chosen for operational reasons and the small sample size, no statistical analysis of data has been made, limiting the generalizability of results.
  • Only one person per household completed the baseline and endline survey, although the intervention was at the household level.
  • The baseline survey was done after the livelihood material distribution was completed. These distributions may have accounted for an improvement in the psychosocial status of beneficiaries.
  • The action research addressed only one type of livelihood intervention (winter farming) as such, it cannot be generalized to other livelihood interventions (e.g. cash for work or vocational building).
  • The short length of PSS support may prevent the full expression of negative feelings as the time to build trust is too short. PSS is a sensitive area that may need more time/resources to address fully.


First of all, the results of the baseline in the two groups allowing us to deduct that the two groups shared a quite similar perception of their situation. Therefore, we can assume that the group can be considered comparable.

This study offers an insight on the interaction between livelihood activities and psychosocial interventions in fragile and conflict-affected settings testing four questions among the experimental and control group.

In answer to those four main questions, we found that a stand-alone livelihood programme does positively impact psychosocial well-being, but it is not guaranteed. For example, the results on the capacity for socialization and trust in and the ability to get social support seems indicate that mere material aid donation does not ensure positive impact and participation in the community.

Second, an integrated PSS and livelihood programme does have a positive impact on psychosocial well-being, and, third, there is larger comparative impact of an integrated PSS-livelihood programme compared to a stand-alone livelihood programme, that is general psychosocial indicators as well as perceptions towards livelihood participation. This was the primary finding of this study, further reinforcing the added value of an integrated approach, as compared a stand-alone livelihood programme. This impact is higher for women than for men.

According to our results, this is true even considering the context of violence due to the conflict. Results suggest that the perception of safety does not depend only on economic conditions and that it is possible to improve a feeling of safety even in a fragile and conflict-affected setting.

Sex-disaggregated data indicate that there are gender-related differences in coping strategies and sociability. A future similar project will need to include gender approach by design.

Regarding disability-disaggregated data, PWD disproportionately positively benefit from PSS, more so than people without disabilities. This is probably true because PWD face more barriers than others and have a correspondingly higher need for external support.

In conclusion, our data demonstrate the specific importance to include PWD in livelihood and PSS programmes, due to the significant benefits they receive compared to persons without a disability. To develop further a PSS more oriented to increase social networks, a future intervention can add group and community inclusive activities not included in the current project.

Outcomes have shown a clear decrease in distress of livelihood beneficiaries who also received PSS, especially on items related to hope, decision-making skills, coping mechanism/self-care, motivation, and ability to carry out daily activities. Despite the elusiveness and ambiguity of the term agency, Emirbayer and Mische (1998) defined it as the capacity of actors to critically shape their own responsiveness to problematic situations. Among all factors measured by the subscales of the tool adopted in this research, four of them can be considered especially closed to the definition of agency by those authors. Hope and motivation are included under the projective element of agency. The decision-making skills and coping mechanisms are incorporated in the practical-evaluative element of agency described by those authors. Finally, because their conception of agency centres around the engagement by actors of the different contextual environments, also the ability to carry out daily activities can contribute to determine agency. Therefore, we can use those four factors of the well-being as an indirect indicator of agency. At this stage, a new question arises: does the PSS actively promote agency in beneficiary of an integrated PSS-livelihood programme, especially among people with disabilities, as our considerations suggest? There is a need for further action-research. Another question that remains to be answered is about the most effective match between a specific PSS intervention model with a specific type of livelihood activity, according to each context.

Finally, due to the mentioned limitations, we cannot pretend to demonstrate a significant change in distress’ level of beneficiaries, who are living in a vulnerable area and they remain exposed to an ongoing conflict. However, the results described above show an increase of the measurement of well-being (up to 89%, with an amelioration in the score of all five dimensions of well-being) among beneficiaries of the integrated service (livelihood aid and PSS) in relation to their status before the intervention. Actually, the outcomes of this research, in addition to the evaluation of the related programme of humanitarian aid and a lesson learnt meeting with the PSS team, has informed the proposal of the following year of project. Moreover, the interest arisen from this experience shared among other INGO working in the same area has promoted different forms of integration on a PSS into livelihood programmes in Syria.

We can consider those data as an inspiring and promising way, to be further tested, to reframe livelihood programmes including some form of PSS for vulnerable persons who try to use aid to restore their resilience.

Acknowledgements

Great thanks to the psychosocial team − not individually mentioned here for security reasons − who are living and working daily in a hard warfare situation, and who agreed to engage themselves in the ethic and professional duty of alleviating stress and suffering for victims of violence. A special thanks to the NGOs involved in the activities on the field for their technical support in all phases of this action-research project.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Agamben G. (1998). Homo sacer: Sovereign power and bare life. Stanford: Meridian.  Back to cited text no. 1
    
2.
Agency For Technical Cooperation & Development (ACTED). (2013). Food security situation and livelihood intervention opportunities for Syrians refugees and host communities in north Jordan. Paris, France: ACTED.  Back to cited text no. 2
    
3.
Brackney B. E., Westman A. S. (1992). Relationships among hope, psychosocial development and locus of control. Psychological Reports Journal, 70(3), 864-866.  Back to cited text no. 3
    
4.
Buecher B., Aniyamuzaala J. R. (2016). Women, work & war: Syrian women and the struggle to survive five years of conflict. Geneva, Switzerland: Cooperative for Assistance and Relief Everywhere (CARE).  Back to cited text no. 4
    
5.
Carpanelli M., Li L., Schwarz M. (2018). Syria visualized [website]. Retrieved from http://www.syria-visualized.com/  Back to cited text no. 5
    
6.
Chambers R., Conway G. (1991). Sustainable rural livelihoods: Practical concepts for the 21st century. IDS discussion paper 296. Brighton, UK: IDS.  Back to cited text no. 6
    
7.
de Gaulejac V., Coquelle C. (2017). La part de social en nous. Toulouse: Eres.  Back to cited text no. 7
    
8.
Dolci D. (1981) Sicilian lives. New York, NY: Pantheon Books.  Back to cited text no. 8
    
9.
Emirbayer M., Mische A. (1998). What is agency? American Journal of Sociology, 103(4), 962-1023.  Back to cited text no. 9
    
10.
Food and Agriculture Organization of the United Nations (FAO). (2016). Resilient livelihoods for agriculture and food and nutrition security in areas affected by the Syria crisis. Rome, Italy: FAO.  Back to cited text no. 10
    
11.
Frith C. D. (2014). Action, agency and responsibility. Neuropsychologia 55, 137-142.  Back to cited text no. 11
    
12.
Handicap International. (2010). Inclusive livelihoods development for all. Lyon, France: Handicap International.  Back to cited text no. 12
    
13.
Hassan G., Ventevogel P., Jefee-Bahloul H., Barkil-Oteo A., Kirmayer L. J. (2016). Mental health and psychosocial well-being of Syrians affected by armed conflict. Epidemiology and Psychiatric Sciences, 25, 129-141.  Back to cited text no. 13
    
14.
Heller F. (2003). Participation and power: A critical assessment. International Association for Applied Psychology, 52(1), 144-163.  Back to cited text no. 14
    
15.
Kumar S., Willman A. (2016). Healing invisible wounds and rebuilding livelihoods: Emerging lessons for combining livelihood and psychosocial support in fragile and conflict-affected settings. Journal of Public Health Policy, 37(1), 32-50.  Back to cited text no. 15
    
16.
Mollica R. F., Cardozo B. L., Osofsky H. J., Raphael B., Ager A., Salama P. (2004). Mental health in complex emergencies. Lancet, 364, 2058-2067.  Back to cited text no. 16
    
17.
Moore J. W. (2016). What is the sense of agency and why does it matter? Frontiers in Psychology, 7, 1272.  Back to cited text no. 17
    
18.
Office for the Coordination of Humanitarian Affairs (OCHA). (2017). Syrian Arab Republic humanitarian response plan: January–December 2017. Geneva, Switzerland: OCHA.  Back to cited text no. 18
    
19.
Petersen E. K., Pedersen M. L. (2010). The sustainable livelihoods approach. From a psychological perspective. Aarhus, Denmark: Aarhus University.  Back to cited text no. 19
    
20.
REACH. (2015). Assessment of needs and humanitarian situation inside Syria: Livelihoods. Geneva, Switzerland: REACH.  Back to cited text no. 20
    
21.
Red Cross. (2010). Psychosocial intervention handbook. Geneva, Switzerland: International Federation Reference Centre for Psychosocial Support.  Back to cited text no. 21
    
22.
Rogers K. (2014). Connecting the dots between psychosocial and economic support. Washington, DC: Devex. Retrieved from https://www.devex.com/news/connecting-the-dots-between-psychosocial-and-economic-support-83436  Back to cited text no. 22
    
23.
Save the Children. (2015). Understanding livelihoods in northern Syria: How people are coping with repeated shocks, constant change and an uncertain future. London, UK: Save the Children.  Back to cited text no. 23
    
24.
Solidarites International. (2016). Myanmar: Bringing back hope with livelihood projects. Paris, France: Solidarites International.  Back to cited text no. 24
    
25.
The Humanitarian Forum. (2015). Strengthening the role of Syrian civil society in the context of education and livelihood sectors workshop report. London (UK): The Humanitarian Forum.  Back to cited text no. 25
    
26.
United Nations Division for Social Policy and Development Disability. (2006). Convention on the rights of persons with disabilities. New York, NY: UN.  Back to cited text no. 26
    
27.
United Nations Economic Commission for Europe (UNECE). (2007). Rural households’ livelihood and well-being. New York, NY; Geneva: UN Wye Group Handbook.  Back to cited text no. 27
    
28.
United Nations High Commissioner for Refugees (UNHCR). (2015). Culture, context and the mental health and psychosocial well-being of Syrians. Geneva, Switzerland: UNHCR.  Back to cited text no. 28
    
29.
Valach L. (1995). Coping and human agency. In Marková I., Farr R. M. (Eds.), Representations of health, illness and handicap 249-265. Langhorne, PA; England: Harwood Academic Publishers/Gordon.  Back to cited text no. 29
    
30.
Wake C., Cheung T. (2016). Livelihood strategies of Rohingya refugees in Malaysia. London, UK: Humanitarian Policy Group Overseas Development Institute.  Back to cited text no. 30
    
31.
World Bank. (2014). Invisible wounds: A practitioners’ dialogue on improving development outcomes through psychosocial support. Washington, DC: World Bank.  Back to cited text no. 31
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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