Analysis of the possible pathways between social and well-being outcomes: a mixed-method study about community-based sociotherapy for refugees in Nakivale Settlement, Uganda

Background
Refugees in Nakivale Settlement, southwestern Uganda, are at risk of suffering from both mental health and social problems due to migration-related stressors. Mental health and psychosocial support is offered to improve their well-being. The theories of change of mental health and psychosocial support interventions often assume that individual and social outcomes are interrelated. By analysing changes in well-being and social support after Community-Based Sociotherapy (CBS), we assess the pathways between these outcomes.
Methods
This study uses a longitudinal mixed-method approach, analysing survey data from 98 CBS participants at three time points, and 11 focus group discussions. We focus on well-being and social support outcomes. We first analysed the quantitative data (paired t-tests, correlations, random-intercept cross-lagged panel model), followed by a qualitative content analysis to interpret the quantitative findings.
Results
We did not find quantitative evidence of within-person influence processes between well-being and social support, and the significantly positive changes in these outcomes between the pre- and posttest declined over time. The qualitative data shed new light on the changes in the lives of the participants after participating in CBS, and the barriers to and facilitators of change.
Conclusions
Among this group of participants, we found no quantitative and limited qualitative evidence that improvements in well-being led to improved social outcomes, or vice versa. We consider how methodological limitations (i.e. our sample size and limited number of survey items) may have influenced our results, and contextual and temporal explanations for the lack of evidence of pathways. This finding stands in contrast with the theories of change of many mental health and psychosocial support interventions, and therefore calls for consideration of the complex realities of people living in refugee settings, rather than assuming simple pathways.