Conflict-driven displacement is an indisputable social determinant of health. Yet, data on changes in health along the migration trajectories of refugees are scarce. This study aims to assess the longitudinal changes in somatic and mental health and use of medication among Syrian refugees relocating from a conflict-near transit setting in the Middle East to a resettlement setting in Europe. Further, we examine different health status trajectories and factors that predict health in the early postmigration period. This is a prospective cohort study. Survey data were collected during 2017-2018 among adult Syrian refugees in Lebanon selected for quota resettlement and at follow-up approximately one year after resettlement in Norway. Our primary outcomes were non-communicable disease (NCD), chronic impairment, chronic pain, anxiety/depression, post-traumatic stress symptoms, and daily use of drugs. We estimated longitudinal changes in prevalence proportions using generalized estimating equations and evaluated effect modification of health outcomes. Altogether, 353 Syrians participated. NCDs declined (12%-9%), while the prevalence of chronic impairment, chronic pain, and use of drugs remained nearly unchanged (29%-28%, 30%-28%, and 20%-18%) between baseline and follow-up. Conversely, mental health outcomes improved (anxiety/depression 33%-11%, post-traumatic stress disorder 5%-2%). Effect modifiers for improvement over time included younger age, short length of stay, and non-legal status in the transit country before resettlement in Europe. We find that mental health outcomes improve from a conflict-near transit setting in Lebanon to an early resettlement setting in Norway, while somatic health outcomes remain stable. Temporal changes in health among moving populations warrant attention, and long-term changes need further scrutiny.

Chronic pain is common among refugees, and often related to mental health problems. Its management, however, is often challenging. A randomized waitlist-controlled trial was designed to study the effect of group physiotherapy activity and awareness intervention (PAAI) on reducing pain disorders, and secondarily improving mental health, among Syrian refugees. A total of 101 adult Syrian refugees suffering from chronic pain were randomized to either the intervention group or the control group, which thereafter also received PAAI after a waiting period. Pain intensity measured by the Brief Pain Inventory (BPI) was the primary outcome. Scores from the Impact of Events Scale-Revised (IES-R 22) and the General Health Questionnaire (GHQ-12) were secondary outcomes. Intention-to-treat analyses (ITT) showed no effect of the intervention on either pain levels (regression coefficient [B {95% CI} of 0.03 {−0.91, 0.96}], IESR scores [4.8 {−3.7, 13.4}] or GHQ-12 scores [−0.4 {−3.1, 2.3}]). Yet, participants highly appreciated the intervention. Despite the negative findings, our study contributes to the evidence base necessary to plan targeted and effective health care services for refugees suffering from chronic pain and highlights the challenge of evaluating complex interventions adapted to a specific group.

Background: Mental health symptoms among refugees are common, often related to chronic pain disorders, and their management is usually challenging. Studies evaluating the effect of group therapies among adult refugees to improve mental health symptoms are scarce. Aims: To assess the effect of Teaching Recovery Techniques (TRT) on mental health and to reduce pain disorder among adult Syrian refugees. Method: A randomized controlled trial was designed to study the effect of a self-help group intervention using TRT. The outcomes, mental health symptoms measured by Impact of Event Scale-Revised (IES-R) and General Health Questionnaire (GHQ-12) and chronic pain measured by Brief Pain Inventory (BPI), were reported as regression coefficients (B) with 95% confidence intervals. Results: Seventy-six adults participated: 38 in the intervention and 38 in the control groups. Intention-to-treat analyses showed a significant effect on general mental health as measured by GHQ-12 with B (95% CI) of -3.8 (-7.2, -0.4). There was no effect of TRT on mental health when assessed by IES-R (-1.3 (-8.7, 6.2)) or on pain levels assessed by BPI (-0.04 (-4.0, 3.9)). Conclusions: This self-help group intervention significantly improved general mental health symptoms among adult refugees but had no effect on trauma symptoms or chronic pain. Higher participation rates might be necessary to achieve the full potential of TRT. Trial registration: The trial was registered with Clinical Trials.gov at https://clinicaltrials.gov/ct2/show/NCT03951909. To include user participation in the design of the interventions, the study was retrospectively registered on 19 February 2019.

Background: There is a high prevalence of pain and post-traumatic symptoms among refugees and feasible interventions to manage these are needed. However, knowledge about the effect of physiotherapy and psychological group interventions among refugees is scarce. Our aim is to determine whether two different interventions, the Physiotherapy Activity and Awareness Intervention (PAAI) and Teaching Recovery Techniques (TRT), reduce pain and post-traumatic symptoms among refugees from Syria living in Norway. Methods/design: Syrian adults with either pain disorders or post-traumatic symptoms, or both, will be recruited to this randomized control trial. The trial will include two separate interventions: participants with dominating pain symptoms will be assigned to the PAAI; and those with a predominance of post-traumatic symptoms will be assigned to the TRT intervention. Participants will be randomized to either the immediate intervention group or the delayed intervention group, for each of the interventions (PAAI and TRT). A minimum of 68 participants will be recruited for the PAAI and 78 participants for TRT, in order to detect clinically and statistically significant symptom improvement, assuming 25–30% attrition after recruitment. The main outcomes for the analyses will be pain intensity measured by the Brief Pain Inventory questionnaire and the scores of the Impact of Events Scale — Revised. The effect will be evaluated at the end of interventions lasting 8 weeks (PAAI) and 6 weeks (TRT) using the same instruments after the end of the intervention, and again 4–6 weeks later. Additionally, a qualitative evaluation will be conducted through an embedded process evaluation and personal interviews with participants after each of the interventions is finished. Discussion: Our study will determine the feasibility of the implementation of two different interventions and the effect of these interventions among refugees from Syria with pain disorders and/or post-traumatic symptoms. Trial registration: Clinical Trials.gov, NCT03951909. Retrospectively registered on 19 February 2019.

Background: Immigrants represent 20.8% of Norway’s population, with 22.2% aged 50+. This study aimed to examine dental service utilization (DSU) and its associated factors among elderly immigrants aged 50 or older in Bergen. Methods: Data were collected through a self-administered questionnaire. Participants were recruited through community organizations and immigrant networks in Bergen using a convenience sampling method. Andersen’s Behavioral Model guided the analysis, with DSU in the past five years as the dependent variable. Independent variables included predisposing, enabling, and need-based factors, as well as health status, health behaviors, and psychological factors. Statistical significance was set at p < 0.05. Results: Of the 185 invited participants, 174 completed the survey, resulting in a 94.3% response rate. The primary outcome variable was DSU within the past 5 years, categorized as regular or irregular attendance. Approximately 37% reported irregular dental attendance during this period. Overall, 70.3% reported visiting a dentist for dental treatment, and about 80.8% cited financial barriers to care. Participants with broader social networks and the ability to contact dentists when needed had twice the odds of regular attendance, and both factors were significantly associated with the use of dental services in the last five years in both unadjusted and adjusted models (OR = 2.00, 95% CI: 0.99–4.11, p = 0.05, and aOR = 1.93, 95% CI: 0.98–3.85, p = 0.05), and (OR = 2.22, 95% CI: 1.07–4.62, p = 0.023, and aOR = 2.02, 95% CI: 0.99–4.09, p = 0.05), respectively. The positive association between flossing and regular visits (OR = 2.00; 95% CI: 1.01–4.03, p = 0.039) was attenuated after adjustment. Conclusion: DSU among elderly immigrants was associated with psychosocial, behavioral, and service factors. Regular dental visits were associated with broader social networks, preventive behaviors, and perceived access to dental services. These findings underscore the importance of improving access to services, promoting preventive care, and utilizing social support to enhance DSU and oral health among older immigrants.

Background: Health, employment, and professional integration are closely linked for migrant health professionals. However, language barriers and complex accreditation processes often hinder foreign-trained professionals from re-entering their fields in host countries. This study evaluated the implementation strategy of a health-promoting labor integration intervention in Norway that placed highly educated migrant health professionals in academic institutions as assistant teachers, where they worked alongside mentors and gained exposure to Norwegian work culture. Methods: A qualitative implementation evaluation informed by implementation science was conducted, focusing on four predefined implementation outcomes: satisfaction, participation, fidelity, and feasibility. Data were collected in Bergen, Norway, through field observations and midway evaluations during the intervention, and semi-structured interviews with 15 mentees and 11 mentors after its completion. Interviews were transcribed and analyzed using Braun and Clarke’s reflexive thematic analysis. Results: Mentees reported increased confidence, professional growth, and meaningful engagement in academic activities. Mentors generally perceived the intervention as rewarding, although some experienced challenges related to unclear expectations and competing responsibilities. Fidelity varied across sites due to mentor–mentee mismatches and bureaucratic delays. Feasibility was enhanced by personalized support, team-based mentoring, and flexible integration into academic settings. Conclusions: Academic placements may promote the integration and wellbeing of migrant health professionals. Addressing implementation challenges before scale-up is essential. Future larger-scale effectiveness studies should build on both the implementation findings reported here and the pilot outcome findings reported elsewhere to assess intervention effects, sustainability, and scalability: