Our Research Methods Case Study aims to provide an insight on how to conduct semi-structured interviews with male refugees on their mental health and integration in the host country. Our starting point was that the literature in this field focuses mostly on refugees as a broad category and/or on refugee women and children and there is rather little information on male refugees’ mental health. As with other refugee populations, male refugees have been exposed to multiple pre- and post-migratory traumatic episodes; it was therefore essential for us to be aware and respectful of their situation. We also knew refugees find hard to talk to individuals who are considered to be in a position of authority, including researchers, and this also had to be considered in our study. We both have experience of working with vulnerable populations and we know that listening empathetically to participants’ stories can lead to vicarious trauma, so we both had a designated person to talk to after conducting the interviews. For this case study, we describe our rationale for using qualitative research with male refugees, how we designed and conducted the in-depth semi-structured interviews, the process of getting the ethical approval/consent, and how we analyzed and made sense of the data. Our aim is to provide an insight into how to conduct research with this population to gain rich data that can help to understand and support them.
By the end of this case, students should be able to
- Understand the rationale for conducting in-depth individual semi-structured interviews with refugees
- Plan the various steps you they need for designing and conducting this type of research
- Approach refugee organizations from where can recruit participants
- Address the ethical issues of conducting research with male refugees
- Interview refugee populations in a manner that is sensitive and respectful of them
- Protect them from vicarious trauma when conducting the interviews
Project Overview and Context
Our aim for this case study is to provide an insight into how to conduct in-depth semi-structured interviews with male refugees regarding their mental health and integration after they have been granted their refugee status.
First, we want to make sure that you are familiar with the term “refugee”; as Article 1 of the 1951 Geneva Convention stated, this is an individual who has “well-founded fear of being persecuted in his or her country of origin for reasons of race, religion, nationality, membership of a particular social group, or political opinion” (United Nations General Assembly [UNGA], 1951, p. 8). In contrast to asylum seekers (who are waiting for their status), refugees have made a claim and obtained the decision to stay in the host country; this decision can be either temporary, with the aim of being reviewed and/or extended (i.e., temporary leave), or permanent (i.e., indefinite leave).
We decided to conduct our investigation because we felt that most of the existing literature in refugees’ mental health focuses on their pre-migratory experience, rather than the challenges they experience after receiving their status (e.g., Mann & Fazil, 2006). Of course, knowing refugees’ pre-migratory experience is essential; we need, in fact, to understand how highly traumatic episodes such as torture, rape, witnessing family members being killed affect them. We also need to be aware of the impact that the journey has had on their mental health. They are likely to have been exposed to physical and psychological abuses by their traffickers and to inhumane conditions in refugee camps. To have a clear understanding of their current situation, we also need to explore how the change of status (i.e., from asylum seeker to refugee) and the challenges related to that affect them. This is one of the main reasons why we made the decision to undertake this research.
Furthermore, we decided to focus our attention on male refuges as we felt that they are underrepresented within the literature in this field. Most of the existing empirical studies focus on either refugees’ (as a generic category) and/or refugee women’s and children’s mental health. We used the small amount of existing literature in this field to start developing our research questions. For instance, we knew that male refugees have been in some cases exposed to gender-based violence in their country and that, during the resettlement process, they have a drop in their status within society, so, for example, those with professional jobs often have to take on unskilled, low status work (Correa-Velez, Spaaij, & Upham, 2013; Mann & Fazil, 2006).
Finally, there were pragmatic reasons for focusing on male refugees’ mental health soon after they receive their status: the second author (who is a psychotherapist working in a clinic for refugees affected by trauma) felt that male refugees, more than females, struggle with mental health issues. Specifically, she felt that in some cases, symptoms of post-traumatic stress disorder can become more severe after they gain their leave to remain. We wanted therefore to find out why/whether this was the case.
Our final aim was to use the evidence of this exploratory study to develop a larger research on how to develop community interventions to promote male refugees’ mental health and integration after they receive their status.
To summarize, our research questions were as follows:
- What are male refugees’ immediate experiences having been granted their status?
- How does this affect their mental health and their integration in the host country?
- What type of support is available to them?
- What are their suggestions regarding the type of interventions needed to promote their mental health and integration?
We knew from existing literature and from our previous research experience that qualitative methods are appropriate with migrants and with refugees in particular, as they allow them to provide their direct opinion and talk freely about their lived experience.
We ruled out running focus groups because we wanted to ask questions relating to their mental health and integration and therefore participants might not have felt comfortable to answer them in a group setting.
We decided therefore to carry out in-depth individual semi-structured interviews because we felt that those represented the best way to survey our participants. Semi-structured interviews allow researchers to explore a set of pre-existing topics in a flexible manner.
To recruit participants, we approached a local organization that provides practical support to asylum seekers and refugees such as English and computer classes and employment workshops. We contacted the manager of the organization (first via email and then in person) to secure her collaboration in the research, including in recruiting suitable participants. For confidentiality reasons, we did not directly access the database of individuals who fitted our selection criteria. We provided the manger with a leaflet containing some generic information about the study, along with our contact details. Potential participants were identified and approached by the manager of the center to establish whether they were willing to take part in the study and, if they were, to arrange a meeting for the interviews. Despite the manager’s collaboration, we found the overall process of recruiting participants difficult and time-consuming; this is relatively predictable when conducting research with refugees. In our case, this was in part because we had quite narrow selection criteria (being male, aged over 18, having an English level that allowed them to sustain a conversation/to give informed consent, and having been granted their status within 2 years from when we commenced the research). In addition, the refugees attended the organization on an infrequent basis after they had obtain their status as the center was mostly for meeting the needs of asylum seekers. Of 11 refugees who were invited to participate in the study, nine agreed; the reason given for not taking part by the remaining two was lack of time. Following the initial contact with the manager of the organization, individuals who showed an interest in our study and who fitted the selection criteria met the first author on an individual basis for more detailed information about the research and to arrange a convenient time/day for the interview.
We submitted our research proposal to the Ethics Committee of our university. Once we received its approval, we forwarded the proposal to the refugee organization from which we then recruited participants. The proposal was discussed and then approved by the committee from where we recruit the participants, which included selected staff members, volunteers, and refugees/asylum seekers.
In conducting this study, we followed the Ethical Guidelines for Good Research Practice with Refugee Studies Centre (2007) and the British Psychological Society (2010) Code of Human Research Ethics. We were aware that specific ethical considerations must be taken into consideration when conducting research with refugees as those are vulnerable individuals who have been exposed to multiple levels of stress. We also knew from existing literature and from previous research experience that refugees are often reluctant to be interviewed by individuals who are perceived to be in a position of authority, including researchers. This might be because, as some of the refugees have mentioned to us before, being asked to provide their opinion is not part of their culture. To them being interviewed matches with being investigated.
Furthermore, being interviewed might bring back memories of being queried about their pre-migratory traumatic situations at asylum tribunals (Bogner, Brewing & Herlihy, 2010). For these reasons, we had to be particularly conscious when we conducted the interviews. The overall interview process was explained to participants in detail, including the research aims and objectives, the confidentiality of the study, the freedom not to answer any questions that they did not feel comfortable to, and the ability to withdraw at any time without any consequences. We made sure that they were clear that we were not linked to the organization from which we recruited them and that we were not going to discuss the content of the interviews with anyone in the center. We also informed participants that taking or not taking part in the study did not have any effect whatsoever on their relation with the organization. Furthermore, participants were encouraged to seek as much clarification as they needed about our research, our role as researchers, and the whole interview process.
After the interviews, we provided a debriefing form and stated verbally that, if they felt distressed by the interview process, they could contact an organization that provides mental health support to refugees (we provided the name of the center, as well as its contact details for this). We also stated that, if we felt mistreated by the researcher during the interview, they could contact and report it to the chair of the ethics committee of our university.
The Potential Effect of Vicarious Trauma on Researchers
Whether or not you are a new or an experienced researcher, listening to refugees’ painful stories can affect you. This is called vicarious trauma and it needs to be considered and addressed when you design and conduct researcher with this population. Remember, acknowledging this is not a sign of weakness, it rather proves that you are competent researcher who is well equipped to conduct this kind of study. In our case, we agreed in advance to have a designated colleague (who was not involved in our research) to talk if we felt distressed about some of the interviews.
This consisted of the following in the order on the information sheet, the consent form, a bio-form (to gather some generic demographic detail about the sample), the interview script, and the debriefing form. All the material was written in a friendly and colloquial manner, without the use of jargon. For the interview script, we had generic questions, which aimed to foster discussion around our research topics. The first interview questions were aimed to “warm up.” For instance, we asked, “Is there a community of people from your country in the area?” and “Do you meet these people?” and “What do you do together?” We had questions on their experience of obtaining their refugee status, their integration process, the type of support available to them, and on their suggestions on how to develop community-based interventions to support their needs. We decided not to have questions that were directly related to traumatic pre- and post-migratory experiences, even if that could potentially mean that participants’ current mental health situation might not fully emerge in the data. For example, the mental health implications for those who may have been traumatized using torture or through witnessing horrifying events were not asked, although many refugees have experienced these kinds of traumatic experience. Instead, we had items such as “Tell us what’s a typical day is like for you.” Our aim was to extrapolate information about their mental health without being too invasive and to allow them to tell us only as much as they were comfortable to.
Engaging With Participants
During the individual interviews, the first author (who conducted them), made sure that participants felt comfortable with the whole process by using an easy-to-understand language and by providing a welcoming atmosphere. To avoid any sort of formal interview setting, the first author also sat with participants at the same side of the desk and she made sure her body language was open and friendly. Before commencing the actual interview, the researcher made sure participants were aware of her role and of the reasons why we decided to undertake the study.
Based on our experience, we can advise that it is essential you discuss your role as a researcher with the participants and how you plan to use the information provided by them since refugees often fear of “being used” by researchers. Furthermore, refugees often fear that any information given to a stranger might be used against them and/or could interfere with their status (Hynes, 2003).
Usually participants asked to check the researcher’s work ID card and her business card. Participants also queried the researcher’s title of “doctor” (some of them thought it meant “medical doctor”) and they asked information about the institution where she worked and the type of research she conducts. You may think that this might be a bit intrusive, but as you can imagine, refugees have been through many investigations and therefore they have valid reasons to be suspicious about providing any information related to their circumstances.
Procedure for Conducting the Interviews
To facilitate participants, we decided to run the interviews in a room free of distraction in the organization from where we recruited them. Prior to each interview, the first author (who conducted them) made sure participants were clear about the content of the information sheet and of the consent form. Some participants did not have high literacy and/or good English and so they were given the option to read the forms with the help of the researcher. After reading the information sheet and the consent form, participants reviewed them with the researcher to make sure they fully understood them. Participants were also informed that they had the choice not to have their interview audio-recorded. Once they signed the consent form, participants were asked to complete the bio-form and then to undertake the interview. It was deemed important to help the interviewees talk freely about topics they raised, and additional questions were only asked to seek clarification, illustration, or further exploration. The overall process lasted approximately 45 min each.
Findings From Our Interviews
We agreed not to have the interviews transcribed by external individuals who were not familiar with this specific population, instead we transcribed the interviews. We felt that this was important for the study as participants did not have English as their first language. Meanings could be lost if the interviews were transcribed from an outsider and the transcripts would have been limited by mechanically putting the spoken sounds on paper. We analyzed the data thematically.
The themes that emerged from our analysis were related to participants’ migratory experience, their transition from being asylum seekers to refugees, and their struggles to settle in the new country, such as finding suitable employment, accommodations, and trying to integrate in the community. Participants indicated that they were still dealing with the effects of their pre- and post-migratory traumatic situations and they felt that they did not receive adequate support to address them. Participants also indicated that they had some specific gender-related issues in their resettlement. For instance, those who had families stated that, even after receiving their status, they could not carry out their usual role as family provider as it was extremely difficult for them to find any type of employment. Furthermore, those who were singles indicated that they were not “normal” as they did not have employment and/or accommodation and therefore they felt that they were not “equipped” to marry. All participants indicated that future interventions should address their needs to find suitable employment, to build stronger support from mental health services, and to provide practical support to became, as they said, “active citizens, who can live and work” in their new country.
Practical Lessons Learned
Interviewing male refugees is important to generate empirical evidence that can support them; however, it is challenging for both participants and researchers. Below are some of the “practical lessons” we learned from our study:
- When conducting interviews with male refugees, it is important to be understanding and respectful of their circumstances. Male refugees have been exposed to multiple traumas and therefore they are very reluctant to talk and disclose information about their life to individuals who they had not met before. When working with them, it is important to build a relationship that is based on respect and does not force into giving information that they are not prepared to disclose. In our case, we felt that, to gain their trust, it was important to involve the wider community from the very beginning of the study. For instance, we decided to submit our research proposal to the organization from which we recruited the participants for feedback. This included refugees who did not take part in our study. Furthermore, we considered the ethics of working with refugees and, before we started the interviews, we took time to discuss our research with each participant. During the interviews, we were careful not to ask direct questions about their mental health and/or any event that could have triggered traumatic memories.
- Listening to refugees’ stories might be difficult, even for experienced researchers. As we said, interviewing individuals who have been traumatized and who might be struggling with mental health issues can be distressing for researchers. When we planned our research, we agreed to have colleagues (i.e., a psychologist and a psychotherapist) who were not involved in our project with whom we could talk to if we need it. It was important for us to keep boundaries between the research we were doing and the potential feelings attached to it.
- Gaining access to refugee organizations can be challenging. Individuals who work with refugee populations are extremely busy trying to deal with practical issues for their clients such as finding suitable accommodation, dealing with their asylum forms, or contacting job centers. They can be under a lot of stress as they often work in charities that find it hard to afford an adequate number of staff members. Therefore, dealing with requests from researchers might be difficult for them. It took us quite a while to obtain an appointment with the manager of the organization from which we recruited participants and then to secure permission to conduct the interviews at the center. We felt it was important to point out the potential benefits of conducting our study. Our aim was to conduct a pilot to develop a bigger study concerning the development of community interventions for male refuges after they receive their leave to remain.
- It was important to be honest to participants about the reason for conducting our study. We found that one of the biggest concerns for refugees who take part in academic studies is that they might simply be used for collecting data for academic papers. We therefore took time to discuss our reasons for undertaking the study and were honest about its limitations as we did not want to build false expectations. We said that the next step of the research (the intervention) would take time to develop.
The strategies needed to design and conduct interviews with male refugees are complex as this is a hard-to-reach population which struggles with multiple levels of pre- and post-migratory stress and therefore is reluctant to engage in research. It is important to plan carefully before approaching organizations from which you hope to recruit participants. It is also imperative to design and conduct the interviews in a manner that is respectful and understanding of the population. In conducting in-depth, semi-structured interviews, we gained information about male refugees’ integration after receiving their status and how this affects their mental health. We gained some essential information which will help us to design a subsequent study on how to develop community interventions to support them.
Exercises and Discussion Questions
- What strategies would you use to approach and secure refugee organizations collaboration in your research?
- What are the challenges you may face in recruiting and surveying male refugees? How would you address these challenges?
- What type of questions would you to ask male refugees to gain a good understanding of their situation?
- What type of strategies would you use when conducting semi-structured interviews with male refugees to be respectful and understanding of their situation?
- What are the challenges for you as a researcher if you were to survey male refugees? How would you address these challenges?