Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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BMJ global health
A systematic review of MHPSS interventions targeting non-clinical Arabic-speaking refugees and/or displaced populations in the MENA region
BACKGROUND: Arabic-speaking refugees and displaced populations in the Middle East and North Africa (MENA) face ongoing adversity that negatively impacts their mental health. Despite increasing mental health needs, there is no published systematic review evaluating non-clinical mental health and psychosocial support (MHPSS) interventions in the MENA region for this population, particularly through a culturally grounded framework. METHODS: We conducted a systematic review of MHPSS interventions published from 2011 to 2022 targeting non-clinical Arabic-speaking adult refugees and/or displaced persons in MENA countries. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and PROSPERO registration (CRD42023421057), we searched ten databases and grey literature sources. Objectives were to identify, appraise and synthesise eligible MHPSS interventions and assess their alignment with the Integrative Complexity (IC)-Adaptation and Development After Persecution and Trauma (ADAPT) framework. Studies were appraised using four validated quality assessment tools and a novel tool assessing links to the IC-ADAPT framework, which integrates an eco-psycho-social model (ADAPT) and a cognitive-interactionist model (IC). A subset of ten top-rated interventions was synthesised for IC-ADAPT alignment. RESULTS: Thirty-eight studies met the inclusion criteria. Most interventions were conducted in Lebanon or Jordan, group-based and delivered by non-specialist facilitators in community settings. Parenting, resilience-building and trauma-focused therapies were the most common modalities. Most studies prioritised feasibility and effectiveness over efficacy. While none explicitly applied IC-ADAPT, several implicitly aligned with its eco-psychosocial systems (eg, bonds/networks, safety/security and roles/identities) and IC (eg, increased 'differentiation'), reporting reduced harsh parenting and improved reflective capacity. Culturally adapted interventions that promoted complex thinking, relational healing and community participation were linked with more favourable outcomes. CONCLUSION: This review highlights the value of culturally sensitive, non-clinical MHPSS interventions in enhancing mental health outcomes for Arabic-speaking refugee populations in MENA. Programmes grounded in eco-psychosocial and cognitive complexity frameworks-such as IC-ADAPT-offer effective, scalable strategies for addressing refugee mental health. Future work should embed these models explicitly to optimise intervention design, relevance and impact. PROSPERO REGISTRATION NUMBER: CRD42023421057.
31 July 2026
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Delayed health-seeking behavior and its associated factors among cancer patients in Ethiopia: A systematic review and meta-analysis, 2025
BACKGROUND: Delayed Health-seeking behavior among cancer patients is a major contributor to late diagnosis, poor prognosis, and high mortality, particularly in low-resource settings like Ethiopia. However, evidence on the magnitude and determinants of delayed care-seeking remains fragmented. OBJECTIVE: This systematic review and meta-analysis aimed to estimate the pooled prevalence of delayed Health-seeking behavior among cancer patients in Ethiopia and to identify associated factors influencing delays. METHODS: This study employed a systematic review and meta-analysis design to assess delayed Health-seeking behavior and its influencing factors among cancer patients in Ethiopia. A systematic search was conducted in PubMed, Scopus, Web of Science, CINAHL, AJOL, Google Scholar, and Ethiopian University repositories until April 27, 2025. The data were extracted from March 10-20 and analyzed from March 21-30, with report generation till April 27, 2025, using R software. Meta-analysis was performed using a random-effects model, with forest plots illustrating pooled prevalence and associated factors. Heterogeneity was assessed using the I² statistic, and study quality was evaluated using a validated tool. RESULTS: Seven studies conducted across multiple regions of Ethiopia were included in the final analysis with a total of 2,641 participants. The pooled prevalence of delayed Health-seeking behavior among cancer patients was 54% (95% CI: 39%-68%). Meta-analysis of associated factors showed that rural residence was significantly associated with delayed Health-seeking behavior, with patients residing in rural areas having more than threefold higher odds of delay (AOR = 3; 95% CI: 1.81-4.19), poor knowledge about cancer was strongly associated with delay, with nearly seven times higher odds among patients with poor knowledge compared to those with adequate knowledge (AOR = 6.63; 95% CI: 2.21-11.05), lack of cancer awareness was also a significant predictor of delayed Health-seeking behavior (AOR = 2.63; 95% CI: 1.75-3.51), and patients without pain were over three times more likely to delay Healthcare(AOR = 3.38; 95% CI: 2.44-4.67) were factors associated with delayed Health-seeking behavior. CONCLUSIONS: Our review showed that half of the cancer patients in Ethiopia experienced delayed health-seeking behavior. Delayed care-seeking was associated with rural residence, poor knowledge, limited awareness of cancer, and absence of pain symptoms. Targeted interventions, including public awareness campaigns, expansion of healthcare services in rural areas, and financial support initiatives, are urgently needed to reduce delays and improve early cancer diagnosis and outcomes. PROSPERO REGISTRATION NUMBER: CRD420251037845.
4 July 2026
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