The impact of group therapy training on social communications of Afghan immigrants.

BACKGROUND: Mental training considers sharing of mental health care information as the primary objective. The secondary objectives include facilitating dialogue about feelings such as isolation, sadness, labeling, loneliness and possible strategies for confronting with these feelings. Group therapy trainings have supportive functioning in accepting the environment so that the members are able to be part of the indigenous groups. However, no study has been ever done on the impact of this educational method on the communication problems of this group. This study aimed to determine the impact of group therapy training on the communication problems of Afghan immigrants.
METHODS: This was a clinical trial study. Eighty-eight Afghan men were investigated. Sampling method was simple sampling method. Thereafter, the study subjects were divided randomly into two groups of test and control based on the inclusion criteria. Data collection tool was a self-made questionnaire about the social problems. For analyzing the data, software SPSS, independent t-test and paired t-test were used.
RESULTS: Reviewing the data indicated lower mean score of the social problems after implementing the group therapy training in social communication compared with before implementing the group therapy training. Paired t-test showed a significant difference between mean scores of the social communication problems before and after the implementation of group therapy training.
CONCLUSIONS: Given the effectiveness of the intervention, group therapy training on social problems in social communication of Afghan immigrants is recommended. This program should be part of continuous education and training of the Afghan immigrants.

RCT Entities:   Population Interventions Outcomes

The United Nations has appointed December 18th as the International Migrants Day. The reason was declared as the importance of immigration phenomenon and the necessity of recognition of the immigrants’ rights. Immigration issue has been enormous dimensions in the past century. Millions of people migrate from one country to another. Currently, there are 130 million migrants all over the world. There are 20 million immigrants who live in the United States of America and around 4-5 million are in Canada. In New York, about 50% of all the school students live in the immigrant families.1 But, immigration of Afghan people to the neighbor countries is somehow an emergency or obligatory and unsafe combined with destruction. The cause of this kind of immigration was civil war and its consequences. Besides, attacks and invasions of the foreign governments were the reasons of unstable situation in this country. Every time, lots of people of this country have migrated to other countries especially some neighbor countries particularly Iran and Pakistan.2 Iran is the major high-immigration country for the Afghan immigrants, although the number of immigrants has always been fluctuating and it has been changed constantly; therefore, no exact statistics can be obtained due to their domestic circumstances and military conflicts.3 But, according to statistics, Iran has the highest number of refugees by accepting about 2,500,000 Afghan refugee immigrants. More than 900 thousands of them have legal residential card and 1.5 million of them should leave Iran.4 It should be noted that Iran's government had accepted several millions of Afghan immigrants during past three decades which was unique in its kind and also is appreciable; moreover, causing some problems for both parties is a possible incident.5 The more social sciences move forward, the more it is obvious that human being is isolated and lonely; lack of communication with others will put him/her at the stake of much social harm such as suicide. Therefore, communication is the milestone and infrastructure of the human society and without it, no culture would be created as a human society feature.6 On the other hand, migration is a particular phenomenon which in different forms influences gender, age groups, and followers of religions, political activists, ethnic minorities, and people with skill, expertise and wealth. And in some cases, it is in the general and universal forms which consequently would leave various and diverse consequences and effects.7 Some other parts of the problem are due to interaction and communication between immigrants and the host. The most obvious problem is the possible prejudices of the immigrant which is resulted from the hostility of the host society. Moreover, immigrants fall to the lowest social class of the host society. They would have temporary jobs that domestic workers will not do them due to unpleasantness, low wages or both. Being in the low society class is associated with high mental disorders. Therefore, the more immigrants take place in the lower social class, the more mental disorder they would experience.8 Cherry and Parker (2005) considered social problems of the immigrant as the followings: business problems; the law job conditions are usually difficult in the host community for the immigrants and they have less access to work permission in comparison with native workers and then, following the joblessness and lack of appropriate job, they would face specific issues and consequently involve with communication problems with the host society. Absence or ambiguity of the legal rights is one of the problems of the refugees; this causes that they always feel that due to the guilt of being an immigrant, no one wants to establish an appropriate relationship with them and no one pays attention to what they have to say. Norms of a community need are the same for everyone in equal privileges and rules, so that the communities not to get involved in a chaos, but unfortunately, most of the immigrants do not have social privileges and benefits. Lacks of these privileges bring about so many problems and disorders for the immigrants.9 In every society, as an immigrant, he/she would have very low contact with the host community or has no contact with them due to the living place. Other racial discriminations including the type of family life, rituals, economic activities, shopping, working and occupation, recreations and even going to school.10 On the other hand, the researcher herself has been living here for 20 years and has seen her countrymen's social problems for many years. And because immigration causes immigrants settle in a new environment, they would have different behaviors than they had before provided that these two environments were not the same, which are usually not.11 Perhaps lack of knowledge and understanding of the immigrants in how to communicate socially have increased their problems. In addition, since social-educational interventions along with strategies in reducing negative feelings, reinforcing realistic expectations, training communication skills and problem solving would result in positive social effects, this study aimed to determine the impact of group therapy training on social communications of Afghan immigrants which will be a valuable intellectual effort.

Methods

This was a clinical trial study which was done in a two-step research for two groups. The researcher investigated the impact of group therapy training as an independent variable on the social communication of Afghan immigrants as a dependent variable. The sampling environment was Isfahan health centers covered by Health Network No.1 because these centers handled most of the health problems of referring Afghan immigrants. The data collection tool included a self-made questionnaire with 20 questions about immigrants’ social communications. Each question had a rating scale which subjects scored them between 0 and 1 (the minimum total score was 0 and the maximum was 20). The questionnaire was made through library studies, internet searching and some interviews with 20 Afghan men who were residing in Isfahan. It has been approved by Nursing Psychiatric Department professors, School of Nursing and Midwifery Health Department, School of Management, Community Medicine Specialists and Psychology Department of School of Medicine of Isfahan University of Medical Science. The researchers, after receiving permission from the relevant authorities, explained the study objectives to the director of the research environment. The first stage of the sampling was simple sampling method. Then, the subjects were randomly divided into two groups of test and control according to the inclusion criteria such as knowing Persian language, having the least literacy for writing and reading, available address and phone number and motivation and ability to participate in the study. They filled in the informed consent form for participating in the study. The study subjects were free to participate or not to participate in the study and all the discussed materials in the group therapy training sessions remained confidential. At the first stage, information of both groups was gathered and then, the test group was justified in order to take part in the sessions and finally, the planning for group therapy training was conducted. The content of educational protocol collected through a pilot study by interviewing 20 Afghan male immigrants. The duration of each session was 45-60 min. Then, the content of educational protocol was shown to the supervisor professors, professional advisers, professors of psychology and educational sciences and then, their comments were gathered. The training was held in six sessions. Educational protocol presented with speeches and discussion. The duration of each session was 60-90 min. The educational content presented by the researcher herself. In order to better use of the taught materials, a manual was already prepared for them. Immediately after the session, the information of both groups was re-collected. Collecting the information, data entered the computer and quantitative and qualitative variables were determined. For analyzing the data, software SPSS, descriptive methods (mean, SD, frequency distribution table) and inferential statistics (paired t-test) were used.

Results

The study sample included 88 Afghan men who were randomly divided into two groups of test (44 subjects) and control (44 subjects). According to the study results, the age range of the subjects was between 18-56 years. Twenty-one subjects (23.9%) were single and 67 of them were (76.1%) married. In addition, statistical results indicated that between the two groups, there was no significant relationship between variables of age (p > 0.16), the residence length (p > 0.23), and number of children (p > 0.09), income (p > 0.27) and education (p > 0.49). The obtained results of the present study showed that the mean score of the social communication problems in the test group was 14 (1.16) and 9.2 (1.6), before and after the implementation of the intervention, respectively. Paired t-test showed a significant difference (p < 0.001). The control group in social communication showed no significant difference before, 14.8 (1.6), and after, 14.7 (1.6), the study (p < 0.34, Table 1).

Table 1

Comparing mean scores of the social communication problems before and after the intervention in test and control group

Discussion

The findings of the study showed no significant difference between variables of age, the residence length, number of children, income and education between the two groups of control and test. In the study of Grittsen et al. on the Iranian and Somali immigrants in Netherland, it was indicated that half of the subjects had a high level of education, but no significant relationship was observed between education levels and using health care services.12 Jashua realized that the level of cultural adaptation was associated with residence length in the United States. They found that the immigrants who have lived longer in the U.S. and experienced the early socialization in the American society seemed to have lack of cultural integration and challenged the compatibility with the new community. Two factors of immigration at the young ages and long residence time in the U.S. were associated with the high risk of mental disorders among immigrants. These two factors are the same as early socialization in the American society.13 In every society, part of the immigrant's problems is related to interaction and communication with the host society. For an immigrant, it is possible to put many important aspects of the life into ethnic group. Therefore, immigrants would have very low contact with the host community or have no contact with them due to living place, resident location and other racial discriminations, the type of family life, rituals, economic activities, shopping, working, occupation, recreations and even going to school.14 Kim (2003) in his studies found that psychological training groups -who culturally are specific- can be kind of interven tion that affects attitude of minority population of the society to the application of the services. Firstly, these cultural group therapy trainings can be helpful comprehensively for the vulnerable cultural groups who form minority population of the community and are at the risk of types of distresses. Besides, they can provide information about professional counseling, the benefits of receiving help, multiple cultural movements and its association with minorities that consequently can cause changes in cognition, attitude, behavior and emotional complexities. This training method can increase the ability of the individuals in developing their information provided that factors such as specificity of the culture and mental training mix together with psychological interventions.15 The researcher believes that the results of this study would be revealed over the time by importance of providing information, knowledge and communication skills training and receiving feedback. Dowrick remarks that group therapy trainings emphasize more on the education and providing recommendation to the individuals rather than treatment; so that the consequences would create a comfortable feeling, positive thinking, pleasant activities and social skills.16 Wells et al. had used this technique in social and health fields which increased the quality and improved the plans.17 Main factor for change process is through education; by participating in a team, their knowledge would be increased about the way others considered and look at them and besides, learn how to develop their interpersonal skills.18 The researchers believe since communication skill education has not ever been used for immigrants, the study subjects were eager to learn new communication techniques other than what they had been used before. As they remarked, they always were looking for a way to change their communication methods, because no one had been annoyed but themselves. And since they live as an immigrant in a new country, the behavior technique and skills for communication in the host country can significantly help them cope with the new situations, adapt them with new environment and provide them with mental health. Therefore, it is recommended that education of communication skills be part of the training programs of this group.

The authors declare no conflict of interest in this study.