Health Promotion International Advance Access published March 23, 2015 Health Promotion International, 2015, 1–10 doi: 10.1093/heapro/dav015
Peer support groups, mobile phones and refugee women in Melbourne Pranee Liamputtong*, Lee Koh, Dennis Wollersheim, and Rae Walker
*Corresponding author. E-mail: [email protected]
Summary In this article, we discuss qualitative findings basing on the experiences of refugee women living in Melbourne, Australia, who participated in a peer support training programme and received a free mobile phone. We pay attention to social support as a health enhancing strategy and empowerment that occurred among the participants. Participation in peer support groups and access to a mobile phone were beneficial for the women. Peer support functioned as social support among group members. The programme allowed the women to be connected to their families and the wider communities and assisted them to access health care and other settlement aspects with greater ease. It also increased personal empowerment among the women. Our programme shows that by tapping on community resources to ameliorate personal or resettlement issues, the burden on service providers can be reduced. Our findings also offer a model for future research and programmes regarding refugee people elsewhere. Key words: peer support, mobile phone, health promotion, refugee women
INTRODUCTION Refugees face many difficulties in their lives, and settling in a new and markedly different environment can be an added difficulty for many of them (Cislo et al., 2010; Correa-Velez et al., 2010; Dow, 2011; Ngum Chi Watts, 2012; Ngum Chi Watts et al., 2013; Beadle, 2014). These difficulties may lead to poor ‘psychosocial adjustment’ and emotional problems (Cislo et al., 2010: 1174) in refugees, who often embody significantly higher mental health problems than other populations in general (Norredam et al., 2009; van Wyk et al., 2012). As elsewhere, refugees in Australia have lower levels of personal well-being than other migrant groups (Australian Survey Research Group, 2011). This is particularly so for newly arrived refugees, and more so for women, who are often culturally displaced, socially isolated (Iglesias et al.,
2003) and have ambivalent feelings about their future (Kaiser et al., 1998; Ngum Chi Watts, 2012). This acculturative stress is likely to result in depression among refugees (Barnes and Aguilar, 2007). For any individual, having to relocate to another social setting necessitates extensive adjustment, which often leads to changes in health status as well as disruptions to family connection and social network (Correa-Velez et al., 2010; Dow, 2011; Ngum Chi Watts, 2012; Ngum Chi Watts et al., 2013). This is more marked among refugees who have experienced violence and civil conflict in their homeland (Palmer and Ward, 2007; Pavlish et al., 2010). For many refugees, resettlement can be very daunting. It has been suggested that the resettlement process that refugees go through can have more negative impact on health and well-being than their pre-migration situations (Correa-Velez et al., 2010; Kurban, 2014).
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Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Victoria 3086, Australia
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Peer support group as social support and health enhancing strategy: theoretical framework In this article, peer support is perceived as a subset of social support in which the relationships are formed between individuals who are similar to each other. Peer support has received much attention within the mental health area (Mead et al., 2001; Solomon, 2004; Schutt and Rogers, 2009). It has been defined as ‘social emotional support, frequently coupled with instrumental support, that is mutually offered or provided by persons having a mental health condition to others sharing a similar mental health condition to bring about a desired social or personal change’ (Solomon, 2004: 393). This concept is clearly relevant to our project, which attempt to use peer support group to enhance the health and well-being of refugee women. In the case of the refugee situation, emotional, physical and tangible support which is offered by ‘peers’, who are also refugees, can lead to desired personal and social changes within their communities. Peer support embodies ‘active ingredients’ which enhance positive health and well-being among group
members (Solomon, 2004; Randall and Salem, 2005). Peer support groups which provide a channel for individuals to periodically meet to address commonly shared concerns and problems have resulted in social support among group members, which has, in turn, led to the improvement of quality of life of those involved (Elafros et al., 2013). Within peer support groups, empathy, sharing, support and assistance are often offered (Solomon, 2004). As such, feelings of social isolation (such as loneliness, rejection and frustration) can be overcome (Schutt and Rogers, 2009). Schutt and Rogers (2009: 699) put it clearly that peer support ‘provides resources for effective functioning and a foundation for coping with stress and loss’. Additionally, a peer support group has been seen as the principal ingredient of the empowerment process (Schutt and Rogers, 2009). Peer support programmes not only increase social support, they can also promote empowerment among group members (Van Tosh and delVecchio, 2000; Dumont and Jones, 2002). Peer support makes the most of the ability of peers to contribute to the situations and needs of others in the group as well as their potential for influential relationships with others (Whittemore et al., 2000; Marino et al., 2007). In our study, we based our research within the peer support framework discussed earlier. The peer support group training sessions and the provision of a free mobile phone offer a means through which meaningful empowerment processes could eventuate (Schutt and Rogers, 2009). Here, we emphasise the empowerment that become materialised at the individual level, and we refer to this as ‘personal empowerment’ (Chamberlin, 1997). According to Chamberlin (1997), this personal empowerment is ‘a multi-dimensional concept’ which embodies the feeling of being part of a group and promotes positive self and the conquering of personal difficulties. Within the refugee context, peer support could empower individuals to find ways to overcome difficulties in their new homeland. Additionally, we contend that participation in peer support group can be perceived as health-promoting behaviour. Within the health behaviour framework (Kafaar et al., 2007), it is assumed that by participating in peer support group, people will receive benefits of some kind. For example, participants may perceive that being a group member would assist them with difficulties in life. Additionally, it will entitle them to some support that will help them fight against isolation and difficulties in their everyday life. As such, participation in peer support group training can be seen as a health-promoting behaviour with the expectation that support from others may follow.
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Nevertheless, there are factors which have helped to protect refugees during their settlement processes, in particular, social support from peers and their own ability to cope (Correa-Velez et al., 2010). According to Mulvaney-Day et al. (2007: 479), social support provided by ‘unrelated, close friends’ has shown a positive influence on the physical and mental health of refugees. Social support can help to alleviate some of the difficulties associated with resettlement in a new environment (Barnes and Aguilar, 2007; Tempany 2009; Kurban, 2014). We contend that one aspect of social support for refugees is being part of a peer support group. In this paper, we discuss the experiences of refugee women who participated in the peer support programme for newly arrived refugee women in Melbourne, Australia. Our project adopted a two-pronged approach to establishing peer support networks among refugee women from similar communities. Peer support training enabled the participants to meet, discuss issues and consequently establish communicative relationships within the peer group. Additionally, the women were given access to a free mobile phone. Research has shown that mobile phone access can act as a health promotion tool (Fukuoka et al., 2012; Pop-Eleches et al., 2011; Rotheram-Borus et al., 2012). In this study, participants were provided with a free mobile phone and free unlimited calls within the peer support group numbers, and to limited set of local and overseas numbers, for a 12-month period, to augment the peer group relationships, as well as relationships with a small number of people and institutions external to the peer group.
P. Liamputtong et al.
Peer support groups, mobile phones and refugee women in Melbourne
Peer support group activities: our project
• Intragroup numbers: peer support group members
from the same community; • Landline numbers: home landline and four participant-
chosen Australian landline, or overseas numbers from selected countries and • Service numbers: telephone interpreter service (TIS), four participant-chosen service provider numbers and two members of the research team who facilitated the peer support groups (L. K. and D. W.). A special agreement was established with the phone service provider that enabled the free calls to be provided cheaply. The phone calls made by the women were recorded automatically in a call log that captured the time, duration and destination of the calls (this aspect is discussed elsewhere). Only outgoing calls could be logged as it was not possible to log incoming calls. The intragroup numbers linked people within their heritage culture. As the Australian landline and overseas numbers were selected by the participant, they were predominantly numbers of close friends or relatives of the participants and therefore classified as numbers associated with the participants’ heritage culture. The third set of numbers provided the participants with links to the host culture. These were the TIS (which provided free access to all government and selected private
service providers); four selected service providers including schools, clinics and hospitals and the two researcher facilitators. It should be noted that there were some women who did not attend all the training sessions, and some who along the way stopped using their phones. However, no one actually gave the phone back and wanted to be taken out of the programme. In our qualitative component (see below), we did include women who made very few calls compared with their colleagues.
Methodology This paper is based on the qualitative component of our project that examines the roles of peer support and mobile phone-enhanced communication in the settlement experience of refugee women living in Melbourne, Australia. A full project has been reported elsewhere (Walker et al., 2014). Initially, potential participants were invited by the Afghan, Burmese and Sudanese community leaders to an information session where the study was explained, questions answered, and participant information sheets and informed consent forms, in both English and the community languages, distributed. A snowball sampling technique was also used, where the first group of participants invited people they had relationships with to join the programme (Liamputtong, 2013). This recruitment process helped to elicit moral approval and practical assistance from heritage culture gatekeepers, husbands or adult children, who had the capacity to influence the women’s participation. In our full study, 111 women were recruited; 44 from the South Sudanese, 31 from the Afghan and 36 from the Burmese communities. The mean length of stay in Australia are 2.88, 4, 4.19 and 6.81 years for the Burmese 1 (B1: mostly Buddhist), Burmese 2 (B2: Muslim), Afghan and Sudanese communities, respectively. Within the consent form were questions that asked participants for yes/no responses to questions requesting participation consent to an interview. Interviewees were selected from those responding ‘yes’ to an interview. Thus, the number of participants who took part in the study component on which this paper is based was not determined by saturation. All of these participants also agreed to being audio-taped. Where possible, women selected for interview were approached directly to invite participation. Where language was a barrier, participation was invited through the relevant interpreter. At the end of the programme, 29 participants were interviewed. Invitations to participate in an interview were based on the women’s mean calls per week and mean call duration (see Table 1). Each cultural group was proportionally represented. Interviews were conducted by the second and third authors, took place in participants’ homes, lasted 60–90 min and were
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The peer support group activities ran for 12 months. Different groups have different start times, but the whole programme started in 2010 and ended in 2012. Participants attended weekly peer support training sessions for the first 6 weeks and five bi-monthly sessions. Group composition and timings were guided by participant preference, resulting in 9 groups with 9–15 members. The women practised ‘swapping time’ where, for 3–5 min, they took turns in the roles of talker and listener. The themes for each session were selected using a strength-based, assets model designed to direct the women’s attention to the positives in their lives (Smith, 2006). These themes included the following: something good, something new; goals and aspirations; educational successes; personal pride and other topics that were defined by circumstances of the time. The group sessions ended with a whole-group discussion during which each woman shared a thought, feeling or anecdote with the rest of the group. The importance of confidentiality was stressed to the participants from the start of the programme, and this helped to establish trust as an expected group norm. The women were presented with certificates of participation at the end of the fifth and the last session. In the third training session, each woman was given a mobile phone with the following unlimited free-call numbers on speed dial:
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Table 1: Group comparison of outgoing call duration, frequency and relationship strength Group
Mean number of Mean Mean number of intragroup calls/ intragroup call landline calls/ week/person duration (min) week/person
Mean landline Mean number of call duration service calls/ (min) week/person
Mean service Strong call duration relationship (min) (%)*
Burmese (B1) Burmese (B2) Afghan Sudanese
12.46 (12.04)
2.99 (1.58)
6.28 (8.01)
5.77 (5.03)
0.27 (0.24)
1.12 (1.31)
11.11 (15.67)
2.32 (1.47)
1.85 (1.18)
3.62 (3.63)
3.46 (2.46)
0.29 (0.47)
0.69 (0.52)
10.09 (12.73)
3.37 (4.4) 13.11 (11.23)
1.8 (1.35) 4.75 (2.25)
3.76 (4.83) 5.21 (5.52)
2.57 (1.8) 5.45 (3.15)
0.19 (0.17) 0.47 (0.52)
3.06 (4.8) 2.07 (2.21)
3.37 (3.01) 7.88 (12.16)
recorded after participant consent. Apart from three participants who were proficient in English, all interviews were assisted by a professional interpreter. Questions explored the women’s programme experiences, the changes in their lives and relationships and the significance of their call patterns. The data were analysed using thematic analysis (Braun and Clarke, 2006). This method of data analysis aims to identify, analyse and report patterns or themes within qualitative data. Initially, we performed open coding where codes were first developed and named. Then, axial coding was applied which was used to develop the final themes within the data. This was done by reorganising the codes that we had developed, from the data during open coding, in new ways by making connections between categories and subcategories. This resulted in themes, which were used to explain the lived experiences of the participants. The emerging themes are presented in the Findings section. Three transcripts were initially coded by two authors (L. K. and R. W.) who are qualitative researchers, and differences in coding discussed and resolved. Subsequently, for all other interview transcripts, uncertainty about assigning codes to specific pieces of text was resolved jointly by the two researchers. Ethics approval for the project was granted by the Faculty Human Ethics Committee, La Trobe University. In presenting the narratives of the women, we adopted the use of fictitious names in order to preserve their confidentiality. For ease of reading, we also minimally edited the verbatim quotes to make them more grammatically correct.
Findings To most of the women in our study, participating in peer training sessions and having access to a mobile phone made a huge difference to their lives. There are several major themes that emerged from the study: creation of social networks, enhancement of well-being and provision of empowering experiences.
Creation of social networks Social networks were created through the programme that was developed for our study. The peer support training sessions and the access to a mobile phone allowed the women more connections with others as well as strengthen their own personal/social networks. Cultivating new social network For most women, the programme provided an opportunity for them to meet other women in their community. Most often, however, social networks between the women were increased due to the effect of group sessions. Many women suggested that having only a mobile phone would not create the network and that it was only through group sessions that such networks developed. Without the [group] meetings, just the mobile, the mobile wouldn′t be helpful because if we didn′t see each other, we didn′t meet each other, we wouldn′t get relationship and get together. (Farhana, Afghan)
However, other women remarked on the benefit of both having access to a mobile phone and participating in peer group session trainings. Meeting others in a group setting and having their mobile numbers and a means to make connection enabled them to connect with others. If it wasn′t for this telephone I wouldn′t know because that person she doesn′t even know my other mobile number (muffled) that I made at the group. So if it wasn′t this group I wouldn′t have met the person. (Rita, Sudanese)
Since the women had more opportunities to connect with others in the community, their lives were changed. For me, I can say there is a change in my life because I met other people that I don′t know before. . . I don′t talk to before [but] now they are part of our community and I get to know them better. (Nyawech, Sudanese)
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Note: standard deviations are in brackets.
Peer support groups, mobile phones and refugee women in Melbourne
Creating strong links within the networks The peer support programme and access to a free mobile phone also created stronger relationships among group members. We particularly noted this relationship, within the Sudanese community, between the older women and the young women who had no parents in Australia. Often, refugee children and young people have lost their parents through war and escape attempts. In these stronger relationships, the older women acted as a mother for these young women.
Social isolation is common among refugees, and some women claimed that they did not have any ‘friends’ prior to the programme, which helped to create a closer connection between the women in the community. For those who might have seen or known each other beforehand, the programme provided an opportunity for them to form a closer relationship. Thus, links between individuals as well as community became strengthened. Having access to a mobile phone and being connected to others in the community allowed the women to strengthen ties with members of their cultural community and participate more fully in it. This is an essential aspect of resettlement for many refugees, including the women in our study. Access to a mobile phone enabled the women to connect with family members who were left behind in their home country. This is crucial for refugees who feel a strong need to be in contact with their family members who live far away from them. For many women, the free mobile phone from the programme arrived at ‘the right time’.
Enhancement of well-being Repeatedly, newly arrived refugees and migrants endured many burdens, particularly emotional burdens, and yet they had few that they could rely on. However, our programme helped to increase the well-being among the women in the study. It not only offered a sense of happiness but also lessened social isolation among the participants. Increasing sense of happiness Participating in the peer support group programme and having access to a mobile phone augmented a sense of happiness among the women. Some women even suggested that the day they commenced the programme was ‘a beautiful day’ for them. The women also talked about
feeling happy to be able to meet others in the peer support training sessions. This sense of happiness took away the worries that most women had in their life, to the extent that some women declared that they have become a ‘free’ person. Access to a mobile phone allowed the women to be connected with their family members at times when they had to be outside their home for an appointment or a class. This helped to lessen their anxiety about those who are left at home, particularly their young children. Importantly, it became apparent that the phones facilitated mutual emotional support among the women. When I call my friends, I share all my feelings with them and I take all of my stories, my concerns and my worries out of my chest. So it makes me feel much better. (Jila, Afghan)
The women talked about the complexity of their lives as refugees and remarked on the value of the phone as a tool to harness the peer resources in response to their emotional needs. Reduction of social isolation As the programme allowed the women to connect to others, this diminished their sense of isolation. Refugee women who were mothers in particular tend to feel more isolated in their new homeland. For the women in our study, although they had children in their lives, things were not the same as they were back in their homeland. Children tended to have a separate life due to school or work and seldom had time for their mothers. This led to feelings of isolation among these women. However, having access to a mobile phone allowed the women to call others and talk instead of not having any meaningful activity to do. This also led to feelings of happiness among the women. Now having this number . . . having this mobile . . . I call my friends you know . . . I call my children even in America [and] I′m here. If it wasn′t this telephone I would be just watching television, you know. I don′t even understand what they are saying, just the picture. But now this telephone has kept us laugh. We call each other and we talk and you laugh . . . We make joke on the phone and we laugh, and you know the more you laugh the happier you are. It has brought us back some memories . . . some of the things that we used to do back home. (Nyibol, Sudanese)
Increasing social support Due to the increased social interaction between individuals through the programme, social support ( physical, emotional and tangible) between group members was
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It is because of this programme . . . we sort of become close . . . [We have become] close to these young woman already. And they are [treated as] our daughters. Some of them, they don′t have their mom here. So, we play their role now and we practice it a lot because of this. (Nyibol, Sudanese)
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created. Repeatedly, the women spoke about the emotional support that they received from others in the group. The women also received tangible support from group members through knowing each other and through the use of mobile phones. Importantly, the mobile phone and access to peer group members on their phone on speed dial took on life-saving significance for some women.
Peer support embodies both receiving and giving support to others. Around practical support, the women became aware of not only their own but other women’s needs and availed themselves to support others in their network.
Provision of empowering experiences Our programme provided several empowering experiences to the women in the study. Many women had not had any opportunity to own technology, such as a mobile phone or computer, in their own country. Having access to new technology such as a mobile phone was an empowering experience for these women. The women felt proud of themselves for having knowledge about, and skills to use, a mobile phone. Additionally, what the women learnt from the peer support training programme empowered them to acquire further skills or learn more about other issues which would become valuable for their lives in a new living environment. The programme assisted the women with the acquisition of English language and provided more opportunities to practice English. The women believed that the connection that they had created through the peer training sessions and the free-call mobile phone gave them an opportunity to be an ‘informed’ individual who would have better knowledge about things around them. They became more confident about travelling to places outside their home or community, which led to feelings of empowerment and self-capability among the women. We got this phone and we contact each other, and then we go everywhere. We know so many places. So that has improved it [life]. We know so many places and we can go everywhere now. (Myint Thin, Burmese)
Access to mobile phones also made things easier for the women. Mobile phones enabled the women to settle into
I have been in trouble many times, you know, with my children. Sometimes there is an accident, and they call me to let me know that it happened and that I needed to come or they were going to send the child to the hospital. One of the children got sick in school, so they called me and I couldn′t call them back because I didn′t have the credit. So I went to school and when I went to pick up the kids, all these incidents already passed. They told me what happened, and I felt that . . . where was I when I was needed? But now with this one [mobile phone], everything is there immediately. If anything happens, ‘come now’, I will be able to because I have the means to call them back. (Suzan, Sudanese)
DISCUSSION In this article, we have focused our attention on the unique aspects of our programme that helped to enhance the health and well-being and ease the settlement process of many recently resettled refugee women. It has been suggested that participating in peer support groups provides beneficial effects to group members (Roth and Crane-Ross, 2002; Solomon, 2004; Ochocka et al., 2006; Rogers et al., 2007; Schutt and Rogers, 2009). The findings of our project support this notion. However, our project also reveals that it was the combination of participation in a peer support group programme and access to a free-call mobile phone that provided the best effect on the well-being of our participants, who were isolated and faced multiple complexities in life refugees (Schutt and Rogers, 2009). Roth and Crane-Ross (2002) and Schutt and Rogers (2009) have suggested that there may be some special features that enforce the positive effects of peer support group. We content that the special feature of free mobile phone access contributes to this positivity. The mobile phone is not only a ‘unifying medium for information exchange’ (Kyem and LeMaire, 2006: 6), but also ‘a social amenity’ (Goodman, 2005: 34) and a means for increased economic opportunities for individuals (Sife et al., 2010). In a study of mobile phone use by immigrants from Guinea-Bissau in Lisbon, Portugal, Johnson (2013) observed that mobile phones are widely used to facilitate relationships within the heritage culture in Lisbon. Importantly, it has been evidenced that the mobile phone
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Once I was at TAFE and doing English classes, I suddenly didn′t feel well. I got stomach-ache and the teacher had to call ambulance. I couldn′t call my husband, but because of this phone, I called one of my friends. I asked her to let my husband know that I was not feeling well and I was taken to the hospital. So at that time, I found out how important this telephone was. Otherwise he wouldn′t know. (Farhana, Afghan)
Australia with better ease. For example, it increased their ease of obtaining essential ingredients for cooking. The mobile phone also allowed the participants to connect with healthcare providers more efficiently. For women who were mothers, the mobile phone allowed them to deal with emergencies that might arise regarding the health and well-being of their children who were at schools.
Peer support groups, mobile phones and refugee women in Melbourne
Peer support and health enhancement We have shown in this paper that participation in peer support group is a health-promoting behaviour. As Kafaar et al. (2007) theorize, by participating in peer support group, individuals will receive some kinds of benefits, such as assistance for dealing with difficulties in life and combating against isolation. Peer support, according to Mead et al. (2001: 135), is a system of gaining and bestowing assistance. It is operated within the ‘principles of respect’ and ‘shared responsibility’ among group members. Peer support is also about having empathetic appreciation
of the situations of others through shared experiences. When individuals in the group sense that they have shared experiences with others, a connection is created. Peer support bestows ‘a sense of connection, belonging, and community’ which frequently falls short among marginalised individuals (Schutt and Rogers, 2009: 699), and this clearly is the situation of refugees, particularly those who are newly arrived, including the women in our study. Clearly, these are health-promoting behaviours resulting from having access to peer support groups. Peer support is a form of social support, which functions both at the individual as well as community levels (Richmond and Ross, 2008; Thoits, 2011). As social support theory suggests, support is reciprocal (Barnes and Aguilar, 2007), the women in our study gave help to others as well as received it when needed. This was particularly so among older women who provided support to young women with no parents living in Melbourne. This support was essential for young people who have experienced loss and grief and for successful settling into a new life (Goodman, 2005; Barnes and Aguilar, 2007). Social support provided by the older women enhanced a sense of belonging and security (Richmond and Ross, 2008) among the younger women. Several authors have theorised that giving and receiving social support can be health-promoting behaviours (Solomon, 2004; Randall and Salem, 2005; Hinton and Earnest, 2010; Umberson et al., 2010; Thoits, 2011). The support that one receives from social ties can act as a buffer against health difficulties (Berkman et al., 2000; Richmond and Ross, 2008). Barnes and Aguilar (2007: 226) argue that being part of a community offers ‘an important sense of belongingness and social identity’. It also promotes an opportunity for the creation of social bonding, resulting in increased social support and improvement of emotional well-being among individuals. This was evident from our findings. Additionally, the women in our study emphasized the practical support they received and provided to other peers in their social group (Finfgeld-Connett, 2005; Barnes and Aguilar, 2007). Peer support was developed into a complex system that benefitted not only the women, but also the community. The women became aware of not only their own but other women’s needs and availed themselves to support their friends.
Peer support and social well-being Refugees and immigrants tend to face social isolation in their new homeland (Hinton and Earnest, 2010; Pavlish et al., 2010), and this is particularly marked for recently arrived individuals (Pavlish et al., 2010). In our study, social isolation, which was experienced by all, was particularly pertinent for women who are mothers (Liamputtong, 2006;
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can function as a health promotion tool (Fukuoka et al., 2012; Pop-Eleches et al., 2011; Rotheram-Borus et al., 2012). This has been witnessed in our study. For example, reconnection is an important part of recovering from trauma and difficulties (Goodman, 2005). For the women in our study, having access to a free-call mobile phone allowed them to ‘reconnect’ with others and family members as well as their traditional ways of life (Goodman, 2005). This helped the women to feel less worried and isolated. Although some women had their own mobile phone prior to participating in our study, our data showed that the freecall element of our mobile phone was important for them. Due to their low income, they frequently ran out of credit in their own mobile phone. Mobile phone calls are expensive, and as most of them are on a prepaid plan, they simply could not afford to make the kind of calls they had made in our programme. They referred to the phone we provided as the ‘magic phone’ because it had unlimited credit. Although some participants said that they were disturbed by unwanted calls at inconvenient times, the benefits of having access to a free mobile phone outweighed this drawback. In our study, peer support is viewed as a subset of social support in which relationships are formed between individuals who are similar to each other. The initial training was undertaken in peer groups, but the provision and receipt of social support extended into the broader community. In our study, peer support training enabled the participants to establish communicative relationships among participants from the same communities, whilst the mobile phones augmented the peer group relationships, and relationships with a small number of people and institutions external to the peer group. Our study builds on the role of peer support in refugee resettlement by adding a reliable communication channel that enables social network development, which in turn influences the acculturation journey of refugee women (see also Walker et al., 2014). In the following sections, we discuss several salient issues emerging from our study.
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not only reduced the participants’ sense of isolation but also helped them to settle in their new homeland with greater ease. Research has shown that, for most refugees and immigrants, a sense of belonging to one’s ethnic community is crucial for the health and well-being among these vulnerable people (Correa-Velez et al., 2010; Moscardino et al., 2010). Empowerment, Wallerstein (2002: 73) suggests, is a ‘social protective factor’ which can also be seen as a ‘health enhancing strategy’. This is clearly seen from our findings. Many women suggested that the connections and knowledge they had cultivated from the programme made them feel ‘brave’ and ‘safe’ enough to get out of their community and to do things that they previously had no opportunity or courage to do. This has created the feeling of empowerment and self-capability among the women. The connections that were cultivated through the programme allowed the women to perform tasks which are more health promoting, for example having a ‘chat’, and obtaining advice from others. In conclusion, our programme provided evidence that appropriate peer support strategies can be incorporated into programmes designed to assist refugees with health and well-being enhancement, as well as acculturation and resettlement needs. We argue that mobile phone technology is ubiquitous and the issues are about making access possible for specific population groups (and we did this by providing free phones and calls) and identifying the uses that are most important to members of particular population groups (Glazebrook, 2004). Our programme has shown that, by tapping on community resources to ameliorate personal or resettlement issues, the burden on service providers could be reduced. The findings of this study also offer a model for future research and health promotion programmes regarding people from other refugee backgrounds, within Australia or elsewhere.
ACKNOWLEDGEMENTS We are grateful to all the women who participated in this study. We thank the Victorian Health Promotion Foundation for providing funding for the study.
FUNDING The authors received financial support from the Victorian Health Promotion Foundation for the research of this article.
REFERENCES Australian Survey Research Group. (2011) Settlement outcomes of new arrivals—report of findings study for Department of
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Ngum Chi Watts, 2012; Benza and Liamputtong, 2014). Most migrant and refugee women have to deal with multiple stresses associated with relocation and social adjustment when settling into a new homeland (Meadows et al., 2001; Pavlish et al., 2010; Kurban, 2014). For refugees who have to deal with multiple difficulties, isolation can be a ‘compounding factor’ which make their life situations worse (Hinton and Earnest, 2010: 224). As a result of participation in peer support trainings, as Wallerstein (2002: 74) suggests, ‘social isolation may be diminished’, and this led to the improvement of health and well-being among the women in our study (Schutt and Rogers, 2009). In an online support group research conducted by van Uden-Kraan et al. (2009), the participants strongly experienced what the authors termed as ‘enhanced social well-being’. Participation in a support group resulted in increased social contacts as well as decreased loneliness. Our results similarly showed this ‘enhanced social well-being’, as participation in peer support groups helped to reduce isolation and loneliness among the women. Additionally, the social support helped the women to feel that they were not dealing with life’s challenges alone (Polakoff and Gregory, 2002; Hinton and Earnest, 2010). We contend that the support that the women received from their peer support group is crucial to their health and well-being and allowed them to deal with their vulnerabilities in a new homeland (Hinton and Earnest, 2010). Additionally, peer support enhances empowerment among individuals in the group (Dumont and Jones, 2002; van Uden-Kraan et al., 2009). Through learning and sharing during the peer support training and communicating on their mobile phones, the women in our study cultivated a sense of their own abilities and had an opportunity to reinforce connections with others. This helped to transform their lived experiences from ‘being socially isolated individuals’ to being part of a larger community (Schutt and Rogers, 2009: 706; Kitchen et al., 2012). This, we believe, is the ‘personal empowerment’ (Chamberlin, 1997) process for the women in our study. Although peer support emphasises ‘individual strengths’, it simultaneously moves ‘towards autonomy’ as well as ‘community building’ (Mead et al., 2001; Dumont and Jones, 2002). Thus, peer support can be empowering for both individuals and their communities. Wallerstein (2002) suggests that participation in a community, and a sense of community belonging, has consistently been seen as a predictor of health and well-being. Wang and Hu (2013) similarly contend that a sense of community and social support received from others in the community can have a protective health effect on individuals. This is apparent in our study. Having a sense of community connection
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Peer support groups, mobile phones and refugee women in Melbourne Pranee Liamputtong*, Lee Koh, Dennis Wollersheim, and Rae Walker
*Corresponding author. E-mail: [email protected]
Summary In this article, we discuss qualitative findings basing on the experiences of refugee women living in Melbourne, Australia, who participated in a peer support training programme and received a free mobile phone. We pay attention to social support as a health enhancing strategy and empowerment that occurred among the participants. Participation in peer support groups and access to a mobile phone were beneficial for the women. Peer support functioned as social support among group members. The programme allowed the women to be connected to their families and the wider communities and assisted them to access health care and other settlement aspects with greater ease. It also increased personal empowerment among the women. Our programme shows that by tapping on community resources to ameliorate personal or resettlement issues, the burden on service providers can be reduced. Our findings also offer a model for future research and programmes regarding refugee people elsewhere. Key words: peer support, mobile phone, health promotion, refugee women
INTRODUCTION Refugees face many difficulties in their lives, and settling in a new and markedly different environment can be an added difficulty for many of them (Cislo et al., 2010; Correa-Velez et al., 2010; Dow, 2011; Ngum Chi Watts, 2012; Ngum Chi Watts et al., 2013; Beadle, 2014). These difficulties may lead to poor ‘psychosocial adjustment’ and emotional problems (Cislo et al., 2010: 1174) in refugees, who often embody significantly higher mental health problems than other populations in general (Norredam et al., 2009; van Wyk et al., 2012). As elsewhere, refugees in Australia have lower levels of personal well-being than other migrant groups (Australian Survey Research Group, 2011). This is particularly so for newly arrived refugees, and more so for women, who are often culturally displaced, socially isolated (Iglesias et al.,
2003) and have ambivalent feelings about their future (Kaiser et al., 1998; Ngum Chi Watts, 2012). This acculturative stress is likely to result in depression among refugees (Barnes and Aguilar, 2007). For any individual, having to relocate to another social setting necessitates extensive adjustment, which often leads to changes in health status as well as disruptions to family connection and social network (Correa-Velez et al., 2010; Dow, 2011; Ngum Chi Watts, 2012; Ngum Chi Watts et al., 2013). This is more marked among refugees who have experienced violence and civil conflict in their homeland (Palmer and Ward, 2007; Pavlish et al., 2010). For many refugees, resettlement can be very daunting. It has been suggested that the resettlement process that refugees go through can have more negative impact on health and well-being than their pre-migration situations (Correa-Velez et al., 2010; Kurban, 2014).
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Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Victoria 3086, Australia
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Peer support group as social support and health enhancing strategy: theoretical framework In this article, peer support is perceived as a subset of social support in which the relationships are formed between individuals who are similar to each other. Peer support has received much attention within the mental health area (Mead et al., 2001; Solomon, 2004; Schutt and Rogers, 2009). It has been defined as ‘social emotional support, frequently coupled with instrumental support, that is mutually offered or provided by persons having a mental health condition to others sharing a similar mental health condition to bring about a desired social or personal change’ (Solomon, 2004: 393). This concept is clearly relevant to our project, which attempt to use peer support group to enhance the health and well-being of refugee women. In the case of the refugee situation, emotional, physical and tangible support which is offered by ‘peers’, who are also refugees, can lead to desired personal and social changes within their communities. Peer support embodies ‘active ingredients’ which enhance positive health and well-being among group
members (Solomon, 2004; Randall and Salem, 2005). Peer support groups which provide a channel for individuals to periodically meet to address commonly shared concerns and problems have resulted in social support among group members, which has, in turn, led to the improvement of quality of life of those involved (Elafros et al., 2013). Within peer support groups, empathy, sharing, support and assistance are often offered (Solomon, 2004). As such, feelings of social isolation (such as loneliness, rejection and frustration) can be overcome (Schutt and Rogers, 2009). Schutt and Rogers (2009: 699) put it clearly that peer support ‘provides resources for effective functioning and a foundation for coping with stress and loss’. Additionally, a peer support group has been seen as the principal ingredient of the empowerment process (Schutt and Rogers, 2009). Peer support programmes not only increase social support, they can also promote empowerment among group members (Van Tosh and delVecchio, 2000; Dumont and Jones, 2002). Peer support makes the most of the ability of peers to contribute to the situations and needs of others in the group as well as their potential for influential relationships with others (Whittemore et al., 2000; Marino et al., 2007). In our study, we based our research within the peer support framework discussed earlier. The peer support group training sessions and the provision of a free mobile phone offer a means through which meaningful empowerment processes could eventuate (Schutt and Rogers, 2009). Here, we emphasise the empowerment that become materialised at the individual level, and we refer to this as ‘personal empowerment’ (Chamberlin, 1997). According to Chamberlin (1997), this personal empowerment is ‘a multi-dimensional concept’ which embodies the feeling of being part of a group and promotes positive self and the conquering of personal difficulties. Within the refugee context, peer support could empower individuals to find ways to overcome difficulties in their new homeland. Additionally, we contend that participation in peer support group can be perceived as health-promoting behaviour. Within the health behaviour framework (Kafaar et al., 2007), it is assumed that by participating in peer support group, people will receive benefits of some kind. For example, participants may perceive that being a group member would assist them with difficulties in life. Additionally, it will entitle them to some support that will help them fight against isolation and difficulties in their everyday life. As such, participation in peer support group training can be seen as a health-promoting behaviour with the expectation that support from others may follow.
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Nevertheless, there are factors which have helped to protect refugees during their settlement processes, in particular, social support from peers and their own ability to cope (Correa-Velez et al., 2010). According to Mulvaney-Day et al. (2007: 479), social support provided by ‘unrelated, close friends’ has shown a positive influence on the physical and mental health of refugees. Social support can help to alleviate some of the difficulties associated with resettlement in a new environment (Barnes and Aguilar, 2007; Tempany 2009; Kurban, 2014). We contend that one aspect of social support for refugees is being part of a peer support group. In this paper, we discuss the experiences of refugee women who participated in the peer support programme for newly arrived refugee women in Melbourne, Australia. Our project adopted a two-pronged approach to establishing peer support networks among refugee women from similar communities. Peer support training enabled the participants to meet, discuss issues and consequently establish communicative relationships within the peer group. Additionally, the women were given access to a free mobile phone. Research has shown that mobile phone access can act as a health promotion tool (Fukuoka et al., 2012; Pop-Eleches et al., 2011; Rotheram-Borus et al., 2012). In this study, participants were provided with a free mobile phone and free unlimited calls within the peer support group numbers, and to limited set of local and overseas numbers, for a 12-month period, to augment the peer group relationships, as well as relationships with a small number of people and institutions external to the peer group.
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Peer support group activities: our project
• Intragroup numbers: peer support group members
from the same community; • Landline numbers: home landline and four participant-
chosen Australian landline, or overseas numbers from selected countries and • Service numbers: telephone interpreter service (TIS), four participant-chosen service provider numbers and two members of the research team who facilitated the peer support groups (L. K. and D. W.). A special agreement was established with the phone service provider that enabled the free calls to be provided cheaply. The phone calls made by the women were recorded automatically in a call log that captured the time, duration and destination of the calls (this aspect is discussed elsewhere). Only outgoing calls could be logged as it was not possible to log incoming calls. The intragroup numbers linked people within their heritage culture. As the Australian landline and overseas numbers were selected by the participant, they were predominantly numbers of close friends or relatives of the participants and therefore classified as numbers associated with the participants’ heritage culture. The third set of numbers provided the participants with links to the host culture. These were the TIS (which provided free access to all government and selected private
service providers); four selected service providers including schools, clinics and hospitals and the two researcher facilitators. It should be noted that there were some women who did not attend all the training sessions, and some who along the way stopped using their phones. However, no one actually gave the phone back and wanted to be taken out of the programme. In our qualitative component (see below), we did include women who made very few calls compared with their colleagues.
Methodology This paper is based on the qualitative component of our project that examines the roles of peer support and mobile phone-enhanced communication in the settlement experience of refugee women living in Melbourne, Australia. A full project has been reported elsewhere (Walker et al., 2014). Initially, potential participants were invited by the Afghan, Burmese and Sudanese community leaders to an information session where the study was explained, questions answered, and participant information sheets and informed consent forms, in both English and the community languages, distributed. A snowball sampling technique was also used, where the first group of participants invited people they had relationships with to join the programme (Liamputtong, 2013). This recruitment process helped to elicit moral approval and practical assistance from heritage culture gatekeepers, husbands or adult children, who had the capacity to influence the women’s participation. In our full study, 111 women were recruited; 44 from the South Sudanese, 31 from the Afghan and 36 from the Burmese communities. The mean length of stay in Australia are 2.88, 4, 4.19 and 6.81 years for the Burmese 1 (B1: mostly Buddhist), Burmese 2 (B2: Muslim), Afghan and Sudanese communities, respectively. Within the consent form were questions that asked participants for yes/no responses to questions requesting participation consent to an interview. Interviewees were selected from those responding ‘yes’ to an interview. Thus, the number of participants who took part in the study component on which this paper is based was not determined by saturation. All of these participants also agreed to being audio-taped. Where possible, women selected for interview were approached directly to invite participation. Where language was a barrier, participation was invited through the relevant interpreter. At the end of the programme, 29 participants were interviewed. Invitations to participate in an interview were based on the women’s mean calls per week and mean call duration (see Table 1). Each cultural group was proportionally represented. Interviews were conducted by the second and third authors, took place in participants’ homes, lasted 60–90 min and were
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The peer support group activities ran for 12 months. Different groups have different start times, but the whole programme started in 2010 and ended in 2012. Participants attended weekly peer support training sessions for the first 6 weeks and five bi-monthly sessions. Group composition and timings were guided by participant preference, resulting in 9 groups with 9–15 members. The women practised ‘swapping time’ where, for 3–5 min, they took turns in the roles of talker and listener. The themes for each session were selected using a strength-based, assets model designed to direct the women’s attention to the positives in their lives (Smith, 2006). These themes included the following: something good, something new; goals and aspirations; educational successes; personal pride and other topics that were defined by circumstances of the time. The group sessions ended with a whole-group discussion during which each woman shared a thought, feeling or anecdote with the rest of the group. The importance of confidentiality was stressed to the participants from the start of the programme, and this helped to establish trust as an expected group norm. The women were presented with certificates of participation at the end of the fifth and the last session. In the third training session, each woman was given a mobile phone with the following unlimited free-call numbers on speed dial:
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Table 1: Group comparison of outgoing call duration, frequency and relationship strength Group
Mean number of Mean Mean number of intragroup calls/ intragroup call landline calls/ week/person duration (min) week/person
Mean landline Mean number of call duration service calls/ (min) week/person
Mean service Strong call duration relationship (min) (%)*
Burmese (B1) Burmese (B2) Afghan Sudanese
12.46 (12.04)
2.99 (1.58)
6.28 (8.01)
5.77 (5.03)
0.27 (0.24)
1.12 (1.31)
11.11 (15.67)
2.32 (1.47)
1.85 (1.18)
3.62 (3.63)
3.46 (2.46)
0.29 (0.47)
0.69 (0.52)
10.09 (12.73)
3.37 (4.4) 13.11 (11.23)
1.8 (1.35) 4.75 (2.25)
3.76 (4.83) 5.21 (5.52)
2.57 (1.8) 5.45 (3.15)
0.19 (0.17) 0.47 (0.52)
3.06 (4.8) 2.07 (2.21)
3.37 (3.01) 7.88 (12.16)
recorded after participant consent. Apart from three participants who were proficient in English, all interviews were assisted by a professional interpreter. Questions explored the women’s programme experiences, the changes in their lives and relationships and the significance of their call patterns. The data were analysed using thematic analysis (Braun and Clarke, 2006). This method of data analysis aims to identify, analyse and report patterns or themes within qualitative data. Initially, we performed open coding where codes were first developed and named. Then, axial coding was applied which was used to develop the final themes within the data. This was done by reorganising the codes that we had developed, from the data during open coding, in new ways by making connections between categories and subcategories. This resulted in themes, which were used to explain the lived experiences of the participants. The emerging themes are presented in the Findings section. Three transcripts were initially coded by two authors (L. K. and R. W.) who are qualitative researchers, and differences in coding discussed and resolved. Subsequently, for all other interview transcripts, uncertainty about assigning codes to specific pieces of text was resolved jointly by the two researchers. Ethics approval for the project was granted by the Faculty Human Ethics Committee, La Trobe University. In presenting the narratives of the women, we adopted the use of fictitious names in order to preserve their confidentiality. For ease of reading, we also minimally edited the verbatim quotes to make them more grammatically correct.
Findings To most of the women in our study, participating in peer training sessions and having access to a mobile phone made a huge difference to their lives. There are several major themes that emerged from the study: creation of social networks, enhancement of well-being and provision of empowering experiences.
Creation of social networks Social networks were created through the programme that was developed for our study. The peer support training sessions and the access to a mobile phone allowed the women more connections with others as well as strengthen their own personal/social networks. Cultivating new social network For most women, the programme provided an opportunity for them to meet other women in their community. Most often, however, social networks between the women were increased due to the effect of group sessions. Many women suggested that having only a mobile phone would not create the network and that it was only through group sessions that such networks developed. Without the [group] meetings, just the mobile, the mobile wouldn′t be helpful because if we didn′t see each other, we didn′t meet each other, we wouldn′t get relationship and get together. (Farhana, Afghan)
However, other women remarked on the benefit of both having access to a mobile phone and participating in peer group session trainings. Meeting others in a group setting and having their mobile numbers and a means to make connection enabled them to connect with others. If it wasn′t for this telephone I wouldn′t know because that person she doesn′t even know my other mobile number (muffled) that I made at the group. So if it wasn′t this group I wouldn′t have met the person. (Rita, Sudanese)
Since the women had more opportunities to connect with others in the community, their lives were changed. For me, I can say there is a change in my life because I met other people that I don′t know before. . . I don′t talk to before [but] now they are part of our community and I get to know them better. (Nyawech, Sudanese)
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Note: standard deviations are in brackets.
Peer support groups, mobile phones and refugee women in Melbourne
Creating strong links within the networks The peer support programme and access to a free mobile phone also created stronger relationships among group members. We particularly noted this relationship, within the Sudanese community, between the older women and the young women who had no parents in Australia. Often, refugee children and young people have lost their parents through war and escape attempts. In these stronger relationships, the older women acted as a mother for these young women.
Social isolation is common among refugees, and some women claimed that they did not have any ‘friends’ prior to the programme, which helped to create a closer connection between the women in the community. For those who might have seen or known each other beforehand, the programme provided an opportunity for them to form a closer relationship. Thus, links between individuals as well as community became strengthened. Having access to a mobile phone and being connected to others in the community allowed the women to strengthen ties with members of their cultural community and participate more fully in it. This is an essential aspect of resettlement for many refugees, including the women in our study. Access to a mobile phone enabled the women to connect with family members who were left behind in their home country. This is crucial for refugees who feel a strong need to be in contact with their family members who live far away from them. For many women, the free mobile phone from the programme arrived at ‘the right time’.
Enhancement of well-being Repeatedly, newly arrived refugees and migrants endured many burdens, particularly emotional burdens, and yet they had few that they could rely on. However, our programme helped to increase the well-being among the women in the study. It not only offered a sense of happiness but also lessened social isolation among the participants. Increasing sense of happiness Participating in the peer support group programme and having access to a mobile phone augmented a sense of happiness among the women. Some women even suggested that the day they commenced the programme was ‘a beautiful day’ for them. The women also talked about
feeling happy to be able to meet others in the peer support training sessions. This sense of happiness took away the worries that most women had in their life, to the extent that some women declared that they have become a ‘free’ person. Access to a mobile phone allowed the women to be connected with their family members at times when they had to be outside their home for an appointment or a class. This helped to lessen their anxiety about those who are left at home, particularly their young children. Importantly, it became apparent that the phones facilitated mutual emotional support among the women. When I call my friends, I share all my feelings with them and I take all of my stories, my concerns and my worries out of my chest. So it makes me feel much better. (Jila, Afghan)
The women talked about the complexity of their lives as refugees and remarked on the value of the phone as a tool to harness the peer resources in response to their emotional needs. Reduction of social isolation As the programme allowed the women to connect to others, this diminished their sense of isolation. Refugee women who were mothers in particular tend to feel more isolated in their new homeland. For the women in our study, although they had children in their lives, things were not the same as they were back in their homeland. Children tended to have a separate life due to school or work and seldom had time for their mothers. This led to feelings of isolation among these women. However, having access to a mobile phone allowed the women to call others and talk instead of not having any meaningful activity to do. This also led to feelings of happiness among the women. Now having this number . . . having this mobile . . . I call my friends you know . . . I call my children even in America [and] I′m here. If it wasn′t this telephone I would be just watching television, you know. I don′t even understand what they are saying, just the picture. But now this telephone has kept us laugh. We call each other and we talk and you laugh . . . We make joke on the phone and we laugh, and you know the more you laugh the happier you are. It has brought us back some memories . . . some of the things that we used to do back home. (Nyibol, Sudanese)
Increasing social support Due to the increased social interaction between individuals through the programme, social support ( physical, emotional and tangible) between group members was
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It is because of this programme . . . we sort of become close . . . [We have become] close to these young woman already. And they are [treated as] our daughters. Some of them, they don′t have their mom here. So, we play their role now and we practice it a lot because of this. (Nyibol, Sudanese)
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created. Repeatedly, the women spoke about the emotional support that they received from others in the group. The women also received tangible support from group members through knowing each other and through the use of mobile phones. Importantly, the mobile phone and access to peer group members on their phone on speed dial took on life-saving significance for some women.
Peer support embodies both receiving and giving support to others. Around practical support, the women became aware of not only their own but other women’s needs and availed themselves to support others in their network.
Provision of empowering experiences Our programme provided several empowering experiences to the women in the study. Many women had not had any opportunity to own technology, such as a mobile phone or computer, in their own country. Having access to new technology such as a mobile phone was an empowering experience for these women. The women felt proud of themselves for having knowledge about, and skills to use, a mobile phone. Additionally, what the women learnt from the peer support training programme empowered them to acquire further skills or learn more about other issues which would become valuable for their lives in a new living environment. The programme assisted the women with the acquisition of English language and provided more opportunities to practice English. The women believed that the connection that they had created through the peer training sessions and the free-call mobile phone gave them an opportunity to be an ‘informed’ individual who would have better knowledge about things around them. They became more confident about travelling to places outside their home or community, which led to feelings of empowerment and self-capability among the women. We got this phone and we contact each other, and then we go everywhere. We know so many places. So that has improved it [life]. We know so many places and we can go everywhere now. (Myint Thin, Burmese)
Access to mobile phones also made things easier for the women. Mobile phones enabled the women to settle into
I have been in trouble many times, you know, with my children. Sometimes there is an accident, and they call me to let me know that it happened and that I needed to come or they were going to send the child to the hospital. One of the children got sick in school, so they called me and I couldn′t call them back because I didn′t have the credit. So I went to school and when I went to pick up the kids, all these incidents already passed. They told me what happened, and I felt that . . . where was I when I was needed? But now with this one [mobile phone], everything is there immediately. If anything happens, ‘come now’, I will be able to because I have the means to call them back. (Suzan, Sudanese)
DISCUSSION In this article, we have focused our attention on the unique aspects of our programme that helped to enhance the health and well-being and ease the settlement process of many recently resettled refugee women. It has been suggested that participating in peer support groups provides beneficial effects to group members (Roth and Crane-Ross, 2002; Solomon, 2004; Ochocka et al., 2006; Rogers et al., 2007; Schutt and Rogers, 2009). The findings of our project support this notion. However, our project also reveals that it was the combination of participation in a peer support group programme and access to a free-call mobile phone that provided the best effect on the well-being of our participants, who were isolated and faced multiple complexities in life refugees (Schutt and Rogers, 2009). Roth and Crane-Ross (2002) and Schutt and Rogers (2009) have suggested that there may be some special features that enforce the positive effects of peer support group. We content that the special feature of free mobile phone access contributes to this positivity. The mobile phone is not only a ‘unifying medium for information exchange’ (Kyem and LeMaire, 2006: 6), but also ‘a social amenity’ (Goodman, 2005: 34) and a means for increased economic opportunities for individuals (Sife et al., 2010). In a study of mobile phone use by immigrants from Guinea-Bissau in Lisbon, Portugal, Johnson (2013) observed that mobile phones are widely used to facilitate relationships within the heritage culture in Lisbon. Importantly, it has been evidenced that the mobile phone
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Once I was at TAFE and doing English classes, I suddenly didn′t feel well. I got stomach-ache and the teacher had to call ambulance. I couldn′t call my husband, but because of this phone, I called one of my friends. I asked her to let my husband know that I was not feeling well and I was taken to the hospital. So at that time, I found out how important this telephone was. Otherwise he wouldn′t know. (Farhana, Afghan)
Australia with better ease. For example, it increased their ease of obtaining essential ingredients for cooking. The mobile phone also allowed the participants to connect with healthcare providers more efficiently. For women who were mothers, the mobile phone allowed them to deal with emergencies that might arise regarding the health and well-being of their children who were at schools.
Peer support groups, mobile phones and refugee women in Melbourne
Peer support and health enhancement We have shown in this paper that participation in peer support group is a health-promoting behaviour. As Kafaar et al. (2007) theorize, by participating in peer support group, individuals will receive some kinds of benefits, such as assistance for dealing with difficulties in life and combating against isolation. Peer support, according to Mead et al. (2001: 135), is a system of gaining and bestowing assistance. It is operated within the ‘principles of respect’ and ‘shared responsibility’ among group members. Peer support is also about having empathetic appreciation
of the situations of others through shared experiences. When individuals in the group sense that they have shared experiences with others, a connection is created. Peer support bestows ‘a sense of connection, belonging, and community’ which frequently falls short among marginalised individuals (Schutt and Rogers, 2009: 699), and this clearly is the situation of refugees, particularly those who are newly arrived, including the women in our study. Clearly, these are health-promoting behaviours resulting from having access to peer support groups. Peer support is a form of social support, which functions both at the individual as well as community levels (Richmond and Ross, 2008; Thoits, 2011). As social support theory suggests, support is reciprocal (Barnes and Aguilar, 2007), the women in our study gave help to others as well as received it when needed. This was particularly so among older women who provided support to young women with no parents living in Melbourne. This support was essential for young people who have experienced loss and grief and for successful settling into a new life (Goodman, 2005; Barnes and Aguilar, 2007). Social support provided by the older women enhanced a sense of belonging and security (Richmond and Ross, 2008) among the younger women. Several authors have theorised that giving and receiving social support can be health-promoting behaviours (Solomon, 2004; Randall and Salem, 2005; Hinton and Earnest, 2010; Umberson et al., 2010; Thoits, 2011). The support that one receives from social ties can act as a buffer against health difficulties (Berkman et al., 2000; Richmond and Ross, 2008). Barnes and Aguilar (2007: 226) argue that being part of a community offers ‘an important sense of belongingness and social identity’. It also promotes an opportunity for the creation of social bonding, resulting in increased social support and improvement of emotional well-being among individuals. This was evident from our findings. Additionally, the women in our study emphasized the practical support they received and provided to other peers in their social group (Finfgeld-Connett, 2005; Barnes and Aguilar, 2007). Peer support was developed into a complex system that benefitted not only the women, but also the community. The women became aware of not only their own but other women’s needs and availed themselves to support their friends.
Peer support and social well-being Refugees and immigrants tend to face social isolation in their new homeland (Hinton and Earnest, 2010; Pavlish et al., 2010), and this is particularly marked for recently arrived individuals (Pavlish et al., 2010). In our study, social isolation, which was experienced by all, was particularly pertinent for women who are mothers (Liamputtong, 2006;
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can function as a health promotion tool (Fukuoka et al., 2012; Pop-Eleches et al., 2011; Rotheram-Borus et al., 2012). This has been witnessed in our study. For example, reconnection is an important part of recovering from trauma and difficulties (Goodman, 2005). For the women in our study, having access to a free-call mobile phone allowed them to ‘reconnect’ with others and family members as well as their traditional ways of life (Goodman, 2005). This helped the women to feel less worried and isolated. Although some women had their own mobile phone prior to participating in our study, our data showed that the freecall element of our mobile phone was important for them. Due to their low income, they frequently ran out of credit in their own mobile phone. Mobile phone calls are expensive, and as most of them are on a prepaid plan, they simply could not afford to make the kind of calls they had made in our programme. They referred to the phone we provided as the ‘magic phone’ because it had unlimited credit. Although some participants said that they were disturbed by unwanted calls at inconvenient times, the benefits of having access to a free mobile phone outweighed this drawback. In our study, peer support is viewed as a subset of social support in which relationships are formed between individuals who are similar to each other. The initial training was undertaken in peer groups, but the provision and receipt of social support extended into the broader community. In our study, peer support training enabled the participants to establish communicative relationships among participants from the same communities, whilst the mobile phones augmented the peer group relationships, and relationships with a small number of people and institutions external to the peer group. Our study builds on the role of peer support in refugee resettlement by adding a reliable communication channel that enables social network development, which in turn influences the acculturation journey of refugee women (see also Walker et al., 2014). In the following sections, we discuss several salient issues emerging from our study.
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not only reduced the participants’ sense of isolation but also helped them to settle in their new homeland with greater ease. Research has shown that, for most refugees and immigrants, a sense of belonging to one’s ethnic community is crucial for the health and well-being among these vulnerable people (Correa-Velez et al., 2010; Moscardino et al., 2010). Empowerment, Wallerstein (2002: 73) suggests, is a ‘social protective factor’ which can also be seen as a ‘health enhancing strategy’. This is clearly seen from our findings. Many women suggested that the connections and knowledge they had cultivated from the programme made them feel ‘brave’ and ‘safe’ enough to get out of their community and to do things that they previously had no opportunity or courage to do. This has created the feeling of empowerment and self-capability among the women. The connections that were cultivated through the programme allowed the women to perform tasks which are more health promoting, for example having a ‘chat’, and obtaining advice from others. In conclusion, our programme provided evidence that appropriate peer support strategies can be incorporated into programmes designed to assist refugees with health and well-being enhancement, as well as acculturation and resettlement needs. We argue that mobile phone technology is ubiquitous and the issues are about making access possible for specific population groups (and we did this by providing free phones and calls) and identifying the uses that are most important to members of particular population groups (Glazebrook, 2004). Our programme has shown that, by tapping on community resources to ameliorate personal or resettlement issues, the burden on service providers could be reduced. The findings of this study also offer a model for future research and health promotion programmes regarding people from other refugee backgrounds, within Australia or elsewhere.
ACKNOWLEDGEMENTS We are grateful to all the women who participated in this study. We thank the Victorian Health Promotion Foundation for providing funding for the study.
FUNDING The authors received financial support from the Victorian Health Promotion Foundation for the research of this article.
REFERENCES Australian Survey Research Group. (2011) Settlement outcomes of new arrivals—report of findings study for Department of
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Ngum Chi Watts, 2012; Benza and Liamputtong, 2014). Most migrant and refugee women have to deal with multiple stresses associated with relocation and social adjustment when settling into a new homeland (Meadows et al., 2001; Pavlish et al., 2010; Kurban, 2014). For refugees who have to deal with multiple difficulties, isolation can be a ‘compounding factor’ which make their life situations worse (Hinton and Earnest, 2010: 224). As a result of participation in peer support trainings, as Wallerstein (2002: 74) suggests, ‘social isolation may be diminished’, and this led to the improvement of health and well-being among the women in our study (Schutt and Rogers, 2009). In an online support group research conducted by van Uden-Kraan et al. (2009), the participants strongly experienced what the authors termed as ‘enhanced social well-being’. Participation in a support group resulted in increased social contacts as well as decreased loneliness. Our results similarly showed this ‘enhanced social well-being’, as participation in peer support groups helped to reduce isolation and loneliness among the women. Additionally, the social support helped the women to feel that they were not dealing with life’s challenges alone (Polakoff and Gregory, 2002; Hinton and Earnest, 2010). We contend that the support that the women received from their peer support group is crucial to their health and well-being and allowed them to deal with their vulnerabilities in a new homeland (Hinton and Earnest, 2010). Additionally, peer support enhances empowerment among individuals in the group (Dumont and Jones, 2002; van Uden-Kraan et al., 2009). Through learning and sharing during the peer support training and communicating on their mobile phones, the women in our study cultivated a sense of their own abilities and had an opportunity to reinforce connections with others. This helped to transform their lived experiences from ‘being socially isolated individuals’ to being part of a larger community (Schutt and Rogers, 2009: 706; Kitchen et al., 2012). This, we believe, is the ‘personal empowerment’ (Chamberlin, 1997) process for the women in our study. Although peer support emphasises ‘individual strengths’, it simultaneously moves ‘towards autonomy’ as well as ‘community building’ (Mead et al., 2001; Dumont and Jones, 2002). Thus, peer support can be empowering for both individuals and their communities. Wallerstein (2002) suggests that participation in a community, and a sense of community belonging, has consistently been seen as a predictor of health and well-being. Wang and Hu (2013) similarly contend that a sense of community and social support received from others in the community can have a protective health effect on individuals. This is apparent in our study. Having a sense of community connection
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