Self-care strategies among Arabic-speaking refugees and the Australian Mental Health Stepped Care Model: a Delphi consensus study

Arabic-speaking refugees and migrants experience elevated levels of anxiety, depression and posttraumatic stress disorder, compared to the host country general population. This study sought to establish consensus on the perceived relevance of different mental health self-care strategies for Arabic-speaking refugees across the four settings of the Australian Mental Health Stepped Care Model: informal community care, primary/generalist care, community-based mental health services, and hospital-based mental health services (formal services). The three-round Delphi study engaged a mixed panel of Arabic-speaking community members recruited from South Western Sydney and health professionals (N = 42). Data were collected via an online questionnaire, which was administered to the community members in face-to-face groups. Participants were asked to consider 73 self-care activities across three rounds. Activities reaching ≥ 75% endorsement were considered to have achieved consensus, those with 65–74% agreement were re-rated in the next round, and those with < 65% agreement were excluded. The community panellists were predominantly older women. Consensus was reached on 46 of the 73 activities considered. Forty-five were endorsed for informal community care, 28 for primary/generalist care, 18 for community-based mental health services, and 4 for hospital-based mental health services. Three lifestyle-related activities (eating a balanced and nutritious diet, attending to personal hygiene and connecting with nature) were endorsed across all four settings, indicating their perceived universal relevance. Overall, activities emphasising social engagement, religious and spiritual practices, and culturally familiar community and leisure activities, were strongly favoured in informal contexts. Psychological strategies, such as goal setting, mindfulness and cognitive reframing, were seen as relevant to both informal community care and formal services. Most culturally and community-grounded mental health self-care strategies for Arabic-speakers with a refugee-like background were found to align with the stepped care framework. These findings can be used as recommendations for practice and program development with focus on integrating these strategies across different settings in collaboration with community organisations and services, and health professionals. Further research is required to examine their relevance for different population subgroups, and their effectiveness and feasibility for integration into clinical care to help address persistent mental health inequities.