Reality drives design of a randomized control community based intervention: Observations from research involving Palestinian refugee youth

This paper discusses lessons learnt from preparing for and implementing a community based RCT with Palestinian youth in their refugee camp in Lebanon. Despite the prominent golden standard assigned to this intervention design in the health promotion literature, there is very little reflection on the intricate details and dilemmas research teams face in applying protocols, especially in developing country settings and particularly with those of multi component interventions involving youth. The randomized trial intervention in question is designed to test the impact of social skills building to improve the mental health of refugee youth in a Palestinian refugee camp and involves youth and significant adults in their community, namely parents and teachers. The objectives of the paper are to point out the dilemmas and difficulties to planning and implementing this trial in a refugee community setting. The observations made evolve from the researchers’ experiences in the field. Such challenges include social environment, target population and design level issues. The lack of control of the already volatile social environment is due to the varying demographic conditions of the community directly influenced by the surrounding urban and country conditions. The lack of interest in the focus of the intervention as compared to livelihood issues governed by state restrictions to community members also influenced recruitment. The disperse nature of the target population despite the assumed confined refugee camp boundaries as well as the characteristics of youth as a life stage added to the challenges. The complexity of the program involving three groups, assigned to intervention and control; as well as the difficulty of adhering to the protocol further complicated matters. Implications for researchers are presented.