Barriers and Facilitators to Co-Creating Interventions with Refugee and Migrant Youth: A Process Evaluation with Implementors

The rise in children experiencing forced displacement and the associated negative mental health effects have led to the proliferation of novel interventions targeting their educational development and mental health and psychosocial support (MHPSS) needs. To improve the acceptability and effectiveness of these interventions for refugee communities, co-creation is often used. However, there is a need to understand the mechanisms that support the co-creation process. This paper explores the process of co-creation within the REFUGE-ED project: an international consortium identifying, co-creating, and implementing educational and MHPSS interventions for refugee youth. The data are drawn from consortium members and site staff who participated in a range of meetings, focus groups, and interviews which occurred before, during, and after the implementation. A qualitative content analysis grounded in the (updated) Consolidated Framework for Implementation Research (CFIR) was then used to identify barriers to and facilitators of the co-creation process. Although numerous barriers and facilitators were identified only two traversed both categories and every stage of the co-creation process: namely, the quality of interpersonal relationships and the clarity of the implementation plan. We discuss relevance of these two factors to the field of co-creation as a means to adapt health interventions targeting youth refugee populations. Considerations, needs, and recommendations for future co-creation interventions are also outlined.