Abstract
Background The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic measure of functional impairment and disability but to date no studies have reported its applicability in a population of Syrian refugees. Aims The aim of this study was to explore the psychometric properties and factor structure of the Arabic version of the WHODAS 2.0 among a population of Syrian refugees in a Jordanian refugee camp setting. The tool was used as part of a screening procedure for a randomised controlled trial assessing the effectiveness of a low-intensity psychological intervention. Method A representative sample of Syrian refugees (n = 650) were screened to assess levels of functional impairment and psychological distress. The screening results were used to explore the internal consistency and dimensionality of the WHODAS 2.0. We assessed level of convergence with the validated Kessler 10-item Psychological Distress Scale (K10), which assesses psychological distress. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to explore the construct validity and factor structure of the WHODAS 2.0. Results The mean baseline WHODAS 2.0 score was 20.5 (s.d. = 7.6). The internal consistency was acceptable (Cronbach's alpha 0.74), with all 12-items appearing to be related to the same construct. The WHODAS 2.0 was positively correlated with the K10 (r = 0.57, P < 0.001). The results of the EFA identified a three-factor solution accounting for 51% of variation, corresponding with factors related to self-activities, external activities and self-care. CFA results indicated good fit of the three-factor solution. Conclusions The results indicated that the WHODAS 2.0 has a three-factor solution and is an acceptable screening tool for use among Syrian refugees.
Highlights
The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic measure of functional impairment and disability but to date no studies have reported its applicability in a population of Syrian refugees
The WHODAS 2.0 was positively correlated with the Kessler 10item Psychological Distress Scale (K10) (r = 0.57, P < 0.001)
The results of the Exploratory factor analysis (EFA) identified a three-factor solution accounting for 51% of variation, corresponding with factors related to self-activities, external activities and self-care
Summary
The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic measure of functional impairment and disability but to date no studies have reported its applicability in a population of Syrian refugees. Refugees face a myriad of pre- and post-migration stressors that have an impact on their mental health and well-being.[1] Levels of disability and functioning in refugee populations are moderated by both environmental and biopsychosocial factors. Environmental factors, such as limited access to basic needs and harsh living conditions, can lead to reduced abilities to function.[2] Psychosocial distress and poor physical health directly have an impact on disability and functioning.[3] There is a well-known link between emotional distress and related impairments in functioning, meaning those with higher levels of distress are likely to experience more marked impairment and disability.[4]. The World Health Organization (WHO) Disability Assessment Schedule (WHODAS) was developed to effectively measure disability across the six domains as outlined in the ICF.[6]
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