Open Access Research article

A pilot with computer-assisted psychosocial risk –assessment for refugees

Farah Ahmad1*, Yogendra Shakya2, Jasmine Li2, Khaled Khoaja3, Cameron D Norman4, Wendy Lou4, Izzeldin Abuelaish4 and Hayat M Ahmadzi5

Author Affiliations

1 School of Health Policy and Management, York University & Dalla Lana School of Public Health, University of Toronto, 4700 Keele Street, HNES Building, Room 414, Toronto, Ontario M3J 1P3, Canada

2 Access Alliance Multicultural Health and Community Services, 340 College Street, Ste 500, Toronto, Ontario, M5T 3A9, Canada

3 Research Coordinator for the project, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada

4 Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada

5 Afghan Association of Ontario, 29 Pemican Crt, Toronto, Ontario, M9M 2Z3, Canada

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BMC Medical Informatics and Decision Making 2012, 12:71  doi:10.1186/1472-6947-12-71

Published: 16 July 2012



Refugees experience multiple health and social needs. This requires an integrated approach to care in the countries of resettlement, including Canada. Perhaps, interactive eHealth tools could build bridges between medical and social care in a timely manner. The authors developed and piloted a multi-risk Computer-assisted Psychosocial Risk Assessment (CaPRA) tool for Afghan refugees visiting a community health center. The iPad based CaPRA survey was completed by the patients in their own language before seeing the medical practitioner. The computer then generated individualized feedback for the patient and provider with suggestions about available services.


A pilot randomized trial was conducted with adult Afghan refugees who could read Dari/Farsi or English language. Consenting patients were randomly assigned to the CaPRA (intervention) or usual care (control) group. All patients completed a paper-pencil exit survey. The primary outcome was patient intention to see a psychosocial counselor. The secondary outcomes were patient acceptance of the tool and visit satisfaction.


Out of 199 approached patients, 64 were eligible and 50 consented and one withdrew (CaPRA = 25; usual care = 24). On average, participants were 37.6 years of age and had lived 3.4 years in Canada. Seventy-two percent of participants in CaPRA group had intention to visit a psychosocial counselor, compared to 46 % in usual care group [X2 (1)=3.47, p = 0.06]. On a 5-point scale, CaPRA group participants agreed with the benefits of the tool (mean = 4) and were ‘unsure’ about possible barriers to interact with the clinicians (mean = 2.8) or to privacy of information (mean = 2.8) in CaPRA mediated visits. On a 5-point scale, the two groups were alike in patient satisfaction (mean = 4.3).


The studied eHealth tool offers a promising model to integrate medical and social care to address the health and settlement needs of refugees. The tool’s potential is discussed in relation to implications for healthcare practice. The study should be replicated with a larger sample to generalize the results while controlling for potential confounders.

Computer-assisted; Health assessment; Community health centre; Pilot; Controlled trial; Refugee