Standardization of Research Methodology on War Trauma in the Middle Eastern Context

Authors

  • Luthfiah Mawar Universitas Sumatera Utara
  • M. Agung Rahmadi Universitas Islam Negeri Syarif Hidayatullah Jakarta
  • Helsa Nasution Universitas Negeri Padang
  • Nurzahara Sihombing SD Negeri 107396 Paluh Merbau

DOI:

https://doi.org/10.62027/praba.v3i2.373

Keywords:

Cultural Validity, Middle East, Research Methodology, Standardization, War Trauma

Abstract

This meta-methodological study evaluates 127 research articles on war-induced trauma in the Middle East, published between 2000 and 2023, with the aim of developing a methodological standardization framework capable of addressing the region-specific contextual complexity. The findings reveal a marked degree of heterogeneity in the methodological approaches employed (χ² = 78.45, p < .001), with 42.5% of the studies utilizing cross-sectional designs, 28.3% employing longitudinal methods, and 29.2% adopting mixed-methods approaches. Meta-regression analysis indicates a highly significant correlation between methodological rigor and the validity of research findings (r = .78, p < .001), reinforcing the importance of consistency in study design. The evaluation of instrument reliability reveals significant variation (α = .65–.92), with instruments based on DSM-5 criteria demonstrating the highest level of internal consistency (M = .86, SD = .08). Further analysis identifies five core components as critical in the methodological structuring of trauma studies within Middle Eastern conflict zones, namely cultural validation of instruments (β = .45, p < .001), data source triangulation (OR = 2.34, 95% CI [1.87–2.81]), contextualization of traumatic experience (R² = .56), sensitivity to conflict dynamics (κ = .82), and the application of ethics tailored to the local context (ICC = .79). These findings extend the work of Bush and Duggan (2013) on methodological biases rooted in Western epistemologies. Additionally, they advance the conclusions of Patel and Hall (2021) regarding the absence of cultural validity in cross-conflict studies, as this research introduces an integrated methodological framework that systematically synthesizes local perspectives with international scientific standards. The primary contribution of this study lies in the development of the Trauma Research Standardization Index (TRSI), a newly designed instrument intended to assess methodological alignment with the specific conflict context of the Middle East. The TRSI demonstrates verified construct validity (construct = .88) and high test-retest reliability (.92), making it a potentially valuable tool in standardizing trauma research across Middle Eastern contexts.

References

Ahmed, S. K., Hussein, S., Chandran, D., Islam, M. R., & Dhama, K. (2023). The role of digital health in revolutionizing healthcare delivery and improving health outcomes in conflict zones. Digital Health, 9, 20552076231218158. https://doi.org/10.1177/2055207623-1218158

Al-Hajj, S., Hammoud, Z., Colnaric, J., Ataya, M., Macaron, M. M., Kadi, K., ... & TBI Working Group. (2021). Characterization of traumatic brain injury research in the Middle East and North Africa region: a systematic review. Neuroepidemiology, 55(1), 20-31. https://doi.org/-10.1159/000511554

Ardino, V. (2014). Trauma-informed care: is cultural competence a viable solution for efficient policy strategies?. Clinical Neuropsychiatry, 11(1).

Benjamin, L., Gillard, S., Jones Nielsen, J., Costa E. Silva, M., & Sin, J. (2025). Cultural adaptations to the assessment and treatment of trauma experiences among racial and ethnic minority groups: A mixed-methods systematic review and meta-analysis. Trauma, Violence, & Abuse, 15248380251320982. https://doi.org/10.1177/15248380-251320982

Benuto, L. T., Casas, J., & O'Donohue, W. T. (2018). Training culturally competent psychologists: A systematic review of the training outcome literature. Training and Education in Professional Psychology, 12(3), 125. https://doi.org/10.1037/tep0000190

Boeije, H., Slagt, M., & van Wesel, F. (2013). The contribution of mixed methods research to the field of childhood trauma: A narrative review focused on data integration. Journal of Mixed Methods Research, 7(4), 347-369. https://doi.org/10.1177/1558689813482756

Brück, T., Justino, P., Verwimp, P., Avdeenko, A., & Tedesco, A. (2016). Measuring violent conflict in micro-level surveys: Current practices and methodological challenges. The World Bank Research Observer, 31(1), 29-58. https://doi.org/10.1596/27698

Bush, K., & Duggan, C. (2013). Evaluation in conflict zones: Methodological and ethical challenges. Journal of Peacebuilding & Development, 8(2), 5-25. https://doi.org/10.-1080/15423166.2013.812891

Campbell, R., Goodman-Williams, R., & Javorka, M. (2019). A trauma-informed approach to sexual violence research ethics and open science. Journal of Interpersonal Violence, 34(23-24), 4765–4793. https://doi.org/10.1177/0886260519871530

Campbell, R., Goodman-Williams, R., Engleton, J., Javorka, M., & Gregory, K. (2023). Open science and data sharing in trauma research: Developing a trauma-informed protocol for archiving sensitive qualitative data. Psychological Trauma: Theory, Research, Practice, and Policy, 15(5), 819. https://doi.org/10.1037/tra0001358

Chaitin, J. (2003). "I wish he hadn't told me that": methodological and ethical issues in social trauma and conflict research. Qualitative Health Research, 13(8), 1145–1154. https://doi.org/-10.1177/1049732303255997

Charlson, F. J., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H. A., & Saxena, S. (2019). New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. The Lancet, 394(10194), 240–248. https://doi.org/10.1016/S0140-6736(19)30934-1

Chatty, D., Crivello, G., & Hundt, G. L. (2005). Theoretical and methodological challenges of studying refugee children in the Middle East and North Africa: Young Palestinian, Afghan and Sahrawi refugees. Journal of Refugee Studies, 18(4), 387–409. https://doi.org/10.1093/refuge/fei037

Conn, L. G., Nathens, A. B., Perrier, L., Haas, B., Watamaniuk, A., Pereira, D. D., ... & da Luz, L. T. (2021). Quality of reporting on guideline, protocol, or algorithm implementation in adult trauma centers: a systematic review. Annals of Surgery, 273(6), e239-e246. https://doi.org/10.1097/SLA.0000000003313

Edelman, N. L. (2023). Trauma and resilience informed research principles and practice: A framework to improve the inclusion and experience of disadvantaged populations in health and social care research. Journal of Health Services Research & Policy, 28(1), 66-75. https://doi.org/-10.1177/13558196221124740

Elliott, D. E., Bjelajac, P., Fallot, R. D., Markoff, L. S., & Reed, B. G. (2005). Trauma‐informed or trauma‐denied: Principles and implementation of trauma‐informed services for women. Journal of Community Psychology, 33(4), 461–477. https://doi.org/10.1002/-jcop.20063

Elliott, K. C. (2016). Standardized study designs, value judgments, and financial conflicts of interest in research. Perspectives on Science, 24(5), 529–551. https://doi.org/10.1162/-POSC_a_00222

Ennis, N., Shorer, S., Shoval‐Zuckerman, Y., Freedman, S., Monson, C. M., & Dekel, R. (2020). Treating posttraumatic stress disorder across cultures: A systematic review of cultural adaptations of trauma‐focused cognitive behavioral therapies. Journal of Clinical Psychology, 76(4), 587–611. https://doi.org/10.1002/jclp.22909

Filkins, B. L., Kim, J. Y., Roberts, B., Armstrong, W., Miller, M. A., Hultner, M. L., ... & Steinhubl, S. R. (2016). Privacy and security in the era of digital health: What should translational researchers know and do about it? American Journal of Translational Research, 8(3), 1560.

Gooberman-Hill, R., Fox, R., & Chesser, T. J. S. (2011). What can qualitative approaches bring to trauma outcome research?. Injury, 42(4), 321-323. https://doi.org/10.1016/j.injury-.2011.-01.021

Goodhand, J. (2000). Research in conflict zones: ethics and accountability. Forced Migration Review, 8(4), 12–16.

Haider, A. H., Hashmi, Z. G., Zafar, S. N., Castillo, R., Haut, E. R., Schneider, E. B., ... & Efron, D. T. (2014). Developing best practices to study trauma outcomes in large databases: an evidence-based approach to determine the best mortality risk adjustment model. Journal of Trauma and Acute Care Surgery, 76(4), 1061-1069. https://doi.org/10.1097-/TA.0000000000000182

Haider, A. H., Saleem, T., Leow, J. J., Villegas, C. V., Kisat, M., Schneider, E. B., ... & Efron, D. T. (2012). Influence of the National Trauma Data Bank on the study of trauma outcomes: Is it time to set research best practices to further enhance its impact? Journal of the American College of Surgeons, 214(5), 756-768. https://doi.org/10.1016/j.-jamcollsurg.2011.12.013

Hamadeh, A., El-Shamy, F., Billings, J., & Alyafei, A. (2024). The experiences of people from Arab countries in coping with trauma resulting from war and conflict in the Middle East: A systematic review and meta-synthesis of qualitative studies. Trauma, Violence, & Abuse, 25(2), 1278–1295. https://doi.org/10.1177/15248380231176061

Herrera-Escobar, J. P., deRoon-Cassini, T., Brasel, K., Nehra, D., Al Rafai, S. S., Toppo, A., ... & Haider, A. H. (2020). Development and validation of a revised trauma-specific quality of life instrument. Journal of Trauma and Acute Care Surgery, 88(4), 501–507. https://doi.org/10.-1097/TA.0000000000002505

Holla, M., & van den Berg, M. (2022). Virtual reality techniques for trauma education. Injury, 53, S64-S68. https://doi.org/10.1016/j.injury.2022.08.067

Hoppen, T. H., Priebe, S., Vetter, I., & Morina, N. (2021). Global burden of posttraumatic stress disorder and major depression in countries affected by war between 1989 and 2019: a systematic review and meta-analysis. BMJ Global Health, 6(7), e006303. https://doi.org/-10.1136/bmjgh-2021-006303

Hosny, N., Tanous, O., Koga, P. M., Abbot, B., & Joseph, S. (2024). Who is the Subject of Trauma? An Interdisciplinary Scoping Review of Trauma and Selfhood in the Arab Region. SSM-Mental Health, 100321. https://doi.org/10.1016/j.ssmmh.2024.100321

Isobel, S. (2021). Trauma‐informed qualitative research: Some methodological and practical considerations. International Journal of Mental Health Nursing, 30, 1456–1469. https://doi.org/10.1111/inm.12914

Khalil, M., & Alameddine, M. (2020). Recruitment and retention strategies, policies, and their barriers: A narrative review in the Eastern Mediterranean Region. Health Science Reports, 3(4), e192. https://doi.org/10.1002/hsr2.192

King, L. A., King, D. W., Salgado, D. M., & Shalev, A. Y. (2003). Contemporary longitudinal methods for the study of trauma and posttraumatic stress disorder. CNS Spectrums, 8(9), 686-692. https://doi.org/10.1017/S1092852900008877

Krause, J. (2021). The ethics of ethnographic methods in conflict zones. Journal of Peace Research, 58(3), 329–341. https://doi.org/10.1177/0022343320971021

Maas, A. I., Harrison-Felix, C. L., Menon, D., Adelson, P. D., Balkin, T., Bullock, R., ... & Schwab, K. (2011). Standardizing data collection in traumatic brain injury. Journal of Neurotrauma, 28(2), 177–187. https://doi.org/10.1089/neu.2010.1617

Maas, A. I., Steyerberg, E. W., Marmarou, A., McHugh, G. S., Lingsma, H. F., Butcher, I., ... & Murray, G. D. (2010). IMPACT recommendations for improving the design and analysis of clinical trials in moderate to severe traumatic brain injury. Neurotherapeutics, 7, 127–134. https://doi.org/10.1016/j.nurt.2009.10.020

Mattar, S. (2011). Educating and training the next generations of traumatologists: Development of cultural competencies. Psychological Trauma: Theory, Research, Practice, and Policy, 3(3), 258. https://doi.org/10.1037/a0024477

Menard, S. W. (2002). Longitudinal research (Vol. 76). Sage. https://doi.org/10.4135/-9781412984867

Menyhért, A. (2020). Trauma studies in the digital age. In The Routledge Companion to Literature and Trauma (pp. 241–256). Routledge. https://doi.org/10.4324/9781351025225-22

Mishori, R., Anastario, M., Naimer, K., Varanasi, S., Ferdowsian, H., Abel, D., & Chugh, K. (2017). mJustice: preliminary development of a mobile app for medical-forensic documentation of sexual violence in low-resource environments and conflict zones. Global Health: Science and Practice, 5(1), 138–151. https://doi.org/10.9745/GHSP-D-16-00233

Newman, E., Risch, E., & Kassam-Adams, N. (2006). Ethical issues in trauma-related research: A review. Journal of Empirical Research on Human Research Ethics, 1(3), 29–46. https://doi.org/10.1525/jer.2006.1.3.29

Newman, P. A., Guta, A., & Black, T. (2021). Ethical considerations for qualitative research methods during the COVID-19 pandemic and other emergency situations: Navigating the virtual field. International Journal of Qualitative Methods, 20, 16094069211047823. https://doi.org/-10.1177/16094069211047823

Patel, A. R., & Hall, B. J. (2021). Beyond the DSM-5 diagnoses: a cross-cultural approach to assessing trauma reactions. Focus, 19(2), 197–203. https://doi.org/10.1176/appi.focus.-20200049

Peleg, T., & Shalev, A. Y. (2006). Longitudinal studies of PTSD: overview of findings and methods. CNS Spectrums, 11(8), 589–602. https://doi.org/10.1017/S109285290001-364X

Pineros-Leano, M., Desrosiers, A., Piñeros-Leaño, N., Moya, A., Canizares-Escobar, C., Tam, L., & Betancourt, T. S. (2024). Cultural adaptation of an evidence-based intervention to address mental health among youth affected by armed conflict in Colombia: An application of the ADAPT-ITT approach and FRAME-IS reporting protocols. Cambridge Prisms: Global Mental Health, 11, e114. https://doi.org/10.1017/gmh.-2024.106

Raghunathan, A. U., Gopal, V., Subramanian, D., Biegler, L. T., & Samad, T. (2004). Dynamic optimization strategies for three-dimensional conflict resolution of multiple aircraft. Journal of Guidance, Control, and Dynamics, 27(4), 586-594.https://doi.org/10.2514-/1.11168

Rasouli, H., Rezaee, M., & Danial, Z. (2014). Statistics in trauma research. Trauma Monthly, 19(2), e17606. https://doi.org/10.5812/traumamon.17606

Seagle, E. E., Dam, A. J., Shah, P. P., Webster, J. L., Barrett, D. H., Ortmann, L. W., ... & Marano, N. N. (2020). Research ethics and refugee health: a review of reported considerations and applications in published refugee health literature, 2015-2018. Conflict and Health, 14, 1–15. https://doi.org/10.1186/s13031-020-00283-z

Sonis, J., Suvak, M. K., & Schnurr, P. P. (2017). Empirical study of trauma: Methodological and statistical considerations.

Villarreal, C. L., Price, M. A., Moreno, A. N., Zenteno, A., Saenz, C., Toppo, A., ... & Stein, D. M. (2023). Regulatory challenges in conducting human subjects research in emergency settings: the National Trauma Research Action Plan (NTRAP) scoping review. Trauma Surgery & Acute Care Open, 8(1). https://doi.org/10.1136/tsaco-2022-001044

Voza, F. A., & Ginzburg, E. (2025). Trauma registry: The first step for global trauma systems development initiated by disaster and conflict zones. Surgery, 182, 109309. https://doi.org-/10.1016/j.surg.2025.109309

Wilson, J. P., & Tang, C. C. S. K. (Eds.). (2007). Cross-cultural assessment of psychological trauma and PTSD. Springer Science & Business Media. https://doi.org/10.1007/978-0-387-70990-1

Wood, E. J., Mazurana, D., Jacobsen, K., & Gale, L. (2013). Reflections on the challenges, dilemmas, and rewards of research in conflict zones. Research Methods in Conflict Settings: A View from Below, 295-308. https://doi.org/10.1017/CBO97811398119-10.021

Xiao, P., Xu, J., & Zhao, C. (2022). Conflict identification and zoning optimization of "production-living-ecological" space. International Journal of Environmental Research and Public Health, 19(13), 7990. https://doi.org/10.3390/ijerph19137990

Zeinoun, P., Iliescu, D., & El Hakim, R. (2022). Psychological tests in Arabic: A review of methodological practices and recommendations for future use. Neuropsychology Review, 32(1), 1–19. https://doi.org/10.1007/s11065-021-09476-6

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Published

2025-05-09

How to Cite

Luthfiah Mawar, M. Agung Rahmadi, Helsa Nasution, & Nurzahara Sihombing. (2025). Standardization of Research Methodology on War Trauma in the Middle Eastern Context. Jurnal Praba : Jurnal Rumpun Kesehatan Umum, 3(2), 151–170. https://doi.org/10.62027/praba.v3i2.373

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