Spiritual First Aid in Humanitarian Crisis Interventions: A Randomized Evaluation in Ukraine

Last registered on August 20, 2026
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Pre-Trial

Trial Information

General Information

Title
Spiritual First Aid in Humanitarian Crisis Interventions: A Randomized Evaluation in Ukraine
RCT ID
AEARCTR-0019371
Initial registration date
August 12, 2026

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
August 20, 2026, 8:59 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

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Primary Investigator

Name
Patrizio Piraino
Affiliation
University of Notre Dame
Contact Primary Investigator

Other Primary Investigator(s)

PI Name
Bruce Wydick
PI Affiliation
PI Name
Jamie Aten
PI Affiliation
PI Name
Kent Annan
PI Affiliation

Additional Trial Information

Status
On going
Start date
2026-08-10
End date
2027-07-31
Keywords
Crime, Violence, & Conflict, Health, Welfare
Additional Keywords
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Humanitarian actors routinely provide spiritual and religious support to conflict-affected populations, but the practice has not, to our knowledge, been evaluated against a randomized counterfactual. This study tests a Spiritual First Aid (SFA) intervention among approximately 1,400 conflict-affected adults presenting at 15 weCare centers in Ukraine. Participants are individually randomized within center to one of four arms crossing SFA with the size of an unconditional cash transfer (standard, or enhanced). Outcomes are measured at baseline, 2 weeks, 6 weeks, and 6 months across five dimensions of flourishing: physical wellbeing, psychological wellbeing, social connectedness, economic security, and spiritual faith. The design estimates the effect of SFA, the marginal effect of doubling an existing transfer, and whether the two are complementary or substitutable.
External Link(s)

Registration Citation

Citation
Annan, Kent et al. 2026. "Spiritual First Aid in Humanitarian Crisis Interventions: A Randomized Evaluation in Ukraine." AEA RCT Registry. August 20. https://doi.org/10.1257/rct.19371-1.0
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
All participants receive an unconditional cash transfer from the implementing partner. Participants randomized to the SFA arms additionally receive Spiritual First Aid: a structured protocol delivered by a trained peer helper across three sessions over two weeks, combining spiritual content, psychosocial support techniques, and relational contact.
The cash transfer is delivered at one of two levels: a standard amount (approximately ₴630) or an enhanced amount at double that value (approximately ₴1,260). The four arms are: standard transfer only; enhanced transfer only; standard transfer with SFA; enhanced transfer with SFA.
SFA is evaluated as a bundle. The design does not isolate the causal contribution of the spiritual content relative to the structured protocol, the trained helper, or the relational contact.
Intervention Start Date
2026-08-13
Intervention End Date
2026-11-30

Primary Outcomes

Primary Outcomes (end points)
Holistic wellbeing index; and five domain indices: physical wellbeing, psychological wellbeing, social connectedness, economic security, spiritual faith. Measured at 2 weeks, 6 weeks, and 6 months.
Primary Outcomes (explanation)
Each domain comprises three survey items: a perception item, a reported-outcome item, and an access item. Items are standardized as z-scores against the T1 arm distribution and signed so that higher values indicate better outcomes. Each domain index is the simple mean of its three standardized items, re-standardized (Kling, Liebman & Katz 2007). The holistic wellbeing index is the mean of the five domain indices. As robustness, indices are also constructed using the Anderson (2008) inverse-covariance-weighted method.
No single wave is designated as the primary endpoint. All three follow-up waves are pre-specified and estimated jointly in a pooled specification with wave-specific coefficients.

Secondary Outcomes

Secondary Outcomes (end points)
PHQ-8 total (0–24); GAD-7 total (0–21); the 15 individual domain items; past-two-week prescribed medication for depression or anxiety.
Secondary Outcomes (explanation)
PHQ-8 (PHQ-9 minus the self-harm item) and GAD-7 are reported in natural units rather than standardized, so that effects can be benchmarked against established minimal clinically important differences and against the wider psychosocial intervention literature. The 15 individual domain items are reported separately from their indices. Medication use is treated as a service-use outcome.

Experimental Design

Experimental Design
Individual-level randomization within 15 weCare centers in Ukraine, in a 2×2 factorial design crossing Spiritual First Aid (yes/no) with cash transfer size (standard/enhanced). Allocation ratio 3:3:4:4 across four arms: standard transfer only (T1), enhanced transfer only (T2), standard transfer with SFA (T3), enhanced transfer with SFA (T4). Target sample approximately 1,400.
Enrollment and randomization proceed in batches as participants present at centers. Assignment is generated from the pre-enrollment roster, so the baseline survey is administered after assignment.
Four survey waves: baseline, 2 weeks, 6 weeks, and 6 months, timed relative to each participant's own baseline. All outcome items are administered at every wave.
Experimental Design Details
Not available
Randomization Method
Randomization done in office by a computer. Assignment is generated in Python from the pre-enrollment participant roster supplied by the implementing partner, using documented scripts with recorded seeds, in batches as enrollment fills. Assignment is at the individual level within center, in a fixed 3:3:4:4 ratio; there is no stratification beyond center. The input roster, scripts, and output archive are retained for replication.
Randomization Unit
Individual, within center.
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
1400 individuals
Sample size: planned number of observations
1400 individuals
Sample size (or number of clusters) by treatment arms
300 individuals standard transfer only (T1); 300 individuals enhanced transfer only (T2); 400 individuals standard transfer with SFA (T3); 400 individuals enhanced transfer with SFA (T4).
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
University of Notre Dame Institutional Review Board
IRB Approval Date
2025-09-04
IRB Approval Number
24-02-8341
Analysis Plan

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