Transforming Pathways from Vulnerability to Resilience among Internally Displaced Populations in Myanmar Using a Constructive Grounded Theory Approach

Transforming Pathways from Vulnerability to Resilience among Internally Displaced Populations in Myanmar Using a Constructive Grounded Theory Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Transforming Pathways from Vulnerability to Resilience among Internally Displaced Populations in Myanmar Using a Constructive Grounded Theory Approach Hein Minn Tun, Nay Zar Win, Hnin Nandar Htut, Nay Nyi Nyi Lwin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8939700/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Following the Military coup in 2021, armed conflict, along with the recent earthquake, have exacerbated the vulnerabilities of displaced populations, leaving them with limited access to essential services and protection. Historically, support for IDPs has predominantly focused on immediate humanitarian needs, such as food, shelter, and medical assistance are crucial; they often frame IDPs solely as vulnerable individuals requiring aid, thereby neglecting opportunities to foster resilience within these communities. Objective To fill the gap in knowledge on how internally displaced persons (IDPS) in Myanmar navigate prolonged crises. This research aims to develop a grounded theory framework that shifts the narrative from vulnerability to resilience. Method A constructivist grounded theory study was conducted using a mix of purposive and snowball sampling approaches, conducting in-depth online and in-person interviews with 13 IDPs and 10 individuals from the IDP support network in Mon, Kayin, Kayah and Eastern Bago regions between December 2024 and March 2025. Participants were eligible for inclusion if they were at least 18 years old and currently residing in an IDP camp or working with IDPS. The interviews were voice-recorded, translated and transcribed. Data were analysed inductively through a multi-stage coding process that included initial, intermediate, and advanced coding, memo writing and constant comparative methods to develop a theoretical model of the process of resilience-building among IDPS in Myanmar. Results The study presents a grounded theory for transformation vulnerability to resilience through five interconnecting dimensions. Armed conflict based on political instability, climate change, disrupted communities through loss of homes and livelihood and forced them into hazardous situations. Fears of airstrikes and heavy weaponry, insecurity, along with economic hardship, have deepened the vulnerable situation. Factors including internal motivation to rebuild their lives, resistance and persistence to injustice, adaptability, and mental strength enabled displaced individuals to rebuild agency and dignity. A multi-level framework, comprising macro-level policy and infrastructure interventions, meso-level community action, and micro-level individual coping strategies, is essential for sustainable resilience. Furthermore, resilience was influenced by positive enablers (community support, indigenous knowledge, religious coping, collective leadership) and hindered by barriers (aid dependency, resource scarcity, selective aid). Conclusion This study provides grounded theory along with the key macro, meso, and micro-level resilience strategies, offering insights to improve current humanitarian approaches. This theoretical framework provides a reference for policymakers and INGOs in reducing vulnerability and building lasting resilience for IDPs in conflict zones like Myanmar Internally Displaced Persons (IDPs) Myanmar Resilience Vulnerability Humanitarian Support. Figures Figure 1 Figure 2 1. Introduction ​​Since the military coup in February 2021, Myanmar has been engulfed in escalating conflict, leading to a significant increase in internally displaced persons (IDPs). As of December 2024, over 3.4 million individuals were displaced due to ongoing hostilities and instability [ 1 ]. This situation was further exacerbated by a devastating 7.7 magnitude earthquake on March 28, 2025, which struck central Myanmar, resulting in over 3,700 fatalities, more than 5,000 injuries, and leaving approximately 200,000 people homeless [ 2 ][ 3 ]. The earthquake severely damaged infrastructure, including homes, schools, hospitals, and roads, particularly in regions already hosting large numbers of IDPs, such as Sagaing and Mandalay [ 4 ]. The disaster compounded the existing ongoing political instability and humanitarian crisis, with an estimated 15 million people affected nationwide, including 1.6 million IDPs residing in the hardest-hit areas [ 5 ]. Recovery efforts have been hindered by continuous aftershocks, limited resources, and the impending monsoon season, which threatens to worsen conditions [ 6 ]. Additionally, this disruption has exacerbated the vulnerabilities of displaced populations, leaving them with limited access to essential services and protection. Historically, support for IDPs has predominantly focused on immediate humanitarian needs, such as food, shelter, and medical assistance. [ 7 , 8 ] While these efforts are crucial, they often frame IDPs solely as vulnerable individuals requiring aid, thereby neglecting opportunities to foster resilience within these communities. [ 9 ] This approach tends to overlook the potential of IDPS to adapt and recover from displacement, limiting the scope of interventions to short-term relief. [ 9 , 10 ] Before the coup, Myanmar had national-level frameworks for community disaster resilience; however, these frameworks mostly addressed natural catastrophes and did not address man-made crises like armed conflict or the unique requirements of IDPs.[ 11 , 12 ] Moreover support the absence of comprehensive strategies that address both immediate needs and long-term empowerment hampers the development of sustainable solutions. In the context of Myanmar, where displacement is protracted and complex, there is a critical need to shift from a vulnerability-centric model to one that also emphasises resilience-building, enabling IDPS to regain autonomy and rebuild their lives. The interplay between vulnerability and resilience has been extensively explored in the context of climate change adaptation. Maru et al. (2014) developed a systems framework to examine adaptation pathways among remote and marginalised communities, highlighting the dynamic relationship between vulnerability and resilience [ 13 ]. Their study identified a feedback loop centred on adaptability, emphasising that while remote communities often exhibit resilience to environmental variability, they also face significant disadvantages that heighten their vulnerability. This duality highlighted the complexity of developing effective adaptation policies. However, while Maru et al.’s framework offers valuable insights, it primarily addresses environmental contexts and does not delve into conflict-induced displacement scenarios. Therefore, there is a need to extend such frameworks to encompass the unique challenges faced by IDPs in conflict settings like Myanmar. In the face of complex humanitarian crises, such as the one unfolding in Myanmar, there is a pressing need for theoretical frameworks that can guide effective interventions. Constructive Grounded Theory (CGT) offers a robust methodological approach to develop such frameworks by systematically analysing qualitative data to generate theories grounded in participants’ experiences [ 14 ]. Applying CGT to the study of IDPs in Myanmar can offer complex insights into how displaced people deal with their situation, adjust to new realities, and develop resilience. In addition to documenting the lived experiences of IDPs, this method helps humanitarian support providers to create intervention designs that are sensitive to their needs and goals. [ 14 ] This will enable them to create more efficient and long-lasting assistance systems by establishing their tactics on empirical data collected directly from the impacted communities. To fill the gap in knowledge on how internally displaced persons (IDPS) in Myanmar navigate prolonged crises, this research aims to develop a grounded theory framework that shifts the narrative from vulnerability to resilience. Given the scale of displacement following the 2021 military coup and compounded by ongoing armed conflict, natural disasters, and socio-political instability, there is a pressing need to reconceptualise humanitarian responses. Using a Constructive Grounded Theory methodology, this study systematically explores the lived experiences of IDPs and the perspectives of those in their support networks to uncover key concepts and relational processes that shape resilience-building. Unlike traditional approaches that frame IDPs solely as victims in need of aid, this research focuses on understanding how individuals and communities adapt, recover, and organise under extreme uncertainty. The resulting theoretical framework is expected to provide actionable guidance for policymakers, non-governmental organisations, and humanitarian practitioners by identifying pathways for long-term empowerment, social cohesion, and mental health recovery. Ultimately, this research contributes to reimagining humanitarian aid through a resilience-oriented lens, offering a grounded and context-sensitive roadmap for future programming in Myanmar. 2. Methodology 2.1. Study Design and Participants This study employs a constructive grounded theory approach, grounded in qualitative research principles, to explore how Myanmar's internally displaced populations (IDPs) transition from vulnerability to resilience. Constructive Grounded Theory, developed by Glaser and Strauss in 1967, provides a systematic and iterative process for theory development, ensuring that emerging concepts are grounded in empirical data rather than preconceived assumptions.[ 15 , 16 ] This study employed a qualitative research design, utilising both online and in-person in-depth interviews conducted with internally displaced populations (IDPs) and their support network in Mon,Kayin, Kayah and Eastern Bago regions between December 2024 and March 2025. A purposive sampling approach was employed to select key stakeholders for interviews. Given the sensitivity of the topic and the challenges in accessing internally displaced populations (IDPs), participants were recruited through referrals facilitated by several non-governmental organizations (NGOs) and a snowball sampling approach. A stakeholder analysis was conducted to identify and engage relevant participants to ensure a comprehensive understanding of the issue. Recruitment was carried out through targeted outreach using specific channels, accompanied by study information, objectives, and informed consent. The research team directly conducted the online interview, and Local Civil Society organisations (CSOs) were communicated with, and selected volunteers were nominated as interviewers. The researcher trained interviewers through online sessions to ensure consistency in conducting the interviews. After obtaining informed consent and contact details, the interviewer directly reached out to participants. At the start of each interview, participants were provided with an explanation of the study’s objectives, procedures, and their right to withdraw at any time without hesitation. Participants were eligible for inclusion if they were at least 18 years old and currently residing in an IDP camp or working with IDPs. Only those who voluntarily consented were interviewed. Each interview lasted between 20 and 35 minutes and was conducted in the Myanmar language. All interviews were audio-recorded, and the researcher took detailed field notes. Interviews continued until data saturation was reached, as indicated by the repetition of narratives. 2.2. Data Collection and Analysis All interviews were conducted in the Myanmar language and followed a structured, constructive grounded theory technique based on Glaser and Strauss[ 15 ]. Themes were identified through an active and reflective process of interpretation and analysis. The researchers familiarised themselves with the data by repeatedly listening to the audio recordings and reviewing the interview notes before transcription. Each interview was transcribed verbatim into English and cross-checked against the original recordings to ensure accuracy. Following data validation, the researcher conducted a word-by-word review of the transcripts and proceeded to the data analysis process described in Fig. 1 . The study uses CATMA (Computer Assisted Text Markup and Analysis) version 7.2.0, Taguette, and Excel software for the coding process. Canva was used to develop a conceptual map for a constructive grounded theory. [ 17 , 18 ] The initial data was analysed thematically by identifying patterns and merging similar responses into overarching themes for the first round of interviews for all stakeholders. The intermediate code was created by merging the key concepts identified in the initial code. Theoretical sampling was employed to collect additional data as needed to fill gaps and strengthen emerging categories. This was followed by focused coding, where similar concepts are grouped into broader categories and the coding framework is refined as new data emerges. The iterative constant comparison method is applied throughout the analysis, ensuring that new data is continuously compared with existing codes and categories to refine theoretical constructs. The study continues data collection until theoretical saturation is reached, meaning no new concepts or themes emerge, ensuring a comprehensive theoretical model. Once this stage is achieved, findings are synthesised into five interconnecting dimensions, resulting in a grounded theory framework that explains the process of resilience-building among IDPS in Myanmar. To enhance theoretical sensitivity, the author has reviewed relevant literature along with existing theoretical frameworks and prior empirical findings on displacement and trauma. Furthermore, the author developed a programmatic logframe tailored to field-level project implementation aimed at supporting resilience-building among IDPS in Southeastern Myanmar. 2.3. Ethical Considerations Before conducting the study, ethical approval was obtained from the Community Ethics Advisory Board (CEAB) at Mae Tao Clinic. All participants were informed of the study’s objectives, and consent forms were provided before each interview, along with assurances that their identity and location would remain confidential throughout the research process. Written consent was obtained from participants who were able to read and write, while oral consent was secured from those unable to provide written consent. To protect participant anonymity, the names of IDP camps, participant names, and locations were omitted. Pseudonyms were assigned during transcription, coding, and data analysis to ensure confidentiality. 3. Results 3.1. Demographic Characteristics of Participants This study involved a varied group of 23 participants drawn from the Kayah, Kayin, and East Bago regions, including internally displaced persons (IDPs), civil society organisation (CSO) leaders, local governance officials, and individuals affiliated with donor agencies. Of the total participants, 14 were male and 9 were female. All individuals representing donor organisations were male. Among the IDPs interviewed, 9 were male and 5 were female. Within CSOs, 3 participants were women and 1 was a man, whereas local governance officials comprised 2 men and 1 woman. The largest age group represented was 31–40 years (8 participants), followed by 21–30 years (7 participants), over 50 years (5 participants), and 41–50 years (3 participants). To ensure participant confidentiality in quoted material, each person was assigned a code based on their gender and role: for example, “Donor_M1, M2” for donors, “Governance_M1, M2” or “Governance_F1, F2” for governance officials, “CSO_M1, M2” or “CSO_F1, F2” for CSO representatives, and “IDP_M1, M2” or “IDP_F1, F2” for IDPs. The findings are organised around key themes from the data and formulated in grounded theory, shown in Fig. 2 . Five interconnecting dimensions were described from the key theme, including the causes of displacement, contextual vulnerabilities, resilience-building factors, strategic interventions, and the conditions that either enable or hinder resilience. 3.2. Causal Condition for Displacement The displacement of populations in Myanmar was driven by interconnected factors. Armed conflict, marked by airstrikes and heavy weaponry along with loss of homes and livelihood, created an environment of fear and instability, forcing many to flee their homes. Climate change further exacerbated the crisis, as environmental degradation disrupted traditional livelihoods like farming and fishing, deepening economic hardship. Political instability compounded these challenges, with year-long civil war and institutional support leaving IDPs without protection or recourse. 3.3. Contextual Factors for Vulnerability Once displaced, populations faced a multitude of vulnerabilities. The fears of airstrikes and heavy weaponry cause psychological trauma in communities to feel safe and stay in their home and work. Additionally, the feeling of insecurity caused by the armed conflict, along with the conscription laws and abduction, has deepened vulnerability. The feeling of safety risk persisted, as many IDPs lived in temporary shelters with little protection from ongoing violence. Economic hardship was widespread, with limited access to income-generating opportunities and markets, pushing displaced families into increasingly vulnerable circumstances. 3.4. Factors Led to Resilience Despite these challenges, resilience emerged through various factors. Rebuilding their lives, driven by an unwavering internal motivation, became a cornerstone of their recovery, enabling them to move forward after the crisis. Adaptation was critical, as people adjusted to new realities by shifting to alternative livelihoods, such as cultivating resilient crops or engaging in informal labour. Resistance and persistence further fueled resilience, with communities uniting to confront external threats and demand their rights. Equally vital was mental strength, often sustained by spiritual beliefs or communal support, which empowered individuals to endure hardship. 3.5 Strategies for Resilience 3.5.1. Macro-level Strategies At the macro level, resilience-building efforts prioritised systemic transformations to address root causes of vulnerability. Policy interventions aimed to promote political stability through inclusive peace processes while safeguarding the rights and dignity of IDPs.Critical infrastructure strengthening, including the rebuilding of healthcare, education systems and information technology, formed the critical foundation for sustainable recovery. Equally vital was proactive disaster preparedness, integrating community-led risk reduction strategies and conflict-sensitive humanitarian approaches to ensure aid interventions strengthened rather than undermined local resilience. 3.5.2. Meso-level Strategies Community-driven solutions were central to meso-level resilience. Collective responses such as farming initiatives, shared shelters, and conflict mediation efforts fostered cooperation and mutual support. Community-driven solutions, such as establishing rice banks for food safety and community-led livelihood approaches like mushroom farming, have provided an ideal approach to support resilience in the community. Strengthening coordination with local civil society organisations, including women empowerment groups, will further support locally based solutions, which will become sustainable in the long term. 3.5.3. Micro-Individual Level Strategies On an individual level, resilience was cultivated through capacity-building initiatives through proper assessments, such as vocational training, such as tailoring for women, motorcycle repair training and organic farming activities, which can expand their ability to rebuild their lives after the conflict. Futhermore, providing livelihood opportunities such as providing seeds for farming or empowering the existing ability of the individual will further enhance the individual's ability to respond and rebuild during crises. Strengthening mental health and psychosocial support, including peer counselling and professional support, addressed the psychological impact of displacement. By expanding mental health and psychosocial support through peer counselling and professional services, communities will develop stronger mental strength to cope with the crisis. 3.6. Intervening Conditions for Resilience 3.6.1. Enablers Certain conditions facilitated resilience. A sense of community, strengthened by shared suffering and collective action, enabled communities to support one another and empower them to respond to crisis. Community leadership played a pivotal role in organising aid and building trust within communities. Religious and spiritual, along with prioritising family, provided emotional and psychological strength, helping individuals and groups navigate trauma and uncertainty. Indigenous knowledge on finding essential food offered practical solutions for survival in hardship situations. 3.6.2. Barriers However, significant barriers hindered resilience efforts and deepened vulnerability. First, prolonged aid dependency often eroded self-sufficiency, creating cycles of reliance on external assistance rather than fostering local solutions. Second, severe resource scarcity frequently triggered intra-community competition, exacerbating tensions in already fragile settings. Third, inequitable aid distribution, particularly when targeting specific groups while excluding others, risks deepening existing vulnerabilities and weakening overall community resilience. 4. Discussion The study presents a grounded theory for transformation vulnerability to resilience through five interconnecting dimensions. Armed conflict based on political instability, along with climate change, disrupted communities through loss of homes and livelihood and forced them into hazardous situations. Futhermore, the vulnerability situation was exacerbated by fears of airstrikes and heavy weaponry, insecurity, along with economic hardship, which has further deepened the vulnerable situation. Factors including internal motivation to rebuild their lives, resistance and persistence to injustice, along with adaptability and mental strength, have demonstrated that resilience was about rebuilding agency, restoring dignity, and finding new opportunities for success rather than only surviving. A multi-level framework, comprising macro-level policy and infrastructure interventions, meso-level community action, and micro-level individual coping strategies, has created an enabling environment that empowers displaced communities to not only recover from crisis but also develop sustainable pathways for long-term resilience. Furthermore, resilience is mediated by both positive enablers (sense of community, social circle support, indigenous survival knowledge, shared suffering,religious coping, collective resistance, community leadership, prioritising family) and negative barriers (aid dependency, Resource scarcity, selective support). The findings of this study align closely with existing literature on forced displacement, vulnerability and resilience building among conflict-affected internally displacement populations. Similar to earlier research, factors such as political instability, armed conflict, loss of livelihoods, and climate change were identified as primary drivers of displacement [ 13 , 19 , 20 , 21 , 22 ] Economic hardship, psychological trauma, and instability were frequently mentioned as vulnerabilities; these results are aligned with research done in South Sudan, Syria, and Afghanistan. [ 19 , 23 , 24 , 25 , 26 , 27 ] The role of spiritual coping and indigenous knowledge echoes studies from Sub-Saharan Africa [ 28 ] and Latin America [ 29 ], while the risks of aid dependency corroborate critiques of humanitarian systems [ 30 , 31 ]. Similar to findings in other humanitarian contexts, resilience emerges through community solidarity, adaptation, resistance to injustice, and spiritual coping [ 13 , 26 , 27 , 32 , 33 ]. Furthermore, this study's theoretical framework demonstrates that multi-level strategies for improving resilience are critical for supporting IDPS as proposed by the Inter-Agency Standing Committee (IASC) and UNHCR on community resilience in crisis settings. [ 34 , 35 , 36 , 37 , 38 ] Despite alignment with broader research, there are notable discrepancies between existing theories and the findings from this study. Conventional resilience models, like Ungar's "navigation and negotiation" theory [ 34 ], Norris's community resilience model [ 35 ], and Y.T. Maru's adaptation pathways model for vulnerability to resilience in remote disadvantaged communities [ 13 ] place a strong emphasis on systemic adaptation and resource access, but they frequently assume that stable external systems, such as government or humanitarian organizations, are available. On the other hand, the situation in Myanmar demonstrated that resilience frequently arises when there are almost no operational institutions. Additionally, previous studies mostly focus on structural factors [ 13 , 35 , 36 , 39 ]; our grounded theory provides resilience strategies at the individual and community levels. The theory emphasises how systemic barriers (such as inequitable aid) may hinder even robust community efforts, especially in the face of current humanitarian support. [ 40 ] Similarly, this study emphasises that resilience is not linear; many IDPs suffer cycles of relocation and reconstruction, often regressing in the face of repeated war, despite previous studies' emphasis on post-traumatic growth in prolonged displacement [ 27 ].In contrast to models that depend significantly on external aid frameworks [ 31 ], the theory presented here highlights enabling conditions and community-driven solutions, indicating that a community empowerment approach is more important for maintaining resilience among Myanmar's displaced populations. This approach aligns with the recommendation by a previous study that focuses on social capital improvement in post-disaster recovery. [ 41 ] The importance of collective resistance in Myanmar's setting also deviates from apolitical resilience models [ 42 ], highlighting the necessity of political stability and local leadership along community-centric multilevel strategies [ 43 ]. These approaches offer a corrective to top-down humanitarian models, aligning with decolonial critiques [ 44 ]. Moreover, the theoretical framework provides a reference for policymakers, INGOs, and development programs to decrease vulnerability and strengthen long-term resilience programs for IDPs communities, especially in conflict-affected countries like Myanmar. This study, guided by a Constructive Grounded Theory approach, has several limitations that warrant consideration. First, the exclusive reliance on qualitative data introduces the potential for subjectivity and researcher interpretation bias. To mitigate this, CMATA and Tagutte software were employed for systematic coding, and member-checking procedures were conducted to validate findings. However, as with all iterative coding processes, there remains a risk of overlooking emerging themes; future studies should integrate regular peer debriefings and validation workshops to enhance analytical rigour. Secondly, the cultural and linguistic diversity of participants from Mon, Kayin, Kayah, and Eastern Bago may limit the transferability of findings to IDP populations in other regions of Myanmar or internationally. While stakeholder analysis was used to ensure representation from a variety of backgrounds, further research should explore the applicability of this theory across different socio-political and cultural contexts. Despite these constraints, the study offers a grounded theory that clarifies the methods by which comprehensive approaches to transform vulnerable IDPs communities into more resilient ones. 5. Conclusions The study presented a grounded theory that reveals five interconnected dimensions for transforming vulnerability into resilience: displacement drivers, contextual vulnerabilities, resilience-building factors, strategic interventions, and enabling, along with constraining conditions for resilience among IDPS. The grounded theory emphasises the vital role of community-driven resilience mechanisms in the absence of steady institutional support, while reaffirming important displacement causes and vulnerabilities found in global contexts. The theory challenges conventional linear resilience models by demonstrating the non-linear, cyclical nature of displacement and the importance of political stability, local leadership, and conflict-sensitive, equitable aid frameworks in fostering sustainable resilience. Despite potential interpretation bias, this study provides grounded theory along with the key macro, meso, and micro-level resilience strategies, offering insights to improve current humanitarian approaches. This theoretical framework provides a reference for policymakers and INGOs in reducing vulnerability and building lasting resilience for IDPs in conflict zones like Myanmar. Declarations Authorship contribution statement All authors were involved in the conceptualisation and investigation of the articles. HMT is involved in data curation, formal analysis, methodology, software, and writing- original and final manuscripts. NZW, HNH and NNNL are involved in data curation, formal analysis, review and supervision of final manuscripts. Declaration of competing interest : The authors affirm that they have no known financial or interpersonal conflicts that would have appeared to impact the research presented in this study. Funding: This research received no funding. Acknowledgements The authors sincerely thank all internally displaced participants, individuals who work with internally displaced populations and individuals who assisted in interviewing and identifying potential participants for this study. Ethics Statement The paper received ethical approval from the Community Ethics Advisory Board (CEAB), with reference number CEAB-2024-016 on 9th December 2024. All the participants were informed that their participation was voluntary. Oral and written informed consent was obtained from all participants before conducting the interview and audio recording, which was in alignment with research ethics. All the participants’ names were assigned pseudonyms. All methods were performed according to relevant guidelines and regulations. Consent to Participate : Oral and written informed consent was obtained from all participants before conducting the interview and audio recording, which was in alignment with research ethics. Consent to Publish : All authors agree on consent for publication. Data Availability: All data generated or analysed during this study are included in this published article. The datasets generated and/or analysed during the current study are not publicly available to preserve the anonymity of study participants; however, they are available from the corresponding author upon reasonable request. 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The Field of Medical Anthropology in Social Science & Medicine. Social Science & Medicine (1982) 196 (January 2018): 233–39. https://doi.org/10.1016/j.socscimed.2017.10.033 Ungar M. Resilience, Trauma, Context, and Culture. Trauma, Violence, & Abuse 14, no. 3 (July 2013): 255–66. https://doi.org/10.1177/1524838013487805 Norris FH, Susan P, Stevens B, Pfefferbaum, Karen F, Wyche, Pfefferbaum RL. Community Resilience as a Metaphor, Theory, Set of Capacities, and Strategy for Disaster Readiness. Am J Community Psychol. March 2008;41:1–2. 127–50. https://doi.org/10.1007/s10464-007-9156-6 . IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. 2007 | IASC. Accessed April 20, 2025. https://interagencystandingcommittee.org/iasc-task-force-mental-health-and-psychosocial-support-emergency-settings/iasc-guidelines-mental-health-and-psychosocial-support-emergency-settings-2007 UNHCR. Operational Guidance on the Engagement of IDPs in Humanitarian Action. UNHCR. 2023. Accessed April 28, 2025: https://www.unhcr.org/sites/default/files/2024-06/CRP-15-UNHCR-engagement-IDPs-90-SC-English.pdf Malteser, International. Building Resilience of Rural Communities in Myanmar: Handbook for Field Practitioners - Myanmar | ReliefWeb, July 28, 2020. https://reliefweb.int/report/myanmar/building-resilience-rural-communities-myanmar-handbook-field-practitioners Southwick SM, Bonanno,George A, Masten, Ann S. Panter-Brick, Catherine, and Rachel and Yehuda. Resilience Definitions, Theory, and Challenges: Interdisciplinary Perspectives. Eur J Psychotraumatology. December 1, 2014;5(1):25338. https://doi.org/10.3402/ejpt.v5.25338 . Chandler D, Reid J. The neoliberal subject: Resilience, adaptation and vulnerability. Rowman & Littlefield International; 2016. 1, Aldrich D. August. Building Resilience: Social Capital in Post-Disaster Recovery, 2012. https://www.ssrc.org/publications/building-resilience-social-capital-in-post-disaster-recovery/ Mac Ginty R. (2011). International Peacebuilding and Local Resistance: Hybrid Forms of Peace | SpringerLink. Accessed April 28, 2025. https://link.springer.com/book/10.1057/9780230307032 Save the Children, Lessons learned from the Central Sahel. Conflict sensitivity is key to more effective and timely humanitarian aid, posted 11 Dec 2023, Assessed: https://reliefweb.int/report/burkina-faso/conflict-sensitivity-key-more-effective-and-timely-humanitarian-aid Peace Insight. Time to Decolonise Aid. Peace Direct, May 10, 2021. https://www.peacedirect.org/time-to-decolonise-aid/ Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterials.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Apr, 2026 Reviews received at journal 05 Apr, 2026 Reviews received at journal 01 Apr, 2026 Reviews received at journal 29 Mar, 2026 Reviewers agreed at journal 24 Mar, 2026 Reviewers agreed at journal 23 Mar, 2026 Reviewers agreed at journal 23 Mar, 2026 Reviewers agreed at journal 21 Mar, 2026 Reviewers invited by journal 18 Mar, 2026 Editor assigned by journal 11 Mar, 2026 Submission checks completed at journal 06 Mar, 2026 First submitted to journal 06 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8939700","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":608399138,"identity":"e91f0a5f-1c56-44bd-8a5e-0fe7d14e29a2","order_by":0,"name":"Hein Minn Tun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYBACfv4exsd//0jIMUgwGDAwsDGASPxAcsYZZgPeBhtj4rUYHMhhk+BtSEtsIFoLw4Gzhw0kdxxO33C7eQPDh7LDDObSDfh1MDb3JT4wPHM4d8OdYwWMM84dZrCccwC/FmaGM8YGCWxALTdyDJh52w4zGNxIwK+FjSHHTOIA2+F0A5CWv8Ro4QFqkWxsS0sAa2EkRouExBljY4YzNoYzgX452HMuncdyBgEt9ud7DB8zVEjI891u3vjgR5m1nLkEAS0o4ADYpaNgFIyCUTAKKAcA+iBJp3ndc0sAAAAASUVORK5CYII=","orcid":"","institution":"Universiti Brunei Darussalam","correspondingAuthor":true,"prefix":"","firstName":"Hein","middleName":"Minn","lastName":"Tun","suffix":""},{"id":608399139,"identity":"428bc494-936e-4b7f-beaf-c9ab9aa3ff60","order_by":1,"name":"Nay Zar Win","email":"","orcid":"","institution":"Community Partners International","correspondingAuthor":false,"prefix":"","firstName":"Nay","middleName":"Zar","lastName":"Win","suffix":""},{"id":608399140,"identity":"a88e4626-314b-4c59-8767-9c3aa3ae852d","order_by":2,"name":"Hnin Nandar Htut","email":"","orcid":"","institution":"Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Hnin","middleName":"Nandar","lastName":"Htut","suffix":""},{"id":608399141,"identity":"44204923-ad99-445b-814b-a7efc8bbfc92","order_by":3,"name":"Nay Nyi Nyi Lwin","email":"","orcid":"","institution":"Khon Kaen University","correspondingAuthor":false,"prefix":"","firstName":"Nay","middleName":"Nyi Nyi","lastName":"Lwin","suffix":""}],"badges":[],"createdAt":"2026-02-22 14:23:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8939700/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8939700/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105149958,"identity":"95144f55-8965-49f5-aa4f-8672b81ac577","added_by":"auto","created_at":"2026-03-22 14:58:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":189129,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eProcess of sampling, data collection and analysis to construct grounded theory for the study.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8939700/v1/b171a1fa9a937b4e5015a292.png"},{"id":105149957,"identity":"7997e354-b2cf-4092-9875-f4f13781ceef","added_by":"auto","created_at":"2026-03-22 14:58:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":487724,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eConstructed Grounded Theory for Transforming Vulnerability into Resilience for Supporting Internally Displaced Populations\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8939700/v1/631717ca779e98b862a0ec8c.png"},{"id":105149960,"identity":"2550a0c1-948c-40e8-8425-934da464ce60","added_by":"auto","created_at":"2026-03-22 14:58:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1354779,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8939700/v1/8e53f7ed-e252-4787-96d3-30400e0c54b0.pdf"},{"id":105149959,"identity":"1765cafa-a327-4b5a-86f0-47004b864c2c","added_by":"auto","created_at":"2026-03-22 14:58:51","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":1309805,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-8939700/v1/75697b6ccc9da27d8e23ed2c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Transforming Pathways from Vulnerability to Resilience among Internally Displaced Populations in Myanmar Using a Constructive Grounded Theory Approach","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003e​​Since the military coup in February 2021, Myanmar has been engulfed in escalating conflict, leading to a significant increase in internally displaced persons (IDPs). As of December 2024, over 3.4\u0026nbsp;million individuals were displaced due to ongoing hostilities and instability [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This situation was further exacerbated by a devastating 7.7 magnitude earthquake on March 28, 2025, which struck central Myanmar, resulting in over 3,700 fatalities, more than 5,000 injuries, and leaving approximately 200,000 people homeless [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e][\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The earthquake severely damaged infrastructure, including homes, schools, hospitals, and roads, particularly in regions already hosting large numbers of IDPs, such as Sagaing and Mandalay [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The disaster compounded the existing ongoing political instability and humanitarian crisis, with an estimated 15\u0026nbsp;million people affected nationwide, including 1.6\u0026nbsp;million IDPs residing in the hardest-hit areas [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recovery efforts have been hindered by continuous aftershocks, limited resources, and the impending monsoon season, which threatens to worsen conditions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, this disruption has exacerbated the vulnerabilities of displaced populations, leaving them with limited access to essential services and protection.\u003c/p\u003e \u003cp\u003eHistorically, support for IDPs has predominantly focused on immediate humanitarian needs, such as food, shelter, and medical assistance. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] While these efforts are crucial, they often frame IDPs solely as vulnerable individuals requiring aid, thereby neglecting opportunities to foster resilience within these communities. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] This approach tends to overlook the potential of IDPS to adapt and recover from displacement, limiting the scope of interventions to short-term relief. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Before the coup, Myanmar had national-level frameworks for community disaster resilience; however, these frameworks mostly addressed natural catastrophes and did not address man-made crises like armed conflict or the unique requirements of IDPs.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Moreover support the absence of comprehensive strategies that address both immediate needs and long-term empowerment hampers the development of sustainable solutions. In the context of Myanmar, where displacement is protracted and complex, there is a critical need to shift from a vulnerability-centric model to one that also emphasises resilience-building, enabling IDPS to regain autonomy and rebuild their lives.\u003c/p\u003e \u003cp\u003eThe interplay between vulnerability and resilience has been extensively explored in the context of climate change adaptation. Maru et al. (2014) developed a systems framework to examine adaptation pathways among remote and marginalised communities, highlighting the dynamic relationship between vulnerability and resilience [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Their study identified a feedback loop centred on adaptability, emphasising that while remote communities often exhibit resilience to environmental variability, they also face significant disadvantages that heighten their vulnerability. This duality highlighted the complexity of developing effective adaptation policies. However, while Maru et al.\u0026rsquo;s framework offers valuable insights, it primarily addresses environmental contexts and does not delve into conflict-induced displacement scenarios. Therefore, there is a need to extend such frameworks to encompass the unique challenges faced by IDPs in conflict settings like Myanmar.\u003c/p\u003e \u003cp\u003eIn the face of complex humanitarian crises, such as the one unfolding in Myanmar, there is a pressing need for theoretical frameworks that can guide effective interventions. Constructive Grounded Theory (CGT) offers a robust methodological approach to develop such frameworks by systematically analysing qualitative data to generate theories grounded in participants\u0026rsquo; experiences [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Applying CGT to the study of IDPs in Myanmar can offer complex insights into how displaced people deal with their situation, adjust to new realities, and develop resilience. In addition to documenting the lived experiences of IDPs, this method helps humanitarian support providers to create intervention designs that are sensitive to their needs and goals. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] This will enable them to create more efficient and long-lasting assistance systems by establishing their tactics on empirical data collected directly from the impacted communities.\u003c/p\u003e \u003cp\u003eTo fill the gap in knowledge on how internally displaced persons (IDPS) in Myanmar navigate prolonged crises, this research aims to develop a grounded theory framework that shifts the narrative from vulnerability to resilience. Given the scale of displacement following the 2021 military coup and compounded by ongoing armed conflict, natural disasters, and socio-political instability, there is a pressing need to reconceptualise humanitarian responses. Using a Constructive Grounded Theory methodology, this study systematically explores the lived experiences of IDPs and the perspectives of those in their support networks to uncover key concepts and relational processes that shape resilience-building. Unlike traditional approaches that frame IDPs solely as victims in need of aid, this research focuses on understanding how individuals and communities adapt, recover, and organise under extreme uncertainty. The resulting theoretical framework is expected to provide actionable guidance for policymakers, non-governmental organisations, and humanitarian practitioners by identifying pathways for long-term empowerment, social cohesion, and mental health recovery. Ultimately, this research contributes to reimagining humanitarian aid through a resilience-oriented lens, offering a grounded and context-sensitive roadmap for future programming in Myanmar.\u003c/p\u003e"},{"header":"2. Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study Design and Participants\u003c/h2\u003e \u003cp\u003eThis study employs a constructive grounded theory approach, grounded in qualitative research principles, to explore how Myanmar's internally displaced populations (IDPs) transition from vulnerability to resilience. Constructive Grounded Theory, developed by Glaser and Strauss in 1967, provides a systematic and iterative process for theory development, ensuring that emerging concepts are grounded in empirical data rather than preconceived assumptions.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] This study employed a qualitative research design, utilising both online and in-person in-depth interviews conducted with internally displaced populations (IDPs) and their support network in Mon,Kayin, Kayah and Eastern Bago regions between December 2024 and March 2025. A purposive sampling approach was employed to select key stakeholders for interviews. Given the sensitivity of the topic and the challenges in accessing internally displaced populations (IDPs), participants were recruited through referrals facilitated by several non-governmental organizations (NGOs) and a snowball sampling approach.\u003c/p\u003e \u003cp\u003eA stakeholder analysis was conducted to identify and engage relevant participants to ensure a comprehensive understanding of the issue. Recruitment was carried out through targeted outreach using specific channels, accompanied by study information, objectives, and informed consent. The research team directly conducted the online interview, and Local Civil Society organisations (CSOs) were communicated with, and selected volunteers were nominated as interviewers. The researcher trained interviewers through online sessions to ensure consistency in conducting the interviews. After obtaining informed consent and contact details, the interviewer directly reached out to participants. At the start of each interview, participants were provided with an explanation of the study\u0026rsquo;s objectives, procedures, and their right to withdraw at any time without hesitation. Participants were eligible for inclusion if they were at least 18 years old and currently residing in an IDP camp or working with IDPs. Only those who voluntarily consented were interviewed. Each interview lasted between 20 and 35 minutes and was conducted in the Myanmar language. All interviews were audio-recorded, and the researcher took detailed field notes. Interviews continued until data saturation was reached, as indicated by the repetition of narratives.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Data Collection and Analysis\u003c/h2\u003e \u003cp\u003eAll interviews were conducted in the Myanmar language and followed a structured, constructive grounded theory technique based on Glaser and Strauss[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Themes were identified through an active and reflective process of interpretation and analysis. The researchers familiarised themselves with the data by repeatedly listening to the audio recordings and reviewing the interview notes before transcription. Each interview was transcribed verbatim into English and cross-checked against the original recordings to ensure accuracy. Following data validation, the researcher conducted a word-by-word review of the transcripts and proceeded to the data analysis process described in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe study uses CATMA (Computer Assisted Text Markup and Analysis) version 7.2.0, Taguette, and Excel software for the coding process. Canva was used to develop a conceptual map for a constructive grounded theory. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] The initial data was analysed thematically by identifying patterns and merging similar responses into overarching themes for the first round of interviews for all stakeholders. The intermediate code was created by merging the key concepts identified in the initial code. Theoretical sampling was employed to collect additional data as needed to fill gaps and strengthen emerging categories. This was followed by focused coding, where similar concepts are grouped into broader categories and the coding framework is refined as new data emerges. The iterative constant comparison method is applied throughout the analysis, ensuring that new data is continuously compared with existing codes and categories to refine theoretical constructs. The study continues data collection until theoretical saturation is reached, meaning no new concepts or themes emerge, ensuring a comprehensive theoretical model. Once this stage is achieved, findings are synthesised into five interconnecting dimensions, resulting in a grounded theory framework that explains the process of resilience-building among IDPS in Myanmar. To enhance theoretical sensitivity, the author has reviewed relevant literature along with existing theoretical frameworks and prior empirical findings on displacement and trauma. Furthermore, the author developed a programmatic logframe tailored to field-level project implementation aimed at supporting resilience-building among IDPS in Southeastern Myanmar.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Ethical Considerations\u003c/h2\u003e \u003cp\u003e Before conducting the study, ethical approval was obtained from the Community Ethics Advisory Board (CEAB) at Mae Tao Clinic. All participants were informed of the study\u0026rsquo;s objectives, and consent forms were provided before each interview, along with assurances that their identity and location would remain confidential throughout the research process. Written consent was obtained from participants who were able to read and write, while oral consent was secured from those unable to provide written consent. To protect participant anonymity, the names of IDP camps, participant names, and locations were omitted. Pseudonyms were assigned during transcription, coding, and data analysis to ensure confidentiality.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Demographic Characteristics of Participants\u003c/h2\u003e \u003cp\u003eThis study involved a varied group of 23 participants drawn from the Kayah, Kayin, and East Bago regions, including internally displaced persons (IDPs), civil society organisation (CSO) leaders, local governance officials, and individuals affiliated with donor agencies. Of the total participants, 14 were male and 9 were female. All individuals representing donor organisations were male. Among the IDPs interviewed, 9 were male and 5 were female. Within CSOs, 3 participants were women and 1 was a man, whereas local governance officials comprised 2 men and 1 woman. The largest age group represented was 31\u0026ndash;40 years (8 participants), followed by 21\u0026ndash;30 years (7 participants), over 50 years (5 participants), and 41\u0026ndash;50 years (3 participants). To ensure participant confidentiality in quoted material, each person was assigned a code based on their gender and role: for example, \u0026ldquo;Donor_M1, M2\u0026rdquo; for donors, \u0026ldquo;Governance_M1, M2\u0026rdquo; or \u0026ldquo;Governance_F1, F2\u0026rdquo; for governance officials, \u0026ldquo;CSO_M1, M2\u0026rdquo; or \u0026ldquo;CSO_F1, F2\u0026rdquo; for CSO representatives, and \u0026ldquo;IDP_M1, M2\u0026rdquo; or \u0026ldquo;IDP_F1, F2\u0026rdquo; for IDPs.\u003c/p\u003e \u003cp\u003eThe findings are organised around key themes from the data and formulated in grounded theory, shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Five interconnecting dimensions were described from the key theme, including the causes of displacement, contextual vulnerabilities, resilience-building factors, strategic interventions, and the conditions that either enable or hinder resilience.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Causal Condition for Displacement\u003c/h2\u003e \u003cp\u003eThe displacement of populations in Myanmar was driven by interconnected factors. Armed conflict, marked by airstrikes and heavy weaponry along with loss of homes and livelihood, created an environment of fear and instability, forcing many to flee their homes. Climate change further exacerbated the crisis, as environmental degradation disrupted traditional livelihoods like farming and fishing, deepening economic hardship. Political instability compounded these challenges, with year-long civil war and institutional support leaving IDPs without protection or recourse.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Contextual Factors for Vulnerability\u003c/h2\u003e \u003cp\u003eOnce displaced, populations faced a multitude of vulnerabilities. The fears of airstrikes and heavy weaponry cause psychological trauma in communities to feel safe and stay in their home and work. Additionally, the feeling of insecurity caused by the armed conflict, along with the conscription laws and abduction, has deepened vulnerability. The feeling of safety risk persisted, as many IDPs lived in temporary shelters with little protection from ongoing violence. Economic hardship was widespread, with limited access to income-generating opportunities and markets, pushing displaced families into increasingly vulnerable circumstances.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Factors Led to Resilience\u003c/h2\u003e \u003cp\u003eDespite these challenges, resilience emerged through various factors. Rebuilding their lives, driven by an unwavering internal motivation, became a cornerstone of their recovery, enabling them to move forward after the crisis. Adaptation was critical, as people adjusted to new realities by shifting to alternative livelihoods, such as cultivating resilient crops or engaging in informal labour. Resistance and persistence further fueled resilience, with communities uniting to confront external threats and demand their rights. Equally vital was mental strength, often sustained by spiritual beliefs or communal support, which empowered individuals to endure hardship.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Strategies for Resilience\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.5.1. Macro-level Strategies\u003c/h2\u003e \u003cp\u003eAt the macro level, resilience-building efforts prioritised systemic transformations to address root causes of vulnerability. Policy interventions aimed to promote political stability through inclusive peace processes while safeguarding the rights and dignity of IDPs.Critical infrastructure strengthening, including the rebuilding of healthcare, education systems and information technology, formed the critical foundation for sustainable recovery. Equally vital was proactive disaster preparedness, integrating community-led risk reduction strategies and conflict-sensitive humanitarian approaches to ensure aid interventions strengthened rather than undermined local resilience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.5.2. Meso-level Strategies\u003c/h2\u003e \u003cp\u003eCommunity-driven solutions were central to meso-level resilience. Collective responses such as farming initiatives, shared shelters, and conflict mediation efforts fostered cooperation and mutual support. Community-driven solutions, such as establishing rice banks for food safety and community-led livelihood approaches like mushroom farming, have provided an ideal approach to support resilience in the community. Strengthening coordination with local civil society organisations, including women empowerment groups, will further support locally based solutions, which will become sustainable in the long term.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.5.3. Micro-Individual Level Strategies\u003c/h2\u003e \u003cp\u003eOn an individual level, resilience was cultivated through capacity-building initiatives through proper assessments, such as vocational training, such as tailoring for women, motorcycle repair training and organic farming activities, which can expand their ability to rebuild their lives after the conflict. Futhermore, providing livelihood opportunities such as providing seeds for farming or empowering the existing ability of the individual will further enhance the individual's ability to respond and rebuild during crises. Strengthening mental health and psychosocial support, including peer counselling and professional support, addressed the psychological impact of displacement. By expanding mental health and psychosocial support through peer counselling and professional services, communities will develop stronger mental strength to cope with the crisis.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.6. Intervening Conditions for Resilience\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.6.1. Enablers\u003c/h2\u003e \u003cp\u003eCertain conditions facilitated resilience. A sense of community, strengthened by shared suffering and collective action, enabled communities to support one another and empower them to respond to crisis. Community leadership played a pivotal role in organising aid and building trust within communities. Religious and spiritual, along with prioritising family, provided emotional and psychological strength, helping individuals and groups navigate trauma and uncertainty. Indigenous knowledge on finding essential food offered practical solutions for survival in hardship situations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.6.2. Barriers\u003c/h2\u003e \u003cp\u003eHowever, significant barriers hindered resilience efforts and deepened vulnerability. First, prolonged aid dependency often eroded self-sufficiency, creating cycles of reliance on external assistance rather than fostering local solutions. Second, severe resource scarcity frequently triggered intra-community competition, exacerbating tensions in already fragile settings. Third, inequitable aid distribution, particularly when targeting specific groups while excluding others, risks deepening existing vulnerabilities and weakening overall community resilience.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe study presents a grounded theory for transformation vulnerability to resilience through five interconnecting dimensions. Armed conflict based on political instability, along with climate change, disrupted communities through loss of homes and livelihood and forced them into hazardous situations. Futhermore, the vulnerability situation was exacerbated by fears of airstrikes and heavy weaponry, insecurity, along with economic hardship, which has further deepened the vulnerable situation. Factors including internal motivation to rebuild their lives, resistance and persistence to injustice, along with adaptability and mental strength, have demonstrated that resilience was about rebuilding agency, restoring dignity, and finding new opportunities for success rather than only surviving. A multi-level framework, comprising macro-level policy and infrastructure interventions, meso-level community action, and micro-level individual coping strategies, has created an enabling environment that empowers displaced communities to not only recover from crisis but also develop sustainable pathways for long-term resilience. Furthermore, resilience is mediated by both positive enablers (sense of community, social circle support, indigenous survival knowledge, shared suffering,religious coping, collective resistance, community leadership, prioritising family) and negative barriers (aid dependency, Resource scarcity, selective support).\u003c/p\u003e \u003cp\u003eThe findings of this study align closely with existing literature on forced displacement, vulnerability and resilience building among conflict-affected internally displacement populations. Similar to earlier research, factors such as political instability, armed conflict, loss of livelihoods, and climate change were identified as primary drivers of displacement [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] Economic hardship, psychological trauma, and instability were frequently mentioned as vulnerabilities; these results are aligned with research done in South Sudan, Syria, and Afghanistan. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] The role of spiritual coping and indigenous knowledge echoes studies from Sub-Saharan Africa [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and Latin America [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], while the risks of aid dependency corroborate critiques of humanitarian systems [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Similar to findings in other humanitarian contexts, resilience emerges through community solidarity, adaptation, resistance to injustice, and spiritual coping [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Furthermore, this study's theoretical framework demonstrates that multi-level strategies for improving resilience are critical for supporting IDPS as proposed by the Inter-Agency Standing Committee (IASC) and UNHCR on community resilience in crisis settings. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDespite alignment with broader research, there are notable discrepancies between existing theories and the findings from this study. Conventional resilience models, like Ungar's \"navigation and negotiation\" theory [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], Norris's community resilience model [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], and Y.T. Maru's adaptation pathways model for vulnerability to resilience in remote disadvantaged communities [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] place a strong emphasis on systemic adaptation and resource access, but they frequently assume that stable external systems, such as government or humanitarian organizations, are available. On the other hand, the situation in Myanmar demonstrated that resilience frequently arises when there are almost no operational institutions. Additionally, previous studies mostly focus on structural factors [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]; our grounded theory provides resilience strategies at the individual and community levels. The theory emphasises how systemic barriers (such as inequitable aid) may hinder even robust community efforts, especially in the face of current humanitarian support. [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSimilarly, this study emphasises that resilience is not linear; many IDPs suffer cycles of relocation and reconstruction, often regressing in the face of repeated war, despite previous studies' emphasis on post-traumatic growth in prolonged displacement [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].In contrast to models that depend significantly on external aid frameworks [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], the theory presented here highlights enabling conditions and community-driven solutions, indicating that a community empowerment approach is more important for maintaining resilience among Myanmar's displaced populations. This approach aligns with the recommendation by a previous study that focuses on social capital improvement in post-disaster recovery. [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] The importance of collective resistance in Myanmar's setting also deviates from apolitical resilience models [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], highlighting the necessity of political stability and local leadership along community-centric multilevel strategies [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. These approaches offer a corrective to top-down humanitarian models, aligning with decolonial critiques [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Moreover, the theoretical framework provides a reference for policymakers, INGOs, and development programs to decrease vulnerability and strengthen long-term resilience programs for IDPs communities, especially in conflict-affected countries like Myanmar.\u003c/p\u003e \u003cp\u003eThis study, guided by a Constructive Grounded Theory approach, has several limitations that warrant consideration. First, the exclusive reliance on qualitative data introduces the potential for subjectivity and researcher interpretation bias. To mitigate this, CMATA and Tagutte software were employed for systematic coding, and member-checking procedures were conducted to validate findings. However, as with all iterative coding processes, there remains a risk of overlooking emerging themes; future studies should integrate regular peer debriefings and validation workshops to enhance analytical rigour. Secondly, the cultural and linguistic diversity of participants from Mon, Kayin, Kayah, and Eastern Bago may limit the transferability of findings to IDP populations in other regions of Myanmar or internationally. While stakeholder analysis was used to ensure representation from a variety of backgrounds, further research should explore the applicability of this theory across different socio-political and cultural contexts. Despite these constraints, the study offers a grounded theory that clarifies the methods by which comprehensive approaches to transform vulnerable IDPs communities into more resilient ones.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThe study presented a grounded theory that reveals five interconnected dimensions for transforming vulnerability into resilience: displacement drivers, contextual vulnerabilities, resilience-building factors, strategic interventions, and enabling, along with constraining conditions for resilience among IDPS. The grounded theory emphasises the vital role of community-driven resilience mechanisms in the absence of steady institutional support, while reaffirming important displacement causes and vulnerabilities found in global contexts. The theory challenges conventional linear resilience models by demonstrating the non-linear, cyclical nature of displacement and the importance of political stability, local leadership, and conflict-sensitive, equitable aid frameworks in fostering sustainable resilience. Despite potential interpretation bias, this study provides grounded theory along with the key macro, meso, and micro-level resilience strategies, offering insights to improve current humanitarian approaches. This theoretical framework provides a reference for policymakers and INGOs in reducing vulnerability and building lasting resilience for IDPs in conflict zones like Myanmar.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors were involved in the conceptualisation and investigation of the articles. HMT is involved in data curation, formal analysis, methodology, software, and writing- original and final manuscripts. NZW, HNH and NNNL are involved in data curation, formal analysis, review and supervision of final manuscripts.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest :\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that they have no known financial or interpersonal conflicts that would have appeared to impact the research presented in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors sincerely thank all internally displaced participants, individuals who work with internally displaced populations and individuals who assisted in interviewing and identifying potential participants for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe paper received ethical approval from the Community Ethics Advisory Board (CEAB), with reference number CEAB-2024-016 on 9th December 2024. All the participants were informed that their participation was voluntary. Oral and written informed consent was obtained from all participants before conducting the interview and audio recording, which was in alignment with research ethics. All the participants\u0026rsquo; names were assigned pseudonyms. All methods were performed according to relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOral and written informed consent was obtained from all participants before conducting the interview and audio recording, which was in alignment with research ethics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors agree on consent for publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article. The datasets generated and/or analysed during the current study are not publicly available to preserve the anonymity of study participants; however, they are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUnited Nations High Commissioner for Refugees (UNHCR). Myanmar Emergency Update (as of 1 June 2024). United Nations High Commissioner for Refugees. 2024. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://myanmar.un.org/en/273228-myanmar-emergency-update-1-june-2024\u003c/span\u003e\u003cspan address=\"https://myanmar.un.org/en/273228-myanmar-emergency-update-1-june-2024\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAP News. 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Peace Direct, May 10, 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.peacedirect.org/time-to-decolonise-aid/\u003c/span\u003e\u003cspan address=\"https://www.peacedirect.org/time-to-decolonise-aid/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Internally Displaced Persons (IDPs), Myanmar, Resilience, Vulnerability, Humanitarian Support.","lastPublishedDoi":"10.21203/rs.3.rs-8939700/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8939700/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFollowing the Military coup in 2021, armed conflict, along with the recent earthquake, have exacerbated the vulnerabilities of displaced populations, leaving them with limited access to essential services and protection. Historically, support for IDPs has predominantly focused on immediate humanitarian needs, such as food, shelter, and medical assistance are crucial; they often frame IDPs solely as vulnerable individuals requiring aid, thereby neglecting opportunities to foster resilience within these communities.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo fill the gap in knowledge on how internally displaced persons (IDPS) in Myanmar navigate prolonged crises. This research aims to develop a grounded theory framework that shifts the narrative from vulnerability to resilience.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA constructivist grounded theory study was conducted using a mix of purposive and snowball sampling approaches, conducting in-depth online and in-person interviews with 13 IDPs and 10 individuals from the IDP support network in Mon, Kayin, Kayah and Eastern Bago regions between December 2024 and March 2025. Participants were eligible for inclusion if they were at least 18 years old and currently residing in an IDP camp or working with IDPS. The interviews were voice-recorded, translated and transcribed. Data were analysed inductively through a multi-stage coding process that included initial, intermediate, and advanced coding, memo writing and constant comparative methods to develop a theoretical model of the process of resilience-building among IDPS in Myanmar.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study presents a grounded theory for transformation vulnerability to resilience through five interconnecting dimensions. Armed conflict based on political instability, climate change, disrupted communities through loss of homes and livelihood and forced them into hazardous situations. Fears of airstrikes and heavy weaponry, insecurity, along with economic hardship, have deepened the vulnerable situation. Factors including internal motivation to rebuild their lives, resistance and persistence to injustice, adaptability, and mental strength enabled displaced individuals to rebuild agency and dignity. A multi-level framework, comprising macro-level policy and infrastructure interventions, meso-level community action, and micro-level individual coping strategies, is essential for sustainable resilience. Furthermore, resilience was influenced by positive enablers (community support, indigenous knowledge, religious coping, collective leadership) and hindered by barriers (aid dependency, resource scarcity, selective aid).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study provides grounded theory along with the key macro, meso, and micro-level resilience strategies, offering insights to improve current humanitarian approaches. This theoretical framework provides a reference for policymakers and INGOs in reducing vulnerability and building lasting resilience for IDPs in conflict zones like Myanmar\u003c/p\u003e","manuscriptTitle":"Transforming Pathways from Vulnerability to Resilience among Internally Displaced Populations in Myanmar Using a Constructive Grounded Theory Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-22 14:58:44","doi":"10.21203/rs.3.rs-8939700/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-16T04:27:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-05T04:47:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-01T20:45:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-29T19:45:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288859342936699797678803609981763751386","date":"2026-03-24T19:21:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213634856594510080408431823396183761018","date":"2026-03-23T14:56:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96457039506105623060822597467710843168","date":"2026-03-23T07:28:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"98842094251777753962424364917984703876","date":"2026-03-21T12:26:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-18T07:21:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-11T09:26:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-06T06:33:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-03-06T06:25:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d2473f94-f18a-49ce-a631-71e6ce66e4e0","owner":[],"postedDate":"March 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T07:08:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-22 14:58:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8939700","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8939700","identity":"rs-8939700","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}