Optimizing Longitudinal Psychosocial Support in Pediatric Heart Transplant Recipients and Their Families.

A quarter of the global population—approximately 2.1 billion people—live in fragile contexts, including 72% of those in extreme poverty []. The 2024 Global Peace Index reveals an historic decline in global peacefulness, with a record 97 countries becoming less peaceful, 56 active conflicts and a sharp rise in military spending and displacement []. As of June 2024, more than 37 million people were forcibly displaced across borders as refugees and 68 million more were displaced within their own countries due to conflict, persecution and disaster []. These trends highlight the urgent need for stronger investment in peacebuilding and conflict prevention over militarization []. In fragile contexts, such as those affected by conflict and forced displacement, social cohesion is critical to fostering peaceful coexistence, reducing inter- and intragroup tensions and supporting pathways to integration. This is particularly true where state structures are weakened or exclusionary [,]. Social cohesion, grounded in trust, a sense of belonging, participation, willingness to help and acceptance of diversity, offers a practical framework for mitigating social tensions and rebuilding fractured societies []. In a world increasingly shaped by uncertainty and instability, the question of how to effectively build social cohesion is critical to promoting peace and supporting sustainable post-conflict and post-disaster reconstruction. However, rigorous evidence on how to build social cohesion in fragile contexts is limited; a recent systematic review identified only 37 papers based on 24 unique studies across all Low- and Middle-Income Countries (LMICs) []. This paper contributes to this limited evidence base by reporting the results of a pilot randomized controlled trial (RCT) of a locally developed, community-based intervention that aimed to promote social cohesion in Lebanon, a fragile state hosting large Syrian and Palestinian refugee populations and affected by deep sectarian divisions and armed conflict. There is no single, universally accepted definition of social cohesion; rather, scholars have articulated the concept in multiple ways, reflecting diverse theoretical frameworks and contextual interpretations. Generally, social cohesion refers to the strength and quality of relationships that bind individuals and groups within a society, enabling cooperation, trust and a shared sense of belonging. It encompasses both horizontal ties, i.e., the connections between individuals and communities, and vertical ties that link people to institutions and the state []. The literature broadly agrees on five interrelated domains of social cohesion: trust, sense of belonging, willingness to participate, willingness to help and acceptance of diversity [,].