Refugee Health Education: Evaluating a Community-Based Approach to Empowering Refugee Women in Houston, Texas

  • Elizabeth Leah Frost University of Texas School of Public Health
  • Christine Markham University of Texas School of Public Health
  • Andrew Springer University of Texas School of Public Health
Keywords: Refugee health, women’s health, health education, program evaluation

Abstract

Although resettlement agencies in the United States assist refugees by offering a variety of local social and health services, refugees are still less likely to access these services. Few studies have evaluated refugee health education interventions focusing on barriers to accessing healthcare and overcoming negative social determinants of health. This study evaluated the feasibility, acceptability, and perceived impact of a yearlong health education intervention to empower Burmese refugee women living in Houston, Texas. The intervention included workshops, community excursions, question and answer (Q&A) sessions, and home visits. The evaluation was a formative qualitative study including interviews with Burmese refugee women who participated in the intervention and local resettlement agency caseworkers. Qualitative content analysis guided the data analysis and was conducted to identify categories and emergent themes. Key findings indicated that motivation to participate in the intervention was impacted by the women’s perceived relevance of health education material to Burmese cultural values and opportunities for hands-on learning to promote self-efficacy. Recommendations for future interventions include the use of community health workers to train refugee health educators, pairing English lessons with health education material to promote development of English language skills, developing teaching materials for refugees with low literacy, establishing bottom-up support from refugee resettlement agencies, and incorporating the social work ecological model to tailor health-focused interventions to the specific needs of the refugee community.

Author Biographies

Elizabeth Leah Frost, University of Texas School of Public Health
Department of Health Promotion and Behavioral Sciences
Christine Markham, University of Texas School of Public Health

Department of Health Promotion and Behavioral Sciences

Associate Professor

Andrew Springer, University of Texas School of Public Health

Department of Health Promotion and Behavioral Sciences

Associate Professor

References

Baird, M.B., Domian, E.W., Mulcahy, E.R., Mabior, R., Jemutai-Tanui, G., & Filipe, M.K. (2015). Creating a bridge of understanding between two worlds: Community-based collaborative-action research with Sudanese refugee women. Public Health Nursing, 32, 388–396.

Balcazar, F.E., Garcia-Iriarte, E., & Suarez-Balcazar, Y. (2009). Participatory action research with Colombian immigrants. Hispanic Journal of Behavioral Sciences, 31(1), 112-127.

Bartholomew, K.L., Markham, C.M., Ruiter, R.A.C., Fernandez, M.E., Kok, G., & Parecel, G.S. (2016). Planning health promotion programs, an intervention mapping approach. San Francisco, CA: Jossey-Bass.

Clark, A., Gilbert A., Rao, D., & Kerr, L. (2014). ‘Excuse me, do any of you ladies speak English?’ Perspectives of refugee women living in South Australia, barriers to accessing primary health care and achieving the Quality Use of Medicines, Australian Journal of Primary Health, 20, 92-97.

Eckstein, B. (2011). Primary care for refugees. Am Fam Physician, 83(4), 429-436.

Glanz, K., Rimer, B.K., & Viswanath, K. (2008). Health behavior and health education, theory, research and practice. San Francisco, CA: Jossey-Bass.

Im, H., & Rosenberg, R. (2016). Building social capital through a peer-led community health workshop: A pilot with the Bhutanese refugee community. J Community Health, 41(3): 509-517.

Khawaja, N.G., White, K.M., Schweitzer, R, & Greenslade, J. (2008). Difficulties and coping strategies of Sudanese refugees: A qualitative approach. Transcultural Psychiatry, 45(3), 489-512.

Lapan, S.D., Quartaroli, M.T., & Riemer, F.J. (2012). Qualitative research. San Francisco, CA: Jossey-Brass.

Mirza, M., Luna, R., Mathews, B., Hasnain, R., Hebert, E., Niebauer, A., & Mishra, U.D (2014). Barriers to healthcare access among refugees with disabilities and chronic health conditions resettled in the US Midwest. J Immigrant Minority Health, 16(4), 733-742.

Montour, J., & Kazmierski, V. (2013). Texas Refugee Health Program-2014 Refugee Health Report. Texas Department of State Health Services.

Morris, M.D., Popper, S.T., Rodwell T.C., Brodine S.K., & Brouwer, K.C. (2009). Healthcare barriers of refugees post-resettlement. J Community Health, 34, 529-538.

Murray, K., Mohamed, A.S., & Ndunduyenge, G. (2013). Health and prevention among East African women in the U.S. J Health Care Poor Underserved, 24(1): 233-246.

National Committee for Health Education. (2016). The health education specialist: A companion guide for professional excellence (7th ed.). Whitehall, PA: National Committee for Health Education.

Pesata, V., Pallija, G., & Webb, A.A. (1999). A descriptive study of missed appoints: families’ perceptions of barriers to care. J Pediatric Health Care, 13, 178-182.

Roger, E.M. (2003). Diffusion of innovations. London: Free Press.

Sheikh-Mohammed, M., Mcintyre, C.R., Wood N.J., Leask J., & Isaacs, D. (2006). Barriers to access to health care for newly resettled sub-Saharan refugees in Australia. Medical Journal of Australia, 185, 594-597.

Simich, L., Beiser, M., Stewart, M., & Mwakarimba, E. (2005). Providing social support for immigrants and refugees in Canada: Challenges and directions. Journal of Immigrant and Minority Health, 7(4), 259-268.

Thoits, P.A. (2011). Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior, 52(2), 145–161.

United States Department of State. (2015). FY15 Refugee Admissions Statistics. Retrieved from https://2009-2017.state.gov/j/prm/releases/statistics/251285.htm.

Vermette, D., Shetgiri, R., Al Zuheiri, H., & Flores, G. (2015). Healthcare access for Iraqi refugee children in Texas: Persistent barriers, potential solutions and policy implications. J Immigrant Minority Health, 17, 1526-1536.

Walker, R., Koh, L., Wollersheim, D., & Liamputtong, P. (2015). Social connectedness and mobile phone use among refugee women in Australia. Health and Social Care in the Community, 23(3), 325-336.

Wilkinson, R., & Marmot, M. (Eds.) (2003). The social determinants of health: The solid facts (2nd ed.). Copenhagen, Denmark: WHO Europe.

Zanchetta, M.S., & Poureslami, I.M. (2009). Health literacy within the reality of immigrants’ culture and language. Canadian Journal of Public Health in Canada 2006; 97(2): S26-S30 22.

Published
2018-09-18