Challenges in health-care service use among Burmese refugees: A grounded theory approach

Shared Decision-Making in the ICU: Communicating With Patients Who Speak a Language of Lesser Diffusion

Effective bidirectional communication is crucial during end-of-life decision-making, which requires clear understanding between clinicians and patients and their family members about treatment options, preferences, and goals of care. For those who have a non-English language preference or who have difficulty speaking, reading, writing, and understanding English, interpreters are essential. However, patients who speak rarer languages, known as languages of lesser diffusion (LLDs), such as Karen, spoken in Thailand and Myanmar, face unique challenges because of limited interpretation resources. In this work, we discuss the case of a Karen-speaking patient admitted to the ICU who lacked decision-making capacity, requiring the involvement of family members who also spoke Karen for a code status discussion. Despite efforts to find an interpreter, no Karen interpreter was available initially, complicating the communication and decision-making about changing the code status to do not resuscitate/do not intubate. A remote Karen interpreter was identified later, allowing for effective communication and clinician assurance that the family did understand the implications of their decision and had made it voluntarily. End-of-life decision-making is complex and challenging, requiring culturally sensitive communication. Patients who speak LLDs face unique difficulties in these discussions compared with those who speak more common languages because of the lack of interpretation resources. The purpose of this case report is to draw attention to these specific challenges and explore ethical concerns when engaging in decision-making conversations with patients and families who speak an LLD.

An exploratory study of resettled Rohingya refugees: Healthcare access and preventive cancer screenings

Research suggests that preventive healthcare needs are high among U.S. refugees from Myanmar; yet no studies have examined healthcare patterns among U.S. Rohingya refugees. We examined participation in preventive cancer screening, healthcare access barriers, and facilitators in a community-based sample of 308 Rohingya refugees in Chicago, Illinois. Descriptives were conducted for the participation rates to preventive cancer screenings, indicated by age and gender. Chi-square tests were used to examine gender differences in barriers and facilitators in healthcare. Participants reported low participation in preventive screenings (e.g. 89.2% never received a Papanicolaou (pap) test). Healthcare access barriers were observed: 82.8% uninsured, 81.2% not knowing where to go for healthcare needs, and 55.1% needed interpretation, with men less likely to have had a doctor's visit in the past year or a regular provider. Findings highlight the urgent need to further develop or tailor interventions to address the healthcare needs for resettled Rohingya refugees.

Refugees' Experiences Accessing and Receiving Health care in the Southwestern U.S

Resettled refugees face physical and mental health challenges including the violence and trauma of their displacement. Once resettled in the U.S. refugees face difficulties accessing healthcare. This qualitative study explored refugees' experiences with barriers and facilitators to accessing healthcare. Thirty-four resettled refugee adults from five different countries of origin participated in focus groups. Study results identified logistical and language barriers to accessing healthcare, experiences with discrimination and fear, and the role of integration in promoting access and satisfaction with healthcare. Implications are provided for improving access to healthcare for refugees in the U.S.

Ethical challenges in organ transplantation for Syrian refugees in Türkiye

BACKGROUND

There is limited information on the ethical issues encountered in living donor organ transplants performed on refugees and asylum seekers. This study investigates the ethical challenges faced by Syrian refugees under temporary protection in Türkiye who engage in living donor organ transplants.

METHODS

From April to July 2022 in Istanbul, the research employed a qualitative design involving semi-structured, in-depth interviews with 27 participants, including organ donors and recipients. The analysis utilized a thematic analytic method.

RESULTS

The findings elucidate two principal themes related to ethical concerns: justice and autonomy. Under the justice theme, several sub-themes emerged, highlighting the multifaceted challenges Syrian refugees face in accessing healthcare services. These include migration and language barriers, significantly impeding their ability to understand medical procedures and rights. Financial difficulties and restricted movement within the country further complicate their access to necessary healthcare. Despite these hurdles, refugees benefit from free access to organ transplantation services and medications, a policy underscoring Türkiye's commitment to healthcare equity for protected populations. The autonomy theme addresses the ethical handling of donor consent and motivation. The results indicate that Syrian refugees undergo a transplantation process free from coercion, with rigorous oversight by organ transplant ethics committees ensuring the prevention of donor abuse. However, despite these protective measures, challenges persist in the informed consent process, primarily due to language barriers that hinder effective communication between healthcare providers and patients. While the efforts of healthcare professionals to assist are recognized as alleviating some difficulties, the broader issues of access to comprehensive health services remain a significant concern. These barriers suggest a need for enhanced linguistic and financial support to improve healthcare accessibility for refugees.

CONCLUSIONS

This study posits that the healthcare framework provided by Türkiye to Syrians under temporary protection can serve as a model for international human rights and social justice. However, it also emphasizes the importance of addressing the persistent obstacles that limit healthcare access for asylum seekers. Recommendations for policy enhancements focus on improving language services, increasing financial support, and expanding the accessibility of comprehensive health services to ensure equitable health outcomes for refugees.

Understanding the Health Literacy Experiences and Practices of Australian-Resettled Myanmar Refugees: Relevance for Nutrition and Dietetics Practice

Background/Objectives: Refugees typically experience poorer health compared with people from non-refugee backgrounds, and health literacy may play a part in this discrepancy. Using the WHO's revised health literacy definitions as a framework, this qualitative study sought to examine the health literacy experiences and practices of Australian resettled refugees from Myanmar from refugee and service provider perspectives. Methods: Four refugee participant focus groups (n = 27) along with one focus group and four interviews with service providers (n = 7) were conducted in Melbourne, Australia, and analysed using deductive content analysis. Results: Our study found that in addition to individual health literacy, community literacy was practiced by Myanmar refugees, thus highlighting the relevance of social support to health literacy. Furthermore, our study found gaps in healthcare service provision and resourcing related to health literacy development and responsiveness by the healthcare system. Conclusions: Our study confirms the relevance of WHO's revised health literacy definitions to Myanmar refugees while also discussing, in the context of nutrition and dietetics practice, the importance of understanding the different aspects of health literacy and how this relates to working with those who are most marginalised to improve their health and wellbeing.

Barriers and facilitators experienced by migrants and refugees when accessing pharmaceutical care: A scoping review

BACKGROUND

Pharmacists in the community are often among the first health professionals encountered by new arrivals. Their accessibility and the longevity of the relationship gives pharmacy staff unique opportunities to work with migrants and refugees to meet their health needs. While the language, cultural and health literacy barriers that cause poorer health outcomes are well documented in medical literature, there is a need to validate the barriers to accessing pharmaceutical care and to identify facilitators for efficient care in the migrant/refugee patient-pharmacy staff interaction.

OBJECTIVE

The purpose of this scoping review was to investigate the barriers and facilitators that migrant and refugee populations experience when accessing pharmaceutical care in host countries.

METHODS

A comprehensive search of Medline, Emcare on Ovid, CINAHL and SCOPUS databases, guided by the PRISMA-ScR statement, was undertaken to identify the original research published in English between 1990 and December 2021. The studies were screened based on inclusion and exclusion criteria.

RESULTS

A total of 52 articles from around the world were included in this review. The studies revealed that the barriers to migrants and refugees accessing pharmaceutical care are well documented and include language, health literacy, unfamiliarity with health systems, and cultural beliefs and practises. Empirical evidence was less robust for facilitators, but suggested strategies included improvement of communication, medication review, community education and relationship building.

CONCLUSIONS

While barriers experienced are known, there is a lack of evidence for facilitators for provision of pharmaceutical care to refugees and migrants and poor uptake of available tools and resources. There is a need for further research to identify facilitators that are effective in improving access to pharmaceutical care and practical for implementation by pharmacies..

Adaptation of the All Aspects of Health Literacy Scale (AAHLS) for Karen refugees: factor analysis

Health literacy has been identified as a significant predictor of healthcare utilization among refugee and immigrant communities. Considering its potential impact on their health outcomes, accurately measuring levels of health literacy among limited English proficiency (LEP) populations is an important area of investigation. This study examined the psychometric properties of a modified version of the All Aspects of Health Literacy Scale (AAHLS), based on Nutbeam's model of health literacy, using an exploratory factor (EFA) and confirmatory factor (CFA) analysis among a sample of Karen refugees, an ethnic minority group from Burma. Results of the EFA confirmed a 3-factor model in our sample. CFA results indicated good model fits, demonstrating a promising use of the AAHLS in assessing health literacy among Karen refugees. The findings of this study support the validity of using this measure among this population and suggest some necessary adjustments to incorporate factors unique to the refugee experience that may affect the interpretation and application of items in the AAHLS. Further replication using other LEP samples is necessary to confirm the psychometric properties of the AAHLS and its ability to assess health literacy using Nutbeam's theoretical model of health literacy.

"Sometimes that Takes You Going the Extra Mile": The Role of Providers' Self-efficacy in Refugee Mental Health Services

To achieve equity for refugee patients in mental health care settings, patient-centered, trauma-informed, and cultural humility practices have gained recognition; however, the use of these practices is not well defined. The implementation process of these practices may require providers' increased self-efficacy, motivation, and cultural intelligence (CQ). Overall, this study aims to understand training needs of health care providers to be able to provide refugee patients with culturally meaningful, patient-centered, and trauma-informed care. This is an explanatory sequential mixed-methods study and surveys (n = 20) were followed by in-depth interviews (n = 7) with health care providers. The results indicate that there is a positive relationship between providers' self-efficacy and CQ. The interviews revealed three major themes including sources of self-efficacy, the importance of trust-building, and creating trauma-informed healthcare systems. The findings suggest that a trauma-informed, patient-centered training focusing on self-efficacy and CQ enhancing activities for health care providers can improve mental health services for refugee patients.

Health disparities among Burmese diaspora: an integrative review

Tens of thousands of displaced Burmese ethnic minorities have endured various adversities for over six decades but are largely underserved. This study aimed to illuminate the health impacts of their misfortunes and unmet areas of concern. Using a holistic lens, we conducted an integrative review of 47 papers spanning the years 2004 to 2022 from diverse data sources. The results revealed widespread multimorbidity, triggered mainly by displacement. The diaspora's problematic health conditions were worse than their host country's general population. There was a strong indication that the diaspora's unfortunate health trajectory is determined early in life. Ongoing human rights violations and grossly inadequate health care interventions deepened pre-existing health conditions. Noteworthy emerging treatment initiatives, including integrative health care, were underutilized. The persisting health and intervention needs among the diaspora warrant advanced studies to facilitate much-needed resource mobilization and collaboration among stakeholders to promote health equity.

Funding

There was no financial support for this manuscript.

Social Determinants of Mental Health Among Karen Refugees from Burma

Extant literature has documented a higher level of mental health issues among refugee populations compared with that of the general population. Mental health problems may significantly decrease refugees' quality of life and interfere with a successful transition to their country of resettlement. Using the social determinants of mental health framework, we examined factors affecting psychological distress among Karen refugees from Burma residing in a mid-size city in a northeastern state in the United States. A total of 201 participants completed face-to-face interviews conducted in the Karen language. Results showed that trauma and religious participation were positively associated and education and health status were negatively associated with psychological distress. The findings of this study reiterate the importance of trauma and health conditions to mental health and suggest potential points of interventions among the resettled Karen refugees.

Fish consumption and awareness of fish advisories among Burmese refugees: A respondent-driven sampling study in Milwaukee, Wisconsin

BACKGROUND

Since 2000, more than 6000 Burmese refugees were resettled in Wisconsin. The Burmese diet is traditionally rich in fish and fish products, and studies show that Burmese refugees continue to rely on local waterbodies for food. Given that Wisconsin has five Areas of Concern (AOC) that are severely affected by pollution, long-term exposure to contaminants in sport-caught fish is a health concern. To better understand fish consumption among Burmese refugees, we conducted a biomonitoring study in Milwaukee. The present study examined Burmese refugees' fish consumption habits and awareness of fish advisories.

METHODS

We used respondent-driven sampling (RDS) methodology to recruit Burmese refugees in Milwaukee. RDS Analysis Tool 7.1 was used to obtain adjusted population estimates for demographic characteristics, fish consumption habits, and awareness of fish advisories. Homophily and equilibrium were investigated to evaluate the effectiveness of RDS in recruitment.

RESULTS

Initiated by five active seeds, we recruited 103 respondents to participate in the study. Respondents had a strong preference to recruit those with the same ethnicity (Homophily-score: 0.614 to 0.699) and a relatively weak preference to recruit those with the same sex (Homophily-score: 0.188 to 0.222) to participate in our study. The majority (72.5%) of respondents were women of childbearing age (WCBA). Most (68.5%) had 8th grade or less education. Regarding sportfish consumption per month in the last year, 30.6% reported eating 1-3 meals and 21.2% reported eating more than 3 meals. When asked about purchased fish consumption per month, 26.3% reported eating 1-3 meals. The overwhelming majority were not aware of safe-eating sportfish guidelines for Wisconsin (88.3%) or Milwaukee waterbodies (96.6%).

CONCLUSIONS

RDS is an effective methodology to recruit hard-to-reach populations, such as the Burmese surveyed in this study. High percentages of WCBA eating potentially contaminated sportfish meals, low awareness of consumption advisories, and limited economic resources make the Burmese population more likely to be exposed to contaminants. Health education efforts should be focused in this vulnerable population, particularly among Burmese WCBA.

Patterns of Primary Care Use Among Young Adult Refugees Resettled in Colorado

Little is known about the prevalence of young adult refugees' primary care use following resettlement in Colorado. Among a sample of Bhutanese and Burmese young adult refugees resettled in Colorado, proportions with a primary care provider (PCP), physical exam in the last 12 months, and knowledge to make an appointment were calculated across 4 years and compared within the refugee population by demographics using Pearson's Chi-Squared tests and compared to older refugees and to the general population using two-tailed tests of proportions. Greater than 70% of young adult refugees reported a physical exam in the last 12 months during the 4 years after arrival. Disparities were identified within young adult refugees by sex, marital status and country of origin. Young adult refugees were significantly different than both refugees over 55 and the general population in terms of their primary care use. Young adult refugees need support to identify PCPs earlier in resettlement and maintain primary care use years after resettlement.

Simple contents and good readability: Improving health literacy for LEP populations

Accessing and receiving quality healthcare in an unfamiliar health system is a significant challenge for many new immigrants and refugees. This study aims to provide a three-phase model to develop a web-based health information website that helps populations with limited English proficiency (LEP) increase health literacy and improve healthcare service access.

METHOD

First, we conducted a needs assessment from community leaders and service providers. Second, we developed contents from credible sources and tested each item using multiple readability tests. Last, we revised each item to lower the readability and retest its readability.

RESULTS

The average reading level for the original 99 topics was assessed at 10.84 (SD= 3.26). After revisions, we were able to lower the readability to 8.56 (SD= 2.96), which was around two grade levels lower, on average.

CONCLUSION

the main purpose for building an English based health information website was to assist the population with LEP. By using simple English with lower readability, it will ease the translation process. This study demonstrates a process to develop suitable contents for populations in need. In the future, incorporating visual aid and other multimedia will be beneficial in user engagement and knowledge retention.