“It’s Hard Because It’s Something New”: Parenting Challenges Faced by Refugees and Immigrants in the United States.

Refugees and immigrants face many challenges when adjusting to a new country that can affect family functioning. Previous research has identified financial, cultural and social barriers to healthy parenting among refugees and immigrants (e.g., Stewart et al., 2014).  Most research in this area has focused solely on new arrivals and interventions designed to support migrant parents are often limited in length (Moinolmolki et al., 2020).

Authors:
Erin Weeks and Jessica Kumar

Refugee and immigrant parents from multiple countries of origin described facing many different parenting challenges associated with migration. Migrant parents noted difficulties with parenting practices like rules, discipline and family roles because of the many differences between their life in their home country and their life in the United States, including:

• Language
• Family structure
• Social norms
• Cultural values
• State and federal laws

Balancing multiple obligations is challenging for any parent, but migrants often raise children with minimal social support, making managing parenting, school, work and home responsibilities even more difficult. Participants described parenting challenges consistent with previous research. Still, most of the participants in this sample had lived in the United States for many years, suggesting that these challenges are long-lasting. Presented September 2021 at North American Refugee Health Conference.

For more information, contact Erin Weeks.

Community-based Collaboration: Meeting Refugees’ Needs During COVID-19

Authors:
Mary Helen O’Connor, Iris Feinberg, Ashli Owen Smith, Andrew Kim, Beverly Burks

Vulnerable communities including RIM and minorities have been disproportionately affected by the ongoing COVID-19 pandemic. For RIM community residents, long-standing health inequities are exacerbated by culturally and linguistically ineffective risk communication practices about COVID-19.  Supporting refugee communities during COVID-19 requires a multi-pronged community-based approach. Our presentation focused  on the efforts of a volunteer multidisciplinary, multi-sector community task force, the Clarkston Community COVID Task Force, to respond to the needs of the refugee community in Clarkston, Georgia as the pandemic unfolded.   The volunteer task force composed of community clinicians, local municipal and health department government representatives, resettlement and social service providers and academics met weekly to prioritize and respond to the needs of the community as the pandemic unfolded.  Approaches included developing COVID-19 mitigation and vaccine information in multiple languages and modalities, distributing PPE and health literate, plain language health education materials, hosting workshops with community partners specifically focusing on families with children, conducting a community needs analysis on the impact of COVID on the social determinants of health for residents and researching vaccine hesitancy and misinformation.

Presented Sep 9, 2021 at the North American Refugee Health Digital Conference .  For more information, contact  Mary Helen O’Connor.

Engaging a Refugee Community to Assess COVID-19 Vaccine Knowledge, Attitudes and Beliefs.

Authors:
Ashli Owen-Smith, Leen Almoner, Iris Feinberg, Mary Helen O’Connor, Erica Heath, Rodney Lyn, Michael Eriksen

Refugee, immigrant and migrant (RIM) communities experience barriers to routine vaccinations even under the best of circumstances for reasons including language barriers, cultural factors and a lack of consistent access to healthcare and/or understanding of how to access healthcare. We do not fully understand RIM communities’ knowledge, attitudes and beliefs (KABs) about the COVID-19 vaccine or how to best develop and disseminate messaging about the COVID-19 vaccine to this population.. Preliminary results suggest that, though there is some variation between language groups with respect to willingness to get the vaccine, there are also some common themes including (1) profound fear about vaccine safety and possible short- and long-term side effects and (2) a great deal of confusion about the cost of and where, when and how to access the vaccine. Participants generally favored using a combination of modalities to disseminate COVID-19 vaccine-related information including through community leaders, doctors, social media and print materials in different languages. Findings will be used to develop, disseminate and evaluate culturally and linguistically appropriate health messaging about the COVID-19 vaccine with the RIM community.

Presented Sep 9, 2021 at the American Refugee Health Digital Conference.  For more information, contact  Ashli Owen Smith

Building a Culture of Health Literacy in the Most Diverse Square Mile in American

Author:
Mary Helen O’Connor

This presentation discussed barriers to health in Clarkston, Georgia which include language and culture, limited English proficiency, fragmented services, trauma, limited access to and use of primary and preventive care services and high rates of chronic diseases.   Solutions presented included taking an asset-based approach to community needs through a community-wide summit, GIS mapping of community resources and creating and delivering culturally and linguistically appropriate materials developed with health literacy guidelines in both print and electronic format.  Presented October 20, 2020 at the Health Literacy Annual Research Conference.

For more information, contact  Mary Helen O’Connor.

Is it Language or Health Literacy? Unpacking Barriers to Refugee Health

Author:
Iris Feinberg

There are 3 million refugees living in the US today whose health and wellbeing may be diminished by not being able to understand and use health information.  Little is known about these barriers to health in multi-ethnic refugee communities.  The purpose of this study was to examine (1) the relationship between English proficiency, health literacy, length of time in the US and health status and (2) differences in poor health status by limited English proficiency and low health literacy individually and in combination to better understand which barriers might be addressed in improving refugee health.  There is a high correlation (Pearson’s r=0.77) between health literacy and English proficiency; they were moderately correlated with health status (0.40 and 0.37, respectively).  Length of time in the US only modestly correlated with health status (0.16).  Health literacy and English proficiency taken individually were strong predictors of health status (health literacy Odds Ratio = 4.0; C.I. 1.6-9.9, English proficiency Odds Ratio = 3.6, C.I. 1.5-9.0) but not significant. Their interaction, however, was significant and accounted for most of the effect (log odds for interaction =1.67, Odds Ratio =5.1, p<.05).  English proficiency and health literacy individually and in combination facilitate poor health and present health-related barriers for refugees.  Length of time in the US for refugees may not correlate with health status despite studies that suggest a change in health over time for the larger immigrant population.

Presented October 20, 2020, at the Health Literacy Annual Research Conference . For more information, contact  Iris Feinberg.

Understanding, Supporting and Addressing Refugee Needs in a Time of Crisis
Authors:
Iris Feinberg, Mary Helen O’Connor, Ashli Owen SmithNot all individuals receive and understand health information equally, in part because of cultural and linguistic differences. Recent research in a heavily populated refugee community indicates that most current COVID-19 information is received through word-of-mouth.Best efforts by clinicians, community workers, social service agencies, public health agencies and media to disseminate evidence-based information are not reaching this audience.Our immediate need was to address healthcare concerns and dispel community myths in a culturally competent and health literate manner. Critical needs are the large household sizes and the many residents who are frontline workers who have to go to work every day. We created an easy-to-read booklet and distributed it within the community. Here are some sample pages. You can access the full booklet. We anticipate beginning a full evaluation study of the booklet soon. Our secondary need was to inform resource distribution in the community through community agencies, health care providers and social service agencies. For example, we found that while many Refugees have food insecurity, they do not participate in food banks. We also found that 30% of families with children in school do not have a laptop, tablet or computer. This data allows the community to focus on providing the most needed help during this crisis.Presented June 27, 2020 at the Academy of Communication in Healthcare virtual conference.  For more information contact Iris Feinberg. 

Social Determinants of Health in Refugee Communities
Authors:
Mary Helen O’Connor and Iris FeinbergApproximately 17,000 refugees who speak 60 different languages have been resettled in Clarkston, Georgia, since 2004 under U.S. Resettlement Program, which provides refugees with legal, financial and social resources to assist them. These resources last from three months to one year and may include health insurance, living stipends, English language classes and job training. Even with this support, refugees continue to struggle with access to basic health care, high rates of mortality and morbidity, trauma-induced stress, lack of health insurance and challenging social determinants of health (SDOH) which impact both well-being and sick care. There is growing consensus that refugee and immigrant health is the public health crisis of this century4.
There is a dearth of evidence about the unique health needs of refugees in the U.S. Health care in Clarkston is provided by two volunteer-led free clinics, several sliding scale clinics, the DeKalb County Board of Health and a local hospital. These primary care teams are at the forefront of caring for Clarkston’s refugee community. Cultural and language dissonance and poor health status exacerbate the challenges that refugees face in accessing health care. Recent findings indicate that health care services are fragmented and often duplicative and that needs such as dentistry, vision and mental health services go unfulfilled. SDOH (e.g.., education, literacy skills, transportation, built environment, culture) further complicates the need for care. We present findings from a recent mixed-methods study in the Clarkston community.
Presented Nov 1, 2019 at the Center for Disease Control Place and Health Conference.  For more information, contact Mary Helen O’Connor.