Research and publications created by the Prevention Research Center at Georgia State.
- Building a Culture of Health Literacy during COVID-19
- Strengthening culturally competent health communication
- Comparing the health and welfare of refugees and non-refugees at the outset of the COVID-19 pandemic: the results of a community needs assessment
- Adaptation and implementation of a parenting curriculum in a refugee/immigrant community using a task-shifting approach: a study protocol
- Public Health Crisis in the Refugee Community: Little Change in Social Determinants of Health Preserve Health Disparities
- The Relationship Between Refugee Health Status and Language, Literacy and Time Spent in the United States
Building a Culture of Health Literacy during COVID-19
* Feinberg, I. (2021) Building a culture of health literacy during COVID-19. New Horizons in Adult Education & Human Resource Development 33 (2) Special Issue: Special Issue: Adult and Continuing Education's https://onlinelibrary.wiley.com/toc/19394225/2021/33/2 Response to the Global COVID‐19 Pandemic https://onlinelibrary.wiley.com/toc/19394225/2021/33/2; 60-64. doi.org/10.1002/nha3.20316 https://doi.org/10.1002/nha3.20316
One in five Americans reads at elementary school levels (U.S. Department of Education et al., 2020). These low literacy skills include the technical part of reading (phonemic awareness, phonics, fluency) and the essential component of comprehension, the cognitive process readers use to understand what they have read. This means over 66 million people cannot read or understand most of the health materials that are currently written about COVID-19. If people do not understand what is being said, whether due to technical reading skills or poor comprehension, they will not be able to follow guidelines and instructions, know when to contact their health provider, or how to protect themselves and their families during this pandemic. We have learned that protective COVID-19 behaviors like wearing a mask and social distancing protect both the individual and the community. Adults who read at elementary levels (low literacy) are also likely to have low health literacy which are the skills that allow one to access, understand and use health information. If we allow adults with low literacy to fail at COVID-19 safeguards and inadvertently share this illness broadly throughout communities, we will all fail. The link between adult education and health literacy is a critical component of improving health outcomes for adults with low literacy. Individual skills such as reading, understanding numeracy issues like risk or probability, locating health information and verbal communication skills are fundamental to improving health literacy and can be successfully taught in adult education and English as a second language classes.
Strengthening culturally competent health communication
* Feinberg,I., Owen-Smith, A., O’Connor, M.H., Ogrodnick, M., Rothenberg, R., & Eriksen, M. (2021) Strengthening culturally competent health communication. Health Security 19 (S1); S41-S49. DOI: 10.1089/hs.2021.0048
Vulnerable refugee communities are disproportionately affected by the ongoing COVID-19 pandemic; existing long-standing health inequity in these communities is exacerbated by ineffective risk communication practices about COVID- 19. Culturally and linguistically appropriate health communication following health literacy guidelines is needed to dispel cultural myths, social stigma, misinformation and disinformation. For refugee communities, the physical, mental and social-related consequences of displacement further complicate understanding of risk communication practices grounded in a Western cultural ethos. We present a case study of Clarkston, Georgia, the ‘‘most diverse square mile in America,’’ where half the population is foreign born and majority refugee. Supporting marginalized communities in times of risk will require a multipronged, systemic approach to health communication including: (1) creating a task force of local leaders and community members to deal with emergent issues; (2) expanding English-language education and support for refugees; (3) including refugee perspectives on risk, health and wellness into risk communication messaging; (4) improving cultural competence and health literacy training for community leaders and healthcare providers; and (5) supporting community health workers. Finally, better prepared public health programs, including partnerships with trusted community organizations and leadership, can ensure that appropriate and supportive risk communication and health education and promotion are in place long before the next emergency.
Comparing the health and welfare of refugees and non-refugees at the outset of the COVID-19 pandemic: the results of a community needs assessment
* Lyons, M. J., O’Connor, M. H., Feinberg, I. Z., Whitaker, D., Eriksen, M., Owen-Smith, A., Jivani, S., Tamer, M., Kim, E., Makor, G. (2021) Comparing the health and welfare of refugees and non-refugees at the outset of the Covid-19 pandemic: the results of a community needs assessment. The Journal of Refugee and Global Health. 4(1); 1-6.
Refugees are a vulnerable population who experiences significant health disparities. They may also be at disproportionately high risk of adverse outcomes due to the COVID-19 pandemic. This paper presents the results of a community needs assessment to investigate the impact of the pandemic on health and welfare in a refugee relocation community in the United States. A multilingual data collection team made up of refugees surveyed 179 participants (128 refugees vs. 51 non-refugees). Only 55.9% of refugee respondents said they would be able to provide enough food for their family this week, compared with 84.0% of non-refugees (p < 0.01) and this difference was even greater for food next week (29.4% vs. 76.0%, p < 0.01). A non-significantly smaller proportion of refugees reported knowing where to go if they were sick (69.1% vs. 81.6%, χ2 = 2.8, p = 0.10) and being able to get the medicine they need (75.0% vs. 87.8%, p = 0.07), while significantly fewer refugees reported feeling safe at home (72.8 vs. 87.8%, χ2 = 4.5, p = 0.04). Overall, refugees fared worse on nearly every measure. These findings should motivate further observational research and inform clinicians about the significant disparities in social determinants of health that refugees may experience during the pandemic.
Adaptation and implementation of a parenting curriculum in a refugee/immigrant community using a task-shifting approach: a study protocol
* Whitaker, D.J., Self-Brown, S., Weeks, A., O’Connor, M.H., Lyons, M., Willing, C., Lee, N.H., Kumar, J., Joseph, H., Reidy, D., Rivers, D., Rao, N. (2021) Adaptation and implementation of a parenting curriculum in a refugee/immigrant community using a task-shifting approach: a study protocol. BMC Public Health. 21:1084; doi.org/10.1186/s12889-021-11148-2
Delivering evidence-based interventions to refugee and immigrant families is difficult for several reasons, including language and cultural issues and access and trust issues that can lead to an unwillingness to engage with the typical intervention delivery systems. Adapting both the intervention and the delivery system for evidence-based interventions can make those interventions more appropriate and palatable for the targeted population, increasing uptake and effectiveness. This study focuses on the adaptation of the SafeCare© parenting model and its delivery through either standard implementation methods via community-based organizations (CBO) and a task-shifted implementation in which members of the Afghans, Burmese, Congolese community will be trained to deliver SafeCare.
Public Health Crisis in the Refugee Community: Little Change in Social Determinants of Health Preserve Health Disparities
* Feinberg, I., O’Connor, M., Owen Smith A., Dube S. (2021). Public health crisis in the refugee community: little change in social determinants of health preserve health disparities. Health Education Research, cyab004, https://doi.org/10.1093/her/cyab004
Structural inequities and lack of resources put vulnerable refugee communities at great risk. Refugees flee their country of origin to escape persecution and flee from war, famine and torture. Resettled refugee communities become particularly vulnerable during times of crisis due to limited English proficiency and poor social determinants of health (SDOH), which create barriers to attaining and sustaining health and wellbeing for themselves and their families. The purpose of this case study was to evaluate SDOH among a refugee community in the Southeastern United States. We surveyed the community twice during a 1-year period to assess various elements of SDOH. Among a primarily African and Southeast Asian refugee community, 76% reported difficulty paying for food, housing and healthcare during the first round of surveys. During the second round of surveys at the beginning of the Coronavirus pandemic, 70% reported lost income; 58% indicated concern about paying bills. There was little change during the 12-month study period, showing that SDOH are an enduring measure of poor health and wellbeing for this vulnerable refugee community.
The Relationship Between Refugee Health Status and Language, Literacy and Time Spent in the United States
* Feinberg, I., O’Connor, M., Owen-Smith, A., Ogrodnick, M., Rothenberg, R. (2020). The Relationship of Language, Health Literacy, and Time in the US to Refugee Health. Health Literacy Research and Practice.2020 Oct; 4(4): e230–e236. Published online 2020 Dec 11. doi: 10.3928/24748307-20201109-01 https://dx.doi.org/10.3928%2F24748307-20201109-01
There are 3 million refugees living in the United States 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 multiethnic refugee communities.
This present study examined (1) the relationship between English proficiency, health literacy, length of time in the US and health status; and (2) differences in poor health status caused by limited English proficiency and low health literacy individually and in combination to better understand which barriers might be addressed by improving refugee health.
Presentations created by the Prevention Research Center at Georgia State .
- “It’s Hard Because It’s Something New”: Parenting Challenges Faced by Refugees and Immigrants in the United States.
- Community-based Collaboration: Meeting Refugees’ Needs During COVID-19
- Engaging a Refugee Community to Assess COVID-19 Vaccine Knowledge, Attitudes and Beliefs.
- Building a Culture of Health Literacy in the Most Diverse Square Mile in American
- Is it Language or Health Literacy? Unpacking Barriers to Refugee Health
- Understanding, Supporting and Addressing Refugee Needs in a Time of Crisis
- Social Determinants of Health in Refugee Communities
“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).
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:
- 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
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.
Engaging a Refugee Community to Assess COVID-19 Vaccine Knowledge, Attitudes and Beliefs.
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.
Building a Culture of Health Literacy in the Most Diverse Square Mile in American
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
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.
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.
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.