- Understanding Risk Factors and Preventive Measures of Cardiovascular Disease in Refugee Communities (BMJ Heart)
- Building a Culture of Health Literacy during COVID-19 (Perspectives in Adult Education)
- Strengthening Culturally Competent Health Communication (Health Security)
- 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 (Journal of Refugee & Global Health)
- Adaptation and Implementation of a Parenting Curriculum in a Refugee/Immigrant Community Using a Task-Shifting Approach: A Study Protocol (BMC Public Health)
- Public Health Crisis in the Refugee Community: Little Change in Social Determinants of Health Preserve Health Disparities (Oxford University Press: Public Health Emergency COVID-19 Initiative)
- The Relationship Between Refugee Health Status and Language, Literacy, and Time Spent in the United States (Health Literacy Research and Practice)
Understanding Risk Factors and Preventive Measures of Cardiovascular Disease in Refugee Communities
Julio Santana MD; Adonias Lemma; Mary Helen O'Connor, PhD; and Heval Kelli, MD.
According to the United Nations High Commissioner for Refugees (UNHCR), there are more than 80 million forcibly displaced persons worldwide as of 2020. This number creates numerous challenges, including the management of patients with chronic cardiovascular disease (CVD) and the associated complications. Despite recognition of the health disparities and policy mandates by the US government to slowly eliminate these barriers, the refugee, immigrant and migrant (RIM) communities continue to experience poor access to preventive healthcare.
Building a Culture of Health Literacy during COVID-19
Iris Feinberg, PhD
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
Iris Feinberg, PhD; Ashli Owen-Smith, PhD; Mary Helen O’Connor, PhD; Michelle Ogrodnick, Richard Rothenberg, MD; and Michael Eriksen, ScD.
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
Matthew J. Lyons, PhD; Mary Helen O'Connor, PhD; Iris Feinberg, PhD; Dan Whitaker, PhD; Michael Eriksen, ScD; Ashli Owen-Smith, PhD; Saiza Jivani, MPH; Mohammad Tamer; Esther Kim, MD; and Ganaro Makor.
Refugees are a vulnerable population who experience 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
Daniel J. Whitaker, PhD; Shannon Self-Brown, PhD; Erin A. Weeks, MPH; Mary Helen O’Connor, PhD; Matthew Lyons, PhD; Cathleen Willging; Nae Hyung Lee, PhD; Jessica L. Kumar; Hannah Joseph; Dennis E. Reidy, PhD; Danielle Rivers; and Nikita Rao.
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
Iris Feinberg, PhD; Mary Helen O'Connor, PhD; Ashli Owen-Smith, PhD; and Shanta Dube, PhD.
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
Iris Feinberg, PhD; Mary Helen O'Connor, PhD; Ashli Owen-Smith, PhD; Michelle Mavreles Ogrodnick, MPH; and Richard Rothenberg, MD.
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.