Objective: Since 2010, more than 527,000 refugees have resettled in the United States (US), most from Asia, fleeing war, violence, and persecution. However, there is little research that integrates findings about health among Southeast Asian refugees (SEAR). Design:We conducted an integrative review of studies that examined health status, risk factors, and barriers to healthcare access among SEAR in the US. We synthesized findings of studies published from 1980, when the Refugee Act was enacted, to 2022 using five databases. We reviewed 20 articles and data were extracted into a table for synthesis.Results: Participants were from Cambodia, Vietnam, Laos, Burma and the Thailand-Myanmar border. Hypertension (12%-64%), hypercholesterolemia (37%-39%), diabetes (0.6%-27%), heart disease (7%), bone and muscle problems (23%-50%), and chronic pain (8%-51%) were most common physical health problems; and PTSD (45%-86%) and depression (20%-80%) were the most common mental health problems.Trauma, resettlement stress, lack of community or religious engagement were associated with mental health problems. Language differences, transportation, and lack of health insurance were the most significant obstacles to receiving healthcare. Conclusion: SEAR experienced worse physical and mental health than the general US population. Different patterns of disease were identified depending on gender, time settled in the US, and ethnic group. Qualitative and longitudinal studies will elucidate refugees' experience and should guide interventions. K E Y W O R D S access to healthcare, ethnic minority, health disparity, health status, refugees 1 BACKGROUND Nearly 89.3 million people were forcibly displaced from their homes worldwide in 2021, and an additional 10 million were displaced in the first 5 months of 2022. Over 27 million currently displaced persons have been designated as refugees (The Office of the United Nations High Commissioner for Refugees (UNHCR), 2022), meaning that they are people who have fled war, violence, conflict, or persecution and have crossed an international border to find safety in another country (United Nations, n.d.). The number of refugees more than doubled from 2010 to 2020 and continues to rise due to unstable political situations in many countries, with more refugees in the world than ever in history. Many refugees have experienced considerable trauma in their home country and during migration (Sangalang et al., 2019). The United States (US) accepts the most refugees and has had the largest resettlement program in the world since the 1970s (UNHCR, 2022). In the past 45 years about 3,450,000 refugees from throughout the world resettled in the US; 600,900 refugees arrived in the US 324

Objectives Advance care planning (ACP) conversations require the consideration of deeply held personal values and beliefs and the discussion of uncertainty, fears, and hopes related to current and future personal healthcare. However, empirical data are limited on how such spiritual concerns and needs are supported during ACP. This study explored board-certified healthcare chaplains’ perspectives of patients’ spiritual needs and support in ACP conversations. Methods An online survey of 563 board-certified chaplains was conducted from March to July 2020. The survey included 3 open-ended questions about patients’ hopes and fears and about how the chaplains addressed them during ACP conversations. Written qualitative responses provided by 244 of the chaplains were examined with content analysis. Results The majority of the 244 chaplains were White (83.6%), female (59%), Protestant (63.1%), and designated to one or more special care units (89.8%). Major themes on patients’ hopes and fears expressed during ACP were (1) spiritual, religious, and existential questions; (2) suffering, peace, and comfort; (3) focus on the present; (4) hopes and fears for family; and (5) doubt and distrust. Major themes on how chaplains addressed them were (1) active listening to explore and normalize fears, worries, and doubts; (2) conversations to integrate faith, values, and preferences into ACP; and (3) education, empowerment, and advocacy. Significance of results ACP conversations require deep listening and engagement to address patients’ spiritual needs and concerns – an essential dimension of engaging in whole-person care – and should be delivered with an interdisciplinary approach to fulfill the intended purpose of ACP.

OBJECTIVE Diabetes knowledge is associated with health, including lower A1C levels. The Diabetes Knowledge Questionnaire (DKQ-24), developed 30 years ago for Mexican-Americans with type 2 diabetes and since used with diverse samples in many countries, contains outdated items that no longer accurately assess current knowledge needed for diabetes self-management. We revised the DKQ-24 and tested psychometric properties of the DKQ-Revised (DKQ-R) with a diverse sample. METHODS We conducted a five-phase instrumentation study, as follows: 1) DKQ-24 items were revised to reflect current diabetes care standards; 2) the Delphi method was used to evaluate the DKQ-R’s content validity (n = 5 experts); 3) cognitive interviews were conducted with people with type 2 diabetes (n = 5) to assess their interpretations of DKQ-R items; 4) cross-sectional administration of the DKQ-R to adults with type 2 diabetes was carried out to assess internal consistency reliability and convergent validity; and 5) an item analysis was conducted using discrimination index and point biserial analysis. RESULTS After receiving the experts’ feedback and conducting the cognitive interviews, 39 items were administered to 258 participants with type 2 diabetes (42.2% women; 29.1% Latino, 42.6% Asian, mean age 55.7 years). To select the final items, we considered the item discrimination index, as well as item-to-total correlations, content area, and participant feedback. The final 22-item DKQ-R uses the same yes/no/I don’t know response format as the DKQ-24. The DKQ-R is strongly correlated with the DKQ-24 (r = 0.71, P <0.01) and weakly correlated with diabetes numeracy (r = 0.23, P <0.01), indicating adequate convergent validity; a Kuder-Richardson-20 coefficient of 0.77 indicated good reliability. CONCLUSION The DKQ-R is a reliable and valid updated measure of diabetes knowledge for diverse populations with type 2 diabetes.