Understanding wellness and barriers to care among Iraqi refugee women in the United States

Abstract

Iraqi refugees in the US experience a high prevalence of non‐communicable diseases. In this article, we explore how cultural and structural realities intersect to influence utilisation of preventative healthcare and cancer screening with the aim of understanding health disparities in this population. We conducted three focus group discussions with a total of 14 Iraqi refugee women living in a northeastern US city in 2016 and analysed the qualitative data using a thematic analysis. Eight themes emerged from our data: (a) ‘prevention is better than cure:' Iraqi refugee women maintain wellness; (b) physical and mental health are interrelated in causing and curing ill‐health; (c) Iraqi refugee women embrace both biomedical and other healing practices; (d) God contributes to healing; (e) cancer is caused by dangerous environments. Three of the eight themes related to barriers to care; (f) multi‐level problems within hospitals and clinics prevent the delivery of care; (g) financial barriers prevent access to care and good health; (h) competing priorities are a barrier to good health. We argue that understanding refugee health requires critical analysis of both culturally informed understandings of health and illness as well as the structural aspects of health disparities that result in limited access to life opportunities, racism and inequality for refugees and their communities.

Access to preventive sexual and reproductive health care for women from refugee-like backgrounds: a systematic review

“…Participants had heard about HPV and vaccination but had limited knowledge about HPV. Pap test and HPV vaccine uptake depended on doctor recommendations and receiving husband or family support .85 Ross Perfetti et al (2019) [ 61 ]; HC USA; CO Iraq Understand health and attitudes towards preventive care, including cancer screening, and how they relate to cultural and structural mediators of health Snowball sampling; Philadelphia community clinic; 3 semi-structured FGDs n = 14; refugees; < 30- > 60 yrs. ; yrs.…”

“…Of the 28 studies, 13 were conducted in the USA [ 48 , 53 , 55 – 57 , 59 – 61 , 63 , 69 , 72 – 74 ], two each in Australia [ 62 , 64 ], Jordan [ 52 , 68 ], Lebanon [ 49 , 50 ] and Canada [ 70 , 71 ], one each in Congo [ 66 ], Israel [ 54 ], Netherlands [ 67 ], Pakistan [ 65 ], South Korea [ 65 ], Thailand [ 47 ] and one was a multi country study which included Bangladesh, Jordan, Djibouti, Kenya, Malaysia and Uganda [ 51 ].…”

“…Studies were qualitative ( n = 16), cross sectional surveys ( n = 8) and mixed methods; a combination of either focus group discussions (FGDs) or semi structured interviews and surveys ( n = 4). Of those using qualitative methods, nine involved FGDs [ 49 , 50 , 53 , 55 – 57 , 59 – 61 ], four semi structured interviews [ 49 , 52 , 58 , 63 ], three in-depth/key informant interviews [ 47 , 56 , 64 ], three both FGDs and in-depth interviews [ 48 , 51 , 54 ] and one used a novel storytelling method [ 62 ]. Of the 12 studies using quantitative methods, nine used face-to-face interview based surveys in respondents’ homes [ 47 , 51 , 65 , 66 , 68 , 70 , 73 ] or in a medical clinic [ 72 ] and one used an online survey [ 57 ].…”

“…Five studies included perspectives of HCPs (not further specified) [ 48 , 51 , 74 ] and one each of physicians [ 54 ] and nurses [ 50 ]. Ethnic groups included Somali /Somali Bantu in seven studies [ 48 , 53 , 55 , 56 , 60 , 72 , 73 ], Syrian [ 49 , 50 , 52 ] and Bhutanese [ 57 , 59 , 64 ] in three studies each, and one each in Afghani [ 65 ], Albanian [ 70 ], Burmese [ 59 ], Cambodian [ 47 ], Congolese [ 66 ], Eritrean [ 54 ], Iraqi [ 61 ], North Korean [ 58 ], Palestinian [ 68 ], West African [ 62 ] or a combination of these ethnic groups [ 51 , 63 , 67 , 69 , 71 ]. Participants’ ethnicity was not described in one study [ 74 ].…”

Utilization, satisfaction and barriers to access of health services for Arabic-speaking refugees resettled in Connecticut, USA after completion of Refugee Medical Assistance (RMA)

“…In that study, a majority of respondents had favorable views of their healthcare but indicated that language barriers made it challenging to access care. Several factors may contribute to these barriers in accessing care, including acculturation, lack of reliable transportation, difficulty navigating the complex US healthcare system, and language and communication barriers[3-5, 32, 33].…”