Promoting the health of refugee women: A scoping literature review incorporating the social ecological model
AUTHORS Maren M. Hawkins, Marin E. Schmitt, Comfort Tosin Adebayo, Jennifer Weitzel, Oluwatoyin Olukotun, Anastassia M. Christensen, Ashley M. Ruiz, Kelsey Gilman, Kyla Quigley, Anne Dressel & Lucy Mkandawire-Valhmu
The health of refugee women after settlement in a new country can be adversely or positively affected by individual, interpersonal, community, and organizational factors. While much previous literature highlights these factors individually, there is a lack of comprehensive synthesis regarding how they interact to influence the health of refugee women. In response, the authors conduct a thematic analysis through a literature review, elucidating how providers can work with refugee women, intervening at multiple levels to improve their health outcomes after resettlement.
The authors find that refugee women are vulnerable to violence during migration and typically have high rates of post-traumatic stress disorder. Moreover, secondary victimization by providers after resettlement is a noted concern. The authors also find that social support is an important factor for reducing isolation and improving access to health care, as well as improving mental health outcomes. However, social support is often difficult to maintain and moderated by factors such as English language fluency. Likewise, health literacy, cultural difference, communication concerns, and accessibility quality influence health care outcomes.
These findings suggest that improved communication and education about the unique needs and concerns of refugee women through an integrated, multi-system approach is necessary to improve their health outcomes. At the individual and interpersonal levels there is a need to address language barriers, improve provider-patient communication and provide appropriate medical and mental health screenings; at the organizational level, inter-organizational communication and awareness are vital; and at the community level, providers can work with community leaders to facilitate education, dialogue and collaboration, to bolster community social support and strengthen awareness of community needs.
How does this research apply to my work?
As a service provider, it is important to be aware that refugee women are vulnerable to violence during migration and typically have high rates of post-traumatic stress disorder. There are also concerns of secondary victimization by providers after resettlement. Thus, programs and services must be adapted in ways that address this concern.
What should I take away from this research?
Previous research lacked a holistic approach in examining the salient factors (e.g., social support, barriers in the healthcare system, and cultural realities) that impact women’s health, post-settlement. Literature on this topic tends to focus on one specific population and one specific health outcome among refugee women. In contrast, this article shows that different ecological factors impact refugee women’s health post-settlement.
What’s the next step?
Individual and interpersonal level: Communication with providers and appropriate screenings and referrals are important for promoting health equity among refugee women at the individual and interpersonal levels.Those providing services to refugee women should be privy to, and ask about, an individual’s experiences and preferences when receiving care. Doing so is a way of conferring some choice to the service user. In interpersonal communication with refugees, providers should also emphasize the availability of services to women, and keep in mind that mental health screening, particularly perinatal and PTSD screening, is vital for refugee women.
It is also important for providers to analyze how social, political, and historical factors may impact the health of refugee clients. Critical, evidence-based awareness of these concerns is necessary to deliver culturally safe care that does not demean, re-traumatize, or further marginalize refugee populations.
Organizational level: It is crucial that healthcare providers are aware of other organizations serving refugees. Providers can help streamline connection to services by providing patients with a list of local organizations that serve refugees, including the particular services they provide. Additionally, using volunteers to aid with healthcare system navigation is an effective approach to improving transition in care.
Community level: Providers serving refugees can educate faith and community leaders on the psychological stressors faced by refugee women, and encourage compassion, confidentiality, and regular contact. This liaison can be beneficial in increasing social support resources for women and for identifying women at risk. Engaging with local organizations and community representatives in determining ways can be a valuable approach to better serving women.
Providers are also responsible to offer compassionate, culturally humble, and collaborative care to women who present themselves at a healthcare facility. Moreover, language tends to be a major barrier to accessing social support in host communities. It is therefore worth encouraging involvement in English language courses, or increasing availability of interpreters, to facilitate further social support and ease transition.