Health services access, utilization, and barriers for Arabic-speaking refugees resettled in Connecticut, USA

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Abstract

Background

Arabic-speaking refugees are the largest group of refugees arriving in the United States since 2008, yet little is known about their rates of healthcare access, utilization, and satisfaction after the end of the Refugee Medical Assistance (RMA) period.

Methods

This study was a cross-sectional observational study. From January to December 2019, a household survey was conducted of newly arrived Arabic-speaking refugees in Connecticut between 2016 and 2018. Households were interviewed in Arabic either in person or over the phone by one of five researchers. Descriptive statistics were generated for information collected on demographics, prevalence of chronic conditions, patterns of health seeking behavior, insurance status and patient satisfaction using the Patient Satisfaction Questionnaire (PSQ-18).

Results

Sixty-five households responded to the survey representing 295 Arabic-speaking refugees – of which 141 (48%) were children. Forty-seven households (72%) reported 142 chronic medical conditions among 295 individuals, 62 persons (21%) needed daily medication, 285 (97%) persons were insured. Median patient satisfaction was > 4.0 out of 5 for 6 of 7 domains of the PSQ-18 but wide variation (scores from 1.0 – 5.0).

Conclusion

Arabic-speaking refugees in Connecticut participating in this study were young. The majority remained insured after their Refugee Medical Assistance lapsed. They expressed median high satisfaction with health services but with wide variation. Inaccessibility of health services in Arabic and difficulty obtaining medications remain areas in need of improvement.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08733-5.

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Most cited references 38

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Healthcare Barriers of Refugees Post-resettlement

Meghan Morris, Steve Popper, Timothy Rodwell … (2009)

The majority of refugees spend the greater part of their lives in refugee camps before repatriation or resettlement to a host country. Limited resources and stress during residence in refugee camps can lead to a variety of acute and chronic diseases which often persist upon resettlement. However, for most resettled refugees little is known about their health needs beyond a health assessment completed upon entry. We conducted a qualitative pilot-study in San Diego County, the third largest area in California, USA for resettling refugees, to explore health care access issues of refugees after governmental assistance has ended. A total of 40 guided in-depth interviews were conducted with a targeted sample of informants (health care practitioners, employees of refugee serving organizations, and recent refugee arrivals) familiar with the health needs of refugees. Interviews revealed that the majority of refugees do not regularly access health services. Beyond individual issues, emerging themes indicated that language and communication affect all stages of health care access—from making an appointment to filling out a prescription. Acculturation presented increased stress, isolation, and new responsibilities. Additionally, cultural beliefs about health care directly affected refugees’ expectation of care. These barriers contribute to delayed care and may directly influence refugee short- and long-term health. Our findings suggest the need for additional research into contextual factors surrounding health care access barriers, and the best avenues to reduce such barriers and facilitate access to existing services.

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Barriers to health care access among refugee asylum seekers.

Ramin Asgary, Nora Segar (2011)

Asylum seekers have poor access to health care. Qualitative data portraying their experience is lacking.

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High prevalence of chronic non-communicable conditions among adult refugees: implications for practice and policy.

Jhumka Gupta, Lauren Graber, Isabel Chen … (2012)

The global rise in non-communicable disease (NCD) suggests that US-based refugees are increasingly affected by chronic conditions. However, health services have focused on the detection of infectious disease, with relatively limited data on chronic NCDs. Using data from a retrospective medical record review of a refugee health program in the urban Northeast (n = 180), we examined the prevalence of chronic NCDs and NCD risk factors among adult refugees who had recently arrived in the US, with attention to region of origin and family composition. Family composition was included because low-income adults without dependent children are at high risk of becoming uninsured. We found that half of the adult refugees in this sample had at least one chronic NCD (51.1%), and 9.5% had three or more NCDs. Behavioral health diagnoses were most common (15.0%), followed by hypertension (13.3%). Half of adults were overweight or obese (54.6%). Chronic NCDs were somewhat more common among adults from Iraq, but this difference was not significant (56.8 vs. 44.6%). Chronic NCDs were common among adults with and without dependent children (61.4 vs. 44.6%, respectively), and these two groups did not significantly differ in their likelihood of having a chronic NCD after adjustment for age and gender (AOR = 0.78, 95% CI = 0.39, 1.55). This study suggests that chronic NCDs are common among adult refugees in the US, including refugees at high risk for uninsurance. We propose that refugee health services accommodate screening and treatment for chronic NCDs and NCD risk factors, and that insurance outreach and enrollment programs target recently arrived refugees.

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Author and article information

Contributors

Hani Mowafi:

ORCID: http://orcid.org/0000-0001-6225-8048

hani.mowafi@yale.edu

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 11 November 2022

Publication date PMC-release: 11 November 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 1337

Affiliations

[1 ]GRID grid.47100.32, ISNI 0000000419368710, Yale School of Medicine, Yale University, ; New Haven, CT USA

[2 ]GRID grid.416744.4, ISNI 0000 0004 0452 9630, Department of Emergency Medicine, , St. Joseph’s University Medical Center, ; Paterson, NJ USA

[3 ]GRID grid.47100.32, ISNI 0000000419368710, Yale Center for Analytic Sciences, , Yale University, ; New Haven, CT USA

[4 ]GRID grid.47100.32, ISNI 0000000419368710, Department of Emergency Medicine, , Yale University, ; 464 Congress Ave, Suite 260, New Haven, CT 06519 USA

[5 ]GRID grid.266097.c, ISNI 0000 0001 2222 1582, School of Medicine, , University of California-Riverside, ; Riverside, CA USA

[6 ]GRID grid.47100.32, ISNI 0000000419368710, Yale School of Public Health, , Yale University, ; New Haven, CT USA

Author information

Hani Mowafi http://orcid.org/0000-0001-6225-8048

Article

Publisher ID: 8733

DOI: 10.1186/s12913-022-08733-5

PMC ID: 9652044

PubMed ID: 36369007

SO-VID: e0befa93-b4b1-4721-904e-5557a24b2731

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 25 November 2021

Date accepted : 25 October 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100011493, Whitney and Betty MacMillan Center for International and Area Studies;

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ScienceOpen disciplines: Health & Social care

Keywords: refugee health,access to health services,patient satisfaction

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ScienceOpen disciplines: Health & Social care

Keywords: refugee health, access to health services, patient satisfaction

Health services access, utilization, and barriers for Arabic-speaking refugees resettled in Connecticut, USA

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Abstract

Background

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Conclusion

Supplementary Information

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Global Health Next Generation Network

Most cited references 38

Healthcare Barriers of Refugees Post-resettlement

Barriers to health care access among refugee asylum seekers.

High prevalence of chronic non-communicable conditions among adult refugees: implications for practice and policy.

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