Needs of refugees: Empowering cultural, ethnic and language minorities to self-advocate via action research

Background: More than 600 refugees resettle annually in the Greater Philadelphia Area (Office of Refugee Resettlement 2005). Refugees experience differential access to services and information as a result of cultural, ethnic and language barriers. Participatory action research (PAR) promotes participant input, and has been hailed as a best practice to incorporate the voices of immigrant populations.

Objectives: (1)To better understand the barriers/facilitators refugees experience when accessing health services/information, and (2) to create a replicable study design to advocate for refugees' needs.

Methods: Focus groups were conducted with Burmese, Meskhetian Turkish and Liberian refugees, using a facial/emotional-recognition response system (P. Ekman 1998; A.M. Martinez and R. Benavente 1998) to assess satisfaction on a Likert scale using culturally competent research methods. A chi-square analysis was conducted to determine significance at a = 0.05, and qualitative feedback was ranked using nominal group technique (NGT).

Results: A strong association was found between length of time in the U.S. and satisfaction level with health (p = .014), as well as between nationality and satisfaction/dissatisfaction toward health (p = .000). 73 percent of uninsured respondends listed having had negative experiences (44 percent of uninsured responded 'extremely dissatisfied') with the U.S. health system. The main barriers to health among ethnic communities surveyed were: insurance status, preference for traditional healers, and confusion with the US health system.