Educating Refugees During an Outbreak: Lessons Learned from the 2009 H1N1 Influenza Response

Background: The emergence of 2009 H1N1 influenza resulted in an extensive public health response, coupled with a comprehensive health education outreach effort. However, whether resettled refugees, whose primary language is not English, received or clearly understood these messages is unclear. Refugee populations are an underrepresented population in H1N1 influenza research, and wide variations exist among language groups with regard to public health knowledge, literacy rates, and time since resettlement.

Objectives: •To determine the knowledge, attitudes, and beliefs of refugee populations during the H1N1 influenza pandemic •To determine sources of information on H1N1 influenza and other health issues for refugee populations •To test H1N1 influenza images and materials translated into refugee languages

Methods: CDC identified key educational messages regarding H1N1 influenza and translated them into seven languages commonly spoken by resettled refugees (Karen, Somali, Burmese, Amharic, Kirundi, Farsi, and Arabic). Illustrations were included in an effort to improve comprehension among low-literacy audiences. Fourteen focus groups were then conducted among resettled refugees in three states (Minnesota, Texas, and California). Responses were analyzed to determine commonalities and differences between groups. An educational session was conducted at the conclusion of each focus group to address any concerns that participants may have had about H1N1 influenza.

Findings: Although knowledge varied considerably among refugee populations tested, the majority of participants had very little knowledge of H1N1 influenza. Commonly encountered themes included myths about transmission, the ability to relate H1N1 influenza symptoms to seasonal influenza symptoms, and reservations about receiving the H1N1 influenza vaccine.