Identifying strategies for gaining access to the Afghan refugee population: A qualitative study

Objectives. This study aimed to identify strategies for engagement of Afghan refugees living in San Diego, a hard-to-reach and understudied group. It was conducted as Phase-I of a larger study on mental/health issues in this population. Methods: We conducted semi-structured qualitative interviews with key-informants from the refugee community in San Diego, which included Afghan community and religious leaders, as well as refugee resettlement and health services providers. Participants were asked about Afghan refugees' socio-demographic characteristics, the pre- and post-migration stressors that Afghans may have encountered through the migration process, and about methods of harnessing sampling and recruitment efforts for increasing this sub-groups' receptivity to taking part in future interviews and surveys assessing mental/health symptoms. Results: Qualitative data suggested unique socio-demographic shifts in Afghan refugee arrivals since 9/11 and that mental health issues are highly prevalent as a result of factors related to the migration process. In addition, the use of broadcast communication through Afghani satellite television networks and linking with clergymen who have established credibility with the community was highly encouraged as a means of advertising and recruiting potential participants. Results also indicated that standard research procedures for gaining informed consent, offering incentives, tape recording of face-to-face interviews, and recruitment of women requires adaptation to make them culturally fitting. Conclusions: The significance of understanding the mental health of Afghan refugees is multi-faceted due to their prolonged exposure to war and their unique conceptions of mental health. Results from this study expose the various dynamics needing consideration before attempting to conduct larger studies with this and similarly hard-to-access sub-groups. Future studies could provide practitioners with tools for incorporating into their standards of practice strategies for treating diverse mental health conditions.