Primary prevention for refugees: Discovering the burden of choice

Refugees resettling in the US historically follow a trajectory of declining health as they adopt American habits of poor diet and low levels of physical activity and sleep. This participatory research study explored health beliefs and behaviors of the new community of refugees from Burma currently resettling in New England from refugee camps. Community members and researchers worked together to adapt a healthy living curriculum entitled “Eat Walk Sleep for Health” (EWS), creating a bilingual educational flipchart. The flipchart was piloted in two workshops with a total of 20 adult men and women. Workshop discussion focused on participants' prior and current health behaviors as well as their current health challenges. An interpreter translated during the discussions which were audio taped, then transcribed and analyzed using standard qualitative methods. Refugee camps constrain food and physical activity related health behaviors. Refugees rely on traditional healing practices but accept western health care. New arrivals are often housebound and isolated; they seek simple maps that prevent them from getting lost in their new communities. Asking about sleep appears to open the conversation about emotional and mental health problems. Refugees want specific information about healthy foods and better understanding of their need for exercise. They also seek information on prevention of health problems common in the US coupled with assistance preserving their traditional beliefs. Post-settlement in the US, retaining good health is challenging. Bilingual flipcharts and neighborhood map drawing provide avenues for open discussion leading to areas for Prevention Research Centers to partner for health.