Barriers impeding and enablers promoting the health and wellness of Afghan Refugees in the San Francisco Bay Area

Background: For more than two decades, Afghans comprised the largest refugee population in the world. With more than 60,000 Afghan refugees in the United States, the largest concentration resides in Northern California. Purpose: As part of a larger dissertation study, this research identified barriers impeding and enablers promoting the health and wellness of female Afghan refugees in the San Francisco Bay Area. Methods: The researcher conducted 40 in-depth qualitative interviews, averaging two hours each and including limited-English proficient women; a focus group; ethnographic participant observation in the local refugee community for more than two years; and consultation with key cultural informants. Maximum variation purposive sampling was used for the interviews. Results: Qualitative analysis of 262 distinct narratives generated several overarching themes. The predominant two barriers consisted of (1) the language barrier and (2) “not knowing the system.” Associated barriers included (3) impoverishment, (4) cultural clashes, (5) the generation gap, and (6) honor and shame. Key themes that enabled refugee wellness were: (1) Developing an ongoing, trusting interpersonal relationship with a “point person” fluent in English and U.S. culture and information systems; (2) learning to speak fluent English; (3) gaining an understanding of how to directly navigate U.S. information systems, such as the health care and social service systems; and, (4) practicing asking questions of professionals in health, human, and social service provider positions. Conclusion: Funding and developing pools of trained “point people” should take high priority since these important interpersonal relationships are central to enhancing the wellness of refugees.