Female Afghan refugees making sense of traumatic events: An explanatory model

Background: Refugees are confronted with multiple adverse political, socio-cultural, and economic stressors that challenge their health and wellness. 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 examined how female Afghan refugees conceptualized and made sense of stressful situations throughout their premigration, migration, and resettlement processes. Methods: The researcher conducted 40 in-depth qualitative interviews, averaging two hours each and including limited-English proficient women; a focus group; participant observation in the refugee community for more than two years; and consultation with key cultural informants. Interview respondents were asked to explain their experiences and perceptions of each important and difficult situation they encountered from the events that led up to their leaving Afghanistan to the present. Maximum variation purposive sampling was used for the interviews. Results: Qualitative inductive analysis yielded 262 stressful situations and five thematic conceptualizations of stressful events: (1) imminent and overwhelming dangers in the homeland; (2) suffocating losses of family members and friends; (3) resolving to flee; (4) bewilderment and confusion in the new country; and (5) struggling to adjust. The study shows how sense making about these often traumatic experiences can exacerbate family tensions, community reputation concerns, and health problems. Conclusions: Public health practitioners working with refugees should be aware of the perspectives of female Afghan refugees about mental health stressors to inform culturally competent care.