Exploring barriers to health services, quality care and diet for refugee communities through the eyes of local service providers

Introduction: North Carolina ranks in the top ten nationally in refugee resettlement with a central county one of the most diverse in the southeast. The objective of this study was to explore experiences and observations of individuals providing direct and regular services to multiple refugee resettlement communities and their barriers to health and nutrition services.

Methods: Participants (n=40) included: medical and social service providers, educators, faith-based, volunteers, and liaisons to a variety of refugee communities. Guided semi-structured interviews were audio-recorded and transcribed verbatim. Themes were identified using content analysis.

Results:  Perceptions were consistent across participants. Resettlement housing was observed to be in poor condition in areas of poverty with transportation barriers. Refugees rarely relocated due to strong community relationships and support. Perceived dietary risks included: difficulties budgeting and maintaining food assistance, hoarding food, high consumption of sodas and sweets, misperceptions regarding American products (ie: perceived need for infant formula) and limited health knowledge. Most maintain preference for “fresh” foods and have strong agricultural skills but lack green-space. Major barriers to healthcare included: poverty, limited initial timeline for Medicaid and language (both lack of interpretation services and translated materials). Type II diabetes, weight gain and dental needs were consistently observed across groups.

Conclusions:  Direct service provider’s experiences and observations working within a diverse resettlement area provide unique insight to consistent barriers facing refugees to achieving good health. While refugees face many barriers, groups often have impressive strengths, such as agricultural skills, on which to focus.