Addressing the Disparity in Refugee Mental Health Services: a Pilot Study of a Traumatic Stress Intervention Utilizing a Language‑Free mHealth Application

Objective: After resettlement, an overwhelming number of refugees struggle with Chronic Traumatic Stress (CTS), the persistence of traumatic events (e.g., re-experiencing past trauma; news of on-going war) coupled with daily post-migration stressors (e.g., poverty, lack of transportation). CTS significantly increases the burden of mental health challenges experienced by refugees. Evidence-based mental health treatments often rely on worksheets, mobile applications, websites, or telephone calls to facilitate the management of distress outside of treatment sessions. Language barriers prevent these strategies from being incorporated into mental health treatment for refugees, which results in a significant disparity in care. Treatments delivered via mobile devices can address this barrier through the use of intuitive images that eliminate the need for text or language-based instruction.Methods: A six-week pilot study assessing the effectiveness of group intervention utilizing a language free, culturally relevant mobile health (mHealth) application was conducted in a sample of Somali-Bantu and Nepali-Bhutanese adult refugee men and women (N=18). Paired-samples t-tests were conducted to compare pre- and post-intervention levels of psychosocial distress, anxiety, depression, and traumatic stress, on the Refugee Health Screener (RHS-15) and an investigator generated coping measure.Results: Results indicated significant reduction (p<.001) in symptoms related to traumatic stress, anxiety, depression and somatic complaints in addition to a significant increase (p<.001) in the use of coping skills.Conclusions: The use of a mobile mental health app, in combination with in-person therapy, was effective in reducing mental health symptomology and in increasing the use of coping skills in Somali-Bantu and Nepali-Bhutanese refugees.

Resettling minority groups : the case of the Somali Bantu

This paper argues the possession of formal education is essential for successful settlement in a western country. Using the Somali Bantu resettlement experience as a case study, this paper highlights the extent to which a lack of basic information can hamper a smooth transition into a western community. It is contended that a long history of social exclusion and intentional discrimination and abuse of the Somali Bantu resulted in their state of illiteracy and or lack of pre-literacy skills, which made their resettlement experience that much more difficult than usual. I will seek to support my argument by use of narrations and case studies obtained from refugee supporting agencies and settlement providing organization reports and the media.

Resettling minority groups : the case of the Somali Bantu

This paper argues the possession of formal education is essential for successful settlement in a western country. Using the Somali Bantu resettlement experience as a case study, this paper highlights the extent to which a lack of basic information can hamper a smooth transition into a western community. It is contended that a long history of social exclusion and intentional discrimination and abuse of the Somali Bantu resulted in their state of illiteracy and or lack of pre-literacy skills, which made their resettlement experience that much more difficult than usual. I will seek to support my argument by use of narrations and case studies obtained from refugee supporting agencies and settlement providing organization reports and the media.

Female Genital Mutilation/Cutting among Somali Women in the U.S. State of Arizona: Evidence of Treatment Access, Health Service Use and Care Experiences

Background. Female genital mutilation/cutting (FGM/C) is associated with adverse sexual, reproductive and psychological sequelae. The aim of this study was to quantitatively explore factors related to satisfaction with FGM/C-related care in the US focusing on access to care, health service utilization, and women’s experiences. Methods. A community-based survey of 879 Ethnic Somali and Somali Bantu women using snowball sampling was conducted in Arizona. Bivariate, multivariable and ordered logistics analyses assessed the relationship between the aforementioned factors measured along six dimensions: non-discrimination, physical, economic, informational, health system accessibility and individual-level health service use factors. Findings. Most participants possessed FGM/C (77.4%), namely Type III (40.2%). FGM/C related health service use was low (14.3%). Perceived discrimination was associated with reduced satisfaction in care (OR = 0.22; CI 0.13–0.37). For FGM/C-specific variables, only recollection of adverse physical or psychological events at the time of circumcision predicted service use (OR = 3.09; CI 1.67–5.68). Somali Bantu (OR = 0.10; CI 0.02–0.44) and highly acculturated women (OR = 0.39; CI 0.17–0.86) had lower odds of service use. Conclusions. Achieving respectful care and outreach to women affected by FGM/C has contextual complexity. However, the clinical implications and insights provided may have broader impacts on advancing health equity for FGM/C-affected women.

Traditional Medicine and Help-Seeking Behaviors for Health Problems Among Somali Bantu Refugees Resettled in the United States

Somali refugees have resettled in the United States in large numbers. The focus of this study was specifically on the Somali Bantu refugees, an ethnic minority group from Somalia. The goal of this study was to understand the following: (a) jinn (invisible beings or forces in Islamic theology) and related health problems resulting from jinn possession affecting Somali Bantu refugees, (b) types of traditional healing practices integrated into help-seeking behavior, and (c) pathways of care utilized to address health problems. In total, 20 participant interviews were conducted with Somali Bantu refugees resettled in the United States. Overall, participants described types of jinn and associated health problems. In addition, participants identified different pathways of care, including formal and informal health care. Participants accessed these pathways both concurrently and sequentially. Somali Bantu utilize complex and varied health care services based on their understanding of the causes of health problems and experiences with care providers.

Collaborative health education for Somali Bantu refugee women in Kansas City

Objective To partner with and understand the health of Somali Bantu refugee women, small group sessions were designed and conducted using a community-based collaborative action research (CBCAR) approach. Health topics identified by this community were presented in 42 sessions with eleven women. Follow-up individual interviews with the women were used to ask questions about health experiences and plan for future health education. The objective of this qualitative study was to provide refugee women with knowledge to help them adjust to new health challenges in the United States, and to share personal narratives in a safe environment. Results The process of sharing health information with the women resulted in a collaborative exchange of culture and community. Individual interviews allowed women to voice their opinions outside of the influence of their community elders. CBCAR is an effective tool to involve refugee communities, and other populations small in number, in addressing their unique health challenges. Results from this study demonstrated that small group sessions and a CBCAR approach can be effective in sharing knowledge within small communities of refugee women. Findings from the study will assist in the future planning of health education programs for refugee women and their families in this community.