Journal of Community Health
Volume 41, Issue 3, 2016, Pages 526-534

Help-Seeking Behavior and Health Care Navigation by Bhutanese Refugees (Article)

Yun K.* , Paul P. , Subedi P. , Kuikel L. , Nguyen G.T. , Barg F.K.
  • a PolicyLab, Division of General Pediatrics, The Children’s Hospital of Philadelphia, 3535 Market St, Rm 1539, Philadelphia, PA 19104, United States
  • b PolicyLab, Division of General Pediatrics, The Children’s Hospital of Philadelphia, 3535 Market St, Rm 1539, Philadelphia, PA 19104, United States, NORC at the University of Chicago, Chicago, IL, United States
  • c Bhutanese American Organization-Philadelphia, Philadelphia, PA, United States, Philadelphia Department of Public Health, Philadelphia, PA, United States
  • d PolicyLab, Division of General Pediatrics, The Children’s Hospital of Philadelphia, 3535 Market St, Rm 1539, Philadelphia, PA 19104, United States, Bhutanese American Organization-Philadelphia, Philadelphia, PA, United States
  • e Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States, Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, United States
  • f Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States, Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, United States, Department of Anthropology, School of Arts and Sciences, Philadelphia, PA, United States, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, United States

Abstract

The objective of this study was to document barriers to care, help-seeking behaviors, and the impact of a community-based patient navigation intervention on patient activation levels among Bhutanese refugees in the U.S. Data sources comprised 35 intake and 34 post-intervention interviews with program participants, 14 intake and 14 post-intervention interviews with patient navigators, and 164 case notes. Textual data were analyzed using the constant comparison method. Patient activation level was assessed at both time points. Participants had limited English proficiency (97 %), limited literacy (69 %), and the lowest level of patient activation (69 %). Participants routinely experienced complex insurance access, coverage, and payment problems and had limited healthcare-related life skills. Help-seeking began within social networks, with high reliance on bilingual, literate family members perceived to have experience with “the system.” Help-seeking was not stigmatized and was instead consistent with societal norms valuing mutual assistance. Participants preferred helpers to act as proxies and required repeated social modeling by peers to gain confidence applying healthcare-related life skills. Following the intervention, only one-third reported the lowest level of patient activation (35 %) and one-third were highly activated (32 %). Bhutanese refugees overcome healthcare access barriers by seeking help from a network of support that begins within the community. Community health workers serving as patient navigators are readily sought out, and this approach is concordant with cultural expectations for mutual assistance. Community health workers serving immigrant groups should model healthcare-related life skills in addition to providing direct assistance. © 2015, Springer Science+Business Media New York.

Author Keywords

emigrants and immigrants Health behavior Patient navigation Self efficacy Health literacy Refugees Community health workers

Index Keywords

patient care immigrant social norm refugee insurance human Refugees middle aged social network Aged Patient Navigation health auxiliary ethnology intermethod comparison Bhutan Pennsylvania interview Humans family Philadelphia model male female clinical article help seeking behavior adult health care access participatory research Community-Based Participatory Research expectation skill Help-Seeking Behavior
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84949527872&doi=10.1007%2fs10900-015-0126-x&partnerID=40&md5=081f23224f08598642bd0a8f03fc3f8f
DOI: 10.1007/s10900-015-0126-x
ISSN: 00945145
Cited by: 6
Original Language: English