1. Ukrainian Refugee Women's Perspective on their Experience in the United States Health Care System
- Author
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Gepshtein, Yana D.
- Subjects
Nursing ,cross-cultural health ,immigrant health ,qualitative research ,refugee women ,women health - Abstract
Background. Healthcare providers working with forcefully displaced populations often possess limited knowledge and skills regarding the care of this population. The reasons are twofold. First, most of the research on refugee health does not consider refugees’ adaptive skills, diversity of experiences, and daily life context. Second, healthcare providers’ understanding of how their socio-cultural environment shapes their practices in the context of refugee care is limited. The purpose of this work is to bridge the gap between refugees' lived experiences and providers' understanding of these experiences. It consists of three manuscripts: a theoretical framework (part one), and study reports (parts two and three). Theoretical Framework: The first manuscript addresses gaps in refugee healthcare and research by applying a relational approach to three theoretical frameworks. Firstly, utilizing Bourdieu's Theory of Practice, it examines how mismatches between the dispositions and skills of refugees and providers contribute to care gaps. Secondly, the Cultural Determinants of Help Seeking by Saint Arnault is employed to explore differences in the meanings assigned by providers and refugees to their interactions. Lastly, Canales' concept of Othering in nursing elucidates how power dynamics in refugee-healthcare system interactions influence care and research. Study Aims: This study’s first aim is to understand how refugee women forcefully displaced by the current war in Ukraine interpret and describe their interaction with the healthcare system in the United States. Second, it aims to explore how refugees negotiate new environments to attend to the health needs of themselves and their families through their displacement. Methods: Refugee women from Ukraine in the US (N=17) participated in semi-structured interviews about their healthcare experiences. Interviews were transcribed and analyzed using Charmaz’s constructivist grounded theory methodology. Results: In the primary data analysis, three priority theoretical elements were identified: barriers to care which encompassed codes such as: uncertainty about costs and finding a trustworthy provider; systemic and organizational features that hinder care, which encompassed codes such the system is confusing and inconsistencies across organizations and providers; and processes and factors that do or would alleviate impediments to care, which encompassed codes such as: clear and relevant information and getting help from others. In the focused data analysis, three main elements were identified: “a rug was pulled from under our feet”: encompassing experiences of loss of familiar environment; experiencing displacement: encompassing experiences such as isolation, uncertainty, and enduring; and reclaiming agency: encompassing actions towards health goals. Conclusion: The study emphasizes the importance of continuity of care in refugee health, indicates the culture-bound nature of trust in healthcare providers, and underscores the essential role of non-formal and non-structured support for refugees. Furthermore, the findings from the study underscores the importance of refugees' connections to their homelands, culture rooted knowledge, and an invaluable role of refugee support networks
- Published
- 2024