Relationships Between English Language Proficiency, Health Literacy, and Health Outcomes in Somali Refugees

Health Related Quality of life Amongst Refugees: A meta Analysis of Studies Using the SF-36

The health of refugees has been widely documented, as has the impact of a range of factors throughout the migration journey from being exposed to violence to the impacts of immigration detention. This study adds to our understanding of health-related quality of life amongst refugees and asylum seekers by evaluating health-related quality of life as measured by the Short-Form 36 (SF-36) Health Survey using meta-analysis. The aims of this study were to (1) provide a summary and overview of health-related quality of life (as measured by the SF-36), including the extent to which this varies and (2) explore the factors that influence health-related quality of life (as measured by the SF-36) amongst refugees and asylum seekers. A search was undertaken of MEDLINE, CINAHL, PSYCINFO and SCOPUS, returning 3965 results. Papers were included if they sampled refugees (or asylum seeker or those with refugee-like experiences) and used the SF-36 (or its variants) as an outcome measure. Mean scores and standard deviations were pooled using a random effects model. The pooled sample size was 18,418. The pooled mean scores for the SF-36 physical summary measures was 54.99 (95% CI 46.01-63.99), while the mental health summary measure was 52.39 (95% CI 43.35-61.43). The pooled mean scores for each of the sub-scales ranged from 49.6 (vitality) to 65.54 (physical functioning). High heterogeneity was found between both summary measures and all sub-scales. In comparison to SF-36 results from general populations in high and middle income countries, these results suggest that refugee quality of life is generally poorer. However, this varied substantially between studies. One issue that is not well clarified by this review are the factors that contributed to health-related quality of life.

Gendered Health Outcome Among Somali Refugee Youth in Displacement: A Role of Social Support and Religious Belief

This study examines the factors influencing physical health status, specifically focusing on the gender differences in risk and promotive factors affecting health outcomes among Somali refugee youth displaced in Nairobi, Kenya (n = 227). A survey was used to assess participants' physical health along with psychosocial factors, somatic symptoms, and demographic characteristics. The study shows that religious belief and somatic symptoms among the total sample were significant predictors in influencing the outcome of physical health. A moderated mediation analysis and logistic regression analyses also revealed gender differences in associated factors as well as health status; female participants reported higher somatic symptoms, associated with a decline in physical health, whereas the protective effect of social support and religious belief promote was found only among male counterparts. Future studies and interventions would be benefited from a gender-specific approach to health promotion and coping mechanisms in this population.

The Impact of Limited English Proficiency on Healthcare Access and Outcomes in the U.S.: A Scoping Review

A majority of individuals with limited English proficiency (LEP) in the U.S. are foreign-born, creating a complex intersection of language, socio-economic, and policy barriers to healthcare access and achieving good outcomes. Mapping the research literature is key to addressing how LEP intersects with healthcare. This scoping review followed PRISMA-ScR guidelines and included PubMed/MEDLINE, CINAHL, Sociological Abstracts, EconLit, and Academic Search Premier. Study selection included quantitative studies since 2000 with outcomes specified for adults with LEP residing in the U.S. related to healthcare service access or defined health outcomes, including healthcare costs. A total of 137 articles met the inclusion criteria. Major outcomes included ambulatory care, hospitalization, screening, specific conditions, and general health. Overall, the literature identified differential access to and utilization of healthcare across multiple modalities with poorer outcomes among LEP populations compared with English-proficient populations. Current research includes inconsistent definitions for LEP populations, primarily cross-sectional studies, small sample sizes, and homogeneous language and regional samples. Current regulations and practices are insufficient to address the barriers that LEP individuals face to healthcare access and outcomes. Changes to EMRs and other data collection to consistently include LEP status and more methodologically rigorous studies are needed to address healthcare disparities for LEP individuals.

Diagnostic Evaluation of Depression Screening Tools in Asian New Zealanders

This study aimed to compare the Kessler Psychological Distress Scale (K10) and Short-Form 12-Item Health Survey Mental Component Score (SF-12 MCS) for the effectiveness as screening tools for depression in Asian New Zealanders. A national, representative New Zealand Health Survey (NZHS) data set was used. In total, 1,277 participants were included in the analyses. The sensitivity and specificity values, as well as the areas under the receiver operating characteristics curves (AUROC), for the K10 and the SF-12 MCS scores were examined. The AUROCs for K10 and SF-12 MCS were 0.787 (95% CI [0.736, 0.837]) and 0.725 (95% CI [0.656, 0.793]), respectively. A less than optimal sensitivity and positive predictive value of K10 support the need to reexamine the optimal cut-off point according to the results of the Youden index. Strengthening the K10 predictive accuracy will increase the practical application among Asian populations.

Posttraumatic stress in adult civilians exposed to violent conflict, war and associated human rights abuses in the Eastern Mediterranean Region: A systematic review and meta-analysis

BACKGROUND

The Eastern Mediterranean Region (EMR) is the stage of the world's most violent conflicts and the origin of the largest refugee population worldwide. These conflicts can result in symptoms of posttraumatic stress (PTS). To date, no comprehensive meta-analysis on proportions of PTS in civilians from the EMR has been conducted. Sample characteristics, methodological, conflict-related and displacement-related factors might affect rates of PTS.

METHODS

A systematic literature search for studies investigating PTS in adult civilians from the EMR was conducted until March 2020 and resulted in 118 individual study samples that were suitable for inclusion. A quality assessment was conducted. A random effects meta-analysis on proportions and sensitivity analyses were performed, and a 95% prediction interval was calculated. Subgroup analyses to identify moderators (e.g. diagnostic instruments, displacement) were conducted.

RESULTS

The quality of the included study samples varied. The pooled estimate of proportions from all 118 study samples was 0.31 (95% CI: 0.27 - 0.35). Heterogeneity was considerable (Q = 10151.58, p < .0001; I² = 98.64%). The prediction interval was 0.01 to 0.76. The results remained unchanged after excluding nine outlier study samples. Heterogeneity remained high in all subgroups (range of I²: 87.91 to 99.62).

LIMITATIONS

Due to heterogeneity the pooled estimate cannot be interpreted. Moderators contributing to heterogeneity could not be detected.

CONCLUSIONS

The proportion of symptoms of PTS in civilians from the EMR varies considerably. The prediction interval indicates that the true rate falls between 1% and 76%. Future studies need to identify variables that affect heterogeneity.

Mental Health Triggers and Protective Factors Among Arabic-Speaking Immigrants and Refugees in North America: A Scoping Review

Poor mental health (MH) is a substantial public health problem, affecting over 13% of the population worldwide. Arabic-speaking immigrants and refugees (ASIR) are at high risk of MH problems due to intercultural adjustment stress, racism and discrimination. This scoping review of 49 studies explored pre- and post-migration MH determinants among ASIR in North America. Pre-migration MH determinants were politically related. English illiteracy was a significant triggering factor for distress and depression. Post-migration sociocultural MH protective factors included positive ethnic identity, spirituality, family support and social cohesion. Resilience, expressed as hope, significantly protected ASIR against depression and distress. MH triggering factors, emanating from social inequalities, were domestic violence, discrimination, stigmatization and poverty. Mixed-methods studies are needed to inform culturally-congruent, MH-promoting and resilience-building interventions. Intersectoral collaboration and Healthy Public Policy, based on the WHO Health in All Policies framework, are required to address social and health inequities, reducing MH challenges among ASIR.

The Relationship Between Refugee Health Status and Language, Literacy, and Time Spent in the United States

Background:

There are 3 million refugees living in the United States today whose health and wellbeing may be diminished by not being able to understand and use health information. Little is known about these barriers to health in multiethnic refugee communities.

Objective:

This present study examined (1) the relationship between English proficiency, health literacy, length of time in the US, and health status; and (2) differences in poor health status caused by limited English proficiency and low health literacy individually and in combination to better understand which barriers might be addressed by improving refugee health.

Methods:

Refugees (N = 136) age 18 to 65 years were recruited using health clinics and refugee resettlement agencies. Survey questions included demographics, health status, health literacy, English language proficiency, social determinants of health, and barriers to getting health care. Interpreters were used as necessary. We used a cross-sectional study with purposeful sampling.

Key Results:

There is a high correlation (Pearson's r = 0.77) between health literacy and English proficiency; they were moderately correlated with health status (r = 0.40 and 0.37, respectively). Length of time in the US only modestly correlated with health status (r = 0.16). Health literacy and English proficiency taken individually were strong predictors of health status (health literacy odds ratio [OR] = 4.0; 95% confidence interval [1.6–9.9], English proficiency OR = 3.6, confidence interval [1.5–9.0]) but not significant. Their interaction, however, was significant and accounted for most of the effect (log odds for interaction = 1.67, OR = 5.1, p < .05).

Conclusions:

English proficiency and health literacy individually and in combination facilitate poor health and present health-related barriers for refugees. Length of time in the US for refugees may not correlate with health status despite studies that suggest a change in health over time for the larger immigrant population. [HLRP: Health Literacy Research and Practice. 2020;4(4):e230–e236.]

Plain Language Summary:

The combined effects of limited English proficiency and low health literacy can create significant barriers to good health outcomes in refugee populations. Length of time in the US for refugees may not correlate with health status despite studies that suggest a change in health over time for the larger immigrant population.

Using Electronic Medical Record Data to Better Understand Obesity in Hispanic Neighborhoods in El Paso, Texas

The prevalence of obesity has been persistent amongst Hispanics over the last 20 years. Socioeconomic inequities have led to delayed diagnosis and treatment of chronic medical conditions related to obesity. Factors contributing include lack of insurance and insufficient health education. It is well-documented that obesity amongst Hispanics is higher in comparison to non-Hispanics, but it is not well-understood how the socioeconomic context along with Hispanic ethnic concentration impact the prevalence of obesity within a community. Specifically studying obesity within Hispanic dominant regions of the United States, along the Texas–Mexico border will aid in understanding this relationship. El Paso, Texas is predominantly Mexican-origin Hispanic, making up 83% of the county’s total population. Through the use of electronic medical records, BMI averages along with obesity prevalence were analyzed for 161 census tracts in the El Paso County. Geographic weighted regression and Hot Spot technology were used to analyze the data. This study did identify a positive association between Hispanic ethnic concentration and obesity prevalence within the El Paso County. Median income did have a direct effect on obesity prevalence while evidence demonstrates that higher education is protective for health.

Immigrant Children's Proficiency in the Host Country Language is More Important than Individual, Family and Peer Characteristics in Predicting Their Psychological Well-Being

Immigrant children are exposed to high levels of psychological distress, leading to an increased risk of mental and physical health problems. In the present study we investigated the impact of first and second generation immigrant children's proficiency in the host country language on their psychological well-being one year later. The effects of gender, family SES, and classmates' characteristics were also examined. A structural equation model was tested on 2334 immigrant children in a representative sample of 561 Italian primary schools taking measurement errors into account. Children's language proficiency significantly predicted their psychological well-being one year later, both in first and second immigrant generations (B = .23; p < .001). None of the other variables had a significant impact. Improving the language skills of immigrant children could promote their mental health, regardless of their backgrounds and whether they were born in the host country or not.