Health Resilience in Arabic-speaking Adult Refugees With Type 2 Diabetes: A Grounded Theory Study During the COVID-19 Pandemic

OBJECTIVES

This qualitative study aimed to describe the lived experiences of Arabic-speaking refugees in managing their type 2 diabetes mellitus (T2DM) while resettling during the COVID-19 pandemic, and to generate a grounded theory of how resilience is used to facilitate living well while facing multiple health stressors.

METHODS

A grounded theory approach was used to conceptualize the dynamic process of resilience in living well with diabetes. Five recently resettled adult refugees with T2DM (2 women and 3 men) participated in unstructured individual interviews in Arabic in New Brunswick, Canada, during the pandemic's second wave (October 2020 to March 2021). Interview data were transcribed and analyzed thematically using open, axial, and core category coding followed by member checking.

RESULTS

Participants identified self-reliance as the core driver for decision-making, actions, and interpretations in health management while experiencing unplanned instability. The process was found to be facilitated by 4 distinct constructs: knowledge seeking, positive outlook, self-care, and creativity.

CONCLUSIONS

The substantive model derived from this study supports a strengths-based approach to clinical assessment and care of refugees with T2DM, notably during disrupted access to primary and preventive services due to forced resettlement and pandemic mitigation measures. More research is needed to increase understanding of how self-reliance can be optimized in resilience-promoting interventions to facilitate diabetes management among populations in posttraumatic circumstances.

Resilience and health in American Indians and Alaska Natives: A scoping review of the literature

American Indians and Alaska Natives suffer from disproportionately high rates of chronic mental and physical health conditions. These health inequities are linked to colonization and its downstream consequences. Most of the American Indian and Alaska Native health inequities research uses a deficit framework, failing to acknowledge the resilience of American Indian and Alaska Native people despite challenging historical and current contexts. This scoping review is based on a conceptual model which acknowledges the context of colonization and its consequences (psychological and health risk factors). However, rather than focusing on health risk, we focus on protective factors across three identified domains (social, psychological, and cultural/spiritual), and summarize documented relationships between these resilience factors and health outcomes. Based on the scoping review of the literature, we note gaps in extant knowledge and recommend future directions. The findings summarized here can be used to inform and shape future interventions which aim to optimize health and well-being in American Indian and Alaska Native peoples.

Evacuation at Home Delayed the First Medical Intervention in Minamisanriku Town after the 2011 Great East Japan Earthquake

INTRODUCTION

In Japan, evacuation at home is expected to increase in the future as a post-disaster evacuation type due to the pandemic, aging, and diverse disabilities of the population. However, more disaster-related indirect deaths occurred in homes than in evacuation centers after the 2011 Great East Japan Earthquake (GEJE). The health risks faced by evacuees at home have not been adequately discussed.

STUDY OBJECTIVE

This study aimed to clarify the gap in disaster health management for evacuees at home compared to the evacuees at the evacuation centers in Minamisanriku Town, which lost all health care facilities after the 2011 GEJE.

METHODS

This was a retrospective cross-sectional and quasi-experimental study based on the anonymized disaster medical records (DMRs) of patients from March 11 through April 10, 2011, that compared the evacuation-at-home and evacuation-center groups focusing on the day of the first medical intervention after the onset. Multivariable Cox regression analysis and propensity score (PS)-matching analysis were performed to identify the risk factors and causal relationship between the evacuation type and the delay of medical intervention.

RESULTS

Of the 2,838 eligible patients, 460 and 2,378 were in the evacuation-at-home and evacuation-center groups, respectively. In the month after the onset, the evacuation-at-home group had significantly lower rates of respiratory and mental health diseases than the evacuation-center group. However, the mean time to the first medical intervention was significantly delayed in the evacuation-at-home group (19.3 [SD = 6.1] days) compared to that in the evacuation-center group (14.1 [SD = 6.3] days); P <.001). In the multivariable Cox regression analysis, the hazard ratio (HR) of delayed medical intervention for evacuation-at-home was 2.31 with a 95% confident interval of 2.07-2.59. The PS-matching analysis of the adjusted 459 patients in each group confirmed that evacuation at home was significantly associated with delays in the first medical intervention (P <.001).

CONCLUSION

This study suggested, for the first time, the causal relationship between evacuation at home and delay in the first medical intervention by PS-matching analysis. Although evacuation at home had several advantages in reducing the frequencies of some diseases, the delay in medical intervention could exacerbate the symptoms and be a cause of indirect death. As more evacuees are likely to remain in their homes in the future, this study recommends earlier surveillance and health care provision to the home evacuees.

The Emergence of Risk Communication Networks and the Development of Citizen Health-Related Behaviors during the COVID-19 Pandemic: Social Selection and Contagion Processes

Amid the novel coronavirus pandemic, a variety of public health strategies have been implemented by governments worldwide. However, the fact that strict government mandates focus on physical distancing does not mean that social connectedness for voluntary risk communication among citizens should be sacrificed. Furthermore, we lack an understanding of citizens' behaviors regarding the voluntary adoption of public health measures and the control of mental wellbeing in the age of physical distancing. Key variables in the response to the global pandemic are the emergence of risk deliberation networks, voluntary compliance with government guidelines, and the restoration of citizens' subjective health. However, little is known about how citizens' health-related behaviors coevolve with social connections for sharing information and discussing urgent pandemic issues. The findings show that selection and social influence mechanisms coexist by affecting each citizen's health-related behaviors and community-led risk discourses in the face of the urgent health crisis.

Applying community resilience theory to engagement with residents facing cumulative environmental exposure risks: lessons from Louisiana's industrial corridor

The presence of legacy pollutants, on-going chemical manufacturing activities, and population shifts have introduced complex, cumulative exposure risks to residents of many highly industrialized communities. These "industrial corridors" present unique challenges to environmental health science professionals, public and private sector decision makers, and residents seeking to make their communities safer and healthier. Social-ecological resilience theory offers a useful framework for the design and implementation of community engagement efforts to help stakeholders take action to reduce their exposure risks. A resilience framework views the human community as a coupled social-ecological system, wherein disturbances to the equilibrium of the system - acute and/or chronic - are common rather than rare events. It recognizes three key capacities of more resilient communities. These are the abilities of community members to self-organize to address changing threat levels, to hold scientifically sound understandings of the risks, and to learn from past experiences and take action - individually or collectively - to adapt to or mitigate the hazards in their local environment. We apply this resilience theory framework to a case study from Camp Minden, Louisiana, conducted through the Louisiana State University (LSU) Superfund Research Center's Community Engagement program and supported by the National Institute of Environmental Health Sciences (NIEHS). The case illuminates a critical path by which resilience theory can be applied to guide bi-directional communication and information-gathering, and co-development of risk-reducing strategies at the community level. These are central elements of community engagement within a contentious, real-world setting. The three components of the resilience framework were supported by specific program mechanisms and activities. The capacity for self-organization among community stakeholders was furthered through the convening of a Dialogue Committee which brought together representatives of concerned residents, regulatory agencies, research scientists, and others. This collaborative problem-solving approach supported a more holistic and scientifically sound understanding of the problem through a series of interactive meetings in which members discussed site-remediation options with thermal-treatment experts and regulators, and shared how recent explosions and concerns about air quality affected them. The members co-developed selection criteria and reached consensus on two types of disposal methods that would best reduce the significant threats to public health and the local environment. We also include a brief summary of our recent randomized survey of over 550 residents of Louisiana's industrialized communities to determine the influences on household-level adaptive behaviors to reduce acute and chronic environmental exposure risks. The results of the logistic regression analysis indicate that residents with more concern and knowledge about environmental hazards, along with confidence in their ability to implement risk-reduction measures - such as checking air-quality forecasts and then limiting outside activities - were much more likely to adopt the exposure-reducing behaviors, even when controlling for socioeconomic and demographic differences among respondents. These findings shed light on the conditions under which residents of these types of communities may be more likely to take action to reduce potential environmental exposure risks, and may help in the design of public education efforts. These "lessons learned" from Louisiana communities facing cumulative environmental exposure risks suggest that application of resilience theory to the design and implementation of community engagement programs may support the longer-term effectiveness of the efforts and enhance overall environmental health resilience. In addition, they provide practical insights about how to operationalize and apply these theoretical concepts to real-world environmental health challenges faced by residents of industrialized communities throughout the world.