Promoting the health of refugee women: a scoping literature review incorporating the social ecological model

Abstract

The health of refugee women after settlement in a new country, can be adversely or positively affected by individual, interpersonal, community, and organizational factors. While much of the previous literature highlights these factors individually, there is a lack of comprehensive synthesis regarding how the factors interact to influence the health of refugee women. We conducted a thematic analysis in our literature review to elucidate how providers can work with refugee women to prevent adverse health outcomes and intervene at multiple levels to improve their health outcomes after resettlement. We reviewed peer-reviewed literature from 2009 to 2019 from Google Scholar, JSTOR, Global Health, PubMed, CINAHL, Sociological Abstracts, and Social Service Abstracts, and also used citation chaining, to identify relevant information pertaining to refugee women’s health. The key terms used for our literature review were, health care, violence, social support, and mental health. In total, we included 52 articles, 3 books, and 8 other sources. We found that refugee women are vulnerable to violence during migration and typically have high rates of post-traumatic stress disorder. There were also concerns of secondary victimization by providers after resettlement. We also found that social support is an important factor for reducing isolation, and improving access to health care, as well as improving mental health outcomes. However, social support was often difficult to maintain, and was moderated by factors such as English language fluency. Health care was influenced by health literacy, cultural difference, communication concerns, and access issues. The findings suggest that at the individual and interpersonal levels there is a need to address language barriers, improve provider-patient communication, and provide appropriate medical and mental health screenings. At the organizational level, inter-organizational communication and awareness are vital. At the community level, providers can work with community leaders, to educate, create dialogue and collaboration, to help facilitate understanding and bolster community social support. Improved communication and knowledge about the unique needs and concerns of refugee women through an integrated, multi-system approach is necessary to improve their health outcomes.

Post-migration Stressors and Subjective Well-Being in Adult Syrian Refugees Resettled in Sweden: A Gender Perspective

“…The present study has several strengths. First, by approaching mental health with a clear gender perspective, the study mitigates a key limitation in refugee research to date, namely the paucity of gender-specific data and evidence ( 40 , 41 ). The findings on gender-specific effects of stress in the resettlement phase may be applied in practice to support and promote gender-sensitive resettlement strategies and initiatives, as well as facilitate research focusing on identifying predictors of well-being outcomes.…”

“…In contrast, a study on Afghan refugee in the US which tested whether social support modified the association between perceived discrimination and psychological distress, did not find any evidence to support this ( 38 ). Refugee women in particular have acknowledged the importance of social support in adapting to their lives in the host country and report that they face barriers to maintaining it in the resettlement phase, both within their own ethnic community and in the host community, often due to language barriers ( 39 , 40 ).…”

“…A weakness in the field of refugee mental health research to date is the limited focus on and reporting of gender specific findings ( 7 , 16 , 17 , 40 , 41 ). Based on the mounting evidence of the importance of gender in understanding the complex links between pre- and post-migration stressors and mental health ( 16 , 17 ), there is a clear need for studies with a gender-focused approach.…”

Barriers and facilitators of health among older adult immigrants in the United States: an integrative review of 20 years of literature

“…However, in regard to ‘migrant’ versus ‘refugee’, Castañeda and Holmes note that “[w]hether a person is identified as a refugee or as some other socially constructed category… depends on historical, sociocultural, political, and economic contexts” [ 27 ]. Thus, the question of choice remains debated among migrants and refugees and the definitions are not “rigid” [ 27 – 29 ]. This is not to say that there is not a difference between a refugee fleeing persecution and a migrant accepting a job in another country, rather that the matter is not easily defined.…”

Health promotion focusing on migrant women through a community based participatory research approach

“…Congolese migrant women in the USA have also, together with researchers, used the CBPR approach for health promotion, resulting in photo and story sharing on themes such as healthcare system issues, social support, and daily experiences of health [ 26 ]. Furthermore, review studies have concluded that community work for migrant women can include the initiation of dialogue and collaboration to increase community social support, which can prevent isolation as well as improving mental health and access to healthcare [ 27 ]. Many stressors, such as housing or work, may affect health among migrant women, and social support may work as a resilience strategy in handling various situations [ 28 ].…”