Health Seeking Behaviors among Displaced Populations/Refugees

*Chika Ejike*

#### **Abstract**

The United States resettles refugees every year. Their population in south-central Kentucky (KY) is diverse and fitting to research into culture-dependent healthcare utilization patterns. A mixed study was conducted with one hundred and ten semistructured questionnaires and three individual interviews. Significant differences were observed between the use of healthcare services and refugees' nationality (F (5, 98) = 4.29, p < 0.001), acculturation (t = −2.03, p < 0.04), and interpreters (t = 1.92, p < 0.05). Beliefs affect use through the level of cultural competency of the healthcare provider. These findings contribute to the health policy debates surrounding this culturally diverse population.

**Keywords:** refugees, cultural competency, health delivery, acculturation, utilization, immigrants

#### **1. Introduction**

The immigrant population in the United States (U.S.) is on the rise; refugees and resident aliens are not excluded. Southcentral Kentucky, with its substantial refugee population is an exemplar of an idealized community that the world is a global village. The process of migration involves varying degrees of economic, social, and environmental dislocation, all of which affect the health and well-being of migrants in the period following migration [1]. Refugee migration, access to healthcare, and physical health are related in complex ways that work to the disadvantage of these immigrants [1]. Once in the host country, refugees more likely live-in poverty and face substantial economic barriers relative to access and utilization of medical care.

Differences in healthcare utilization among refugees from developing countries occur due to the strong impact of culture on health. Hence, immigrant culture poses a challenge in seeking help [2]. To understand cultural underpinnings of health and the use of health services among immigrants especially refugees, it is essential to note that decisions relating to healthcare use are bound by a social context [2]. The use of formal healthcare is constrained by the lack of knowledge, limited resources, and access to care, as well as cultural differences in illness and help-seeking behavior [2]. Despite the increased interest in refugees' use of welfare and social services, and in the future of the American healthcare system, surprisingly little is known, especially on a national level, about the healthcare utilization patterns of migrants or their participation in government funded insurance programs [2]. Some researchers are aware that statistics may mask differences in health service use and reasons people seek professional care; therefore, it is important to combine qualitative and quantitative approaches to broaden our understanding of the study.

## **2. Background**

The 1965 amendments to the Immigration and Nationality Act, which changed the pace and composition of immigration to the United States, will have continuing ramifications for many years. Refugees are individuals who have been forced to flee their country of origin due to fear of persecution caused by racial, religious, or social group identification and those who have refugee status in the U.S. [3]. Unlike other immigrants, for example, foreign workers, tourists and students, refugees do not leave their home country by choice and cannot or will not return to that country.

The United States is a melting pot, one that retains cultural richness from various populations [4]. Considering the extent of ethnic diversity in the American society, surprisingly few empirical investigations exist on health service use among refugees. Researchers also know little about the extent to which the healthcare system addresses the needs of these individuals. However, as the U.S. immigration quotas increase, more research is needed on specific immigrant populations to learn about their unique cultural patterns of healthcare utilization. The importance of understanding the concept is evident by the less than sufficient scholarly work about this group [2]. Various studies have shown that limited information exists on refugees' knowledge of healthy behaviors, how much they engage in such behaviors, or whether they have the desire to learn healthier habits when needed. Researchers have identified a growing body of knowledge surrounding the influence of culture on health behavior and healthcare utilization practices [4]. Obvious reasons exist to expect differences in healthcare utilization among refugees' due to the impact of culture on health [5].

This study helps to better understand the role of culture in health service use. In addition, it provides insight and data about the refugee community in south-central, Kentucky, and similar rural areas [2]. The study examines useful information about the expectations or needs of refugees as being consumers in the healthcare system of the U.S. and highlights cultural patterns in their knowledge of preventive health and health-seeking behaviors [2]. Furthermore, to serve more appropriately this category of immigrants i.e., refugees, it is essential to understand the unique cultural beliefs and values that influence their utilization of healthcare services, their health status and health outcomes [2]. Recognizing the dynamics between culture and health is essential, thus, culture guides and influences various aspects of life, including health [2].

To address the healthcare needs of these refugees', this study reports on the culturally associated patterns in healthcare service use. Hence, the influence of culture was viewed as refugee cultural characteristics, perceived barriers, and perceptions on health status with regards to utilization of healthcare services. The research questions were as follows [6]:

