Cultural Health Asset Mapping to Reduce Health Disparities: A Community Based Participatory Research Project In the East African Refugee Community

Background and Purpose: The number of East African immigrants and refugees in the United States has increased significantly in the last decade, and Minnesota ranks first among all metropolitan areas for Somali and Oromo refugees (Minnesota State Demographic Center, 2009). There is a growing awareness of health and mental health disparities for East African refugees, such as post-traumatic stress disorder, depression, autism, cancer, and substance abuse, and that culturally relevant interventions must recognize the social determinants of health. While social workers and health professionals have made efforts to improve health and mental health interventions in refugee communities, such interventions typically are not designed specifically based on the communities' cultural assets and there is limited evidence on the effectiveness on interventions in these communities (Bhui, Warfa, Edonya, McKenzie & Bhugra, 2007). The purpose of this study is to understand the cultural health assets among two East African populations that can be utilized to promote culturally relevant health interventions.

Methods: This study used a cultural health assets mapping approach, modified from the Asset-Based Community Development framework developed by Kretzman & McKnight (1993), to determine the cultural health assets. The researchers developed a CBPR partnership with Somali and Oromo communities in Minnesota and collaborated on all aspects of the research project from research design to data analysis to dissemination. Five bilingual community members were hired and trained as asset mappers and conducted 70 cultural health asset mapping interviews with Somali and Oromo community members using a semi-structured interview tool. Interviews were conducted in Somali and Oromo and translated into English. Two focus groups were conducted with community stakeholders and East African health professionals. Data were coded to identify cultural and health assets that could be used to develop culturally relevant interventions. More than 450 themes and subthemes emerged from the data.

Results: The top themes that were discovered in this study common to both Somali and Oromo communities were that religious beliefs, religious traditions, the culture of sharing and interconnectedness, and the prominence of oral traditions were considered cultural health assets that can be used as building blocks for building interventions that address the social determinants of health. Unique Oromo cultural health assets that emerged strongly were the tradition of proverbs and the strong Oromo value of religious tolerance, and unique Somali cultural health assets that emerged strongly were the importance of traditional foods and medicines and traditional chants, poetry and storytelling. Somali and Oromo community members formed working groups to identify ways to use the cultural health assets findings from this study to develop health interventions that help cancer, diabetes and high blood pressure within their communities.

Conclusions and Implications: The specific cultural health assets identified within this study are useful for the development of any culturally relevant social work or health intervention within these communities, and for informing practice with these communities broadly. An assets-based CBPR approach that engages community members appears particularly suitable for research with refugee populations that is aimed towards developing culturally relevant social work or health interventions.