Health Care Utilization Among Bhutanese Refugees: Exploring Culture, Access, and Needs

Background and Purpose

Since the 1970s, the United States has received over 3 million refugees and these diverse individuals have established new homes across all 50 states (U.S. Refugee Act of 1980, 2012; U.S. Department of State, 2015). Approximately 78,000 Bhutanese refugees have resettled in 40 states since 2007 (U.S. Department of State, 2015). This study examines health care utilization of Bhutanese refugees post-resettlement in the United States. While there is little research about their experiences, the few available studies and newspaper accounts indicate that Bhutanese refugees have great medical needs in addition to facing a myriad of resettlement challenges in the United States. There are no long established Nepali-Bhutanese communities in the United States to receive and educate new immigrants, therefore their resettlement process is reliant on resettlement agencies and health care institutions. In-depth interviews were conducted with members of this immigrant population in order to understand key constructs and vulnerability factors. Findings from this region-specific study may be relevant to interventions and policies for refugees across the United States. 

Methods

Using grounded theory methods, this study identifies individual-level factors and structures that affect health access and help-seeking among the Bhutanese refugee community. In-depth interviews were conducted with 30 participants between the ages of 19 and 65 who have lived in Philadelphia for more than 12 months. These individuals are now beyond the eight-month period of federally funded Refugee Medical Assistance. Interview data were analyzed through a grounded theory approach using NVivo software.

Findings

This study examined key vulnerability factors that underlie the process of health services utilization, medical needs that influence help-seeking, and individuals’ perception of health services in the United States.  Language and the ability to navigate health care systems are major factors that influence health care utilization among Bhutanese refugees. This study finds that the family is very important to Nepali-Bhutanese culture, thus individuals’ help-seeking behaviors and health services utilization need to be understood within a family systems construct. This study also identified structures that affect health care utilization among this population including the U.S. health care system, refugee resettlement policies, and health care policies.

Conclusion and Implications

This study describes medical needs, perceptions of health services, and cultural factors within the Bhutanese refugee community. The researcher is constructing middle range theories about Bhutanese refugees’ health care experiences in order to contribute to the gap in the literature about this new population’s health access in the United States. Implications from this study may generalize to other ethnic communities in the U.S—this may allow for the development of more comprehensive policy-making for refugees and immigrants in the U.S. The results of this study may enable resettlement agencies, social service organizations, and health care institutions to better serve the Nepalese-Bhutanese population and to develop culturally salient interventions for newly arriving refugees, particularly those communities which lack long established co-ethnic ties.