Building Cultural Health Capital in the Refugee Community: A Qualitative Participatory Evaluation of Community Health Workshops with Bhutanese Refugees

Background and Purpose: Refugee communities in the U.S. face a myriad of post-migration challenges. Cultural and linguistic barriers after resettlement such as obstacles to adequate health care, contribute to many health disparities (Fiscella, Franks, Doescher, & Saver, 2002; Paradies, 2006). To understand the complex health needs and cultural barriers refugee communities face, the concept of cultural health capital was applied to this evaluation study. Cultural Health capital (CHC) is defined as culture-based resources and skill sets that function as leverages and assets to promote health (Shim, 2010). This provides a fine lens to understand outcomes from community-based health workshops led by trained refugee community leaders.

Methods: This study conducted a participatory evaluation to examine outcomes of a Community Health Workshop (CHW) focusing on cultural resources as well as challenges for health promotion in the refugee community (Fawcett, et al., 2003). Six Bhutanese refugee leaders in addition to stakeholders actively engaged in the research process to help develop the CHW, consisting of eight sessions relating to healthy eating, coping with acculturation challenges and daily stressors of resettlement, and recognition of common mental health issues in the refugee community. Twenty-two out of 25 recruited Bhutanese community members completed all 8 sessions. Evaluation questions were embedded to each session in addition to the pre- and post-group interview, ending with the research team conducting a thematic analysis by applying the concept of CHC.

Findings: Positive outcomes related to CHC were reported from both the participants and the community leaders who facilitated CHW. Culture was a central theme to understand both barriers and strengths impacting participants’ ability to maintain and promote health. Preservation of culture through language was vital to community building in the Bhutanese refugee community and thus, to the increase in access to community support and health resources. The cultural language, however, was also recognized as a main source of acculturation gap and barriers to health care in the host community. Capacity building empowered the leaders in the community to inspire and educate the refugee participants and bring everyone together around the common goal. The CHW provided an avenue to share knowledge and increase social and cultural capital that led to an increase in health capital among the participants. Participants reported an increase in nutrition knowledge, healthy stress coping, and awareness of mental health and healthy practices, in addition to positive psychological outcomes, such as an increase in hope and stress relief as well as healthy eating habits.

Conclusion: The CHW fostered cultural health capital not only by increasing knowledge and skills around health and mental health, but also by strengthening the community systems to exchange cultural wisdoms and support for health promotion. The community-based intervention model helped to embed the cultural strengths and resources of a community by empowering the community members to take the lead and play an active role in their learning and help one another through the process, and help shape the CHW for future use. Further implications and challenges of the study will be also discussed.