Acculturation and Health Services Utilization Among Bhutanese Refugee Families

Background and purpose

For the past 5 years, approximately 70,000 refugees are admitted to the United States annually. Refugees’ resettlement experiences are complex as they adjust to a new culture and life in the U.S. This adjustment process is referred to as acculturation. Acculturation has been defined as the changing processes in human behavior and values as a result of contact with a new culture. Acculturation has a profound impact on refugees in the United States and this study considers its role in health care utilization among Bhutanese refugees in one United States city. Many refugees retain much of their native culture while adapting to their host country; thus, they may experience inner conflicts between their native culture and their host culture (Henry, 2012). Dissonant acculturation results when children acculturate faster or more completely than parents; this study finds that dissonant acculturation appears to be occurring within Bhutanese refugee families and carries implications for health access and health services utilization (Portes & Rumbaut, 2006).

Methods

For this grounded theory study, the researcher conducted qualitative interviews with 30 Bhutanese refugee adults who have been living in Philadelphia, PA for at least one year.  Sampling strategies included purposive and snowball sampling.  The semi-structured interview guide, developed in conjunction with Bhutanese refugee community members, included questions related to health access and utilization as well as individual social and cultural experiences.  Interview transcripts were coded and analyzed using the qualitative data analysis software package, NVivo.     

Findings

As the younger generation, children and grandchildren, often have higher levels of English proficiency relative to the older generations in this population, this study finds that dissonant acculturation is occurring within Bhutanese refugee families. Children appear to be acculturating to U.S. culture faster than their parents and role reversal appears to be occurring in relation to health care navigation among Nepali-Bhutanese families. This study finds that language, a key component of acculturation, acts as a major barrier and facilitator to health access among Bhutanese refugees.  English language proficiency has a profound impact on family members’ health care utilization and navigation. Individuals’ roles in health care navigation appear to carry broader social implications, as they may be incongruent with other social roles that the individual occupies within the family.   

Conclusions and Implications

This study illuminates the importance of acculturation and its connection to challenges that Bhutanese refugees face regarding health access and services utilization.  The findings from this assessment may be generalizable to other refugee and immigrant ethnic groups across the United States.  Important implications of this study include: bolstering community and social support for refugees, improving the efficacy of cultural orientations for newly arriving refugees, and bettering the interventions and services provided by resettlement agencies and health care providers related to acculturation, language interpretation and family system-level support.