Relational Interviewing and Participant Recruitment in Community-Engaged Health Research with Bhutanese Refugees

Background and Purpose: The recent refugee crisis has become a major global concern and the United States has raised its annual ceilings for refugee arrivals. The purpose of this study was to examine health care utilization among Bhutanese refugees in one U.S. city during the post-resettlement period. More than 85,000 Bhutanese refugees have resettled across 41 states in the U.S. since 2007.  Bhutanese refugees arrive from two decades of refugee camp life in Nepal.  There is a dearth of research on the health needs and resettlement outcomes of this group in third countries of resettlement. The presentation discusses the interviewing and participant recruitment processes of a community-engaged study. This symposium raises important ethical and methodological considerations for community-engaged social work research with refugee populations.

Methods:  Data were gathered through in-depth interviews with Bhutanese refugees between the ages of 19 and 65 who have lived in Philadelphia, PA for more than 12 months.  Using grounded theory methods, the researcher identified individual-level and structural-level factors that affect health access and help-seeking among Bhutanese refugees.  Thirty Bhutanese refugees were formally recruited into the study through snowball and purposive sampling.  An additional 41 Bhutanese individuals were encountered during the data collection process.  Interview data were analyzed using NVivo software.  This qualitative study exercised relational constructivist approaches by formulating the study’s research questions, instrument, and recruitment strategy in consultation with Bhutanese refugee community members.

Findings: This study identifies vulnerability factors that underlie the process of health services utilization among Bhutanese refugees. Key themes that emerged include: family health navigation, acculturation, insurance status, resources, health needs, types of services used, and outcomes.  These themes suggest that language, culture, social networks, health systems, and prior experiences with health care interact with each other and inform refugees’ health care utilization processes.  Findings from this study may carry broad implications for social work with refugees in clinical, direct-practice, and community-level settings as well as for researchers who may be undertaking community-engaged research.

 

Conclusions and Implications: This study describes medical needs, perceptions of health services, and cultural factors within the Bhutanese refugee community. The research contributes to the gap in the literature about this refugee population’s health access after third country resettlement. The resulting methodological processes in this project demonstrate the implications of relational approaches to community-engaged research with refugee communities. This qualitative study finds that community-engaged research with refugees accords with relational constructivist research methods. A relational constructivist stance enables collaboration between researchers and participants, which may promote participatory approaches in cross-cultural research. Findings from this region-specific study may be relevant to research, interventions and policies for refugee resettlement and services across the United States and in other Western countries.