Social Capital Among Bhutanese Refugees: Protective Factors and Enabling Characteristics in Health Care Utilization

Background and purpose

More than 15 million refugees are receiving protection and assistance from the Office of the United Nations High Commissioner for Refugees and this number is expected to grow due to current global crises (UNHCR, 2016).  The United States will be affected by the increase in refugee claimants, as the government has raised the ceiling for refugee arrivals. During their migration journey, refugees lose their support systems, including family ties and cultural contexts. Research demonstrates that social capital is among the most important factors related to refugee adaption and psychosocial outcomes (Carswell, Blackburn & Barker, 2011; Schweitzer et al, 2006). Ethnic communities are an important source of social capital for immigrants and may mitigate challenges associated with systemic barriers and assimilation (Portes & Rumbaut, 1995). Limited research explores the relationship between refugees’ social capital and health outcomes. The purpose of this presentation is to examine the interaction between social capital and health care utilization among Bhutanese refugees in one U.S. city.

Methods 

This qualitative study relies on data collected through in-depth interviews with Bhutanese refugee adults who have lived in the United States for over one year. 30 Bhutanese refugees were formally recruited into the study; 71 individuals total were encountered during the data collection process. This qualitative study exercised relational constructivist approaches by formulating the research questions, instrument, and recruitment strategy in consultation with Bhutanese community members. Interview questions were related to health services utilization, health insurance status, perception of health services, concerns about health care access, and self-reported health status. Interview data were analyzed using NVivo software. Using grounded theory methods, the researcher identified individual-level and structural-level factors that affect health access and help-seeking among Bhutanese refugees. 

Results

The data indicate that Bhutanese refugees have high social network density and strong co-ethnic ties.  Respondents lived in households of four or more individuals and described regular interaction with neighbors and relatives. Participants pointed to two protective factors of social capital that promote health services utilization— information sharing and social support. English-speaking family members often play a large role in the family’s health access. The results demonstrate that help-seeking behaviors and health services utilization for this population need to be understood within a family systems construct. This study identified vulnerabilities and strengths that underlie the process of health services utilization among refugees.

Conclusions

Refugee communities may act as an important source of social capital that may improve health access and resettlement outcomes. Social support and dense social networks appear to enable Bhutanese refugees’ health care utilization and act as protective factors during the resettlement process. The study’s findings may be relevant to refugees resettling in the United States and other countries. Findings from this region-specific study may be relevant to research, interventions and policies for refugee resettlement and health care. This presentation has implications for social work practice with refugees in clinical and community-level settings. The research contributes to the gap in the literature about this refugee population’s health access after third country resettlement.