Exploring Resource Utilization and Health Care Gaps Among Sri Lankan Tamil Refugee Parents and Adolescents in Indian Refugee Camps

Numerous epidemiological studies have shown that migration-based daily stressors such as lack of housing, poverty, and unemployment are associated with physical and psychological health difficulties affecting the functioning of refugees. Research also has identified strong links between refugee health difficulties and complex family dynamics.  However, the mechanism linking migration daily stressors, family dynamics, and distress among refugees has not been studied well. The dearth of scientific knowledge on complex refugee family dynamics has resulted in a lack of family-based, culturally appropriate resources and interventions in many refugee host countries. The purpose of this theoretically grounded study is to explore the formal and informal resources available in refugee camps to address refugee parents and adolescents daily stressors, family conflicts and distress.

Using the grounded theory approach, 120 refugee families (120 parents/120 adolescents) were selected using purposive sampling from a regional camp area in Trichy, which is located in the state of Tamil Nadu, India. The researchers used in-depth, semi-structured interviews to generate data in an effort to understand the formal and informal resource utilization in refugee camps and their relationships with these resources and the approach they use to access these resources.  Interviews were conducted in Tamil and were audio-taped. The interview guide focused on four general areas of the main three themes - daily stressors; family conflict; distress: availability of resources, relationships with resources, ways of accessibility, and utilization of resources. Questions within each general area were open ended and designed to elicit a broad range of views and opinions from participants. Interview transcripts and field notes were analyzed by the research team after each interview. The data analysis began immediately after the first interviews, with the researchers meeting to identify sensitizing concepts for later interviews and to form initial ideas about codes. The data was analyzed based on the grounded theory approach, in which data collection and analysis are conducted concurrently as an iterative process, patterns are identified in the data through codes, and salient themes and concepts are developed based on interaction with the data.

Participants were 60 percent male and 40 percent female with an average age for adolescents being 16 years and 46 years for parents. 75 adolescents and 115 parents identified family as their informal support to receive material things, protection, and financial support. Around 90 adolescents and 110 parents identified Tamil culturally based social service organizations as formal support to receive educational care and material resources. 6 adolescents and 85 parents used a traveling monthly medical clinic which provides basic medical care. Findings suggest that refugee families may have more actively engaged with, and had positive perceptions of informal resources like their families, with the Tamil culturally based agencies. However, refugee families identified severe gaps in health care resources including specialized medical care and counseling services. The findings of this study are examined in the context of the Conservation of Resources theory. Practice and policy implications for addressing health promotion needs of refugee families and future research for community based intervention development for positive family dynamics are also highlighted.