Health Literacy and Healthcare Use Among Karen Refugees

Background and Purpose: Refugee populations have higher healthcare needs due to physical and psychological symptoms related to their refugee-related experience. However, they tend to underutilize healthcare services, which is often associated with a lack of preventative services and thus poor health outcomes. Identified barriers to healthcare access among refugee populations include low basic health literacy (BHL), limited English language proficiency (ELP), and difficulties with navigating the U.S. healthcare system. The purpose of this study is to examine the unique factors of healthcare utilization among Karen refugees from Burma residing in Buffalo, New York.

Methods: Data were collected from face-to-face interviews with 104 Karen refugees from Burma between age 18 to 83. The outcome variable was a number of visits to their primary care provider (PCP) in three categories (none, once, two or more times) in the past 12 months. Based on the Andersen-Newman model, we included sex (female=1), age, employment status (employed=1), and education as predisposing factors; ELP (range 1-4), BHL (0-9), and health insurance (yes=1) as enabling factors; and Trauma symptoms (refugee health symptoms-RHS, 0-56), self-rated physical health (SRPH, 1-4), self-rated mental health (SRMH, 1-4), and the number of health conditions (HC, 0-9) as needs factors. The analyses were conducted using Stata v12.

Results: Descriptive results showed that 18 (17.3%) did not visit their PCP, 26 (25.0%) visited once, and 59 (56.7%) visited two or more times. Seventy (68.0%) were women. Fifty-one (49.0%) were employed. The average education was 4.6 (SD=4.74) years. The average ELP score was 1.45 (SD=0.67). The average BHL score was 4.06 (SD=1.58). Ninety-eight (95.2%) had health insurance. The average trauma symptoms score was 11.63 (SD=9.54); SRPH score was 3.01 (SD=1.17); SRMH score was 2.79 (SD=1.04); and the average number of HC was 1.57 (SD=1.43). Ordinal logistic regression analysis results showed that the odds of PCP visit were associated with being female (Odds ratio(OR)=3.67; 95% confidence interval (CI)=1.42-10.88); higher BHL score (OR=1.36; 95% CI=1.02-1.82); and higher SRMH (OR=1.77; 95% CI=1.02-3.08).

Conclusion and Implication: The findings revealed a unique pattern of healthcare service use model for Karen refugees in this studyThe results suggest that Karen males are less likely to visit their PCP, despite no difference in health conditions from their female counterparts. Confirming that the level of BHL significantly affect the odds of visiting their PCP in this study sample is an important discovery and has central implication for broader health prevention strategy with Karen people living in the United States. Finally, it is concerning to see that lower SRMH is associated with a significantly decreased odds of PCP visits, as previous studies indicate that refugees, including Karens, likely have greater mental health challenges due to their experiences of being a refugee. The results of this study highlighted the importance of mental health issues that impact their healthcare and may suggest the needs of mental health support in the community for this population.