Determinants of Healthcare Use Among Refugees from Burma

Background: Burmese refugees resettled in the United States since early 2000 after enduring decades of political, religious, and ethnic persecutions in Burma. Current literature indicates that healthcare needs for refugees, including the refugees from Burma, are greater than the general population or other immigrants due to their past refugee-related trauma. However, many Burmese refugees experience barriers because of language and cultural differences when it comes to understanding the role of healthcare in the United States. Using the Andersen-Newman Model, this study aimed to examine unique factors associated with healthcare use among Burmese refugees.

Methods: Using a convenience sampling method, 256 adult refugees from Burma were interviewed, either in Burmese or Karen language. Healthcare utilization in the previous 12 months was assessed with the frequency of visits to primary care provider (PCP; none, once, two or more times). We used ordinal regression analysis to model the PCP visits. Based on the Andersen-Newman model, we included sex (female=1), ethnicity (Burmese, Karen, Others), age (range, 18-87), employment status (employed=1), and years of education (0-22) as predisposing factors; English language proficiency (ELP; 1-6), health insurance status (insured=1), income ($0-$3500+), and PCP satisfaction (0-3) as enabling factors; and trauma symptoms using refugee health screener (RHS); 0-56), psychological distress using Hopkins symptom checklist (HSCL; 1-4), alcohol-related problems using alcohol use disorder identification test (AUDIT; 0-4), and self-rated physical health (SRPH; 1-5) as needs factors.

Results: Descriptive results indicated that, in the past 12  months, 33 (12.9%) did not visit their PCP, 63 (24.6%) saw their PCP once, and 160 (62.5%) saw their PCP two or more times. One hundred forty-seven (57.4%) were female. Eighty-four (32.8%) were Burman, 100 (39.1%) were Karen, and 72 (28.1%) were other ethnic refugees from Burma. The mean age was 40.2 years (SD=12.78). One hundred twenty-seven (49.6%) were employed. The mean education was 6.82 (SD=5.05) years. The mean ELP was 2.13 (SD=1.22). Two hundred thirty (89.8%) had health insurance. The mean monthly income was between $1500 and $2000. The mean PCP satisfaction was 1.9 (SD=0.59). The mean RHS score was 10.5 (SD=10.6). The mean HSCL was 1.47 (SD=0.55). The mean AUDIT was 2.05 (SD=3.93). The mean SRPH was 3.02 (SD=1.09). The results of ordinal logistic regression analyses revealed that being older (OR=1.05; 95% CI=1.01-1.09), being unemployed (OR=0.38; 95% CI=0.15-0.97), lower income (OR=0.69; 95% CI=0.52-0.91), greater PCP satisfaction (OR=2.25; 95% CI=1.14-4.42), greater RHS (OR=1.10; 95% CI=1.01-1.19), and lower HSCL (OR=0.12; 95% CI=0.03-0.53) significantly increased the odds of PCP visits.

Implications: The results of the current study offered practical information about healthcare use among refugees from Burma. As expected, age and employment (as predisposing factors), PCP satisfaction (as an enabling factor), and RHS (as a need factor) increased the likelihood of PCP visits. However, unexpectedly, lower income, lower HSCL score, but not greater ELP were significantly associated with increased odds of PCP visits. Discussions will address contextual factors beyond the questions included in the survey in explaining the potential reasons for unexpected results.