Challenges of Refugee Family Dynamics: Perspectives of Health Care Workers from a Refugee Camp

Background and Purpose: The cultural variations in parenting processes tend to persist over time and are transferred across generations, creating conflicts in families which can prompt physical and mental health issues including youth isolation, reduced social interactions, stress and fatal suicides which are identified as a significant, emerging public health issues Refugee research often overlooks the impact of their unique cultural contexts on their parenting process, family dynamics and family health. The objective of this Qualitative Community Based Participatory Research (CBPR) was to understand the challenges experienced by refugee families to foster positive family dynamics through in-depth semi-structured interviews with health care workers from Trichy refugee camp.

Methods: This study was conducted between June and August, 2018 in collaboration with Organization for Eelam Refugee Rehabilitation (OfERR) by using purposive sampling to recruit their 32 health care workers (ages 30 - 71) from Trichy refugee camp via posted fliers at the camp.The sample is predominantly female (72% female; 31% male), 100% Sri Lankan Tamil refugees and 80% worked with this population for more than 5 years. The 45 minutes long semi-structured interviews were held in a private room at the OfERR regional offices. The interview guide focused on three general areas: parenting process, family conflict and family physical and mental health. Interview transcripts and field notes were analyzed, and audio recordings of the interviews were transcribed and analyzed using a thematic analysis approach. The coding system combined deductive approaches based on a priori categories, such as transition challenge or transition strategy, with inductive approaches based on themes that emerged directly from the transcribed text.

Results: Our analysis found that refugee families hold a mix of culture specific and non-culture specific parental perceptions and practices. They often experience more than one culture during their settlement journey. In addition, they incorporate non-culture specific parental perceptions into their parenting processes that are common to other communities. Although the mixed parental perceptions and practices emphasize their unique cultural identity, their contradictory nature influenced interpersonal relationships inside and outside of their families, often creating identity crises, somatic symptoms, sleeping difficulties, anxiety and resentment. Their parent-adolescent interactions emphasized parents’ control over adolescents’ lives, parents’ high expectations of adolescents, and showed little or no parental warmth towards adolescents.. The study outcomes elaborated that the consequences of rejecting or disobeying parental rules include more parental control strategies, and physical and psychological punishment -- not parental responsiveness. The circumstances, like authoritarian parenting, gendered parental control and pressure to keep collective silence to uphold their cultural identity, could play a significant role in refugee family health.

Conclusions and Implications: The results from this study expand social work knowledge from prioritizing refugee health as the only support refugees need to survive in host countries to include less obvious, yet clearly significant needs such as providing protective measures to foster positive family dynamics. Further research is warranted on exploring concepts within refugee family dynamics and the process for receiving specialized medical care which will guarantee a community-engaged, culturally specific, collaborative intervention model.