Community Health Workers' Perspective on Family Functioning Among Sri Lankan Refugees

Background and Purpose: The United Nations High Commissioner for Refugees (UNHCR) reports that approximately 27.1 million refugees globally are enduring prolonged displacement, evidenced by the Tamil refugee community from Sri Lanka. Such protracted displacement profoundly impacts traditional family roles and dynamics, introducing a spectrum of transmigrational stressors. This study aims to explore the multifaceted role of health workers in these refugee camps, their perceptions of family dynamics, parenting strategies, and refugee use of community-based services.

Method: This study, conducted at the Trichy refugee camp in Tamil Nadu, India, is part of a larger mixed-methods investigation involving families from the camp. This qualitative study employed purposive sampling to recruit families with the support of community health workers. The research team conducted two focus groups with community health workers (N = 18), who also identified as Tamil refugees. Data collection followed ethical guidelines with informed consent obtained from participants, and supported by community elders, health workers, and community embedded research team. We utilized thematic analysis (Braun and Clarke’s six steps) to explore themes within the collected data.

Results: The study identified three central themes: (1) Parenting and Family Practices, highlighting values of hard work, respect for elders, and conflict avoidance to maintain family honor; (2) Services for Family Conflict and Challenges, emphasizing the scarcity of trained counselors and the cultural barriers in seeking external help; (3) Potential solutions for integrating services for families into the community, revealing obedience-focused parenting as a contributor to family conflicts. These patterns suggest a complex relationship between cultural norms, parenting styles, and the psychosocial well-being of families, underscoring the essential role of health workers in helping families navigate these dynamics against a background of scarcity and entrenched displacement. Further, the family dynamics and protections in the community hinder individuals’ ability to engage with community resources that are available.

Conclusions and Implications: This qualitative study aimed to understand the role of health workers in these refugee camps, illuminating how they work to support the mental health and family functioning of their own Tamil refugee community. This is a critical study in the area because of its approach to exploring refugee health worker experiences working in their own community and being an integral component to interventions. Community health workers are instrumental in improving family dynamics and overall well-being among Tamil refugees, emphasizing the urgent need for culturally sensitive support mechanisms in refugee settings. Their work not only mitigates immediate psychosocial stressors but also lays the groundwork for long-term family resilience, pointing to a significant area for policy development and resource allocation.