Navigating Social Determinants of Health Among Refugee Newcomers: A Qualitative Exploration of Meaning of Healthy Living Among Afghan, Bhutanese, and Congolese Refugees

Background and Purpose: Refugee populations in the United States face numerous challenges related to social determinants of health (SDoH), resulting in disparities in resource access and healthcare utilization. Understanding the perspectives of refugee newcomers on healthy living within their communities in relation to SDoH is essential yet underexplored in the literature. This study investigates the multidimensional SDoH influencing healthy living among Afghan, Bhutanese, and Congolese refugees, offering insights for refugee resettlement practice and social integration policy.

Methods: Qualitative focus group interviews were conducted with Afghan (n=13), Bhutanese (n=22), and Congolese (n=12) refugees as part of larger community-based participatory research initiatives known as Newcomer Community Wellness Workshops. Participants shared experiences and perceptions regarding factors impacting health management, promotion, and conceptualizations of healthy living. A hybrid thematic analysis was utilized to identify key themes and patterns, aligning emergent themes with multidimensional SDoH frameworks.

Results: Analysis revealed a complex landscape of SDoH among refugee populations, highlighting the significance of community and social context (social integration, support systems, community engagement), access to healthy options (food, healthcare system), neighborhood and physical environment (safety, housing, walkability), and economic stability (debt, expenses, support). Moreover, individual beliefs and practices for healthy living extended beyond physical health to include emotional, intercultural, and spiritual well-being, underscoring the importance of addressing holistic needs in health promotion. Interpersonal relationships and community dynamics emerged as pivotal in shaping health perceptions and behaviors, with community leaders playing a significant role in promoting well-being. However, challenges in maintaining informal community relationships and connectivity to cultural traditions were noted, highlighting the need for intentional efforts to foster social support networks and preserve cultural practices.

Conclusions and Implications: This study emphasizes the importance of recognizing the intricate interplay of factors influencing refugee health outcomes and advocating for culturally responsive health promotion initiatives. Group-based health education or interventions can foster culturally relevant collective coping mechanisms at the community level, amplifying the synergy between collective action and health literacy. Implications for refugee resettlement practice and social integration policy include tailored interventions addressing multifaceted SDoH, enhancing healthcare access, addressing social determinants such as employment and housing, and nurturing supportive community networks. Holistic approaches to refugee resettlement and social integration policy must prioritize addressing SDoH to ensure equitable healthcare access and support the health and well-being of refugee populations, embedded within broader policy frameworks for refugee integration and inclusive community development. Developing culturally sensitive interventions, informed by an understanding of how communities define healthy living, is imperative for fostering equitable healthcare access and supporting refugee health and well-being. To achieve this, comprehensive efforts to address SDoH should engage policymakers, practitioners, and community stakeholders to create inclusive and supportive environments for refugee newcomers.