Picturing Access: Afghan Refugees Navigating Health and Healthcare in Rural Resettlement Communities

Close to 90,000 Afghan refugees have been resettled in the United States since 2021, often placed in rural communities where health resources are scant, yet limited research has documented the challenges they face in accessing healthcare. Photovoice, a participatory research method through which individuals take pictures to document individual and community level issues surrounding a particular phenomenon and then reflect upon them in multiple group discussions, was used to examine how race, ethnicity, class, religion, and immigration status intersect within rural geography to influence the healthcare access experience and overall wellbeing of Afghan refugees living in rural resettlement communities in Vermont. Photovoice has been shown to be effective in developing rapport, empowering members of racial and ethnic minoritized communities, and generating rich dialogue around complex social and structural issues and their impact on health among vulnerable populations. Co-researchers were asked to take photographs representative of their experiences, making sure to capture both barriers and facilitators, in accessing resources related to their health. Photos were discussed during focus groups using a modified SHOWED method. Visual content analysis of the photographs, and thematic analysis of focus groups (N= 8) with Afghan men and women in a rural resettlement community, revealed five common themes: 1) lost in translation; 2) reliance on informal supports; 3) basics for health; 4) maintaining norms and expectations; and 5) desire to be heard. Findings lend support to the utility of photovoice and highlight healthcare access issues facing immigrant and refugee populations that policymakers and healthcare providers should address.