Refugees' Involvement in Routine Healthcare Screening Services: Application of the Andersen Model of Health Care Utilization

Introduction: As of May 2024, the United Nations High Commissioner for Refugees (UNHCR) estimated approximately 122 million forcibly displaced people worldwide, including 63.3 million internally displaced persons and 44.4 million refugees. In fiscal year (FY) 2024, the United States (U.S) resettled 100,034 refugees—the highest number in three decades. Refugees are at increased risk of developing health-related complications and may require screening due to traumatic experiences involving war, violence, and persecution. As such, access to healthcare support services is critical. This study applies the Andersen Model of Health Care Utilization (AMHCU) to examine the factors influencing refugees’ involvement in healthcare screening services in the U.S.

Methods: This cross-sectional study analyzed data from the 2020 Annual Survey of Refugees (ASR). The sample included 1,527 refugees aged 16 years and older who resettled in the U.S. between 2015 and 2019. Independent variables were selected based on the AMHCU framework and included predisposing factors (gender, age, education level, marital status, race/ethnicity, discrimination, and region of resettlement), enabling factors (type of insurance, employment, and access to transportation), and need factors (self-reported depressive symptoms and physical health conditions). The dependent variable was involvement in routine healthcare screening services, coded as “yes” or “no.” Multivariate logistic regression determined the significant associations between AMHCU selected factors and refugees’ involvement in health screening services. Data were analyzed using SPSS vs. 29.0, with a significance level set at p<0.05.

Results: Approximately 72.6% of resettled refugees were involved in routine healthcare screening services. Logistic regression results indicated that 5 out of 13 selected factors, particularly refugees who identified as Hispanic/Latino by race/ethnicity (OR = 2.36, 95% CI= 1.03–5.40, p = 0.042), those who were employed (OR = 0.52, 95% CI = 0.33–0.83, p = 0.007), those who reported depressive symptoms in the past 30 days (OR = 1.76, 95% CI = 1.11–2.78, p = 0.016), and those with good physical health (OR = 1.98, 95% CI = 1.17–3.34, p <.01) were more likely to be involved in routine health screening services. In contrast, refugees with Medicaid or other health insurance were less likely to be involved in routine healthcare screening services compared to those without health insurance (OR = 0.41, 95% CI = 0.25–0.68, p<.001).

Conclusion: This study emphasizes the urgent need to enhance access to healthcare services through affordable health insurance coverage. Policymakers should prioritize expanding Medicaid eligibility and subsidized insurance options for refugee populations with limited financial resources. Additionally, culturally tailored health education and awareness programs are crucial. These initiatives should focus on improving health literacy, addressing misconceptions about the healthcare system, and providing language support services to empower refugees to regularly engage in preventive health and routine health screening services in the U.S.