Health-Illness Transition of First Generation Refugees: A Review of Literature on Afghan Refugees

Purpose:  Refugees often resettle in the host country with a substantial health burden: high rates of psychological distress and trauma, high rates of infection and parasitic disease from the country of origin, and the increased susceptibility to chronic diseases of the developed world. The long term health promotion and disease prevention in this population requires an understanding of factors that facilitate healthy transitions for refugees resettling into developed countries. The purpose of this study is to synthesize literature for facilitating and inhibiting factors of the health-illness transition conditions that Afghan refugees experience upon resettlement. 

Methods: A systematic review was conducted, aimed at synthesizing peer-reviewed literature pertaining to the health issues and experiences of Afghans resettled in industrialized nations. Five databases were used to identify studies published between 1979 and 2015. Twenty-six studies met the inclusion criteria consisting of 2 mixed-method, 15 qualitative, and 9 quantitative studies. The emerging Middle Range Theory of Transitions provides a framework to analyze the data. 

Results: The first ethnographic health needs assessment in the US with early Afghan refugees was conducted nearly three decades ago in the SF Bay Area. Since then, little is still known about the post-resettlement health trajectory of Afghans. Overall, only one intervention study, one cancer incidence study and one prevalence study including Afghan populations, have been identified. These published reports are extremely limited due to the inaccurate racial categorization of Afghans in public health data and availability of data is limited to newly arrived refugees during the initial health screening which have no clear guidelines for assessing non-communicable diseases and risk factors. Three components of the transition conditions, the personal, community and societal level factors that influence positive or negative adjustment were analyzed. Themes from the qualitative synthesis described gender roles, family and kinship, adjustment, intergenerational conflicts, and aging as factors, which shape the outcome responses of fluid, integrative identities, as described by the transitions theory. Quantitative findings indicated prevalence of psychological distress, elevated cholesterol levels and increased risk for developing cancer. 

Conclusion: Even with the paucity of research on the long-term health of Afghans in developed countries, existing studies suggest that chronic health and health promotion should be a priority to address among this population. Research among Afghan refugees indicate that family ties and kinship are central to the cultural values of this population and provides a basis to further explore social level influences on health promotion and disease prevention. This review is preliminary work needed for developing a framework for health promotion or hypothesis-driven quantitative study informed and guided by the Theory of Transitions.