Culturally Sensitive Teaching Strategies to Improve Health for Refugees in San Antonio, Texas

It is well known that social determinants of health (SDH) affect health. In the United States, researchers are challenged to focus attention on social and economic factors related to health and to investigate the links between SDH and vulnerable populations. Refugees in the United States are a vulnerable population and at risk for poor health and social outcomes due to past and present circumstances. In 2015, the United Nations High Commissioner for Refugees reported that of the 65.3 million persons forcibly displaced worldwide, an estimated 21.3 million of those were refugees. The United States remains a world leader in refugee resettlement and is expected to admit 85,000 refugees in Fiscal Year 2016 with at least 10,000 of those from Syria. Texas is a national leader in refugee arrivals and provides culturally sensitive comprehensive health assessments and referrals during the resettlement process.

Resettlement can be stressful as refugees may have suffered life-threatening circumstances prior to flight from their countries. Shortly after reaching the United States, refugees face the difficult tasks of learning to speak English, finding employment, and knowing whom to ask for help. Researchers have reported four reoccurring barriers that can affect refugees’ transition to the United States: 1) Culture, as health beliefs and social norms vary from country to country; 2) Language issues around verbalizing their needs; 3) Discrimination and stigmatization specifically related to mental health, religious or regional stigma; and 4) Logistical concerns around transportation, finding housing, and navigating the health care system. These internal and structural issues can create barriers to care and contribute to health disparities in this population.

In the Population-Focused Health course at the University of Texas Health Science Center at San Antonio, School of Nursing, students are introduced to social determinants of health and social justice at the community level through a community assessment process. Each clinical group is required to complete a windshield survey, analyze public health data, conduct key informant interviews and focus health promotion within specific census tracts. The Center for Refugee Services (CRS) is an independent 501(c)3 nonprofit agency that was established in 2010 and is run by volunteers who provide educational and support resources to the refugee community in Northwest San Antonio. At the CRS, the students learn about primary and secondary prevention strategies within the context of cultural sensitivity and safety. A student project may consist of a health fair, screenings, or health education presentations based on refugee request and need. In the planning and implementation of these projects, the students have to frame the message around health promotion, identify internal and structural barriers, and plan for logistics such as working with interpreters and translators. This community partnership has been transformational for both the refugees and students. The refugees appreciate the collaboration with the University of Texas Health Science Center and the students share that they can translate the concepts of social justice and cultural sensitivity and safety into their care of vulnerable populations in acute and community settings.