7.2-O6Using digital storytelling to examine the links between housing and health for people from refugee and asylum seeking backgrounds in Australia

Abstract

Background: Housing is a social determinant of health but little is known about how housing may influence health and wellbeing for people from refugee and asylum seeking backgrounds. Digital storytelling is a participatory arts-based research method generally involving the production of 2-5 minutes audiovisual clips. As part of a broader study in South Australia a digital storytelling process was used to examine the link between housing and health for refugees and asylum seekers. Method: Seven refugees and asylum seekers from the Middle East participated in the project over two months. Participants worked with researchers and film makers to plan and produce short films reflecting their experiences around home, housing and wellbeing. Participants also participated in interviews about their experiences of the process itself. Results: The project illuminated a range of links between housing and health, particularly for asylum seekers who faced additional barriers to securing appropriate housing. A range of ethical issues were raised during the project including concerns about identifying participants in the films and material that could compromise refugee claimant status. There were also tensions between the research objectives and the community development aspirations of the project. Conclusions: The project indicated a range of ways that housing can affect health and wellbeing for refugees and asylum seekers. Digital storytelling as a participatory research method offers a unique way to explore such aspects of the refugee resettlement journey, but requires consideration of a range of ethical and practical factors. Main messages: Housing and health and wellbeing were linked for refugees and asylum seekers Digital storytelling offers a potentially empowering way to conduct research with refugees and asylum seekers to explore resettlement experiences, but requires a number of important ethical and practical considerations. Background: Over the past six years, an estimated 5.5 million Syrian refugees have been displaced worldwide, with over 18,000 Syrian refugees resettled to the United States of America. Over half the Syrian refugees in the US are children, whose age and refugee status jeopardize their abilities to attain quality healthcare. While there have been significant efforts globally to determine unifying themes to improve care for this vulnerable population, little is known about the health of Syrian refugees in America. This qualitative study sought to elicit the health needs and expectations of Syrian refugee children as perceived by their parents. Methods: 20 Syrian refugee parents residing in Cincinnati were interviewed in Arabic by bilingual members of the research team using a semi-structured interview guide. The interviews were audio-recorded, transcribed, and translated into English. Three members of the research team did independent coding of each interview. Results: Inductive thematic analysis identified four salient themes: stressors, health barriers, health expectations, and resilience behaviors. Parents indicated frustration and dejection due to identified environmental and psychosocial stressors. Parents expected shorter wait times, more medications, and more lab work during medical visits. Syrian refugee parents are unsatisfied with the American healthcare system but satisfied with healthcare providers. Parents identified lack of transportation , adequate translation services, care coordination, and health literacy as barriers to quality healthcare. Parents identified using their faith and the community to overcome barriers. Conclusions: Syrian parents identified unmet health needs and stressors. Faith and community resources are being utilized to compensate for deficiencies in institutional support and to erode barriers to care. It is essential for healthcare providers to understand the needs and expectations of Syrian refugee families in order to provide the most effective healthcare services. Further study is needed to implement and evaluate interventions that target identified barriers. 7.2-O8 What are the values and preferences toward primary healthcare of newly arriving refugees and other Background: Newly arrived migrants arrive to new healthcare with hopes and expectations but also subconscious cultural beliefs and past experiences. This study examines how diverse migrants' values influence their primary healthcare seeking choices. Methods: We identified a sample of newly arriving migrants from 11 countries in collaboration with settlement organizations in Ottawa and Gatineau, Canada. Following a pilot phase, we posed a series of choice questions (cost, time, interpreter services, mode of delivery) within a discrete choice experiment related to a semi-urgent condition. We analyzed data using logistic regression analysis, evaluating the factors and interactions between them. Results: Over 3000 choice scenarios representing 102 newly arrived refugees were collected. Preliminary results suggest that there is a strong preference for in-person services rather than over the phone communication when controlling for other factors, including oral interpretation. Secondary preferences included lower costs and shorter waiting times. Conclusions: The strong in-person preference stands as a barrier to use of tele-health services by this population. The need for trust and personal relationships may be factor, but more research is needed to better design and deliver primary healthcare services and policies. Main message: Newly arriving migrants prefer in-person consultations even more than interpretation. Secondary preferences included lower costs and shorter waiting times.