Examining community capacity to support Karen refugee women's mental health and well-being in the context of resettlement in Canada

From 2005 to 2009, Karen refugee women and their families living along the Thailand Burma border were the largest group to be resettled in South Western British Columbia. Research suggests that communities located at the metropolitan periphery lack capacity to provide equitable, inclusive and accessible services for minority populations. Moreover, there exist growing inequities in health and health care for refugee women. As a result of historical oppression, many Karen women arrived in Canada with lower literacy, lower education and exposure to trauma and violence; however, little is known about Karen women’s needs for resettlement. The purpose of this study was to examine community capacity in the context of Karen women’s resettlement, i.e. to understand the social and structural processes that impacted their mental health and well-being, the factors that intersected to support their resettlement process, and the ways the receiving community responded to their resettlement needs. Ethnographic data was collected over a seventeen-month period, including participant observation and, in-depth individual and focus group interviews with Karen women, settlement workers, health care and social service providers (N=38). Drawing on postcolonial feminist theory and tenets of intersectionality and cultural safety, findings suggest that non-government organizations promoted successful resettlement and mitigated the effects of trauma by supporting Karen women’s health literacy. However, settlement reforms underpinned by neoliberal governance structures resulted in gendering and mainstreaming of settlement services, negatively impacting the Karen women and families’ ability to access health care services and social supports. The overall lack of knowledge about their needs, integrated support for translators and formal social support systems challenged nurses, allied health care providers and settlement workers in their attempts to provide equitable health care and social resources. These structural aspects of community capacity created contexts of increased vulnerability and dependency for Karen women. Capacity-building strategies fostering advocacy, collaborative partnerships, reciprocal support, and flexibility across service sectors (non-government organizations and primary and public health) facilitated community capacity to support the mental health and well-being of Karen women during resettlement. Recommendations are proposed for integrated systems of care that promote social justice and that are culturally safe and trauma- and violence-informed.Applied Science, Faculty ofNursing, School ofGraduat