Refugee health education: Evaluating a community-based approach to empowering refugee women in Houston, Texas

Refugees resettled in the United States often encounter a multitude of barriers accessing healthcare which leads to an overall decline in health. Few evaluation studies have been conducted to assess refugee health education interventions in the United States. The aim of this study was to determine the feasibility, sustainability, and impact of a yearlong health education intervention implemented to empower Burmese refugee women living in a refugee community in Houston, Texas. The intervention included fourteen workshops, eight community excursions, one health fair, three Q&A sessions, and home visits twice a month. Workshop topics were identified from focus groups with refugees and case managers from resettlement agencies. The evaluation of the intervention was structured as a formative qualitative study. Eleven interviews were conducted with Burmese refugee women who participated in the intervention and five interviews were completed with caseworkers from local resettlement agencies. Content analysis was done using Grounded Theory to code data and develop themes. Results indicated that motivation to attend the workshops and learn health education material was impacted by perceived benefits and a desire to learn information that would best benefit the family. Community development through building community capacity and creating social network systems encouraged peer-to-peer learning. Goodness of fit was a characteristic highly valued by the resettlement agency, and in turn, influenced buy-in both from resettlement agency staff. Recommendations for future refugee health interventions include use of the community health worker model to train refugee health educators to overcome language barriers, pairing English lessons with health education material to promote development of English language skills, developing teaching materials for refugees with low literacy, and establishing buy-in and bottom-up support from the refugee resettlement agencies