The impact of postresettlement stressors and access to health care on health outcomes in recently resettled refugees in the United States.
The impact of postresettlement stressors and access to health care on health outcomes in recently resettled refugees in the United States.
复制标题
安置后压力因素和获得医疗保健的机会对最近在美国安置的难民的健康结果的影响。
DOI：
10.1037/ort0000697
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Goodkind,JessicaR
中科院分区：
文献类型：
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作者：
Lardier,DavidT;Hess,Julia;Winter,Lucas;Goodkind,JessicaR
这项混合方法的研究探讨了将经济，社会和医疗保健资源的部署与情绪困扰和身体健康结果联系起来的机制。审查这些机制对于为减少美国和其他重新安置环境中的健康差距和改善难民健康的战略、政策和其他干预措施提供信息至关重要。本研究的数据是作为美国西南部一个中等城市随机对照试验的一部分收集的。来自143个家庭的290名最近重新安置（< 3岁）的成年难民参加了这项研究（36.2%为阿富汗人，32.8%为伊拉克/叙利亚人，31.0%为五大湖非洲人; 52%为妇女）。通过半结构化访谈收集定性访谈数据。一个纵向结构方程路径模型的定量数据从三个时间点超过12个月测试的假设，从定性研究结果出现。在半结构化访谈中，在美国的难民（a）将更严重或新的身体健康问题的发展归因于与经济不稳定和有限的社会支持有关的重新安置后的压力因素，这些压力因素导致了他们的情绪困扰，（B）报告了在美国获得医疗保健的几个障碍，包括对医疗保健资源的了解不足，病人与提供者的沟通不足，以及驾驭复杂的美国医疗保险体系，所有这些都加剧了他们的身体健康问题。在这些定性研究结果的指导下，纵向定量数据显示：（a）移民后压力源与情绪困扰和自我报告的身体健康状况不佳有关，（B）情绪困扰介导了移民后压力源与全球健康满意度之间的关联，（c）情绪困扰与全球健康满意度呈负相关。调查结果记录了难民在美国医疗保健系统所创造的独特环境中所经历的压力源，以及这些压力源如何通过增加情绪困扰而导致身体健康状况不佳。（PsycInfo数据库记录（c）2023阿帕，保留所有权利）
This mixed-methods study examines mechanisms connecting the deployment of economic, social, and health care resources to emotional distress and physical health outcomes. Examining such mechanisms is critical for informing strategies, policies, and other interventions for reducing health disparities and improving refugee health in the United States and other resettlement contexts. Data for this study were collected as part of a randomized control trial in a mid-sized city in the Southwestern United States. Two-hundred ninety recently resettled (< 3 years) refugee adults from 143 households were enrolled in the study (36.2% Afghan, 32.8% Iraqi/Syrian, and 31.0% Great Lakes African; 52% women). Qualitative interview data were collected via semistructured interviews. A longitudinal structural equation path model of quantitative data from three time points over 12 months tested hypotheses that emerged from qualitative findings. In semistructured interviews, refugees in the United States (a) attributed the development of worse or new physical health problems to postresettlement stressors related to financial instability and limited social support that contributed to their emotional distress and (b) reported several barriers to accessing health care in the United States, including insufficient knowledge of health care resources, inadequate patient–provider communication, and navigating complex American health insurance systems, all of which exacerbated their physical health problems. Guided by these qualitative findings, longitudinal quantitative data revealed that:(a) postmigration stressors were associated with emotional distress and poor self-reported physical health,(b) emotional distress mediated the association between postmigration stressors and global health satisfaction, and (c) emotional distress was negatively associated with global health satisfaction. Findings document stressors refugees experience in the context of the unique environment created by the American health care system and how these stressors contribute to poor physical health through increased emotional distress.(PsycInfo Database Record (c) 2023 APA, all rights reserved)