Sastre Lauren, Haldeman Lauren
University of North Carolina at Greensboro, Greensboro, USA.
MEDICC Rev. 2015 Oct;17(4):18-24. doi: 10.37757/MR2015.V17.N4.5.
INTRODUCTION In 2012, North Carolina ranked in the top ten states in refugee resettlement, with central Guilford County one of the most diverse in the southeast. OBJECTIVE Examine the local resettlement environmental, nutrition and health barriers and needs of refugees in Guilford County, as perceived by individuals providing services to them. METHODS Participants (n = 40) included: medical and social service providers, educators, faith-based volunteers, resettlement agency caseworkers and liaisons to a variety of refugee communities. Guided semistructured interviews were audio-recorded and transcribed verbatim. Themes were identified using deductive content analysis and categorized by frequency of reporting by participants. RESULTS Perceptions were consistent across participants regarding a diverse local refugee population. Resettlement housing was observed to be in poor condition, located in areas of poverty with transportation barriers. However, refugees rarely relocated, due to strong community relationships and support. Perceived dietary risks included: difficulties budgeting and maintaining food assistance, hoarding food, high consumption of sodas and sweets, misperceptions regarding US products (e.g., perceived need for infant formula), and limited health knowledge. Respondents observed that most refugees preferred "fresh" foods, and had strong agricultural skills but lacked green space. Major barriers to health care reported were: poverty, short duration of initial Medicaid coverage, and language (both lack of interpretation services and translated materials). Providers consistently observed type 2 diabetes, weight gain and dental problems across refugee groups. CONCLUSIONS Direct service providers' experiences and observations working with a diverse resettlement population provide unique insight into consistent barriers to achieving good health that confront refugees. While refugees face many barriers, groups often have impressive strengths, such as agricultural skills, on which to focus. KEYWORDS Refugees, emigration, immigration, minority health, health care disparities, diet, environment, USA.
引言
2012年，北卡罗来纳州在难民安置方面位列前十，吉尔福德县中部是东南部最多元化的地区之一。
目的
考察吉尔福德县为难民提供服务的人员所感知到的当地难民安置环境、营养及健康方面的障碍和需求。
方法
参与者（n = 40）包括：医疗和社会服务提供者、教育工作者、宗教志愿者、安置机构个案工作者以及与各类难民社区的联络人。采用半结构化访谈并进行录音，逐字转录。通过演绎性内容分析确定主题，并按参与者报告的频率进行分类。
结果
参与者对当地难民群体的多样性看法一致。安置住房状况不佳，位于贫困地区且交通不便。然而，由于强大的社区关系和支持，难民很少搬迁。感知到的饮食风险包括：预算困难和维持食品援助、囤积食物、汽水和甜食消费量高、对美国产品存在误解（如认为婴儿配方奶粉有必要）以及健康知识有限。受访者指出，大多数难民更喜欢“新鲜”食物，具备很强的农业技能，但缺乏绿地。报告的医疗保健主要障碍包括：贫困、初始医疗补助覆盖时间短以及语言问题（既缺乏口译服务也缺乏翻译材料）。提供者一致观察到各难民群体中存在2型糖尿病、体重增加和牙齿问题。
结论
直接服务提供者与多样化安置人群合作的经验和观察结果，为了解难民在实现良好健康方面面临的一致障碍提供了独特视角。虽然难民面临许多障碍，但各群体往往有令人印象深刻的优势，比如农业技能，可加以关注。
关键词
难民；移民；少数族裔健康；医疗保健差异；饮食；环境；美国
