Harvard Medical School, Boston, MA, USA.
Department of Women Children & Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
Health Soc Care Community. 2019 Nov;27(6):1430-1437. doi: 10.1111/hsc.12810. Epub 2019 Jul 23.
Iraqi refugees in the US experience a high prevalence of non-communicable diseases. In this article, we explore how cultural and structural realities intersect to influence utilisation of preventative healthcare and cancer screening with the aim of understanding health disparities in this population. We conducted three focus group discussions with a total of 14 Iraqi refugee women living in a northeastern US city in 2016 and analysed the qualitative data using a thematic analysis. Eight themes emerged from our data: (a) 'prevention is better than cure:' Iraqi refugee women maintain wellness; (b) physical and mental health are interrelated in causing and curing ill-health; (c) Iraqi refugee women embrace both biomedical and other healing practices; (d) God contributes to healing; (e) cancer is caused by dangerous environments. Three of the eight themes related to barriers to care; (f) multi-level problems within hospitals and clinics prevent the delivery of care; (g) financial barriers prevent access to care and good health; (h) competing priorities are a barrier to good health. We argue that understanding refugee health requires critical analysis of both culturally informed understandings of health and illness as well as the structural aspects of health disparities that result in limited access to life opportunities, racism and inequality for refugees and their communities.
美国的伊拉克难民中，非传染性疾病的发病率很高。在本文中，我们探讨了文化和结构现实是如何相互交织影响预防性医疗保健和癌症筛查的利用，以了解这一人群中的健康差距。我们于 2016 年在一个美国东北部城市对 14 名生活在那里的伊拉克难民女性进行了三次焦点小组讨论，并使用主题分析对定性数据进行了分析。我们的数据中出现了八个主题：（a）“预防胜于治疗”：伊拉克难民女性保持健康；（b）身心健康相互关联，导致和治愈疾病；（c）伊拉克难民女性同时接受生物医学和其他治疗方法；（d）上帝有助于治愈；（e）癌症是由危险的环境引起的。其中有三个主题与护理障碍有关；（f）医院和诊所内的多层次问题阻碍了护理的提供；（g）经济障碍阻碍了获得护理和健康的机会；（h）优先事项的竞争是健康的障碍。我们认为，要理解难民的健康问题，需要对健康和疾病的文化认知以及导致获得生活机会、种族主义和不平等机会有限的健康差距的结构方面进行批判性分析，这些机会是难民及其社区面临的。
