Vu Milkie, Besera Ghenet, Ta Danny, Escoffery Cam, Kandula Namratha R, Srivanjarean Yotin, Burks Amanda J, Dimacali Danielle, Rizal Pabitra, Alay Puspa, Htun Cho, Hall Kelli S
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
Front Glob Womens Health. 2022 Dec 14;3:1048700. doi: 10.3389/fgwh.2022.1048700. eCollection 2022.
Refugee women have poor outcomes and low utilization of sexual and reproductive health (SRH) services, which may be driven by access to and quality of SRH services at their resettled destinations. While healthcare providers offer valuable insights into these topics, little research has explored United States (U.S.) providers' experiences. To fill this literature gap, we investigate U.S. providers' perspectives of healthcare system-related factors influencing refugee women's access and utilization of SRH services. Between July and December 2019, we conducted in-depth, semi-structured interviews with 17 providers serving refugee women in metropolitan Atlanta in the state of Georgia (United States). We used convenience and snowball sampling for recruitment. We inquired about system-related resources, facilitators, and barriers influencing SRH services access and utilization. Two coders analyzed the data using a qualitative thematic approach. We found that transportation availability was crucial to refugee women's SRH services access. Providers noted a tension between refugee women's preferred usage of informal interpretation assistance (e.g., family and friends) and healthcare providers' desire for more formal interpretation services. Providers reported a lack of funding and human resources to offer comprehensive SRH services as well as several challenges with using a referral system for women to get SRH care in other systems. Culturally and linguistically-concordant patient navigators were successful at helping refugee women navigate the healthcare system and addressing language barriers. We discussed implications for future research and practice to improve refugee women's SRH care access and utilization. In particular, our findings underscore multilevel constraints of clinics providing SRH care to refugee women and highlight the importance of transportation services and acceptable interpretation services. While understudied, the use of patient navigators holds potential for increasing refugee women's SRH care access and utilization. Patient navigation can both effectively address language-related challenges for refugee women and help them navigate the healthcare system for SRH. Future research should explore organizational and external factors that can facilitate or hinder the implementation of patient navigators for refugee women's SRH care.
难民妇女在性健康和生殖健康（SRH）服务方面的结果较差且利用率较低，这可能是由她们重新安置目的地的SRH服务的可及性和质量所驱动的。虽然医疗服务提供者对这些话题提供了有价值的见解，但很少有研究探讨美国提供者的经历。为了填补这一文献空白，我们调查了美国提供者对影响难民妇女获得和利用SRH服务的医疗系统相关因素的看法。2019年7月至12月期间，我们对美国佐治亚州亚特兰大大都市地区为难民妇女提供服务的17名提供者进行了深入的半结构化访谈。我们采用便利抽样和滚雪球抽样进行招募。我们询问了影响SRH服务获得和利用的系统相关资源、促进因素和障碍。两名编码员使用定性主题方法分析数据。我们发现交通便利性对难民妇女获得SRH服务至关重要。提供者指出，难民妇女更喜欢使用非正式口译援助（如家人和朋友）与医疗服务提供者希望提供更正式口译服务之间存在矛盾。提供者报告说，缺乏资金和人力资源来提供全面的SRH服务，以及在使用转诊系统让妇女在其他系统中获得SRH护理方面存在一些挑战。文化和语言协调的患者导航员成功地帮助难民妇女在医疗系统中导航并解决语言障碍。我们讨论了对未来研究和实践的启示，以改善难民妇女获得和利用SRH护理的情况。特别是，我们的研究结果强调了为难民妇女提供SRH护理的诊所的多层次限制，并突出了交通服务和可接受的口译服务的重要性。虽然研究较少，但使用患者导航员有可能增加难民妇女获得和利用SRH护理的机会。患者导航既可以有效解决难民妇女与语言相关的挑战，又可以帮助她们在医疗系统中获得SRH护理。未来的研究应该探索能够促进或阻碍为难民妇女的SRH护理实施患者导航员的组织和外部因素。
