Adult refugees' perspectives on the impact of trauma and post-migration hardships on learning.

Background: Research shows that adult refugees' well-being and future in the reception country heavily depend on successfully learning the host language. However, we know little about how adult learners from refugee backgrounds experience the impact of trauma and adversity on their learning.Objective: The current study aims to investigate the perspectives of adult refugee learners on whether and how trauma and other adversity affect their learning.Methods: We conducted in-depth interviews with 22 adult refugees (10 women) attending the Norwegian Introduction Programme (NIP). The participants came from six Middle Eastern, Central Asian, and African countries. Two questionnaires were included, one about past stressful life events (SLESQ-Revised), and one about mental health symptoms and current psychological distress following potentially traumatic experiences (PCL-5).Results: Participants held varying beliefs about trauma's impact on learning: that it had a constant impact, that it was situational, or that it had no impact. Other aspects they brought up as having an essential effect on learning and school attendance include psychological burdens from past and present school experiences, and post-migration hardships such as loneliness, depression, ongoing violence, and negative social control. Post-migration trauma and hardships exacerbated the burden of previous trauma and were frequently associated with a greater negative influence on learning.Conclusion: This study adds new insights from adult refugee learners themselves into how post-migration hardships as well as trauma can impact their learning, and the importance of recognising their struggles. A safe space is required for refugees to open up about their difficulties in life and with learning. This knowledge can be used to enhance teaching practices, foster better teacher-student relationships, and inform policy-making decisions, ultimately benefiting both individuals and society.

Adult refugee learners' own perspectives on the impact of trauma on learning varied from constant to situational to no impact at all.Other factors identified as impacting learning and school attendance included, amongst others, psychological burdens from past and present school experiences, ongoing violence, forced family separation, and negative social control.Post-migration trauma and hardships were frequently associated with a greater negative influence on learning than the burden of previous trauma.

Delivering therapy over telephone in a humanitarian setting: a pilot randomized controlled trial of common elements treatment approach (CETA) with Syrian refugee children in Lebanon.

BACKGROUND: In recent years, the number of forcibly displaced persons has risen worldwide, with approximately 40% being children and adolescents. Most of them are hosted in low- and middle-income countries (LMICs). Many individuals meet the criteria for mental health issues, which can also be exacerbated by a number of risk factors, including low socioeconomic status, displacement, and stressors linked to conflicts in their country or region of origin. However, the vast majority never receive treatment for their psychological problems due to multiple reasons, including a shortage of mental health professionals in LIMCs, transportation challenges in accessing clinics, and clinic hours conflicting with family commitments. In the current study we investigated whether individual psychotherapy delivered by trained lay counsellors over telephone to Syrian refugee children living in Lebanon is effective and overcomes barriers to treatment access. METHODS: After adaptation of Common Elements Treatment Approach (CETA) to remote delivery over telephone (t-CETA), preliminary effectiveness of the treatment modality was assessed with a pilot single blind randomised controlled trial including a total sample of 20 refugee children with diagnosed mental health problems. Data was analysed applying a Bayesian approach. RESULTS: There was a significant session-by-session decrease in self-reported mental health symptoms over the course of treatment. Independent assessments showed that t-CETA resulted in a greater reduction of symptoms than standard in-person treatment as usual. There was no difference between groups for impairment. Importantly, the majority of children allocated to t-CETA completed treatment whilst no children in the treatment as usual condition were able to do so. CONCLUSION: The study provides preliminary evidence that telephone-delivered psychotherapy in a humanitarian setting, delivered by lay counsellors under supervision, works and significantly increases access to treatment compared to traditional in-person treatment. However, findings remain to be replicated in larger trials. TRIAL REGISTRATION: Clinical Trials. gov ID: NCT03887312; registered 22nd March 2019.

Edward K. Barsky (1897-1975): Surgery, activism, and the Spanish Civil War.

Edward K. Barsky (1897-1975) was born and raised in New York City and became a surgeon at Beth Israel Hospital. During the political upheaval of the 1930s, Barsky became passionate about the cause of the Spanish Republic during the Spanish Civil War, as the democratically elected government came under siege by insurrectionists led by General Francisco Franco. Barsky transformed his beliefs into action as a founder of the American Medical Bureau to Aid Spanish Democracy, where he led a medical mission to the Spanish frontlines from 1937 to 1939. In Spain, Barsky organized American hospitals and operated under fire, contributing to significant advances in battlefield medicine. After the fall of the Republic in 1939, Barsky returned to the United States and his career as a surgeon in New York while also dedicating himself to the cause of Spanish refugees. His political activities, however, made him a target of political persecution by the House Un-American Activities Committee, and he ultimately lost both his freedom and his medical licence. Barsky was a surgeon, scientist, humanitarian, and activist, and his life illustrates the often complicated ties between politics and the practice of medicine.

A psychosocial bouldering intervention improves the well-being of young refugees and adolescents from the host community in Lebanon: results from a pragmatic controlled trial.

BACKGROUND: Mental health and psychosocial support (MHPSS) is increasingly considered vital for addressing the needs of displaced communities. The mental health of young people in Lebanon, including members of the host community and refugees, has been severely affected by multiple crises. Physical activity (PA) is an effective means for enhancing mental health, but evidence of PA's impact on mental health among forcibly displaced populations is still emerging and often varies widely across studies. METHOD: In this waitlist-controlled study, we examined the effectiveness of an 8-week psychosocial bouldering group intervention offered by the nonprofit organization ClimbAID on psychological well-being, distress, self-efficacy, and social cohesion in a group of mostly Syrian refugee adolescents residing in the Bekaa Valley, Lebanon. The intervention consisted of 8 sessions and took place once a week for 2 h in a group of up to 12 adolescents with 2 trained facilitators and up to 2 volunteers, supervised by a climbing instructor and a social worker. Multilevel analyses were performed for all outcomes. RESULTS: 233 people were included in the study. The dropout rate was approximately 33%. The IG improved significantly more than the waitlist group in terms of overall mental well-being and psychological distress. Group allocation was a significant predictor of improvements in mental well-being and psychological distress and showed a trend toward predicting self-efficacy. There was no positive impact of the intervention on social cohesion. CONCLUSIONS: Even in complex humanitarian settings of forced displacement, a psychosocial bouldering intervention reduces psychological distress and increases well-being in a mixed group of host and refugee youth in Bekaa, Lebanon. TRIAL REGISTRATION: Prospectively registered with ISRCTN 13005983, registered April 1st, 2022.

Feasibility and Acceptability Study of a Culturally Adapted Web-Based Intervention to Reduce Suicidal Ideation for Syrian Asylum Seekers and Refugees in the United Kingdom: Protocol for a Mixed Methods Study.

BACKGROUND: The war in Syria has displaced over 6.8 million people, more than any other conflict since the Second World War. As a result, Syrian asylum seekers and refugees have experienced several life-changing events, resulting in high rates of anxiety, depression, posttraumatic stress disorder, and suicidal ideation (SI). To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI developed for general populations was culturally adapted for and with Syrian asylum seekers and refugees in the United Kingdom. The study revealed the importance of understanding their lived experience with migration and the acculturative process in providing treatment for SI. This study will now assess the feasibility and acceptability of the culturally adapted intervention for this population. OBJECTIVE: The first phase of the study will include recruiting participants and delivering the web-based intervention (1) to assess the feasibility of meeting recruitment goals and recruitment rates and (2) to assess the feasibility of outcome measures. The second phase of the study will include one-to-one semistructured interviews (1) to assess the suitability of the culturally adapted intervention in terms of recruitment and adherence rates and barriers and facilitators to engagement and (2) to assess the acceptability of the intervention in terms of its cultural relevance and appropriateness. METHODS: This is a protocol for a single-group, noncontrolled, mixed methods feasibility and acceptability study of a culturally adapted web-based intervention to reduce SI for Syrian asylum seekers and refugees in the United Kingdom. The study will assess the feasibility of recruitment goals, recruitment rates, adherence rates, and outcome measures using individual participant tracking forms, which will be analyzed quantitatively. The suitability and acceptability of the intervention will be assessed using one-to-one semistructured interviews with 12 participants who completed the intervention, which will be analyzed qualitatively. RESULTS: Recruitment began in February 2024 and will run until 30 participants are recruited to the study or until the end of July 2024. Thus far, 19 participants have provided informed consent, 16 were eligible and enrolled, and 12 have completed a postintervention interview. No data have been analyzed. The study, including the write-up period, is expected to end in December 2024. CONCLUSIONS: Despite experiencing several stressors related to forced displacement and high rates of mental health issues, access to treatment is still limited for Syrian asylum seekers and refugees in the United Kingdom. To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI was culturally adapted in collaboration with Syrian asylum seekers and refugees in the United Kingdom. This study will now assess the feasibility and acceptability of the intervention and culturally appropriate recruitment strategies. TRIAL REGISTRATION: ISRCTN ISRCTN11417025; https://www.isrctn.com/ISRCTN11417025. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/56957.

Socioecologies in shaping migrants and refugee youths' sexual and reproductive health and rights: a participatory action research study.

OBJECTIVE: This study explores socioecological factors facilitating the sexual and reproductive health and rights (SRHR) experiences of migrant and refugee youth (MRY) in Greater Western Sydney, Australia. MRY may be at higher risk for poorer SRH outcomes due to cultural, linguistic, and systemic barriers. METHODS: Using participatory action research, 17 focus groups were conducted with 87 MRY aged 15-29 from diverse cultural backgrounds. Data were analysed thematically, using socioecological framework. RESULTS: Key facilitators of MRY's SRHR were identified at the microsystem and exosystem levels, including (1) Peer dynamics and support, with friends serving as trusted confidants and sources of advice; (2) Safety and contraceptive choices, highlighting the importance of access to contraception and STI prevention; and (3) Digital platforms for SRHR information access, with online resources filling knowledge gaps. CONCLUSION: Findings suggest the need for SRHR interventions to leverage peer support networks, expand access to contraceptive options, and develop culturally appropriate digital resources for MRY. Further research is needed to identify and enhance facilitators across all socioecological levels to comprehensively support MRY's SRHR needs.

Migrants and refugee youth often struggle to access sexual and reproductive health information and services in their new countries. This study is an attempt to understand what helps young migrants and refugee maintain their sexual and reproductive health and rights in Greater Western Sydney, Australia. Our aim was to identify the positive factors in their environment that make it easier for them to access and use sexual health resources. We talked to 87 migrants and refugee youth aged 15­29 from various cultural backgrounds, conducting 17 group discussions about their experiences with sexual health. Our main results show three important factors that help these young people. The results were, that (1) Many young people trust their friends for advice and information about sexual health, (2) Having choices about contraception and ways to prevent sexually transmitted infections was important, and (3) The internet, especially social media and search engines, is a major source of sexual health information for young people. Understanding these helpful factors can guide better support for young migrants and refugees. It shows sexual health programs need to use peer support in sexual health programs, make sure young people can easily access contraception and protection and create trustworthy online resources about sexual health that are culturally appropriate. Our findings show more research is needed to find other ways to support young migrants and refugees with their sexual and reproductive health. This will help create better health services and education programs for these young people.

Evaluation of a Pharmacist-Led Multidisciplinary Approach to the Treatment of Latent Tuberculosis in Refugee Patients in the Primary Care Setting.

BACKGROUND: Treatment of latent tuberculosis infection (LTBI) is essential for refugee patients that have been relocated to the United States to prevent progression to active infection. OBJECTIVE: To determine the effectiveness of a multidisciplinary team approach, embedded within a primary care clinic, to treatment of LTBI in newly resettled refugee patients compared to a local health department. METHODS: This was a single-center, retrospective chart review of newly resettled refugee patients 18-89 years old with diagnosis of LTBI. The primary objective was completion rate of LTBI therapy within one year of resettlement. Secondary objectives were incidence of adverse events, regimen switches, and adherence rate. RESULTS: A total of 58 patients were included in the study; 14 individuals through the multidisciplinary clinic and 44 individuals with the local health department. Completion of therapy within 1 year of resettlement was seen in 71.4% (n=10) of patients in the multidisciplinary clinic compared to 72.7% (n= 32) at the health department. There were 7 patients who underwent a regimen switch, all of which were in the health department arm. Adverse effects occurred in 14.2% of patients in the multidisciplinary clinic and 15.9% of patients in the health department arm. Treatment adherence was 98.6% in the multidisciplinary clinic and 90.5% in the local health department arm. CONCLUSION: Use of a multidisciplinary team was successful in completion of LTBI treatment in refugee patients, helping to alleviate barriers to treatment completion by ensuring adherence and close follow-up.

Home, School, and Community-based Services for Forcibly Displaced Youth and Their Families.

Forced displacement can expose youth to unimaginable levels of traumatic life events. We discuss how home-based, school-based, and community-based services can be strategically situated to address the psychological sequelae of such events. Given the systemic challenges that refugee youth face when establishing trust in their new environments, are often from collectivist cultural backgrounds, espouse stigma towards professional help seeking, and must prioritize accessing services for their basic needs, these types of settings can be particularly relevant. In the administration of such services, we advocate for an intentional approach to addressing basic needs as well as using cultural brokers, validated measures, and family- and school-based interventions.

The use of creative art therapy to address the mental health of refugee adolescents: a systematic review.

INTRODUCTION: Creative art therapy (CAT) has become increasingly popular as a means of promoting positive mental health among adolescent refugees when accompanied by interdisciplinary interventions that engage families and communities. In this pre-registered systematic review (PROSPERO: CRD42022372538), we evaluated and synthesized the available literature reporting the use of CAT as a diagnostic, treatment and mental health promotion intervention with adolescent refugees, aged 10-24 years. METHODOLOGY: We conducted a systematic search of the grey and black literature published in English and Arabic between 2012 to 2022 on 10 databases. RESULTS: Systematic database searches revealed 397 articles but only 5 met our inclusion criteria. These studies reported some positive outcomes but the evidence supporting the effectiveness of CAT as a diagnostic, treatment and mental health promotion intervention with adolescent refugees, aged 10-24 years is inconclusive. CONCLUSION: The findings of this review point to the need for more methodologically robust studies that describe the intervention, implementation, and therapeutic approaches in greater detail to strengthen the evidence for the use of CAT with adolescent refugees.

SARS-CoV-2 Infection and Other Communicable Diseases Identified Among Evacuees From Afghanistan Arriving in Virginia and Pennsylvania, August to September 2021.

In 2021, the US government undertook Operation Allies Welcome, in which evacuees from Afghanistan arrived at 2 US ports of entry in Virginia and Pennsylvania. Because of the rapid evacuation process, the US government granted evacuees an exemption to a Centers for Disease Control and Prevention (CDC) requirement in place at that time-namely, that air passengers present a negative SARS-CoV-2 viral test result or documentation of recovery from COVID-19 before they boarded international flights bound for the United States. This study describes cases of SARS-CoV-2 infection detected among 65 068 evacuees who arrived at the 2 ports of entry in August and September 2021. Because evacuees were a population at increased risk for infection with diseases of public health concern, CDC staff helped coordinate on-site and on-arrival testing, visually observed evacuees for signs and symptoms of communicable disease, and referred evacuees for further evaluation and treatment as needed. CDC staff used antigen or nucleic acid amplification tests at the ports of entry to evaluate evacuees aged ≥2 years without documentation of recent SARS-CoV-2 infection. CDC staff isolated evacuees with confirmed SARS-CoV-2 infection and quarantined their close contacts, consistent with CDC guidance at the time, before evacuees rejoined the repatriation process. Of 65 068 evacuees, 214 (0.3%) were confirmed as having SARS-CoV-2 infection after port-of-entry testing. Cases of measles, varicella, pertussis, tuberculosis, hepatitis A, malaria, leishmaniasis, and diarrheal illness were also identified. Although the percentage of SARS-CoV-2 infection was low in this evacuated population, communicable disease detection at US ports of entry, along with vaccination efforts, was an important part of a multilayered approach to mitigate the transmission of disease in congregate housing facilities and into US communities.

Advancing Refugee Health Data Management: The Implementation of ICD-11 in UNRWA's Primary Care System.

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) was one of the earliest healthcare systems globally to implement the International Classification of Diseases, Eleventh Revision (ICD-11) across its 140 clinics serving 5.9 million Palestine refugees. This paper discusses the integration of ICD-11 into UNRWA's cloud-based electronic medical record (EMR) system, identifying both the barriers and facilitators involved and analyzing trends in clinical documentation and healthcare utilization. The key challenges included data privacy provisions, integration into a coordinated care model, complex classification schema for primary care settings, frequent staff turnover, and limited data analysis capabilities. Conversely, facilitators included physician-tailored training and on-site support, system compatibility, a multidisciplinary team approach, policy support from UNRWA and the World Health Organization (WHO), and leadership commitment and effective change management. Medical officers (MOs) using ICD-11 reported greater satisfaction with the system's capabilities in managing and visualizing health information. This article contributes to the discourse on health data management in complex humanitarian settings, offering insights into the benefits and challenges of implementing advanced classification systems like ICD-11. Future research should explore longitudinal impacts and further integration with global health systems, ensuring that the advancements in classification continue to support the overarching goal of health equity and access in vulnerable and hard-to-reach populations.

Understanding the Health Literacy Experiences and Practices of Australian-Resettled Myanmar Refugees: Relevance for Nutrition and Dietetics Practice.

Background/Objectives: Refugees typically experience poorer health compared with people from non-refugee backgrounds, and health literacy may play a part in this discrepancy. Using the WHO's revised health literacy definitions as a framework, this qualitative study sought to examine the health literacy experiences and practices of Australian resettled refugees from Myanmar from refugee and service provider perspectives. Methods: Four refugee participant focus groups (n = 27) along with one focus group and four interviews with service providers (n = 7) were conducted in Melbourne, Australia, and analysed using deductive content analysis. Results: Our study found that in addition to individual health literacy, community literacy was practiced by Myanmar refugees, thus highlighting the relevance of social support to health literacy. Furthermore, our study found gaps in healthcare service provision and resourcing related to health literacy development and responsiveness by the healthcare system. Conclusions: Our study confirms the relevance of WHO's revised health literacy definitions to Myanmar refugees while also discussing, in the context of nutrition and dietetics practice, the importance of understanding the different aspects of health literacy and how this relates to working with those who are most marginalised to improve their health and wellbeing.

A Proactive Telephonic Outreach Program to Address Unmet Social Needs of Children in Immigrant and Refugee Families at a Federally Qualified Health Center.

OBJECTIVE: We developed a telephonic outreach and care coordination program for children in immigrant and refugee families (CIRF) at a federally qualified health center (FQHC) in North Carolina to address unmet health-related social needs (HRSN). METHODS: Participants were recruited between December 2020 and October 2021. Eligible children were ages 0-5, non-English speaking, and were seen at the FQHC in the 2 years prior. A bicultural/bilingual case manager completed telephonic outreach to caregivers of participants with HRSN screening. Bilingual patient navigators made follow-up calls to assess connection to resources and to develop strategies for addressing unmet needs. RESULTS: Three hundred forty-two families received outreach; 212 (62.0%) completed the baseline questionnaire. The majority (N = 160, 75.5%) completed at least one follow-up. The majority (N = 186, 88.1%) were Spanish-speaking, and over two-thirds (N = 149, 70.3%) were uninsured. Most participants had between 3-5 HRSNs identified (N = 121, 57.1%); "employment" (n = 158, 74.5%) and "food" (n = 138, 65.1%) were the most common. Despite repeated assistance, the majority of participants struggled to link to a community resource for their highest priority need (N = 123, 78.3%). CONCLUSION: Proactive phone-based HRSN screening may be a feasible and effective intervention to facilitate the identification of social needs for CIRF. The delivery of the intervention in languages other than English may have further contributed to program acceptability. Despite program feasibility and acceptability, community-level barriers to the resolution of HRSNs persist. While similar care coordination models can be considered to identify the high burden of unmet HRSN among CIRF, addressing the limited capacity of community-based resources for this population will be a critical component to ensuring the sustainability of such programs.

Suicidal behaviors among refugee women in Jordan: post-traumatic stress disorder, social support and post-displacement stressors.

BACKGROUND: This paper examines the frequency of suicidal behaviors (suicidal ideation or attempt) among a sample of Syrian refugee women living in non-camp settings in Jordan. We asked several questions surrounding suicide and examined the associations between post-traumatic stress disorder (PTSD), social connectedness, post-displacement stressors and suicidal behaviors. METHODS: Participants (n = 507) were recruited using a clinic-based systematic sampling from four health clinics throughout Jordan in 2018. We used a multivariable logistic regression to examine the hypothesis of whether positive screening for PTSD (PCL-5), social isolation (have no friends or family members available to help), and greater number of post-displacement stressors (PMLD Checklist) is associated with suicidal behaviors. RESULTS: Approximately one-tenth (9.86%) of participants surveyed reported suicidal behaviors (suicidal ideation or attempt) in the past six months. Our hypothesis was partially supported. In the adjusted multivariable analyses, screening positive for PTSD [OR:4.02 (95% CI:1.33, 12.15)] increased odds of suicidal behaviors, while having one friend or family member available to help when in need [OR:0.31 (95% CI:0.13, 0.78)] decreased odds of suicidal behaviors. We did not find any associations between the number of post-displacement stressors and suicidal behaviors in the multivariable model. CONCLUSION: Agencies and practitioners addressing suicidal behaviors among Syrian refugee women should provide interventions that aim to reduce PTSD symptoms and social isolation. Potential intervention includes screening for mental health symptoms and suicidal behaviors during routine visits with service providers, as well as providing proper mental health and psychosocial support services according to the mapping of available services.

Development and effects of the PARENT (Parenting Acceptable Real Empathy Nurture Training) program for mothers who defected from North Korea.

AIM AND BACKGROUND: North Korean refugee mothers struggle with the two-fold burden of adaptation and parenting in a new environment. This study aimed to develop and examine the effects of a parenting program for North Korean refugee mothers. METHODS: This quasi-experimental study was conducted with 65 North Korean refugee mothers who were recruited through the Korea Hana Foundation Center and Sajowi. The experimental and control groups comprised 33, 32 participants respectively. A program was conducted across eight sessions, each lasting about 90-120 min. The data were analyzed using the χ2 test, independent t-test, and paired t-test. RESULTS: Significant differences were observed in the parenting efficacy (t = -10.03, p < .001) and child related stress (sub domain-parenting stress) (t = 3.24, p = .002) scores. While intergroup differences were observed for parenting efficacy (t = 5.48, p < .001), no significant differences were observed for parenting stress (parent related) (t = -0.22, p = .825) and parent-child relationship (t = 0.87, p = .387) and no intergroup differences were observed for parenting stress (t = -1.10, p = .274) and parent-child relationship (t = 1.06, p = .290). CONCLUSION: This study is significant to the field of nursing because North Korean refugee mothers who needed parenting education have high parental efficacy scores after intervention, which expresses confidence in parenting. This study proposed a parenting education intervention framework focusing on emotional empathy for North Korean refugee mothers who want to provide healthy parenting despite the challenges they encounter as immigrants, which will improve their confidence in parenting. It can serve as a source of basic data for designing parenting education intervention frameworks for refugees in the future.

Contextualizing HIV testing experiences within the HIV prevention cascade: qualitative insights from refugee youth in Bidi Bidi refugee settlement, Uganda.

BACKGROUND: There remain key knowledge gaps regarding HIV testing needs and priorities among refugee youth in low and middle-income country (LMIC) humanitarian settings. The HIV prevention cascade framework focuses on three domains (motivation, access, effective use) central to prevention uptake, yet is understudied in relationship to HIV testing, particularly among refugee youth. Uganda is an exemplar context to explore refugee youth HIV testing needs and priorities as it hosts 1.5 million refugees and is Africa's largest refugee hosting nation. In this study, we explored perceptions and experiences regarding HIV testing among refugee youth living in Bidi Bidi refugee settlement, Uganda. METHODS: We conducted a community-based research study in Bidi Bidi Refugee Settlement, one of the world's largest refugee settlements with over 195,000 residents. This qualitative study involved four focus groups (2 with young women, 2 with young men) with refugee youth aged 16-24 living in Bidi Bidi refugee settlement. We applied thematic analysis informed by the HIV prevention cascade to understand domains of motivation, access, and effective use that emerged as salient for HIV testing engagement. RESULTS: Participants (n = 40; mean age: 20 years, standard deviation: 2.2) included refugee young women (n = 20) and young men (n = 20), of whom 88% had a lifetime HIV test and 58% had ever heard of HIV self-testing. Participant discussions described HIV testing motivation was influenced by dimensions of: HIV treatment and testing knowledge; risk perception; positive and negative consequences of use; and social norms regarding gender and age. Access to HIV testing was shaped by: limited availability; distance and language barriers; confidentiality concerns; and affordability. Effective use of and engagement with HIV testing was related to HIV serostatus knowledge self-efficacy and in/equitable partner dynamics. CONCLUSIONS: Complex, multi-level factors shape motivation for, access to, and effective use of HIV testing among refugee youth in Bidi Bidi. Findings align with the HIV prevention cascade framework that helps to identify gaps to inform intervention development with youth in humanitarian settings. HIV testing approaches tailored for refugee youth in contexts such as Bidi Bidi can foster HIV prevention and treatment literacy, gender equity, gender-based violence prevention, and intersectional stigma reduction.

Doctors' experience providing primary care for refugee women living with chronic pain: a qualitative study.

BACKGROUND: The experiences of GPs in Australia highlight key considerations regarding workload demands, remuneration incentives and the practical implications of working in regions with high ethnic density. This exploration helps to understand the elements that influence GPs delivery of care, particular for refugee women who exhibit disproportionately higher rates of chronic pain. This qualitative study explored the experiences of GPs providing care for refugee women living with chronic pain. METHODS: Semi-structured interviews were undertaken with 10 GPs (9 female and 1 male) practicing across metropolitan Melbourne, Australia. GPs were recruited via purposive sampling and a snowballing strategy. Participants work experience ranged from one to 32 years. Audio recordings of the interviews were transcribed verbatim and stored in qualitative data Nvivo 12 software for coding. Transcripts of interviews were analysed thematically using a phenomenological approach. RESULTS: Three overarching themes were identified: (1) meeting the needs of refugee women living with chronic pain; (2) the role of the GP; and (3) the challenges of the health care system. These themes reflected the complexity of consultations which arose, in part, from factors such as trust, the competencies of clinician's and the limitations posed by time, funding and interpreter use. CONCLUSION: GPs acknowledged the uniqueness of refugee women's chronic pain needs and whilst doctors welcomed care, many were often challenged by the complex nature of consultations. Those that worked in settings that aligned with refugee women's needs highlighted the importance of cultivating culturally safe clinical environments and listening to their patients' stories. However, system level challenges such as time, funding and resource constraints created significant challenges for GPs. Exploring GPs experiences allows for a better understanding of how vectors of disadvantage intersect in health care and highlights the need to better support doctors to improve health care provision for refugee women living with chronic pain.

Maternal Health Experiences, Depression, and Anxiety Among Refugees and Displaced Persons in Iraq: A Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: Improving maternal health is one of the World Health Organization's (WHO) key priorities, grounded in a human rights approach and linked to efforts on universal health coverage. This study aimed to assess maternal health experiences among refugees and displaced women in Iraq during the COVID-19 pandemic. METHODS: A cross-sectional study was done on 1321 women of reproductive age living in four camps supervised by the Barzani Foundation Charity in the Kurdistan Region of Iraq from June to August 2021. Researchers developed a questionnaire, and the data was collected by four staff members working in the camps through direct interviews with women. The World Health Organization Brief (WHOQOL-BREF), generalized anxiety disorder seven-item (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) scales were used to measure quality of life (QoL), anxiety, and depression. The frequency, percentage, percentile, and the Chi-square test were used for data analysis. RESULTS:  The women's mean age (SD) was 31.9 (±7.7) years. Around two-thirds of women attended the camp's healthcare facilities, and 16.4% attended the private facilities. Women mentioned the following as barriers to seeking health services: COVID-19 (387/29.3%), transportation (351/26.6%), lack of someone watching children (300/22.7%), and language (242/18.3%). The rate of high-level QoL among currently pregnant women (8/8.7%) was significantly (p = 0.002) less than the rate among nonpregnant women (297/24.2%). More than half (734/55.6%) of the women had mild depression, 247/18.7% had major depression, and 50/3.8% had severe major depression. Regarding anxiety, 580/43.9% had minimal anxiety, 467/35.4% had mild anxiety, 173/13.1% had moderate anxiety, and only 101/7.6% had severe anxiety. CONCLUSIONS: Refugees and internal displaced women in Iraq have barriers to seeking maternal healthcare. They suffer from low QoL, depression, and anxiety. Factors affecting the quality and accessibility of maternal healthcare in the camps should be studied. Health policymakers have to consider its improvement.

A Scoping Review of the Intimate Partner Violence Literature Among Afghans Across Contexts.

The purpose of this scoping review was to ascertain the scope and nature of the literature focused on intimate partner violence (IPV) among Afghans across contexts, including Afghanistan. The scoping review adopted a systematic approach to search for, identify, and include peer-reviewed articles published in English. Fifty-two articles were retained in the final analysis, which generated results on IPV prevalence; multi-level risk and protective factors; qualitatively derived contextual factors; associations of IPV with adverse physical and psychological outcomes; IPV-related help-seeking behaviors; programs and interventions; the role of religion; IPV-related policies; and the role of fiction. Findings indicate that past-year physical IPV prevalence ranged from 52% to 56% in Afghanistan and 79.8% among Afghan refugees displaced in Iran. Studies conducted in Afghanistan identified a range of IPV risk factors occurring at the individual (e.g., age and employment), interpersonal/household (e.g., acceptance of IPV and violence perpetrated by in-laws), and societal levels (e.g., conflict/displacement). The findings highlight a rich literature on IPV in Afghanistan and significant gaps in IPV research across the Afghan diaspora and in contexts of displacement and resettlement. The results advance understanding of the drivers of IPV in the diverse Afghan population and highlight context-specific gaps, and needs for intervention and future research. These gaps indicate the importance of conducting research elucidating how risk and protective factors associated with IPV shift in forced migration and resettlement, and an urgent need for the development and testing of services and programs that respond to the specific needs of Afghan women experiencing IPV across contexts.

A qualitative study of negative sociocultural experiences of accessing primary health care services among Africans from refugee backgrounds in Australia: implications for organisational health literacy.

BACKGROUND: Primary health care is the first point of contact for patients from refugee backgrounds in the Australian health system. Sociocultural factors, including beliefs and value systems, are salient determinants of health literacy and access to primary health care services. Although African refugees in Australia have diverse sociocultural backgrounds, little is known about the influence of sociocultural factors on their experiences of accessing primary health care services. Guided by the theoretical framework of access to health care, this study examined from the perspective of African refugees how culturally and religiously conditioned, constructed and bound health beliefs, knowledge and practices influence their experiences of access to, acceptance and use of primary health care services and information in Australia. METHODS: This exploratory, qualitative study involved 19 African refugees from nine countries living in New South Wales, Australia. Semi-structured interviews were conducted and recorded using Zoom software. The interviews were transcribed verbatim and analysed using a bottom-up thematic analytical approach for theme generation. RESULTS: Four main themes were identified. The themes included: participants' experiences of services as inaccessible and monocultural and providing information in a culturally unsafe and insensitive manner; the impact of the clinical care environment; meeting expectations and needs; and overcoming access challenges and reclaiming power and autonomy through familiar means. The findings generally support four dimensions in the access to health care framework, including approachability, acceptability, availability and accommodation and appropriateness. CONCLUSION: African refugees experience significant social and cultural challenges in accessing primary health care services. These challenges could be due to a lack of literacy on the part of health services and their providers in servicing the needs of African refugees. This is an important finding that needs to be addressed by the Australian health care system and services. Enhancing organisational health literacy through evidence-informed strategies in primary health systems and services can help reduce disparities in health access and outcomes that may be exacerbated by cultural, linguistic and religious differences.