"It's different here" Afghan refugee maternal health experiences in the United States.

BACKGROUND: The number of Afghan families in the US has grown over the past two decades, yet there is a paucity of research focused on their maternal healthcare experiences. Afghan families have one of the highest fertility rates in the world and typically have large families. As the US faces rising maternal mortality rates, it is crucial to understand factors that affect health outcomes for culturally distinct groups. We aimed to better understand Afghan women's maternal health experiences in South Texas as a step toward designing culturally sensitive care. METHODS: Using a qualitative descriptive design, twenty Afghan women who gave birth in the US within the past 2 years participated in audio-recorded interviews. The first and second authors conducted each interview using a semi-structured interview guide. The authors used an in vivo coding method and qualitative content analysis of the transcribed narrative data. RESULTS: We identified three broad categories with corresponding sub-categories: 1) Maternal Healthcare Experiences: pregnancy, birthing, and postpartum, 2) Communication: language barrier, relationship with husband, and health information seeking, 3) Access to Care: transportation and financing healthcare. The participants expressed perspectives of gratefulness and positive experiences, yet some described stories of poor birth outcomes that led to attitudes of mistrust and disappointment. Distinct cultural preferences were shared, providing invaluable insights for healthcare providers. CONCLUSIONS: The fact that the Afghan culture is strikingly different than the US mainstream culture can lead to stereotypical assumptions, poor communication, and poor health outcomes. The voices of Afghan women should guide healthcare providers in delivering patient-centered, culturally sensitive maternity care that promotes healthy families and communities.

A Life Course Theory Approach to Understanding Eritrean Refugees' Perceptions of Preventive Health Care in the United States.

Thousands of Eritreans flee their homes each month, embarking on dangerous journeys. With these extreme life experiences in mind, this qualitative study aimed to better understand Eritrean resettled refugees' perceptions of United States (US) preventive health care through the lens of the Life Course Theory. Through secondary thematic analysis of narrative data, two over-arching themes emerged: 1) a thirst for information, understanding and affordable health care and 2) attitudes of gratitude and hope despite lack of information and funding. Health promotion programs should focus on enhancing community engagement while nurturing protective factors of resiliency and hope to improve information dissemination and access to affordable health-care services.

Defining and classifying co-curricular interprofessional education in the health professions: a scoping review protocol.

OBJECTIVE: This scoping review will identify, characterize, and classify co-curricular interprofessional education activities and practices. INTRODUCTION: According to the World Health Organization, interprofessional education occurs when students from two or more professions learn about, from, and with one another to enable effective collaboration and improve health outcomes. As such, interprofessional education is imperative to health professions education. Globally, competency frameworks and guidelines have urged educators to reach consensus about interprofessional education terminology and to integrate this form of education into formal curricula. Voluntary interprofessional education that takes place outside formal curricula (ie, co-curricular) is frequently used to overcome well-documented barriers (eg, discordant academic calendars). We will explore the global literature to identify, characterize, and classify published examples of co-curricular interprofessional education activities. INCLUSION CRITERIA: This review will consider voluntary interprofessional education involving students from at least two different health professions. These education activities will take place outside the formal curriculum and will not result in transcript designation. METHODS: The search strategy will aim to locate primary studies from peer-reviewed journals indexed in MEDLINE, CINAHL, Scopus, ERIC, and Academic Search Complete. The results will be limited to English-language publications from 2009 until the present. Two independent reviewers will screen titles and abstracts, and potentially relevant papers will be assessed in detail. Data will be extracted using a tool developed by the reviewers. Descriptive statistics will be used to characterize the data, which will be presented in diagrammatic, tabular, or other relevant formats.

San Antonio refugees: Their demographics, healthcare profiles, and how to better serve them.

OBJECTIVE: The recent refugee crisis has resulted in the largest burden of displacement in history, with the US being the top resettlement country since 1975. Texas welcomed the second most US-bound refugees in 2016, with a large percentage arriving in San Antonio. Yet, the composition of the San Antonio refugees has not been described and their healthcare needs remain ill-defined. Through this study, we aim at elucidating their demographics and healthcare profiles, with the goal of devising recommendations to help guide refugee program development and guide other refugee resettlement programs. METHODS: Data from 731 charts belonging to 448 patients at the San Antonio Refugee Health Clinic (SARHC) were extracted and analyzed. Data included age, gender, country of origin, first language, interpretation need, health insurance status, medical history, vital signs, diagnoses, and prescribed medications. RESULTS: Women constituted the majority of patients (n = 267; 56.4%), and the median age of all patients was 39 (Q1:26, Q3:52). Nepali-speaking Bhutanese patients were the most represented group (n = 107, 43.1%), followed by Iraqi (n = 35, 14.1%), Burmese (n = 30, 12.1%), and Iranian (n = 19, 7.7%) refugees. Of those who responded, 200 (86.6%) did not have any form of health insurance. Additionally, 262 (50.9%) had a body-mass index (BMI) in the overweight or obese range. Further, 61.4% (n = 337) had blood pressures in the hypertensive range, while 9.3% (n = 51) had an elevated blood pressure. On average, each patient had 1.9 complaints, with abdominal pain, headaches, and cough being the predominant complaints. Allergic rhinitis, viral upper respiratory infections, and elevated blood pressure were the most common diagnoses. However, the list of common diagnoses differed per country of origin. CONCLUSION: The SARHC demographics were different from those of other Texas refugees. The rate of the uninsured and the burden of non-communicable diseases were high. Furthermore, each refugee subgroup had a different set of common problems. These findings reveal important considerations for refugee healthcare providers and the unique approach that may be required for different communities.

Using Interprofessional Education to Promote Oral Health Literacy in a Faculty-Student Collaborative Practice.

The aim of this study was to assess the oral health literacy knowledge gained by patients who are refugees, community members, and medical and nursing students after participating in an interprofessional education collaborative of students and faculty from the University of Texas Health San Antonio Schools of Dentistry, Medicine, and Nursing. In this faculty-student collaborative practice, all patients were triaged (including oral hygiene status and alcohol/tobacco use), and tailored treatment options were offered following assessment of their dental, medical, and social histories. The study was designed as a pre-post assessment of an educational intervention on oral health literacy. In the pretest, all groups were invited to respond to questionnaires assessing their knowledge of oral health. After participants engaged in oral hygiene instruction demonstrations and received information about an oral health literacy campaign, a posttest was conducted to assess knowledge gained. A total of 151 patients who were refugees, 38 medical students, 34 nursing students, and 17 community/parish members voluntarily participated in this initiative. Each group had a significant increase in mean oral health literacy score from pre- to posttest: patients 33.5%, community/parish members 22.3%, nursing students 20.8%, and medical students 13% (all p<0.0001). These results showed that the oral health literacy initiative helped increase all participants' oral health literacy and knowledge of preventive care.