Psychological Distress, Post-Traumatic Stress, and Suicidal Ideation Among Resettled Nepali-Speaking Bhutanese Refugees in the United States: Rates and Predictors.

INTRODUCTION: Bhutanese refugees may exhibit psychological distress (PD), post-traumatic stress (PTS), and suicidal ideation (SI), but little is known about predictors of these mental health problems. PURPOSE: To examine rates and predictors of PD, PTS, and SI among Bhutanese refugees. METHODS: Cross-sectional correlational study of 209 Bhutanese refugees in Midwestern United States. Data were collected using the Hopkins Symptom Checklist/Nepali version and Refugee Health Screener-15/PTS subscale and then analyzed using simultaneous multiple regression. RESULTS: Rates of PD, PTS, and SI were 18.7%, 8.1%, and 7.7%, respectively. Significant predictors of PD were a history of mental health treatment (p<.001) and fewer years of schooling (p = .032). Predictors of PTS were history of mental health treatment (p<.001), female gender (p = .016), fewer years of schooling (p = .012), and being single/previously married (p = .004). PTS predicted SI (ρ<.001). DISCUSSION: Health providers should routinely assess Bhutanese refugees' mental health status for timely further assessment and treatment.

Validation of the Hopkins Symptom Checklist-25/Nepali Version Among Bhutanese Refugees in the United States.

BACKGROUND: Bhutanese refugees' mental problems are relatively high. The Hopkins Symptom Checklist-25 (HSCL-25) has been used widely in examining refugees' mental health, but its psychometric properties in Nepali version is unknown. PURPOSE: To examine psychometric properties of the HSCL-25/Nepali version. METHODS: Bhutanese refugees (n = 209) responded to demographic questionnaire, the HSCL-25/Nepali, and the Refugee Health Survey-15. Exploratory factor analysis (EFA), convergent validity, and internal consistency were performed. RESULTS: After three rounds of EFA, item 14 was deleted resulting in HSCL-24/Nepali with good construct validity and excellent internal consistency (α = .94). CONCLUSIONS: The HSCL-24/Nepali version is reliable and valid and can be used to culturally, appropriately assess psychological distress of Bhutanese refugees as it omits item 14 that captures individual's sexual interest.

Assessing the Mental Health of Refugees Using the Refugee Health Screener-15.

In 2017, 352 refugees were relocated to the Kansas City, Kansas area. As part of the relocation process, newly arrived refugees receive physical and mental health screenings. This study is a retrospective analysis of the results of 92 Refugee Health Screener-15 (RHS-15) surveys collected from February to December 2017 and interviews with the healthcare providers who administered the surveys in a primary care clinic.The most commonly reported mental health symptoms included the following: too much thinking or too many thoughts; muscle, bone, or joint pain; and crying easily. Thirty-seven refugee surveys (40%) indicated the need for follow-up mental health screening. A significant small correlation (r = .22, p = .03) was found between female gender and the depression subscale of mental health symptoms. Provider interviews revealed challenges associated with conducting mental health screening of newly arrived refugees in a primary care setting.

Descriptive, Qualitative Study of Women Who Use Mobile Health Applications to Obtain Perinatal Health Information.

OBJECTIVE: To determine the extent to which perinatal mobile health applications (mHealth apps) are usable and desirable for women who seek information about childbearing. DESIGN: A descriptive, qualitative research design. SETTING: Through snowball sampling, participants were recruited from the social media sites Craigslist, Nextdoor, and Facebook and were asked to provide friends with a study invitation letter. PARTICIPANTS: Sixteen women who were pregnant or in the postpartum period and had used mHealth apps participated in the study. METHODS: Semistructured interviews were conducted to determine how participants perceived and used mobile applications for information about pregnancy. Participants were then given a perinatal app and asked to find specific information with the use of a think-aloud process. Data were organized, coded, and then grouped into concept maps in an iterative process until themes emerged. RESULTS: The themes that emerged were as follows: mHealth Apps Are a Source of Support During Childbearing, mHealth Apps Are Functional Tools, and There Are Limitations of mHealth Apps. Participants felt supported when they used mHealth apps because the information was personalized and they could use the apps to connect with family and the online community. mHealth apps have perceived limitations because women sometimes feel disconnected from the information they receive, some providers and families do not support their use, and security issues may be a concern. CONCLUSION: mHealth apps can be useful educational tools. Providers can support women by recommending select apps for use. Because of minimal oversight from app distribution platforms or health care organizations in the development and use of educational mHealth apps, a system to certify or verify mHealth apps should be developed.

Experiences and Attitudes Among Psychiatric Mental Health Advanced Practice Nurses in the Use of Telemental Health: Results of an Online Survey.

BACKGROUND: Telemental health (TMH) growth is driven by recent trends in health delivery systems and disparities in access to mental health services. There are currently no standard educational guidelines to prepare psychiatric mental health advanced practice nurses (PMH-APRNs) in TMH delivery. OBJECTIVE: To survey practicing PMH-APRNs across the United States about their experiences and attitudes about use of TMH. DESIGN: Eighty-three participants from the American Psychiatric Nurses Association online discussion board completed a nine-item survey. QUESTIONS INCLUDED: Length of time practicing as a PMH-APRN, TMH use in practice, populations served, and TMH background. RESULTS: A majority had been practicing as a PMH-APRN for less than a decade and had used TMH, although most reported no prior education or training in this delivery method. Participants did indicate a desire for TMH education. CONCLUSION: This survey affirms the prevalence of TMH use among PMH-APRN providers, lack of formal training, and necessity for standardized educational guidelines in TMH delivery.

Liminality in cultural transition: applying ID-EA to advance a concept into theory-based practice.

As global migration increases worldwide, nursing interventions are needed to address the effects of migration on health. The concept of liminality emerged as a pivotal concept in the situation-specific theory of well-being in refugee women experiencing cultural transition. As a relatively new concept in the discipline of nursing, liminality is explored using a method, called ID-EA, which we developed to advance a theoretical concept for application to nursing practice. Liminality in the context of cultural transition is further developed using the five steps of inquiry of the ID-EA method. The five steps are as follows: (1) inductive inquiry: qualitative research, (2) deductive inquiry: literature review, (3) synthesis of inductive and deductive inquiry, (4) evaluation inquiry, and (5) application-to-practice inquiry. The overall goal of this particular work was to develop situation-specific, theory-based interventions that facilitate cultural transitions for immigrants and refugees.

Creating a Bridge of Understanding between Two Worlds: Community-Based Collaborative-Action Research with Sudanese Refugee Women.

OBJECTIVE: To explore the process of partnership between university researchers, students, and South Sudanese refugee women to address the health challenges associated with their resettlement transition to the United States. DESIGN AND SAMPLE: This qualitative study used a community-based collaborative action research (CBCAR) framework in the design, collection, and analysis of the qualitative data. Twenty refugee women participated in this study. INTERVENTION: Five health education seminars followed by an audio-recorded focus group were held over 9 months. A final focus group was held to confirm derived themes and develop an action plan. RESULTS: The partnership between the refugee women and researchers resulted in awareness of how power structures and differing expectations affected the process. The dialog in the focus groups provided an opportunity for refugee women to voice challenges to their health in resettlement. A pattern was recognized about how political and sociocultural events affected the process of CBCAR. Dialog and sharing differing worldviews and perspectives led to insights about ways to improve the health of the South Sudanese refugee community. CONCLUSIONS: CBCAR is a useful framework to address health concerns of a refugee community. Insights from this study provided a foundation for a future intervention research project with the refugee women.

Perspectives of northern Ugandan health providers about the effect of cultural beliefs and practices on birth outcomes.

This research is important for those interested in the health of women and children in Africa, specifically the country of Uganda. Maternal and infant mortality rates in Uganda, especially northern Uganda, are very high. Many health providers from resource-rich countries are interested in partnering with health providers in low-resource countries such as Uganda to improve maternal and infant mortality, yet they know very little about the traditional and indigenous beliefs and practices and how these factors contribute to the success of intervention programs. It is essential that cultural considerations be included in interventions. In this article, researchers from the United States offer the perspectives of providers in Uganda regarding an intervention program in which the Americans participated.

Well-being in refugee women experiencing cultural transition.

This article presents a situation-specific theory of well-being in refugee women experiencing cultural transition. The theory resulted from 2 studies, an ethnography and a community-based collaborative action research project, with refugee women from South Sudan, who were resettled to the United States. The theory extends the middle-range theory of transition to include cultural transition as a distinct type of transition with a unique set of properties and conditions including 3 phases-separation, liminality, and integration. Community action research is discussed as a culturally relevant intervention for nurses working with immigrants and refugee populations to foster well-being in resettlement.

Well-being in Dinka refugee women of southern Sudan.

The purpose of this study was to understand the health and well-being of Sudanese refugee women who were resettled with their children to the United States. The design was an interpretive ethnography using individual interviews and participant observation with extensive field notes. The findings describe personal factors as well as community and social conditions that influenced the health and well-being of the refugee women and their families. These influences are captured in the three themes that emerged from the study: (1) liminality--living between two cultures, (2) self-support--standing on our own two legs, and (3) hope for the future. These themes describe a process of how refugee women achieve well-being in the transition to a new country and culture. The study contributes to our theoretical understanding of how to develop culturally congruent interventions for resettled refugees.

Lessons learned from translators and interpreters from the Dinka tribe of southern Sudan.

This article discusses the methodological challenges associated with working with translators and interpreters from the Dinka tribe of southern Sudan during an ethnographic study with refugee Dinka women who were resettled with their children in the United States. Navigating the cultural differences between the researcher, the translator, and the interpreters provided a deeper understanding about the culture of the study population. The lessons learned included the importance of cultural congruence between the interpreters and participants; the education, training, and experience of the interpreters; and the difficulties encountered in preparing interpreters according to university institutional review board requirements. Cultural differences such as time perception and communication and literacy styles were negotiated throughout each phase of the study. The most valuable lesson learned from this experience was the importance of the relationship between the researcher, the translator, and the interpreters as well as between the interpreters and participants to achieve credibility and trustworthiness of the study results.