Demographic Factors Associated with Health in a Senior Refugee Population in Idaho

Research Article

Ann Nurs Res Pract. 2019; 4(1): 1034.

Demographic Factors Associated with Health in a Senior Refugee Population in Idaho

Anderson A1* and Nies MA2

¹Nursing Instructor, College of Eastern Idaho, Idaho Falls, Idaho, USA

²Director of Nursing Research and Professor, College of Nursing, Idaho State University, Pocatello, USA

*Corresponding author: Anderson A, Nursing Instructor, College of Eastern Idaho, Idaho Falls, Idaho, USA; Email: [email protected]

Received: June 19, 2019; Accepted: June 24, 2019; Published: July 01, 2019

Abstract

Aims: The aim of this study was to determine the relationship between demographic characteristics and health, and if demographic characteristics predicted health of refugees. A second aim was to determine the association between self-rated health and objective health of refugees.

Design: This study used a descriptive cross-sectional design.

Methods: Secondary Data Analysis.

Results: Refugees living in USA longer than two years reported better health than refugees who lived in the USA less than two years for whom data was available. Age was not found to predict health in senior refugees. Refugees that reported race as Asian, Black/African American, or Hispanic/Latino reported poorer self-rated health than refugees that reported race as White.

Conclusion: Prior studies focused on the general population of refugees, whereas this investigation focused only on senior refugees in Idaho. The study variables country of origin, ethnicity, and marital status, were not found to be associated with health.

Impact: Refugees in this study reported better health after living in the USA for two years or longer. There is an opportunity for nurses and other health care professionals to collaborate with individuals providing refugee community resources. Nurses working with refugee resettlement agencies can provide health screening and education to refugees after their resettlement period. Education should include information about the USA healthcare system, common conditions or diseases refugees may have, treatment options, and resources in the community that refugees can use to enhance their health.

Keywords: Refugee; Demographic Factors; Health, Nurses; Health Care Professionals

Introduction

Refugees are individuals who have left their country of citizenship because they feared persecution due to their race, religion, nationality, social group, or political opinion and are unwilling or unable to appeal to their country of origin for protection due to fear . Research on refugee health [1] has focused on the resettlement period when refugees are settling into their new lives in their host country [2]. There is a lack of research on the health of refugees after the resettlement period. The purpose of this study was to examine demographic characteristics, number of years living in the USA, and relation to overall health status of senior refugees in Idaho.

Materials and Methods

Background

Health care is often neglected because of the challenges of moving and settling into a new country [3]. In addition, refugees that settle in the USA might neglect their health care because the refugees do not understand the healthcare system in the USA or mistrust the USA healthcare system [4]. There is a gap in research regarding refugee health after the resettlement period. However, it is known that refugees continue to have poor health outcomes even after establishing themselves into host country communities [5].

Madeline Leininger’s Culture Care Diversity and Universality Theory [6], theorizes that while the concept of health is universal, the meaning of health is defined by a person’s culture. Leininger’s Sunrise Model helps envision a cultural world of different life influences to explore global factors that have the potential to influence culture and health [7]. Culture influences health and a person’s idea of their own health. Because health is influenced by cultural and individual factors, there is a need to understand which factors influence health for refugees.

Leininger’s theory helps guide healthcare professionals understanding of culture and health [7]. Culturally diverse communities can provide challenges to health care providers because the meaning of health and how someone feels about their health is influenced by their culture [8]. To understand refugee health, it is important for healthcare providers to recognize how cultural factors influence health.

Aims

The aim of this study was to determine the relationships between demographic characteristics and health, and if demographic characteristics predicted health of refugees. A second aim was to determine the association between self-rated health and objective health of refugees.

Design

A descriptive cross-sectional design was used. Secondary data was used to determine the association of demographic characteristics; age, gender, country of origin, race, ethnicity, marital status, number of year’s refugees lived in USA, self-rated health and objective health of senior refugees.

Sample

A convenient sample of previously collected data from the Idaho Senior Refugee Interprofessional Holistic Health Project was utilized for this study [9]. This secondary data analysis consisted of 110 senior refugees who participated in the Idaho Senior Refugee Project from September 2016 to February 2018 and were over age 50. Any individual who had never been considered a refugee or was younger than 50 was excluded.

A power analysis in G*Power was performed to determine an optimal sample size to determine a statistically significant result for Pearson Chi-Square test. A dependent variable with three categories, two degrees of freedom was used to measure the needed sample size. For the multiple independent variables, varying numbers of categories were evaluated. For independent variables with two categories, the needed sample size was determined to be N = 108 for an effect size of w = 0.3 with power = 0.80, and alpha set at 0.05.

Data collection

Data for the main study was collected by health professional students with the use of a translator and supervised by preceptors during a home visit to senior refugees. The Research Electronic Data Capture (REDCap) program on study laptops was used to collect and store participants’ information during home visits.

Measures included a demographic questionnaire covering age, gender, country of origin, race, ethnicity, marital status, years living in the USA, and the first question from the Health-Related Quality of Life (HRQOL) to measure self-rated health [10]. The first question from the HRQOL survey asks, “Would you say that in general your health is excellent, very good, good, fair, or poor” [10]. Refugees who rated their self-rated health as excellent, very good, or good were classified into good health, refugees who rated their health as fair were classified into fair health, and refugees who reported their health as poor were classified into poor health.

For the objective health measure, weight and height were obtained to calculate Body Mass Index (BMI), and blood pressure was recorded on a home visit. A BMI of 18.5-25 was categorized as good health. BMI 15-18.5 (underweight) or between 25-30 (overweight) was categorized as fair health. While a BMI under 15 (severely underweight) and above 30 (obese) was categorized as poor health [11]. Blood pressure was classified into categories of normal blood pressure, pre-hypertension, and hypertension [11], to determine the health of each refugee. Blood pressure of 120/80 and under was considered normal blood pressure and was categorized as good health. Pre-hypertension was classified as 121-139/81-89, and blood pressure in this range was categorized as fair health. Hypertension was classified as above 140/90. Blood pressures in this range were categorized as poor health [11].

Ethical considerations

The Human Subjects Committee (IRB) at the University approved the study. After approval from the IRB and receipt of the REDCap deidentified data, the study was conducted.

Data analysis

The statistical package SPSS 25.0 was used to analyze the data. Interval data such as age and number of years living in the country was converted into ordinal scale variables. The association of independent variables such as age, gender, country of origin, race, ethnicity, marital status and number of years living in the country, were assessed using Pearson Chi-Square Test of Independence. Cramer’s phi or V were reported as the measure of association. Ordinal regression was utilized to examine the relationship of demographic variables, selfrated health, and objective health.

Validity and reliability

Translators communicated in the refugee’s language to provide understanding of the information. The first question from the Health-Related Quality of Life (HRQOL) has been used previously to measure self-rated health [10]. Standard calculations were used to calculate BMI from height and weight. Blood Pressure was obtained using standard arm cuff procedures.

Results

Characteristics of the Sample Population. The ages of the refugees ranged from 50-96, with a mean age of 63. Age was broken into two categories based on a mean age of 63, (1) ages 50-63 and (2) ages 64 and older. Of the 83 refugees that reported country of origin, they reported originating from one of twelve different countries: Afghanistan (n = 5), Bhutan (n = 23), Democratic Republic of Congo (n = 4), Republic of Congo (n = 21), Palestine (n = 1), Iraq (n = 13), Burundi (n = 4), Myanmar (n = 7), Somalia (n = 2), Rwanda (n = 1), Pakistan (n = 1), and Armenia (n = 1). Country of origin was categorized into two categories (1) Eurasia and (2) Africa. All the refugees completed the question regarding race, and that they identified with one of four races, white (n = 27), Hispanic or Latino (n = 1), Asian (n = 43), or Black or African American (n = 39). For this study race was separated into two categories, (1) White and (2) Other.

Of the 67 refugees that reported ethnicity, they identified with one of four ethic groups, Congo (n = 2), Bembe (n = 1), Afghani (n = 1), Not Hispanic or Latino (n = 63). For this study ethnicity was separated into two categories (1) Not Hispanic or Latino and (2) Other. Of the 85 refugees that reported marital status, single (n = 10), married (n = 58), divorced (n = 1), widowed (n = 16). Two categories, (1) Married and (2) Single (single, divorced, and widowed) were used.

Of the 80 refugees that reported the number of years they had lived in the USA, (n = 38) lived in the USA under two years and (n = 42) lived in the USA 2 years or longer. The two-year cut off point was created to distinguish between newly arrived refuges and established refugees. The longest a refugee reported living in the USA was 14 years, while four refugees reported living in the USA less than one month.

All refugees in the sample completed self-rated health and objective health indicators. Of the 110 refugees that completed selfrated health, they reported one of six responses, excellent (n = 4), very good (n = 6), good (n = 11), fair (n = 41), poor (n = 43), didn’t know (n = 4), and refused to answer (n = 1). Refugees that refused or did not know their self-rated health were not classified.

Refugees BMI varied from 15.6 to 49.4, with M = 28, and SD = 6. Refugees Systolic Blood Pressure (SBP) varied from 102 to 238, with M = 142 and SD = 22. Refugees Diastolic Blood Pressure (DBP) varied from 50 to 120, with M = 85, and SD = 13. Table 1 presents demographic variables and health variables for refugees. Not all refugees responded to all questions, therefore the frequency varies according to the number that answered each question.

Citation: Anderson A and Nies MA. Demographic Factors Associated with Health in a Senior Refugee Population in Idaho. Ann Nurs Res Pract. 2019; 4(1): 1034.