North American Refugee Health Conference 2024

Background
Meaningful engagement between public health, health systems, and refugee and immigrant communities—a key recommendation of the US Public Health 3.0 framework—is essential to ensure that programs are accessible and responsive to community priorities. In the context of program evaluation and research, the term community engagement encompasses a range of ideas and practices, from superficial forms of data collection and outreach, to more thorough consultation and cooperation with a community, to equally shared efforts and community-driven projects. Each level of engagement presents opportunities and challenges and should be implemented intentionally with clear communication about roles to honor partners’ strengths.

Content
This oral abstract will present a collaboration between the National Resource Center for Refugees, Immigrants, and Migrants (NRC-RIM, Minneapolis, MN) and Refugee Women’s Network (RWN, Decatur, GA), that supported a community-driven program evaluation of RWN’s community health promotion projects. We will share how RWN drove the program design, recruitment, data collection, and program assessment, while NRC-RIM offered technical support on data management, assessment, and dissemination for funders and other stakeholders. Each partner will discuss the opportunities and challenges associated with this type of collaboration, and how the collaboration benefited both partners.

Diego de Acosta | NRC-RIM
deaco011@umn.edu

Temple Moore | Refugee Women's Network
temple.moore@riwn.org

Kimberly Yu | NRC-RIM
yu000623@umn.edu

Sarah Hoffman | NRC-RIM and UofM School of Nursing
hoff0742@umn.edu

Elizabeth Dawson-Hahn | NRC-RIM and UofW Division of General Pediatrics
eedh@uw.edu

Erin Mann | NRC-RIM
mann0255@umn.edu

Ingrid Johansen | Minnesota Immunization Networking Initiative
ijohans1@fairview.org

Background
Technology and access to public health information has been consistent in refugee resettlement. This presentation will elevate the importance of tailored information in social media to enhance access to trusted health information. Since 2017, the Cultural Orientation Resource Exchange, under the International Rescue Committee (IRC) has created and managed Settle In. Redefining the resettlement and integration experiences of newcomers, Settle In supports a multilingual website, app, and social media presence—all of which are simple, clear, and reliable. This presentation will utilize IRC's evidence-based approach to deliver the practical steps for tailoring social media content for refugees and other newcomers.

Content
Settle In developed a guidance document for newcomer-facing content, to be published July 2024, to ease the burden of refugee resettlement stakeholders in communicating information efficiently on social media. Many stakeholders have health and social service backgrounds, but struggle with streamlining social media content tailored to newcomers. This guidance document, funded by NRC-RIM, is an easy-to-use tool that includes recommendations for types of language used, time intervals for when to push out priority information, and best practices around the use of imagery associated with impactful wording.

Emily Kaiser leads CORE’s interactive newcomer-facing digital initiative teams, including two Settle In Facebook pages. She has more than 15 years of experience in the field of digital communications, including social media management, digital content management, and content creation. She holds a BA in Journalism from the University of Minnesota. Emily presented at the 2023 NAHRC and has led interactive digital and in-person workshops with U.S. Resettlement Agency and Resettlement Support Center staff.

Miri Kudinov oversees Settle In Facebook engagement with newly arrived Ukrainians and supports overall management, monitoring and evaluation of the project's activities Settle In team for Ukraine response. Miri brings over 10 years’ experience in operations and program management in healthcare, banking, and social services. Miri holds a B.A in Sociology and Anthropology and a Master’s degree in Public Health and Healthcare Administration from Bar Ilan University.

Faiza Mahamud is the Digital Content Officer for CORE. She is responsible for helping oversee and manage the strategic direction, including growth of CORE’s Settle In platforms, with a focus on newcomer-facing content development. Mahamud brings more than a decade of experience in public policy, communications, and digital strategy. Mahamud holds degrees from Augsburg University and the University of Minnesota's Humphrey School of Public Affairs.

Background
Low vaccination rates among immigrant and refugee communities are due to myriad factors. Often, key factors that influence vaccination uptake –e.g., location of vaccination sites, language of communication, approach to education ---are planned without the input of newcomer community members. Community-engaged approaches, including human-centered design, incorporate community input at a project’s conception. In turn, community input and leadership may enhance vaccine accessibility and trust in vaccination programs.

Content
By the end of this panel discussion attendees will be able to:

1) Describe key steps in multi-lingual, human-centered design with newcomer communities;

2) Understand (and feel prepared to emulate) at least 2 approaches to multi-lingual, human-centered design to support newcomer vaccine access, confidence or education.

Instructional Methods
Moderated panel discussion (60-min) with 5 min welcome; 10 min introduction to human-centered design informed by newcomer communities; 15 min international case study; 15 min domestic case study; and 15 min moderated QA from the audience. Attendees will share questions both written and orally, and be invited to share their own experiences. Attendees will also receive a handout with 2 additional local examples drawn from real-world experience (1 hospital-based, 1 department of health-based) plus guiding questions for developing comparable projects.

Dr. Elizabeth Dawson-Hahn | University of Washington
eedh@uw.edu

Background
Most forcibly displaced newcomers have experienced traumatic events. After coming to the U.S., many experience additional challenges due to pressured adaptation, poverty, and other stressors. The impact is profound, with forcibly displaced people having much higher rates of depression, anxiety, and traumatic stress disorders. At the same time, services and supports may be out of reach due to language barriers, stigma, money, and cultural mismatch.

The International Rescue Committee (IRC) has worked to adapt evidence-based and -informed mental health interventions so they are culturally relevant, meaningful, and can be delivered by trained paraprofessionals. Using recent examples of interventions implemented with Afghan and other recently arrived communities across the United States, facilitators will give practical examples of promising programs delivered by trained paraprofessionals, including providing program evaluation data and tangible resources for participants to implement the same or similar programs in their contexts.

Content
Following the workshop, participants will be able to:
1. Identify three accessible mental health interventions (Afghan Adjustment Support Curriculum, "Attachment Vitamins", Teen Girl Group sessions)
2. Understand the key factors that enable intervention success.
3. Locate linguistically and culturally accessible psychoeducation materials.

Instructional Methods
Presenters will give a 15-minute oral presentation on three successful mental health interventions, followed by 15 minutes of questions and answers.

Dr. Rabia Jalalzai | IRC Atlanta
rabia.jalalzai@rescue.org

Lizbeth Gonzalez, MA | IRC Tucson
lizbeth.gonzalez@rescue.org

Jessica Dalpe, MA | IRC New Jersey
Jessica.Dalpe@rescue.org

Allison Wu | IRC San Jose
allison.wu@rescue.org

Background
The National Resource Center for Refugees, Immigrants, and Migrants (NRC-RIM) COVID-19 health education portfolio included four main campaigns; these were informed by community perspectives, professionally designed, rigorously translated in more than 40 languages, and customizable with drag-and-drop templates. The campaigns saw over 100,000 downloads from 50 states and 175 countries. In 2023 NRC-RIM commissioned a retrospective external evaluation of this portfolio to inform future work.

Methods
The evaluation used a mixed methods approach: a targeted survey that received 408 responses; 25 in-depth interviews with users from organizations across the country; 10 key informant interviews; 18 materials testing workshops conducted in 6 community host sites and in 6 languages; a Delphi panel of experts in health communications, multilingual communication, and RIM communities; and secondary data analysis of accountability reports, social media and website analytics, and more.

Results
The most effective health education campaigns include culturally tailored messages tying health behaviors to community values; professional and culturally validated translation; evidence-based information with limited jargon; and culturally relevant and specific images and colors. Health education materials are most effective in the hands of trusted messengers.

Conclusion
Effective health communications campaigns should be timely, culturally responsive, trustworthy, accurate, and linguistically relevant. They should promote critical health information while supporting RIM communities in making informed decisions about their health. There are several strategies to achieve these goals that rely on the strengths and wisdom of communities. Lessons learned from this evaluation can inform the future work of any organization serving RIM communities.

Syreeta Wilkins | NRC-RIM
slw@umn.edu

Erin Mann | NRC-RIM
mann0255@umn.edu

Ian Allen | NRC-RIM
allen595@umn.edu

Background
There is limited US childhood vaccine safety information in languages other than English/Spanish. When extant, it is rarely informed by community input. To address this gap, we used human-centered design (HCD) to develop childhood vaccine safety messaging—inclusive of COVID-19—with three working groups in five languages; (a) Pashto, Dari; (b) Kinyarwanda, Kiswahili; (c) Ukrainian. 

Methods
We recruited participants nationally with attention to language, cultural, and community expertise, and internal community diversity. Meetings followed semi-structured facilitation guides to elicit input on messages, vocabulary, message modalities, and dissemination. Three working groups of ~8 people which each met 7 times in 15 months. We recorded meetings. We then coded transcripts using matrices to analyze key HCD activities – a method adapted from rapid qualitative analysis for health services research.  

Results
HCD allowed for representation of holistic community identity, e.g., preferred colors, clothing, and family images. Messages highlighted: vaccination rationale, vaccination schedules, and the role of public health authorities ensuring vaccine safety. The Ukrainian group created a family-oriented poster on safety. The Afghan group created a brochure for community health workers describing the vaccine schedule. The Congolese (DRC) group created a video FAQ. We also translated vaccine schedules and an overview of US vaccine quality assurance. Materials were disseminated via email distribution list developed with guidance from working groups, a webpage, social media, and print grants, as recommended by all three groups. 

 Conclusion
HCD can be used by health and public health organizations to create community-informed messages in languages other than English.  

Nadege Mudenge | Children’s Hospital of Philadelphia
mudengen@chop.edu

Dr. Mohammad Iqbal Wali Khan | MHEDS
mkhan@mheds.org

Amina Ibrahim | University of Washington
aminai15@uw.edu

Dr. Elizabeth Dawson-Hahn | University of Washington
eedh@uw.edu

Adrien Matadi | Denver Health and Hospital Authority
Adrien.matadi@dhha.org

Tammy Melnik | MHEDS
tmelnik@mheds.org

Patty Stubber
pstubber@mheds.org

Dr. Kristine Knuti Rodrigues | Denver Health and Hospital Authority
kristine.rodrigues@dhha.org

Besty Ruckard | Denver Health and Hospital
betsy.ruckard@dhha.org

Erin Mann | NRC-RIM
mann0255@umn.edu

Syreeta Wilkins | NRC-RIM
slw@umn.edu

Dr. Katherine Yun | Children’s Hospital of Philadelphia
yunk@chop.edu

Background
Afghan newcomers can face significant challenges while navigating the US healthcare system due to its complexity and oftentimes limited language and cultural accessibility. Compounding this, newcomers’ unfamiliarity with how to access care, the different levels of care available, and varying levels of digital literacy add to these challenges.

In partnership with the National Resource Center for Refugees, Immigrants, and Migrants (NRC-RIM), the International Rescue Committee (IRC) has implemented different models of community-responsive public health initiatives across the U.S. to increase healthcare navigation and health education support for the Afghan community.

Content
Following the workshop, participants will be able to:

1) Identify three innovative models for supporting healthcare navigation, including Home Visitation, Speaker’s Series, and Personalized Health Workbook.

2) Reflect on how to implement similar models within their organizations or local settings.

3) Locate customizable, culturally and linguistically appropriate client-facing and provider-facing Afghan healthcare navigation and health promotion resources.

Instructional methods
Facilitators will provide an overview of three innovative models that support healthcare navigation for Afghan newcomers. Facilitators will provide practical tools and translated health promotion resources to support the implementation of these processes into participants’ work contexts.

Lizbeth Gonzalez | IRC Tucson
lizbeth.gonzalez@rescue.org

Feven Bekele | IRC Atlanta
Feven.Bekele@rescue.org

Helen Pattou | IRC Denver
Helen.Pattou@rescue.org

Nazi Tokhi | IRC San Diego
Nazi.Tokhi@rescue.org

Background
The Minnesota Immunization Networking Initiative (MINI) addresses barriers to accessing immunizations through partnerships with community organizations that serve refugee, immigrant, and migrant (RIM) communities. With experience providing free influenza vaccines in trusted community spaces, MINI effectively pivoted to provide COVID-19 vaccinations in 2021. This presentation outlines strategies utilized in this model of community-based care, to serve as guidance for health system, public health, and community-based collaborations.

Methods
Pivoting from influenza to COVID-19 vaccinations, MINI addressed new considerations around equity and efficiency of vaccine delivery to RIM communities. MINI’s community-informed approach prioritized communication and shared decision-making with community partners. They established regular meetings, adapted communication methods to meet community partners’ preferences, and adjusted clinic locations and frequency based on need.

Results
Through this, MINI (1) grew community partnerships, (2) implemented a low-tech scheduling system to address technology gaps, (3) changed operations to meet vaccine requirements, and (4) increased multilingual staff. From February 2021 to September 2023, MINI organized 1,120 clinics across 237 sites and administered 43,123 COVID-19 vaccinations. Of those vaccine recipients, 88% were Black Indigenous or other People of Color, and 55% preferred a language other than English.

Conclusion
Because of the effectiveness of their approach to community-based care and resulting trust of community partners, MINI has continued to respond to evolving needs of RIM communities. More recently they have started to address issues such as gaps in pediatric COVID-19 vaccination, been tasked with supporting comprehensive vaccinations to new arrivals, and other emerging community health priorities.

Ingrid Johansen | Minnesota Immunization Networking Initiative
Ingrid.Johansen@fairview.org

Mohammed Selim | Minnesota Immunization Networking Initiative
Mohammed.Selim@fairview.org

Kimberly Yu | NRC-RIM
yu000623@umn.edu

Background
Responding to increased Afghan newcomer arrivals in 2021/2022, the International Rescue Committee Salt Lake City (IRC SLC) conducted a needs assessment to understand sexual and reproductive health (SRH) challenges of Afghan women.

Methods
During March 2023, IRC SLC initiated Afghan Women’s SRH Needs Assessment and Provider Feedback Survey. The assessment, culturally validated and piloted, targeted women aged 18–55 who arrived within five years and service providers. Using mixed-methods quantitative surveys and qualitative interviews, results revealed significant barriers to SRH services.

Results
Of 41 participants, 56.1% expressed discomfort discussing contraception with male providers, while 78% preferred a female interpreter. Moreover, 65.9% had not accessed contraceptives in the US, with 78% unaware of availability at no cost. Gender dynamics heavily influenced family planning decisions, with male partners predominantly making choices around contraceptive use (68.3%) and number of children (65.9%). Cultural norms were identified as key obstacles to accessing preventive care. Clinic-level findings underscored capacity constraints and insufficient discussions on SRH rights and family planning.

Conclusion
IRC SLC developed plans to address identified gaps and enhance SRH outcomes among Afghan newcomers. Core activities include women's SRH classes with childcare, empowerment groups, teen-specific education, men's engagement sessions, and preventive health workshops. System-level changes, including contraception clinics and integrated SRH discussions, were implemented. This intervention reflects IRC SLC's commitment to addressing diverse SRH needs of Afghan women in Salt Lake City, empower community, facilitate informed decision-making, and improve healthcare access.

Annie Shaw | IRC Salt Lake City
annie.shaw@rescue.org

Jonessa White | IRC Salt Lake City
jonessa.white@rescue.org

Lizbeth Gonzalez | IRC Tucson
lizbeth.gonzalez@rescue.org

Background
Operation Allies Welcome (OAW) required the collaboration of resettlement agencies, federal partners, health systems, public health, and social service and community-based organizations to coordinate movement and address the emergent and ongoing needs of newly arrived Afghans. Our purpose was to: 1) identify and disseminate promising practices that promote the health and wellbeing of Afghan newcomers; and 2) situate foundational themes describing the structure, implementation, and outcomes within those practices.

Methods
Our interdisciplinary team conducted 29 qualitative cross-sector interviews with professionals purposively sampled from public health, health systems, social services, and community organizations. Participants represented diverse contexts, US regions, and points of intervention in the array of initiatives supporting Afghan newcomers. We coded the interview transcripts using a deductive framework, with an initial coding frame derived from domains outlined in the semi-structured interview guide.

Results
Using rapid descriptive qualitative analysis, we identified five themes underpinning five best and promising practices. Themes included challenging assumptions, fostering meaningful relationships, understanding and addressing barriers, social connection, and housing rights education. Practices included distributing culturally and linguistically tailored mental health educational materials, establishing informal community advisory boards, facilitating culturally grounded healthcare access, ensuring immediate access to religious and culturally appropriate necessities, and implementing peer-based social support programs.

Conclusion
OAW facilitated the physical relocation of individuals while supporting the health and wellbeing of Afghan newcomers. Results elevated effective strategies and provided valuable insights for future initiatives supporting displaced populations, namely that it is critical to prioritize collaboration and holistic support systems to ensure successful resettlement.

Sarah Hoffman | NRC-RIM and University of Minnesota School of Nursing
hoff0742@umn.edu

Yesenia Garcia | NRC-RIM and University of Washington
Yesenia.Garcia@seattlechildrens.org

Erin Mann | NRC-RIM
mann0255@umn.edu

Diego de Acosta | NRC-RIM
deaco011@umn.edu

Kimberly Yu | NRC-RIM
yu000623@umn.edu

Elizabeth Dawson-Hahn | NRC-RIM and  University of Washington Division of General Pediatrics
eedh@uw.edu