ABSTRACT
This article examines the ethics of research design and the initiation of a study (e.g., recruitment of participants) involving refugee participants. We aim to equip investigators and members of IRBs with a set of ethical considerations and pragmatic recommendations to address challenges in refugee-focused research as it is developed and prepared for IRB review. We discuss challenges including how refugees are being defined and identified; their vulnerabilities before, during, and following resettlement that impacts their research participation; recruitment; consent practices including assent and unaccompanied minors; and conflicts of interest. Ethical guidance and regulatory oversight provided by international bodies, federal governments, and IRBs are important for enforcing the protection of participants. We describe the need for additional ethical guidance and awareness, if not special protections for refugee populations as guided by the National Institutes of Health (NIH) Guiding Principles for Ethical Research.
Subject(s)
Ethics Committees, Research , Ethics, Research , Informed Consent , National Institutes of Health (U.S.) , Refugees , Humans , United States , Informed Consent/ethics , North America , Conflict of Interest , Research Design , Patient Selection/ethics , Biomedical Research/ethics , Minors , Guidelines as Topic , Vulnerable PopulationsABSTRACT
The number of refugees globally grew to 35.3 million in 2022, and many refugees are exposed to various health risks along their migration journey. As a result, they may arrive in host communities with numerous health issues, including communicable diseases and chronic and mental health conditions. Navigating the healthcare system in a host country proves to be a significant challenge for them, leading to delayed care. This qualitative study explored the convolute healthcare needs of refugees in the United States by soliciting insights from stakeholders involved in refugee resettlement and healthcare. In-depth interviews were conducted with fifteen stakeholders who work closely with refugees, including healthcare providers, cultural/clinical health navigators supporting refugees, staff from refugee resettlement agencies and governmental entities, and researchers studying refugee health. Following informed consent, interviews were audio-recorded, transcribed verbatim, and imported into MAXQDA 2022 (VERBI Software) for thematic analysis. The results revealed key themes, including the heterogeneity of refugee populations, limited awareness of preventive healthcare, high prevalence and suboptimal management of chronic conditions, complexity of the healthcare system, lack of follow-up, and language barriers. Further research is warranted concerning the long-term health of refugee populations in the United States. Additionally, more tailored programs involving peer educators are recommended to support refugee communities in navigating the complex healthcare system in the host country.
Subject(s)
Qualitative Research , Refugees , Refugees/psychology , Humans , United States , Female , Male , Health Services Needs and Demand , Health Services Accessibility , Delivery of Health Care , Adult , Stakeholder Participation , Health Personnel/psychology , Chronic Disease/epidemiologyABSTRACT
This article describes hematologic, nutritional, allergic/asthmatic conditions, lead screening, and management of these among immigrants and refugees. Some of these conditions present more frequently or differently in the newcomer population. Early identification and treatment are key to improving health outcomes. Screening and treatment suggested in this article are based on current guidelines and are intended for primary care providers who are caring for refugee and immigrant patients, especially within a medical home. Special considerations include level of education, instruction, demonstration, and cultural humility.
Subject(s)
Emigrants and Immigrants , Mass Screening/organization & administration , Refugees , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/ethnology , Asthma/diagnosis , Asthma/ethnology , Communicable Diseases/diagnosis , Communicable Diseases/ethnology , Cultural Characteristics , Diet/ethnology , Hematologic Tests , Humans , Hypersensitivity/diagnosis , Hypersensitivity/ethnology , Kidney Function Tests , Lead/blood , Liver Function Tests , Mass Screening/standards , Risk Assessment , United States/epidemiologyABSTRACT
To create healthy public spaces, Philadelphia prohibits smoking in city-owned and operated parks. Identifying the prevalence and characteristics of smoking in Philadelphia Parks would be useful for monitoring purposes; yet no studies have collected this data. This study identified the prevalence and characteristics of smoking among adult patrons entering three Philadelphia Parks (Washington Square Park, Independence Square Park, and Louis Kahn Park). During May and June 2016, we observed patrons entering the parks on Thursday afternoons. We used handheld electronic devices to categorize patrons by smoking status, age, gender, and tobacco product. We used logistic regression to assess the association of these variables with smoking. We observed 4822 people, of which 10.6% were children. Smoking was noted among 2.6% of adults in Washington Square Park, 2.6% of adults in Independence Square Park, and 7.7% of adults in Louis Kahn Park. Patronizing Louis Kahn Park was associated with greater likelihood of smoking (OR 3.11, CI 1.77-5.46) compared to Washington Square. Males were more likely than females to smoke (OR 1.45, CI 1.01-2.09). Higher likelihood of smoking among males concurs with previous studies. Higher prevalence in Louis Kahn Park may be due to differences in park patron demographics compared to other parks. Results could be used as a baseline for periodic monitoring of smoking in parks in order to inform implementation of the smoke-free park policy in Philadelphia.
