RESUMO
Purpose: Refugees from the Democratic Republic of Congo have rapidly increased since 2016 and are growing to represent one of the top refugee groups in the United States. They are at high risk for health inequities, yet, there is limited qualitative research exploring the health needs, assets, and experiences of this group and even less longitudinal research. In addition, women refugees are understudied across all global contexts. Therefore, the purpose of this study was to conduct longitudinal qualitative research to provide rich contextual data on health and integration experiences of Congolese refugee women when they were newly resettled in 2016 and 3 years later in 2019. Methods: We conducted photovoice and interviews with 16 women in March through May of 2016 and 10 of the same women in March and April of 2019. Results: Women chose and discussed photos revealing a multitude of assets and needs spanning 2016 and 2019. Experiences with nutrition and food security were illuminated and are the focus of this article. Two major themes were access to food in contrast with availability of abundance of food in the United States and concern about what constitutes healthy food in the United States contrasted with accessing healthy and culturally appropriate food in the United States. Findings highlight strength bases of nutritional knowledge, attitudes, and skills as well as a strong social network aiding food security demonstrated by the Congolese refugee women in the study, offering an opportunity to shift to an assets and strength-based approach. Findings also note risk of food insecurity linked to barriers to employment and sociohistorical reflection on living with food shortages before migration to the United States that should be considered as providers strive to provide culturally relevant care. Conclusion: Findings offer contextual data for health care providers and public health professionals to improve nutritional health promotion and food security support for this population. Overlooking nuanced structural barriers may lead to providers perpetuating health inequities for this population.
RESUMO
Refugees have recently been thrust into the spotlight worldwide. The strikingly negative rhetoric currently surrounding refugees calls for increased action from public health educators. In 2016, the largest proportion of refugees to the United States came from the Democratic Republic of Congo. This presents the opportunity to explore health needs as Congolese refugees resettle in the United States, with women taking priority due to health disparities linked to gender-based discrimination, trauma, sexual and gender-based violence, lower literacy rates, and less access to learning English. Insight into experiences of Congolese women in the United States is critical for the proactive development of socioculturally relevant health promotion rather than reaction interventions once health inequities are exacerbated. Therefore, to better understand perceptions and experiences of Congolese women in Indianapolis related to health and health care, a community-based participatory research study with an anthropological approach was conducted in collaboration with a refugee resettlement agency utilizing photovoice and semistructured interviews. Sixteen women participated in six photovoice sessions and home-based interviews. Selected photos, photo stories, and interview transcripts were analyzed using ethnographic content analysis. Major themes were health care system issues, social support, and daily experiences of health. Findings provide needed insight into the sociocultural context of health for Congolese refugees in the United States for both health educators and resettlement agencies. Findings also revealed specific priority areas for culturally tailoring health education and assets on which to build when promoting health for this population. Additionally, lessons were learned about the power of an anthropological, community-based participatory research approach to qualitative research for promoting health equity.
