Challenges in Maternal Health Care Access for Refugee Women in the United States: Developing a Health Care Navigation Competency Scale

Abstract

Introduction: Despite specific needs and inherent conditions, there is a paucity of literature on refugee maternal health, particularly for Muslim refugee women resettled in the US. Furthermore, once in the US, refugees must quickly learn how to navigate the complex US health care system, which necessitates a high level of competency. However, not all refugees are able to develop such navigation skills, resulting in frustration, stress, and gaps in health care. In addition, despite growing empirical knowledge about health navigation for marginalized populations, few studies have explored the competency of refugees to navigate the complex health care system in the US. To address these gaps, the study investigated the maternal health care experiences of Muslim refugee women resettled in the US and developed and validated a Health Care Navigation Competency Scale for refugee communities in the US. Specific Aims: The specific aims of this study were to 1) delineate the literature on maternal health among refugee populations resettled in the US, 2) identify needs, barriers, and facilitators related to access to maternal care among Muslim refugee women resettled in the US, and 3) develop a Health Care Navigation Competency Scale as a tool to measure the level of competency among refugee populations. Methods: To delineate the body of literature on maternal health among refugee women resettled in the US, electronic databases were searched in PubMed, CINAHL, PsycINFO, and EMBASE from inception through July 2021. Also, the study employed two qualitative research methods: in-depth interviews and ‘go-along’ interviews for Aim 2. In-depth interviews were conducted among Afghan, Iraqi, and Syrian refugee women (n=17) using a semi-structured interview guide, and six go-along interviews were done at different locations. The interviews were recorded and transcribed verbatim, imported into MAXQDA 2020 (VERBI Software), and analyzed based on content analysis methods. Aim 3 involved a series of processes to develop the scale: the extensive literature review, fifteen stakeholder interviews, the Delphi method and cognitive interviews. Conclusions: This study revealed the complex contextual factors in which refugee populations find themselves. Given the population's heterogeneity, a more nuanced understanding of refugee maternal health is required, as are more tailored programs for the most vulnerable groups of refugee women. The Health Care Navigation Competency Scale can be utilized as a tool to identify refugees with limited competency in navigating the complex health care system in the US and provide them with more tailored support.