Year of Publication

2015

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth G. Tovar

Clinical Mentor

Karissa Porter

Committee Member

Dr. Chizimuzo (Zim) T.C Okoli

Abstract

Problem Statement: United States refugees often encounter significant barriers when adapting to their new host country; such as cultural and language barriers, and difficulty in navigating through the American healthcare system. For example, navigating through the American Pharmacy system to buy or refill medications is a great challenge for most refugees. To make matters worse, most refugees have difficulty understanding medications instructions which puts them at risk for making medication errors.

Purpose: The purpose of this study was to develop, implement, and evaluate the feasibility of delivering an evidence based health literacy medication educational program for all newly-arrived refugees attending refugee orientation classes at the Kentucky Refugee Ministry (KRM) in Lexington Kentucky, United States. The project, Refugee Health Literacy Program (R-HeLP) was designed to enhance medication knowledge among new refugees in Lexington and to bridge some healthcare barriers they encounter when they first come to the United States.

Methods: A convenience sample of 12 new refugees attending the newcomer orientation classes at the KRM were recruited to participate in the Refugee Health Literacy Program(R-HeLP). A script of a simple power point presentation that met the health literacy level for refugees was designed and delivered (and translated into Arabic, French, Spanish, and Swahili). A Pretest/ posttest design was used to examine the change in participants’ knowledge of medication use before and after the intervention. A Client Satisfaction Questionnaire (CSQ-8) was used to assess participants’ satisfaction with the program.

Results: The participants (N=12) were either Arab (58%) or African (42%) refugees. They were primarily males (75%), between 18-30 years of age (58%). There was overall increase in participants’ knowledge of medication use scores from baseline to post intervention (pretest to posttest in 62.5%; 5/8) of the questions; however, Wilcoxon signed-Ranks test indicated the change was not statistically significant (Z=1.1, p= 0.500). Program development and delivery at KRM was feasible. Participants rated high satisfaction with the educational intervention based on the CSQ evaluation questionnaires (range, mean). The median satisfaction score was 23 (range=19-24). The success of the program was demonstrated by the fact that all participants rated the program as good or excellent; 75% said all needs were met and, 88% reported that they would come back to the educational program and 75% reported that they would refer a friend to the program.

Conclusions/Implications for Practice: Refugees have low English proficiency and low health literacy, they originate from diverse cultural backgrounds. Existing literature affirm that persons with Limited English Proficiency (LEP) are affected more by health literacy barriers compared with native English speaker. Therefore, culturally appropriate health literacy programs should be developed for LEP persons such as refugees to improve their knowledge of health literacy.