title: Help-Seeking Behavior and Health Care Navigation by Bhutanese Refugees.
abstract: The objective of this study was to document barriers to care, help-seeking behaviors, and the impact of a community-based patient navigation intervention on patient activation levels among Bhutanese refugees in the U.S. Data sources comprised 35 intake and 34 post-intervention interviews with program participants, 14 intake and 14 post-intervention interviews with patient navigators, and 164 case notes. Textual data were analyzed using the constant comparison method. Patient activation level was assessed at both time points. Participants had limited English proficiency (97 %), limited literacy (69 %), and the lowest level of patient activation (69 %). Participants routinely experienced complex insurance access, coverage, and payment problems and had limited healthcare-related life skills. Help-seeking began within social networks, with high reliance on bilingual, literate family members perceived to have experience with "the system." Help-seeking was not stigmatized and was instead consistent with societal norms valuing mutual assistance. Participants preferred helpers to act as proxies and required repeated social modeling by peers to gain confidence applying healthcare-related life skills. Following the intervention, only one-third reported the lowest level of patient activation (35 %) and one-third were highly activated (32 %). Bhutanese refugees overcome healthcare access barriers by seeking help from a network of support that begins within the community. Community health workers serving as patient navigators are readily sought out, and this approach is concordant with cultural expectations for mutual assistance. Community health workers serving immigrant groups should model healthcare-related life skills in addition to providing direct assistance.
authors.affiliation: PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, 3535 Market St, Rm 1539, Philadelphia, PA, 19104, USA. yunk@email.chop.edu.
authors.forename: Katherine
authors.initials: K
authors.lastname: Yun
authors.affiliation: PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, 3535 Market St, Rm 1539, Philadelphia, PA, 19104, USA.|NORC at the University of Chicago, Chicago, IL, USA.
authors.forename: Papia
authors.initials: P
authors.lastname: Paul
authors.affiliation: Bhutanese American Organization-Philadelphia, Philadelphia, PA, USA.|Philadelphia Department of Public Health, Philadelphia, PA, USA.
authors.forename: Parangkush
authors.initials: P
authors.lastname: Subedi
authors.affiliation: PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, 3535 Market St, Rm 1539, Philadelphia, PA, 19104, USA.|Bhutanese American Organization-Philadelphia, Philadelphia, PA, USA.
authors.forename: Leela
authors.initials: L
authors.lastname: Kuikel
authors.affiliation: Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.|Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Giang T
authors.initials: GT
authors.lastname: Nguyen
authors.affiliation: Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.|Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA.|Department of Anthropology, School of Arts and Sciences, Philadelphia, PA, USA.|Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA.
authors.forename: Frances K
authors.initials: FK
authors.lastname: Barg
mesh_terms: D000328:Adult; D000368:Aged; D001631:Bhutan / Q000208:ethnology; D055812:Community-Based Participatory Research; D005260:Female; D000066505:Help-Seeking Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D062526:Patient Navigation; D015143:Philadelphia; D012036:Refugees
keywords: Community health workers; Emigrants and Immigrants; Health behavior; Health literacy; Patient navigation; Refugees; Self efficacy