Association Between Acculturative Stress and Healthcare Seeking Among Iraqi Refugees
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Association Between Acculturative Stress and Healthcare Seeking Among Iraqi Refugees


Introduction: The current refugee crisis is the most pressing global challenge, threatening the safety, wellbeing, and quality of life of 80 million forcibly displaced individuals. Refugees’ experiences of pre-and post-migration trauma, post-migratory stressors, the additional burden of resettling in a new country, and a history of mental illness make the acculturation process of refugees unimaginably difficult and taxing, both mentally and physically. There is a lack of research exploring acculturative stress as a barrier to seeking healthcare.Methods: Participants in this study consisted of 213 Iraqi refugee women resettled in San Diego, California. The Social, Attitudinal, Familial, and Environmental Acculturative Stress (SAFE) scale was used to assess acculturative stress in the sample. Healthcare access, history of mental illness, and demographic information were also collected. Statistical analyses included analysis of variance (ANOVA), Tukey post-hoc pairwise testing, Mann-Whitney two-sum rank tests, t-test procedures, and chi-square tests to determine the association between acculturative stress and healthcare access. A Directed Acyclic Graph (DAG) was constructed to represent the focal relationship and confounding variables. Results: Quantitative analysis indicated higher levels of acculturative stress are associated with lower levels of education, increased financial strain, history of mental illness, and seeking mental health care. Predictors of acculturative stress specifically increased financial strain and history of mental health were also significantly associated with putting off or not seeking healthcare. Conclusion: The results of this study highlight the barriers to healthcare services refugees face upon resettlement. An understanding of these barriers will help with targeted interventions to ensure the health and wellbeing of refugees. Future research should examine qualitative reasons why refugees postpone care.

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