Examining Health Care Access for Refugee Children and Families in the North Carolina Triangle Area.


BACKGROUND Resettled refugees are at increased risk of poor health outcomes due to acculturation challenges, logistical barriers, experiences of trauma, and other barriers to care that are poorly understood. Refugee children may be particularly vulnerable due to disruptions in health, well-being, education, and nutrition during the resettlement process.METHOD To describe the health care barriers facing refugees in the North Carolina Triangle area (comprised of Durham, Chapel Hill, Raleigh, and their surrounding areas), we conducted three focus group interviews (in Arabic, French, and Swahili) with 25 refugee parents from Syria, Iraq, Central African Republic, the Democratic Republic of the Congo, and Chad. We also administered a survey to nine organizations that provide services for refugees.RESULTS Focus group responses highlighted the multidimensional nature of health care barriers for refugee families and children, encompassing challenges with acculturation, communication, transportation, finances, and health literacy. Organizations emphasized similar challenges and described their efforts to improve access to services through increased communication, coordination, and seeking new financial support for programs.LIMITATIONS Given the geographic focus of the study, results may not be generalizable to other populations and settings. Men spoke more than women in some focus groups, and participants may have been influenced by more vocal contributors. Furthermore, this study is limited by a lack of health outcomes data.CONCLUSIONS This study suggests that the health care needs of refugees living in the North Carolina Triangle area can be better met by providing comprehensive, coordinated, and culturally relevant care. This could include minimizing the number of visits by integrating multiple services under one roof, providing trauma-informed interpreters, and offering accessible transportation services.





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Publication Info

Hunter, Kelly, Brandon Knettel, Deborah Reisinger, Pranav Ganapathy, Tyler Lian, Jake Wong, Danielle Mayorga-Young, Ailing Zhou, et al. (2020). Examining Health Care Access for Refugee Children and Families in the North Carolina Triangle Area. North Carolina medical journal, 81(6). pp. 348–354. 10.18043/ncm.81.6.348 Retrieved from https://hdl.handle.net/10161/21912.

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Brandon Knettel

Assistant Professor in the School of Nursing

Brandon Knettel, Ph.D. is a licensed psychologist and Assistant Professor with a primary appointment in the Duke University School of Nursing and a secondary appointment in the Duke Global Health Institute. His areas of specialization are global mental health and health behavior, with a focus on care engagement, nurse-led models of care, stigma reduction, and mental health support for people living with HIV. At DGHI, he teaches a course in Global Mental Health for the Master's of Science in Global Health program. 

Dr. Knettel’s international projects are primarily located in Moshi, Tanzania, where he completed a one-year VECD Fogarty Global Health Fellowship to evaluate a community health worker program for HIV care engagement. In 2021, he received a NIMH K08 Career Development Award to develop a brief telehealth counseling intervention to address suicidal ideation and improve care engagement among people living with HIV in Tanzania. He is also leading pilot research to extend access to treatment for opioid use disorder in North Carolina, and was co-PI of a DGHI pilot grant to improve the understanding of cancer-related stigma in Tanzania.


Deborah Reisinger

Professor of the Practice of Romance Studies

Deb Reisinger, Ph.D., is Professor of the Practice in Romance Studies and affiliate faculty in the Duke Global Health Institute. She is Director of Duke's Language Outreach Initiatives, overseeing the Cultures and Languages Across the Curriculum (CLAC) program and the Shared Course Initiative for Less Commonly Taught Languages with UVA and Vanderbilt. She is currently serving as Interim Dean of Academic Affairs for Trinity College.

Deb is lead author of Affaires globales: S'engager dans le monde professionnel en français - niveau avancé (Georgetown Press, 2021), co-author with Joan Clifford of Community-based Language Learning: A Framework for Educators (Georgetown Press, 2019), and author of Crime and Media in Contemporary France (Purdue Press, 2007). She has published numerous articles on language pedagogy, community-based learning, and French for Specific Purposes. 

Deb teaches courses in service-learning, global displacement, and French for Specific Purposes, including global health, public policy, and marketing. Her current research focuses on transformative learning and community-based pedagogies.

She chaired the College Board's World Languages Academic Advisory Committee from 2016-2023 and served as co-chair of the AP French Language and Culture Exam development committee from 2018-2021. From 2013-2018, she served as Chair of the American Association of Teachers of French (AATF) Commission on French for Specific Purposes. 

Deb regularly directs Duke summer study abroad programs, including Duke in ProvenceDuke in Provence-virtualDuke in Aix-en-Provence, Duke in Montréal, and Duke in Paris.  

In 2022, she was named Chevalier dans l’Ordre des Palmes Académiques by the French Republic.


Nathan Maclyn Thielman

Professor of Medicine

Broadly, my research focuses on a range of clinical and social issues that affect persons living with or at risk for HIV infection in resource-poor settings. In Tanzania, our group is applying novel methods to optimize HIV testing uptake among high-risk groups. We recently demonstrated that the Discrete Choice Experiment (DCE), a form of stated preference survey research, is a robust tool for identifying (a) which characteristics of HIV testing options are most preferred by different populations and (b) which tradeoffs individuals make in evaluating testing options. Building on more than a decade of productive HIV testing research in the Kilimanjaro Region, the next phase of our NIMH funded project will test the hypothesis that DCE-derived HIV testing options significantly increases rates of testing among groups at high risk for HIV infection. This work holds promise not only for optimizing HIV testing uptake in the Kilimanjaro Region, but also for applying novel tools in the service of translational epidemiology and implementation research.


Kathryn Whetten

Professor in the Sanford School of Public Policy

Director, Center for Health Policy and Inequalities Research
Research Director, Hart Fellows Program,
Professor, Public Policy and Global Health 
Professor, Nursing and Community & Family Medicine 
Pronouns: they/them

Kathryn Whetten is the Principal Investigator on multiple grants and publishes numerous scientific articles every year. In addition, they mentor many students and give guest lectures and presentations throughout the year.

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