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Profile of Refugee Primary Care Access and Delivery Needs in Pima County

Refugees are resettled into the Tucson metropolitan area of Pima County at a rate of between 600-800 persons annually. They come from every continent and diverse backgrounds, speak a range of languages, including Arabic, Kirundi, Somali, Mai Mai, Nepali, Burmese and Swahili, and all of them hold in common the need to learn to navigate an unfamiliar and complex primary health care delivery system. The challenges they face in this process, and the challenges encountered by health and human service agencies in providing optimal services to them have been documented anecdotally in Pima County, but as yet, have not been closely examined qualitatively. This project included a primary care service needs assessment focusing on the population of refugees in Tucson, as well as a service delivery and training needs assessment of primary care providers in Pima County. Using a model of community-based, participatory research, I formed a Refugee Primary Care Work Group who guided the development and implementaion of a survey among a multidisciplinary universe of service providers to identify the range of refugees’ priority and unmet needs, and the challenges they currently face in serving new refugees (cultural, linguistic, economic, among others). Once the provider survey was complete, we employed the same participatory model to develop and conduct group and individual interviews with refugees from at least six different language groups, to elicit health concerns, barriers to accessing services, and recommendations for improvement of outreach and services. An interdisciplinary team of graduate students from the disciplines of public health, nursing, and information resources and library science were involved, under my supervision and guidance, in development, implementation, data collection and management, analysis and community reporting of the findings. Diverse agencies including Arizona Health Sciences Library, refugee resettlement agencies, urgent care facilities, primary health care providers, Pima County Health Department Public Health Nurses and Pima County Public Library assisted in this process in an advisory capacity. Findings and recommendations have been utilized by RISP-Net and PCCHTF to take steps to respond to identified needs and recommendations, to include fundraising and program modification wherever indicated and possible, and will assist in dissemination of findings through local, state and national networks. The work group has continued with my leadership, unfunded, beyond March 2010, and I presented findings at the APHA Annual Meeting in Denver in November 2010.
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