Determining the Barriers and Beliefs of Salt Lake City Iraqi Refugee Torture Survivors Related to Metabolic and Cardiovascular Disease

The 2003 war in Iraq caused the displacement of over 4.2 million people. Since 2007, over 60,000 Iraqi refugees have resettled in the United States. In Utah, Iraqi refugees are the second largest refugee population. Iraqi refugees have a high prevalence of metabolic and cardiovascular disease prior to resettlement to the United States. Torture exposure, which is high among Iraqi refugees, increases the lifetime risk of metabolic and cardiovascular disease. During integration into western society, barriers prevent refugees from appropriate metabolic and cardiovascular disease prevention, diagnosis, and management. The primary objective of this DNP project is to determine Iraqi refugee torture survivors' understanding of metabolic and cardiovascular disease, their perceived barriers to accessing health care, and the perceived barriers and factors that cause or perpetuate lifestyle choices associated with metabolic and cardiovascular disease. The secondary objective is to disseminate the research findings to the Salt Lake Iraqi community and a wider audience of refugee health care providers and policy makers. The project utilized a community-based participatory research model to collaborate with a local organization that provides mental health services to Iraqi refugee torture survivors. The organization hosted three focus groups with 5, 7, and 9 participants (n=21). Questions were designed to determine the shared understandings of the Iraqi refugee community related to metabolic and cardiovascular disease and to identify the social and cognitive factors that affect their health behavior and access to health services. Data was analyzed using thematic categorization and organized into a thematic network model. Seven major themes were developed during the focus group discussions including: understanding of metabolic and cardiovascular disease, health care access barriers, dietary habits, exercise habits, dietary modification factors, exercise modification factors, and suggestions for health care services. Subthemes were developed from each major theme. Understanding the perspective of Iraqi patients is important for refugee health care providers and policymakers, as this is the first step in tailoring care to be most effective. There is a need for health care providers to acknowledge the impact of emotional symptoms on metabolic and cardiovascular disease development and progression and assist refugee patients in eliminating barriers to accessing care through community resources and education about the health care system in Utah. Health programs for Iraqi refugees should address emotional and physical causes of illness through education, group exercise, and group discussion. Iraqi women have more significant barriers than men due to cultural beliefs and traditional gender roles and therefore should be the priority of health programs for Iraqi refugees.