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Item Effectiveness of Cross‐cultural Education for Medical Residents Caring for Burmese Refugees(Wolters Kluwer, 2016-09) McHenry, Megan S.; Nutakki, Kavitha; Swigonski, Nancy L.; Pediatrics, School of MedicineBackground: Limited resources are available to educate health professionals on cultural considerations and specific healthcare needs of Burmese refugees. The objective of this study was to determine the effectiveness of a module focused on cross-cultural considerations when caring for Burmese refugees. Methods: A brief educational module using anonymously tracked pre- and post-intervention, self-administered surveys was developed and studied. The surveys measured pediatric and family medicine residents' knowledge, attitudes, and comfort in caring for Burmese refugees. Paired t-tests for continuous variables and Fisher's exact tests for categorical variables were used to test pre- and post-intervention differences. We included open-ended questions for residents to describe their experiences with the Burmese population. Results: The survey was available to 173 residents. Forty-four pre- and post-intervention surveys were completed (response rate of 25%). Resident comfort in caring for Burmese increased significantly after the module (P = 0.04). Resident knowledge of population-specific cultural information increased regarding ethnic groups (P = 0.004), appropriate laboratory use (P = 0.04), and history gathering (P = 0.001). Areas of improved resident attitudes included comprehension of information from families (P = 0.03) and length of time required with interpreter (P = 0.01). Thematic evaluation of qualitative data highlighted four themes: access to interpreter and resources, verbal communication, nonverbal communication, and relationship building with cultural considerations. Discussion: A brief intervention for residents has the potential to improve knowledge, attitudes, and comfort in caring for Burmese patients. Interventions focused on cultural considerations in medical care may improve cultural competency when caring for vulnerable patient populations.Item Evaluating the Burmese Population and their Use of the Women, Infants, and Children Program(2020-10) Schultz, Lisa Klenk; O'Palka, Jacquelynn M.; Blackburn, Sara; Bigatti, Silvia M.This pilot study examines the use of the Women, Infants, and Children (WIC) program by the Burmese population in Indianapolis, Indiana. A significant number of Burmese people migrated to the Indianapolis area starting in 2004. Many of them are families with young children and are enrolled in the WIC program. Language barriers and cultural differences make it more difficult for the WIC program to meet the needs of these families. To what extent is the WIC program meeting their needs? To answer this question, Burmese WIC participants enrolled in the Marion County WIC program were invited to participate in this study. Study participants received a survey at the time of their appointment at the WIC office. The survey included questions that focus on how the Burmese people feel about the foods provided and the nutrition education they receive on the program. Of the 30 study participants, 28 of them or 93.3% reported WIC as being very helpful. Some foods were reported as not being utilized as frequently by the Burmese population on the WIC program, including tortillas, brown rice, and whole wheat pasta. In addition, twenty six of the 30 participants or 86.7% reported the nutrition education they receive on WIC as being very helpful. Participants reported learning many new things through WIC nutrition education including how best to feed their infants and children, as well as breastfeeding being the best for their babies.Item Perceptions and Barriers to Care for Burmese Refugees, a multi-method qualitative study(2024-04-25) Nadeem, Manahil; Messmore, NikiBACKGROUND Since 2015, Indiana has been home to over 40,000 Burmese refugees (1). Although the Model Minority Myth would lead U.S. policymakers to believe that all Asian Americans are wealthy, overwhelmingly have college degrees, and have access to health insurance, this is a fallacy (2). According to the Pew Research Center, only 38% of Burmese residents in the U.S. speak English and 25% of Burmese residents experience poverty. Although there is little research on Burmese health outcomes in the U.S., research points to poor health outcomes (3). STUDY OBJECTIVE/HYPOTHESIS This research project aims to identify the barriers and perceptions to healthcare for Burmese refugees and provide plausible solutions. This project includes a narrative review of the existing literature combined with interviews with physicians who specialize in immigrant care. METHODS A narrative review was conducted via PubMed and Google Scholar to analyze the research published on the healthcare of Burmese refugees in the United States. Search terms and MESH terms like refugees, Myanmar, Burma, southeast Asian people, Rohingya, health services accessibility, health status disparities, social determinants of health, and socioeconomic factors were used. Ultimately, 40 articles were included. Interviews with physicians specializing in immigrant care in Indianapolis were also conducted and included in this study. The project includes interviews from Dr. Ashley Overley, CEO of Sandra Eskenazi Mental Health Center, and Dr. Maurice Henein, a family medicine physician at Community Health Network's Center for International Health. RESULTS 40 articles, published in 2005-2023, were included and analyzed for themes. The barriers to care for Burmese refugees are related to languages & communication, healthcare structure, pediatric care, reproductive care, and mental health. Many articles expressed a dire need for reliable interpreters and trauma-informed care (4,5). Moreover, cost and the concept of preventative care are the largest barriers relating to healthcare structure. For pediatric care, research indicates that Burmese parents feel that physicians do not obtain proper consent before treating their children. (6,7,8). Mental health is often equated to craziness when translated and is difficult to navigate with patients (11). Lastly, research found that Burmese women wanted to talk about sex during their health visits, but did not want to initiate the conversation themselves (14,15). Interviews with expert physicians were included in this study. The interviewers expressed that physicians should mobilize community partners and take part in cultural trainings. CONCLUSION AND RECOMMENDATIONS This project aimed to evaluate healthcare for Burmese refugees and provide solutions accordingly. After analyzing the research, it is critical we advocate for reliable interpreters for our patients. Without proper communication, it is impossible to build rapport and trust. Moreover, physicians should educate their patients about the importance of preventative care, mental health, and reproductive health screenings. To improve the quality of care they provide, physicians should initiate workshops and empower community organizations that are providing help to their patients. Indianapolis is home to one of the largest populations of Burmese refugees; it is time we provide the best healthcare for them.Item "Understand us and acknowledge our reasons": Perspectives from Burmese refugee families on interactions with their pediatricians(Elsevier, 2023-03-20) Sui, Htayni; Thomas, Melissa; Tial, Biak Len; Roose, Anna; McHenry, Megan S.; Health Policy and Management, School of Public HealthIntroduction: Indianapolis is home to one of the largest Burmese communities in the United States; however, little is known of Burmese families' experiences with medical providers. The complex health history of Burmese refugees, coupled with the necessity of quality childhood care for later development, demonstrates a need for medical residents to better understand their diverse patient populations. This study aimed to understand Burmese families' perspectives on their interactions with their pediatric providers. Material and methods: Semi-structured interviews were conducted with 15 Burmese refugee families, which were audio-recorded, transcribed, and translated. A patient-centered care framework guided interview questions and directed content analysis. Results: Themes that emerged from individual interviews often related with cross-cultural communication, including patient engagement in care, challenges utilizing an interpreter, and concerns about discussing sensitive issues with healthcare workers. Overall, parents had positive perceptions of their child's pediatrician, but some distrusted interpreters and other members of the healthcare staff. Though parents reported a desire to be more involved in their child's care, they felt uncomfortable engaging with sensitive topics. A large barrier to care was lack of time during appointments. Discussion: Through understanding the perspectives of Burmese refugee families, pediatricians and training programs for medical professionals may consider ways to enhance the patient-provider relationship and health outcomes for this population.