“Basically, everything needs to be adapted”: provider perceptions of challenges and recommendations for effective health care with Karen people

• DOI: https://doi.org/10.1108/IJMHSC-01-2022-0001
• Published date: 08 September 2022
• Date: 08 September 2022
• Pages: 271-285
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work,economy & organizations,Labour movements
• Author: Tonya L. Horn,Jennifer S. McCleary

“Basically, everything needs to be

adapted”: provider perceptions of

challenges and recommendations for

effective health care with Karen people

Tonya L. Horn and Jennifer S. McCleary

Abstract

Purpose –Karen people from Burma are a new population in resettlement countries. While research

increasingly documentstheir health needs, few studies describe how health-careproviders adapt their

practices to servethis group. The purpose of this study was to explore the experiencesof providers who

work withKaren patients/clients in health settings,documenting the challengesthey face, how they adapt

their practiceand recommendations.

Design/methodology/approach –This study used a qualitativesurvey and one phone interview with a

total of 20 providers who hadfirst-hand experience caring for Karen people in health settings.Data were

analyzedusing qualitative content analysis.

Findings –Two main categories described challenges providers faced in working with Karen people in

health settings: system-level challenges and interpersonal communication challenges. Five main categories

described specific strategies and support needed to adapt practice for Karen patients in health settings:

strategies for improving communication and mutual understanding; partnering with Karen staff, interpreters

and cultural brokers; strategies for building trust and rapport; addressing needs related to case

management, care coordination and social determinants of health;recommendations for provider training.

Originality/value –This paper contributessuggestions for adapting practiceto meet the health needs of

Karen people from theperspective of health-care providers in a locationthat is nationally recognized for

its excellencein refugee health.

Keywords Karen refugees, Burma, Newly resettled refugees, Cross-cultural health care,

Refugee health, Refugee integration, Health equity

Paper type Research paper

Background

Karen people are an ethnic group from Burma who have been engaged in armed

resistance for nearly 70years. They have experienced widespread human rights violations,

primarily by the Burmese military (Cook et al.,2015). A study with resettled Karen people

documented that 27.4% reported experiencing torture, and 86% experienced war trauma

(Shannon et al.,2015). In 2005, the USA began resettling refugees from Burma who were

primarily Karen. They were the largest group resettled in the USA between 2006 and 2019

(Blizzard and Batalova, 2018;Zongand Batalova, 2015). Over 19 countries worldwide have

also resettled Karen people (WorldData.info, 2022).

Karen people are a heterogenous group who speak different languages and practice

different religions, though traditional medicine and beliefs often remain influential (Barron

et al., 2007). Although education is highly valued and teachers take great risks to maintain

Tonya L. Horn is based at

the School of Social Work,

University of St. Thomas,

St. Paul, Minnesota, USA.

Jennifer S. McCleary is

based at the Department of

Social Work, University of

Minnesota-Duluth, Duluth,

Minnesota, USA.

Received 5 January 2022

Revised 5 July 2022

Accepted 21 August 2022

This study was made possible

by a Graduate Research Team

Grant from the University of

St. Thomas, Center for Faculty

Development (2019). The

authors thank June Way, Kayla

Ulsby, Amanda Ament-Lemke,

Ka Yang and Seynab Hussein

for their early contributions to

this work.

Funding: This research study

was provided through a

Graduate Research Team

Grant ($9,885) from the

University of St. Thomas Center

for Faculty Development.

DOI 10.1108/IJMHSC-01-2022-0001 VOL. 18 NO.3 2022,pp. 271-285, ©Emerald Publishing Limited, ISSN 1747-9894 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jPAGE 271