Disparities In Health Service Utilization



Disparities in Health Service Utilization Among Refugees

Disparities in Health Service Utilization Among Refugees


· Language barriers, including limited English proficiency, stigmatization, poor access to social welfare programs, immigration status, lack of health insurance, and marginalization are some of the leading factors hindering appropriate healthcare utilization among refugees.

Nursing Area of Focus

Cardiovascular Disease (CVD):

· According to Kamimura et al. (2017), refugees resettled in the United States report a higher prevalence of cardiovascular disease than other subpopulations.

· Langellier et al. (2014) observe health utilization disparities between foreign-born refugees and US-born immigrants, primarily due to language discordance and organizational barriers. Minas (2016) attribute CVD risk factors to chronic exposure to mental health issues, physical trauma, depression, disrupted livelihoods, and rampant socioeconomic challenges facing refugees.


· Because disease awareness is a prerequisite for successful prevention and CVD management, focusing on self-management efficacy could improve health utilization and reduce the underlying risk factors (Langellier et al., 2014).

Cultural Group

· Given the lack of awareness about CVD among foreign-born refugees, adult immigrants are more vulnerable than other migrants’ subgroups (Langellier et al., 2014).

Nursing Cultural Model

Giger and Davidhizar Transcultural Assessment Model

· This model consists of six cultural dimensions, social organizations, biological variations, time, environmental control, space, and communication that support the development of culturally congruent approaches to diverse ethnocultural populations (Higginbottom et al., 2011).

Theoretical Application

Nursing Cultural Model and Cultural Group

· The Giger-Davidhizar Transcultural Model provides a framework for assessing foreign-born adult refugees to strengthen culturally sensitive modalities and promote better patient outcomes (Higginbottom et al., 2011).

CVD Self-Care and Cultural Competence

· Public health education programs for primary and secondary interventions demonstrate positive improvements in addressing modifiable CVD risks (Minas, 2016; Langellier et al., 2014). Because foreign-born adult refugees face composite obstacles in accessing culturally appropriate health services, applying the Giger-Davidhizar Transcultural Model can enhance the efficacy of holistic assessments and improve their overall utilization of primary health services (Minas, 2016; Higginbottom et al., 2011).

Implications to EBP Nursing Practice

Psychoeducation Program:

· Prioritize cultural and socioeconomic needs to foster trust, therapeutic interactions, and patient-centered interventions.

· Assist immigrants to navigate America’s complex health care system; Provide a direct referral to a specific health practitioner.

· Screen for mental health risks; Assess CVD risk factors to inform the choice of best self-care modalities; Lead and coordinate a multidisciplinary approach to a refugee patient with CVD.

· Consider seeking an interpreter; Translate CVD health campaigns, outreach resources, and directories to diverse languages.


· Cultural socioeconomic, cultural, and communication barriers has adverse impacts on the use of healthcare services among refugees. Foreign-born adult immigrants are particularly vulnerable to poorer health outcomes due to linguistic discordance. As a result, these groups are prone to disproportionate disease burden and prevalence of preventable conditions such as CVD.

· Given the significance of cultural competence in addressing health disparities, nurse practitioners need to focus on integrating appropriate cultural frameworks such as the Giger-Davidhizar Transcultural Model’s theoretical application to alleviate barriers inhibiting optimal uptake of health services among adult refugees.


Higginbottom, G. M., Richter, M. S., Mogale, R. S., Ortiz, L., Young, S., & Mollel, O. (2011). Identification of nursing assessment models/tools validated in clinical practice for use with diverse ethno-cultural groups: An integrative review of the literature. BMC nursing10(1), 16.

Kamimura, A., Sin, K., Pye, M., & Meng, H. W. (2017). cardiovascular disease-related health beliefs and lifestyle issues among Karen refugees resettled in the United States from the Thai-Myanmar (Burma) border. Journal of Preventive Medicine and Public Health50(6), 386.

Langellier, B. A., Garza, J. R., Glik, D., Prelip, M. L., Brookmeyer, R., Roberts, C. K., … & Ortega, A. N. (2014). Immigration disparities in cardiovascular disease risk factor awareness. Journal of immigrant and minority health14(6), 918-925.

Minas, H. (2016). Mental Health and Cardiovascular Disease Risk in Refugees. In: Alvarenga M., Byrne D. (eds) Handbook of Psychocardiology (pp. 713-725). Springer, Singapore. https://doi.org/10.1007/978-981-287-206-7_34