Working with immigrant and refugee populations: issues and Hmong case study

Library Trends, Fall, 2004 by Margaret Allen, Suzanne Matthew, Mary Jo Boland

ABSTRACT

There is a critical need to provide culturally and linguistically appropriate health information for immigrant and refugee populations. This article discusses the challenges related to providing health information for immigrants and refugees in the context of developing health education/ health literacy programs. It includes lessons learned from National Library of Medicine (NLM)-funded health information programs in Wisconsin, particularly the Hmong health projects funded by the NLM Specialized Information Services Division. Topics include special needs of immigrant and refugee populations; health care for immigrants and refugees; identifying and working with partner organizations; examples of successful efforts; and finding funding sources for health information literacy projects.

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For immigrants and refugees, finding useful health information is just one piece of the huge task of adapting and surviving in a new country. We need to "walk in their shoes" and listen to their stories before rushing into solutions based on our personal worldview of libraries and the World Wide Web as free sources of knowledge on a wide variety of topics, including health and disease. While we know that we need to take the time to learn about cultures other than our own, there is an immediate need to provide culturally and linguistically appropriate health information for immigrant populations. National standards require that most health care providers provide culturally and linguistically appropriate patient information. Those providing this health information and education are often frustrated in their search for appropriate resources. This is particularly true when working with refugees who have had minimal exposure to Western culture and health care systems.

This article will discuss issues related to health information for immigrants and refugees in the context of developing health education/health literacy programs for these underserved populations. When working with these populations, providing access to information via libraries and the Web is not enough--we need to work with consumer and patient educators to develop appropriate resources and programs that meet their information needs. The challenges involved will be illustrated with examples from National Library of Medicine (NLM)-funded outreach programs in Wisconsin. The focus will be on lessons learned from the Hmong Health Information Promotion (2001-2003) and the Hmong Health Education Network (2003-2004), both funded by contracts from the NLM Specialized Information Services Division. These Hmong health projects are partnerships managed by the Northern Wisconsin Area Health Education Center (NAHEC). The needs assessment process used to develop these projects is applicable to many populations. For more on needs assessment, review the community analysis advice offered in Consumer Health Information for Public Librarians (Baker & Manbeck, 2002).

The following topics will be addressed:

* Special needs of immigrant and refugee populations

* Health care for immigrants and refugees

* Identifying and working with partner organizations

* Examples of successful efforts

* Funding sources for health information literacy projects

Learning about the first three of these topics is the basis for the needs assessment that is the foundation for any health literacy program designed for a specific population. For immigrants and refugees, this process takes most of us out of our "comfort zone." Unless we make the effort to reach out beyond serving those who come to our libraries, and also take advantage of cultural competency learning opportunities, we miss the opportunity to serve those in greatest need. In other words, we need to learn from interpersonal networking and educational programs as well as the literature. In "Walk in Their Shoes," the keynote to the National Network of Libraries of Medicine Greater Midwest Region (NN/LM, GMR) Outreach Symposium of 2003, Dr. Kathleen de la Pefia McCook urged librarians to get involved in their communities (de la Pena McCook, 2003b). She used the example of sitting on a board looking at housing issues as her way of getting involved in the community. By networking with other organizations serving immigrants, librarians will come to recognize opportunities for health literacy partnerships. We need to contact local service agencies to find opportunities to work together on health literacy initiatives. For example, through networking with United Way, Dr. Suzanne Matthew, the Northern Wisconsin Area Health Education (NAHEC) director, learned of Wausau's Minority Interagency Group, which meets six times a year. Meetings include updates on various programs for minorities in Marathon County. While this group started some twenty years ago because of the Hmong refugees, the recent regional Hispanic population increase has expanded the group's focus.

Note that needs assessment and planning will continue as projects are implemented. By working with refugee and immigrant populations, you will continue to learn things about the culture and language that will change your perception of what works, so plans need to be flexible with room for changing methods and approaches. EthnoMed (www.ethnomed.org) is an excellent example of a librarian working with clinicians and educators to develop online resources to support culturally competent care and patient education for immigrants in the Seattle area. As Ellen Howard stated in her excellent NN/LM GMR Outreach Symposium presentation, "While we intended to develop EthnoMed in a systematic way, because of funding opportunities and the need for specific information, the growth and development of the site has been more opportunistic than systematic" (Howard, 2003). It is particularly important to address this issue when developing funding proposals for health literacy initiatives for immigrants and refugees. Timelines need to be as flexible as possible to achieve goals and objectives while maintaining the specificity required by grantors. Program implementation always seems to take longer than you think it should due to the complexity of the needs and cultural structures and the need to work with multiple partners to achieve goals. However, by working with populations instead of doing for them, the products--health education programs and information resources--will be more valuable for these groups.