Refugee health is a significant public health concern in the United States due to existing disparities and limited access to health information and health promotion programs. The goal of the dissertation research was to better understand the health situation of a rapidly growing population of Bhutanese refugees and to make recommendations to improve their wellbeing. Three studies were conducted to accomplish this goal: 1) a systematic literature review examining health studies of Bhutanese refugees in the United States 2) a qualitative analysis of health experiences of Bhutanese refugee groups in Worcester, Massachusetts, and 3) program recommendations based on community perspectives of this Bhutanese refugee group. A systematic review on existing literature on Bhutanese refugee health studies in the United States yielded eleven studies which either examined risks, barriers, and health perceptions, or aimed to implement a program targeted to improve health conditions of Bhutanese refugees. The systematic literature review gave insight to specific gaps in knowledge and intervention strategies for health research in Bhutanese refugees. Next, four focus groups and semi-structured interviews were conducted with Bhutanese refugee community members and leaders from August to November 2016 in Worcester, MA. Data analysis revealed that major health barriers stemmed from traumatic history with health care; institutional and social barriers to health; and cultural conceptualizations and stigmatization of prevalent health issues. The participants also offered recommendations to address the barriers they identified. This included recommendations to increase access to relevant health information and education, utilize existing social support from the community, implement community health discussion groups, and to initiate the training and employment of community health advocates. Findings demonstrated that community engagement is essential in developing health programs. Integration of cultural awareness, community structure, and adequate representation and advocacy in refugee or other vulnerable groups must be considered when implementing public health programs. Future research on vulnerable groups should consider the multifaceted barriers which are faced to implement appropriate methodology for community health development.
