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Similar a UHHR Wellness Group for Trauma Survivors – Baseline
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UHHR Wellness Group for Trauma Survivors – Baseline
- 1. USING FOCUS GROUP DATA FROM IRAQI TRAUMA SURVIVORS TO PERSONALIZE WELLNESS CURRICULUM Sarah Al-Obaydi, M.B.Ch.B Fulbright Scholar, MPH candidate/University of Utah
- 2. BACKGROUND Over 25,000 refugees have been resettled in Utah Up to 35% of refugees are torture survivors 57% of Iraqis and 79% of Somalis About 15,000 torture survivors live in Utah Torture survivors are more at risk of chronic diseases
- 3. THE HARVARD PROGRAM IN REFUGEE TRAUMA (HPRT) “Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World.” Richard Mollica, 2006 Developed for Cambodian torture survivors. Still running
- 4. HPRT CURRICULUM IDEAS 1. HEALTH What is health and why is it important? What can be done to prevent illness? 2. NUTRITION What is a balanced diet? How is processed food different than native foods found in homeland? What are good foods to eat and what should be avoided? What are the benefits and risks of traditional cooking? 3. EXERCISE How is the lifestyle in America different than at home? Why should we exercise? What are culturally acceptable methods of exercise?
- 5. 4. STRESS REDUCTION, DEPRESSION AND CHRONIC DISEASE How can we reduce stress and self-regulate intense emotions? What is sleep hygiene? What is meditation and deep breathing? How is depression linked to chronic disease? 5. PRIMARY CARE How to talk to your doctor? The importance of a doctor/patient relationship The importance of medication instructions 6. GRADUATION Certificate Ceremony Award (ie: Gym membership)
- 6. FOCUS GROUP(S) Cultural difference Needs difference More ideas Need to modify HPRT
- 7. MEN’S FOCUS GROUP June 27, 2012 During a UHHR men’s group meeting 8 Iraqi men Run by: Ted Adams, Brent Pace, Mark Linnell
- 8. WOMEN’S FOCUS GROUP June 29, 2012 During a UHHR women’s group meeting 8 Iraqi women Run by: Sarah Al-Obaydi
- 9. FOCUS GROUP RESULTS Definition of health: Women physical and psychological wellbeing Men social life Main concerns: 1. Depression 2. Lack of sleep 3. Exercise 4. Nutrition 5. Cultural difference (language barrier)
- 10. LOGISTICS: 6 months to modify the curriculum. Input from focus groups Help from experts in nutrition, exercise, psychotherapy
- 11. HOW WE USED THE RESULTS TO MODIFY THE CURRICULUM Existing HPRT curriculum Each session consists of: Stress management Exercise Nutrition Main topic (sleep, recipe modification, how to talk to your doctor, preventive health, lapse/relapse)
- 12. EXAMPLES: Topic Main Discussion Reinforcement Sleep Sleep specialist: physiology of sleep 1. MOS sleep survey 2. Relaxation exercises Diet Nutritionist 1. Recipe modification 2. Healthy snacks by group & discussion 3. Handouts in Arabic& English Exercise Exercise students 1. Follow-up every week 2. Women’s only exercise session at Peak’s Academy
- 14. UHHR WELLNESS GROUP FOR TRAUMA SURVIVORS – BASELINE MEASURES FOR FEMALE PARTICIPANTS Sarah Al-Obaydi, M.B.Ch.B. Fulbright scholar, MPH candidate, University of Utah
- 15. BACKGROUND Over 25,000 refugees have been resettled in Utah Up to 35% of refugees are torture survivors About 15,000 torture survivors live in Utah Torture survivors are more at risk of chronic diseases HPRT for Cambodian torture survivors UHHR modified HPRT health promotion curriculum
- 16. SELECTION CRITERIA I. UHHR clients II. females III. Initially interested in wellness IV. Available Fridays from 11:00 am -1:00 pm
- 17. METHODS Pre and post wellness group questionnaires SF-36 V1 CDC’s Health Risk Appraisal MOS- Sleep Scale (Quality of sleep ) Self-efficacy for diet and exercise behaviors* Iraqi women filled all the questionnaires in Arabic.
- 18. RESULTS- PARTICIPANTS’ CRITERIA: 13 women participated 9 Iraqis 4 African (Gambia, Kenya,2 Democratic Republic of Congo) Median age: 37 Education: High school
- 19. SF-36 RESULTS- WOMEN’S GROUP VS. US NORMS 0 10 20 30 40 50 60 PF RP BP GH VT SF RE MH trauma survivors US norm-based scale scores
- 20. SF-36 – PCS & MCS 0 10 20 30 40 50 60 PCS MCS Trauma surivors US norm-based scale scores
- 21. CDC’S HEALTH RISK APPRAISAL-RESULTS Physical activity: Only 7 women are physically active About 10-30 minutes/day of light-moderate exercise. Tobacco smoking: Only one participant smokes cigarettes and she is thinking of quitting. Alcohol use: None 1 participant rides beside a driver who has been drinking. Seat belt use: All
- 22. NUTRITION: n=7 n-=3 n=2 n=1 Fruit and Vegetables Servings/day 1 serving 2 servings 3 servings 4 servings
- 23. n=5 n=4 n=1 n=1 Servings of high fiber or whole grain/day 1 serving 2 servings 4 servings 5 servings
- 24. n=2 n=7 n=2 n=1 n=1 Servings of high fat food/day 0 serving 1 serving 2 serving 4 servings >4 servings
- 25. n=4 n=5 n=1 n=2 n=1 Servings of sugar sweetened drink(s)/day 0 serving 1 servings 2 servings 3 servings 4 servings
- 26. DEPRESSION 0 5 6 2 0 4 9 0 Almost Never Some of the Time Most of the Time Almost all of the time N=13 little interest in doing things felt depressed or hopeless
- 27. ANXIETY & HIGH STRESS 0 8 2 3 1 6 2 4 Almost Never Some of the Time Most of the Time Almost all of the time N=13 unable to stop worrying or control your worrying felt nervous or anxious
- 28. PAIN 6 7 0 A lot Some None How much pain have you felt?
- 29. GENERAL HEALTH 6 6 1 0 0 6 4 2 1 0 Poor Fair Good Very Good Excellent N=13 condition of teeth and mouth general health
- 30. SLEEP 0 2 4 6 8 10 participants hours/night hours/night
- 31. DAYTIME SLEEPINESS 0 2 4 6 8 Always Usually Sometimes Rarely Never N=13 how often have you felt sleepy during daytime?
- 32. MOS-SLEEP SCALE RESULTS: MOS-Scale Median Standardized Score Sleep disturbance scale 85 Snoring 0 Sleep SOB/headache 80 Sleep adequacy 40 Daytime somnolence 26.6 Sleep problems index 1 63.3 Sleep problems index 2 66.7 Median, N=7
- 33. A COMPARISON BETWEEN UHHR GROUP AND US-NORMS: 0 10 20 30 40 50 60 70 UHHR group US norm
- 34. ACKNOWLEDGMENT Office of Refugee Resettlement (ORR) SelectHealth Lisa Gren, PhD/Division of Public Health,U of U Mara Rabin, MD/UHHR Ted Adams, PhD/IMC Mark Linnel,CSW/ UHHR Patricia Eisenman. PhD/ Exercise & Sport Science, U of U Kate O’Farrel/ Exercise & Sport Science, U of U Cassidy Wareing/ Exercise & Sport Science, U of U Jennifer North/ Division of Nutrition, U of U Kevin Shilling, MD Ala’a Ameen, UHHR- interpreter
Notas del editor
- It is estimated that over 25,000 refugees have been resettled in Utah . The majority of these refugees live in the Salt Lake City area. Refugees living in Utah come from over 40 countries. It is estimated that 5-35% of the world’s refugees are torture survivors, the most extreme form of trauma exposure. In some populations, such as the Iraqi and Somali, the estimates of torture survivors are 57% and 79% respectively. Utah is home to both of these populations. It’s likely that Utah has over 15,000 survivors living here. Many torture survivors suffer from depression, anxiety, and/or PTSD. Many have chronic pain. There are a number of medical studies that document that trauma survivors are at an increased risk of developing chronic disease as compared to a non-traumatized population. One example of this is that in the general population, there is a 5% prevalence of diabetes mellitus, while in Cambodian torture survivors the prevalence of diabetes is 20%
- The Harvard Program in Refugee Trauma (HPRT) developed a health promotion/disease prevention course for Cambodian torture survivors and it is the only research study that was done to estimate the burden of PTSD on a certain refugee population. This course has been running for the past 10 years. Data on other refugee population is unavailable since research in this area is so limited. *Richard Mollica, 2006
- Many parts of our curriculum are based on HPRT curriculum
- Each refugee population has different culture and needs from the other so we can’t copy HPRT as is. Iraqi torture survivors might have different needs from Cambodians Also, they might have more ideas and preferences of what should be included in the health promotion curriculum
- UHHR has a regular men’s and women’s social group meetings, so we went to one of the men’s groups to run a focus group
- We asked the participants what is their definition of health :Women included both physical and psychological wellbeing as part of their concept of good health. Men reported that good health was related to social constructs, such as meeting with each other and with their group facilitator Both women and men identified mood (depression and anxiety) and lack of sleep as their main concerns. Both groups recognized that exercise and diet were important to health. With regard to exercise, women were particularly interested in learning to use gym equipment while men prefer walking, swimming and playing soccer. Both men and women mentioned their interest in learning about healthy diets and how to prepare healthy meals. Women were interested in expanding their group to learn healthy behaviors, while men mentioned they would prefer to learn healthy behaviors in their existing group and then teach these concepts to their families. common illnesses: hypertension, dm, hypercholestrolemia, hyper/hypothyroidism, osteoporosis
- It took us about 6 months to modify the HPRT curriculum and change the existing one according to the focus group’s needs and what experts think it is useful and important to address.
- Integrating the topics into each session, rather than 1 session on each (in isolation). gave us a chance to check in on progress and reinforce concepts at every session.
- Guided imagery exercise and mouthful exercise
- Many participants shared stories about the difficulties they are facing due to language barrier especially in doctors appointments. Many of them had their clinics appointments cancelled (more than once) because the interpreter was not available and they didn’t know that they have the right to have a phone interpreter if the in-person interpreter was not present, so we developed this card to give to the participants in hope it will solve the problem.
- Over 25,000 refugees have been resettled in Utah – most in the Salt Lake City area. The Harvard Program for Refugee Trauma (HPRT) curriculum has been shown to reduce the development of diabetes and hypertension in Cambodian trauma survivors living in the United States. We modified this curriculum to address the needs of an Arabic-speaking population of trauma survivors receiving health services at Utah Health and Human Rights (UHHR) in Salt Lake City, UT. Our goal was to assess knowledge, attitude, behavior, and quality of life of wellness group participants at the beginning and end of the 8-session course.
- Clients are primary and/or secondary torture survivors A primary torture survivor: is The definition of a primary survivor is a person who was tortured or who witnessed the torture of another person. A secondary survivor is a close family member/spouse/partner of a primary survivor.
- Results from the self-efficacy survey for diet and exercise behaviors will be presented in a poster by Cassidy Warelng and Kate O’Farrel
- Compare to US results and particular things to refugee experience (eg mental score) bcoz this will be number ne that we need to address first tc PF=physical function RP=physical role functioning BP=bodily pain GH= general health perception VT=vitality SF=social role functioning RE=emotional role functioning MH=mental health
- The baseline scores for the physical and mental health scales for the SF-36 quality of life survey were 26.9and 31.5 respectively. There was more variation in the mental health score, with an interquartile range (IQR) of 9.3, than there was in the physical health score (IQR=3)
- most of the participants said they eat 1-2 servings, only one said she eats 4 servings while the recommendation is 4-5 servings/day! http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Suggested-Servings-from-Each-Food-Group_UCM_318186_Article.jsp (American heart association guidelines)
- Most women eat 1-2 whole grain servings, 2 said they don’t eat any! Current guidelines are 6-8 servings/day
- Most women eat 1-2 servings while only one said that she eats 7 servings (African) Recommendation is 1-2/day
- More than half of the women drink within the current recommendations (5 or less/week) while only 4 said they drink about 3 drinks/day
- Nine of them said their depression affected their social life
- 6 of the participants said their high stress is a problem for them in handling their health, finance, social relationships and work. But the good thing is that almost all of the m receive emotional support except 1 participant said she doesn’t
- Pain is a huge problem among torture survivors, all women said they feel pain to some extent
- Only 4 women said they need others to help them in their everyday life, while 7 needed help in shopping
- An adult needs an average of 8 hours sleep/night The participants’ responses varied between 1 and 8 hours! 4 out of 13 said they snore
- The lower the score the better the result, therefore we can see that those people suffer from sleep disturbance, shortness of breath and headache during sleep.