Qualitative evaluation of a social inclusion program for Karen and Karenni refugees in Victoria, Australia

BACKGROUND: Karen and Karenni refugees from Myanmar face significant barriers to access and engagement in health services due to high levels of vulnerability and disability. Social isolation and limited access to resources have been identified as important barriers to health engagement; however, research on social inclusion programs, which might assist in overcoming poor access, have been limited in number and by methodological constraints This study examined the impact of a social inclusion program on the health-seeking behaviours of Karen and Karenni refugees in Melbourne's western suburbs, by identifying the key enablers and barriers to improving health engagement. METHODS: Semi-structured interviews were conducted with both refugees and healthcare practitioners, and subsequently analysed with both deductive and inductive thematic analysis. Interviews explored refugees' understanding of their health conditions, and their engagement with the Victorian healthcare system, as well as healthcare practitioners' impressions of the above. RESULTS: Health practitioners (5) and refugees (14) had similar perspectives. Outcomes demonstrated partially improved engagement, specifically a greater willingness to seek help for physical compared with mental health complaints, and a clear preference for community-based over hospital care. Enablers included social connection and psychological safety, which fostered a sense of identity that enhanced functioning and health-seeking capacity. Program effectiveness was hampered by refugee-specific and systemic barriers, including cultural differences, low health literacy, social issues and inaccessible hospital systems. CONCLUSIONS: This research highlights the effectiveness of a community-led, culturally-sensitive intervention in empowering Karen and Karenni refugees to engage in health care. Findings support increased funding for ongoing program delivery, and can inform development of more refugee-specific health services nationwide and globally.