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. Author manuscript; available in PMC: 2023 May 22.
Published in final edited form as: J Transcult Nurs. 2023 Jan 25;34(2):143–150. doi: 10.1177/10436596221149692

A Qualitative Inquiry of Older Afghan Refugee Women’s Individual and Sociocultural Factors of Health and Health Care Experiences in the United States

Hafifa Siddiq 1, Qais Alemi 2, Eunice Lee 3
PMCID: PMC10202198  NIHMSID: NIHMS1899065  PMID: 36695336

Abstract

Introduction:

Approximately 132,000 Afghans have resettled in the United States since the 1980s and are now aging. As older adults, sociocultural factors influence health and health-related behaviors. This study aimed to explore older Afghan refugee women’s perceptions of individual and sociocultural factors of health and health care experiences.

Methods:

A focused ethnography methodology was conducted with 27 semi-structured interviews with older Afghan refugee women, family members, and community key informants in Southern California. Recorded interviews were transcribed and analyzed using inductive thematic analysis.

Results:

Five themes were identified as key to health promotion in the post-migration setting: (a) health promotion through Islam, (b) the centrality of family, (c) ongoing stressors that impact health, (d) needing support in navigating health services, and (e) miscommunication leading to mistrust of health care providers.

Discussion:

Health interventions should consider social and cultural contexts and faith-based and family-centered approaches when addressing older Afghan refugee women’s long-term health and well-being.

Keywords: older Afghan women, health beliefs, health promotion, immigrant health, refugee

Introduction

Afghan refugee women have been resettling in the United States since the 1980s as a result of displacement due to protracted wars and conflicts in Afghanistan. Afghan women are now aging and face multiple layers of inequities and challenges to maintaining their health and well-being (Kumar et al., 2020; Siddiq et al., 2020). Particularly, Afghan women may face increased burden of chronic disease and mental health issues and face challenges in accessing preventive health services (Naja et al., 2019; Yun et al., 2012). Registered nurses and health care providers in community settings who provide chronic disease management are well positioned to respond to the distinct needs of resettled refugees (Siddiq & Rosenberg, 2021).

Afghan Diaspora

Displacement from Afghanistan is a result of over four decades of political warfare and violence in the country (Batalova, 2021). Several waves of migration have occurred: (a) the 1980s Soviet–Afghan war, (b) the 1990s Civil War, (c) post 9/11 U.S.-led intervention, and (d) the 2021 withdrawal of U.S. forces from Afghanistan (Koser, 2014). The largest wave of Afghan refugees arrived in the United States in the 1980s, and most resettled in New York, Virginia, and California. As another humanitarian crisis unfolds in Afghanistan, the United Nations High Commissioner for Refugees (UNHCR) estimates that around 80% of about a quarter of a million Afghans were women and children forcibly displaced since the end of May 2021 (United Nations High Commissioner on Refugees [UNHCR], 2021).

Afghan Refugee Women’s Health

Pre-migration experiences of war, trauma, and displacement are stressors that affect refugees’ mental health. Stressors in the post-migration setting may compound traumatic experiences or other stressors before and during their migration journey. Like other refugees or displaced migrants, there is a high prevalence of common mental health disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) among Afghans in high-income countries (Alemi et al., 2014). Prior research suggests Afghan women associate depression with more somatic symptoms, indicating gendered experiences of mental health (Alemi et al., 2016; Stempel et al., 2016). Refugee populations generally underutilize mental health care (Mazumdar et al., 2022). A study examining the help-seeking behaviors of Afghans identifies factors like more severe level of distress and identifying as female, predicts help-seeking for psychological distress (Alemi et al., 2018). However, the unique needs and priorities of refugees are generally under-addressed in health services (Lau & Rodgers, 2021). In a recent review of the literature, community-based mental health interventions tailored for refugees from Muslim-majority countries, focus on younger-aged groups with little attention to the specific needs of older adult women (Siddiq et al., 2022). There is a need to consider age, displacement trauma, and post-migration stressors on the psychosocial well-being of older adult refugees (Ajrouch et al., 2020).

Like other U.S. immigrant and refugee groups, Afghan women are at risk for worsening health outcomes the longer they reside in their country of resettlement. Although prevalence data on chronic diseases among Afghans are limited, emerging research on refugees suggests this population faces increasing rates of chronic diseases the longer they reside in the United States (Kumar et al., 2020; Yun et al., 2012). This may be due to the increased risk of developing chronic health issues in later life, multi-morbidity, sedentary lifestyle, and decreased quality of life (Debesay et al., 2022). Unfamiliarity with preventive health behaviors like screening for chronic diseases like cancer may also contribute to poorer health outcomes (Siddiq et al., 2020). Despite the burden of ill health, Afghan women residing in the United States are underrepresented in public health promotion efforts and research.

Social and Cultural Influences

Many Afghans are Muslim and have unique social, cultural, and religious influences on health beliefs and health-related behaviors. Afghans have religion-informed beliefs that influence their health practices and may be misunderstood by health care providers (Attum et al., 2022). In addition, Afghanistan is a traditionally patriarchal culture, and women rely on men as family gatekeepers for input on decision-making, including seeking health care (Afrouz et al., 2022). According to seminal research, family is the most critical institution in Afghan culture and is also likely to influence women’s health behaviors (Lipson & Omidian, 1992).

Afghans are an underrepresented minority group in the United States, yet represent one of the largest and longest-standing refugee populations in the world. Therefore, the current study aimed to explore older Afghan refugee women’s perceptions of individual and sociocultural factors of health and health care experiences.

Method

Qualitative Study Approach

Using a focused ethnography study design, we examined Afghan women’s shared values and beliefs about health and health care experiences (Wall, 2014). We conducted semi-structured, open-ended interviews with Afghan women, family members, and community key informants residing in Southern California. The interview started with a general and open-ended question about the meaning of health and migration experiences. This was followed by questions about perceptions of health and health care experiences. Interview questions are outlined in Table 1.

Table 1.

Preventive Health Construct Interview Questions for Afghan Womena.

What comes to your mind when you think about “health”?
What do you do to stay healthy? Where did you learn about how to stay healthy?
Who or what helps you when you have a problem with your health?
In what ways are they helpful?
When do you go to the doctor or health clinic?
Are there reasons/things that make it difficult for you to seek healthcare? If so, what are they?
How do you think your religion or culture influences your health?
How do you think your community or neighborhood (where you live) influences your health?
What are important health issues you think affect Afghan women?
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a

Interview questions for family members and community key informants were reworded from “you” to in terms of “Afghan women that you know.”

Researcher Characteristics and Reflexivity

The primary researcher (H.S.) who developed the research questions, study design, data collection, and analysis of the present study is a female, doctorate-prepared registered nurse of Afghan descent. The primary researcher kept a reflexive journal throughout the study as notions about the study, the population of focus, and preconceived ideas were documented as memos. The primary researcher acknowledges that her experiences as a daughter of refugees and immigrants sensitize her to particular notions about the phenomenon of interest. The research team also included a male Afghan research mentor (Q.A.) with a public health background and a female Farsi-speaking research assistant with health care experience.

Sampling Strategy

The participants were recruited using convenience and snowball sampling techniques. Women were recruited through the research assistant’s network, and a local Imam at a faith-based institution announced the study to congregants. After interviewing the first few women and their family members, women identified initial community key informants. The primary investigator and research assistant recruited other key community informants through a refugee-serving organization, a resettlement agency, and Afghan social media networks.

Inclusion criteria for this study consisted of a purposive sample of 14 Afghan women over 50 born in Afghanistan. Inclusion criteria for family members were defined as any household member that the woman identified as having the most influence on their health-related decisions. Inclusion criteria for community key informants were that they were either identified by Afghan women as having had a significant impact on their health decisions or had worked with Afghan or refugee communities for at least 2 years. Expanding study participants to include family and community key informants contextualize women’s descriptions of their social and structural environment and provide a community-level perspective to enrich findings.

Data Collection Methods

The first author conducted semi-structured interviews lasting approximately 45 min to 1 hr with 14 Afghan women in their homes and other locations of their preference. Most women (n = 9) requested an interpreter during interviews. A trained Farsi-speaking (in both Dari and Pashto dialects) research assistant served as the interviewer for Farsi-speaking participants. Recorded interviews in Dari or Pashto were then translated and transcribed into English by the primary author and research assistant. After transcription, a native speaker (an English-Farsi educator) assessed random selections of interview recordings for transcription accuracy to consider alternative data translations. Slight translation discrepancies did not influence significant changes in the interpretation of the data. At the same time, the first author interviewed English-speaking participants (n = 5). Follow-up interviews with five Afghan women’s family members were conducted in English because none requested a Farsi-speaking interviewer.

Data Collection Instruments and Technologies

After each interview, women and their family members completed a demographic questionnaire offered in English or Farsi or read aloud by the interviewer. A total of eight community key informants who were fluent in English were interviewed English. After obtaining consent, a recording device was turned on, and notes were taken during the interview. All participants provided consent to be recorded. Verbal consent with a study information sheet was used (Smith, 2009). Participants were provided a US$20 local store gift card for participation.

Data Analysis

The coding process of interview transcripts followed the general step-wise thematic analysis Braun and Clarke (2006) outlined using an inductive approach. Transcripts were coded line by line and imported into Atlas.ti software to facilitate the categorization. In the first step, coding was employed descriptively, resulting in 165 initial process codes. Second, redundant and extraneous codes were combined or eliminated, resulting in 53 focused codes. Third, relations between the 53 codes were further clustered into 10 categories. Finally, topic summaries of each type were developed, and these categories were further refined into themes with supporting quotations. Hand-written notes during interviews were used as an immediate source of reflection. These notes were not coded but were supplementary to the thematic analysis.

Results

This study identified five themes related to the psychosocial and cultural influences on Afghan women’s perceptions of health and health care experiences. Themes included: Health promotion through Islam, the centrality of family, ongoing stressors and “worries that never end,” needing support navigating the health care system, and miscommunication leading to mistrust with health care providers. Detailed sociodemographic information can be found in Table 2.

Table 2.

Sample Characteristics of Participants (N = 27).

Afghan women (n = 14) Age range M = 62.7 (SD = 11.19)
Married 64% (n = 9)
Below high school 57% (n = 8)
Medical/Medicare 71% (n = 10)
Years in the United States M = 23.4 (SD = 9.4)
Family member (n = 5) Age range M = 34
Daughter 100% (n = 5)
College educated 100% (n = 5)
Key informant (n = 8) Health field 50% (n = 4)
Community worker 50% (n = 4)
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Theme 1: Health Promotion Through Islam

Health was described as a state of well-being—with features such as a positive emotional state and the ability to socialize and have a spiritual connection with God. Participants emphasized the importance of having good health and described health holistically. Another participant states, “the thing about health that comes to mind is that overall if you’re good, mentally or physically.” Women identified health in terms of physical function or lack of symptoms and specifically identified wellness features such as a positive emotional state and the ability to socialize and have a spiritual connection with God. Islam was referred to as guiding, promoting health, and preventing illness. A participant states, “Of course, our religion helps us to be healthy, we stay away from alcohol … we follow the Quran [Holy Book] and we have to take care of our body.” Some women described the concept of prevention through diet and cleanliness, influenced mainly by religious practices. One participant stated, “One part of our religion focuses on cleanliness, to be pure, like for praying.” On the other hand, being unable to perform religious actions such as ablution, fasting, and prayer due to physical illness or chronic pain may be a source of stress for women. One participant stated, “With my situation [diabetes and cancer], unfortunately, I cannot fast this year, but I do everything else … I always have a connection with Allah [God]. Always, always. That’s very, very important.”

Theme 2: The Centrality of Family

Older-aged Afghan women described their family as a motivating factor in maintaining health. In addition, not being able to be close, socialize with them, or maintain good relations can be a source of stress. Most women emphasized the primary consequence of having an illness would be their inability to fulfill their role within the family; as described by one participant, “I want to be healthy to live and support my children.” A family member explains the debilitating consequences of her mother’s back pain and other symptoms. This pain impacted her mother’s ability to pray or socialize with family: “One of the things she’s [mom] mentioned to me was that she misses praying and putting her forehead on the ground. That’s what she misses the most . . ..” Most women described a primary consequence of having an illness limited women’s ability to fulfill their role within the family as described by one participant, “If you’re sick, you are in bed all the time, you can’t take care of your husband, you can’t take care of your family, your house, kids, grandkids, or if someone needs you in the family.” While some women identified the positive consequence of prioritizing family through a sense of fulfillment and love from their dedication to their family, others recognized the negative result of prioritizing family on health.

Theme 3: Ongoing Stressors and “Worries That Never End”

Over half of Afghan women reported chronic health issues and concerns over their own and family’s health and well-being. Women described specific worries and stressors that negatively influenced their current satisfaction with their health. “When Afghan women come here, they come with a lot of stress. They come here with a different culture and society; after the kids grow up, you [still] worry a lot,” one participant described. Another participant explained the compounding stress on Afghan women due to a shift in traditional roles: “… There’s more pressure for Afghan women because they do everything in the home, and sometimes they [women] even do more than the husband.”

Family Issues.

Family problems related to broken family ties due to displacement, shifting gender roles, and cultural conflict after resettlement were described as sources of distress. Participants recalled distressing memories of war in Afghanistan and the process of fleeing their home country, resulting in the death of certain family members or being separated from their parents, siblings, or husbands. A participant stated, “They put my husband in jail, and I was alone in my big house, so I took my young daughters and escaped to Pakistan … the bombs destroyed things around my house, and I was terrified. Being alone was the hardest part.” Women also illustrated how their family structures in the United States differed significantly from what they were used to back home. A family member illustrated,

being a woman in Afghanistan meant that you were cared for by your family; it didn’t matter if you had three or four or even more than six children, your extended family would help care for them, but here, you have to find work and have the stress of paying bills, to help your husband and no one to help you.

Physical Health Concerns.

More than half of women reported a history of at least one chronic health issue or health-related problem, including diabetes, arthritis, cancer, high blood pressure, and pain in the stomach, head, lower back, knees, or difficulty walking. Women revealed health concerns, explicitly identifying physical symptoms and pain as sources of stress and concern. For example, a participant illustrates, “diabetes and rheumatism bother me too much.” Women were mainly concerned over unmanaged pain and expressed helplessness with chronic pain. Another participant states, “Sometimes, I cannot handle it at all, and it makes me very weak, and I cannot take the pain anymore.”

Mental Health Concerns.

For those open to discussing it, mental health was a significant concern among Afghan women. Participants described living in a country with a different culture and family conflict was a source of stress. One participant states, “I think 99% of Afghan women have depression because of family issues.” An Afghan key informant shared concerns over social isolation and depression among the elderly and stated, “I think older people who are isolated end up being depressed.” A health provider described health concerns for newly resettled refugees. She stated,

Some of the patients that I see, they usually don’t notice, but I see that they tend to struggle with anxiety, depression, or PTSD from their experience of being displaced from home and placed in refugee camps and realizing that life here is going to be just as difficult or maybe even more difficult than life back home.

Theme 4: Needing Support and Navigating the Health Care System

Turning to the Family for Support.

All participants described the importance of family members’ involvement in their health and decision-making. Women generally endorsed an extended family perspective, defined by kinship through the extended family, siblings, and in-laws through marriage. Family members were essential to accessing health care for women with higher dependency needs and overcoming language and transportation barriers. “I seek help from my husband and family. I do not drive, and my nephew and niece help me interpret to my doctor.” Women also turned to family members who were more fluent in English and had access to transportation to help advocate for their health and information needs. A participant states, “now the children are a huge help. They know everything, search on the internet, and teach their parents.” An Afghan health provider further illustrated the need for family support among resettled refugees: “[Older adult Afghans] who have family members who come to their appointments tend to be less isolated because they have a support group.”

Seeking Community Support.

Women in the study also emphasized the need to seek community resources for assistance with language, job placement, education, and health information, especially during the initial resettlement. Initially, resettling within an established Afghan community appeared to be a valuable part of integrating into life in the United States. For instance, one woman said, “I think being with other Afghans can positively affect you. When we came here, they helped a lot, especially they help Afghan women and kids.” However, not all women had access to a supportive community. Other participants also illustrated the hardships of not having community resources. A participant illustrates, “I help my friends if there are any health issues if I have information for it, I will tell them … ” Another participant stated, “The [Afghan] people who came a long time ago should help them.”

Key informants identified the mosque as where the community gets together through worship and community programs, and therefore an appropriate place for health promotion. “Somebody could go to the mosque, someone could go in there, educate them, answer their questions.” In addition, some women with high dependency needs do not seek out activities in the community due to frailty. “No, I do not go to any of those places. I cannot go because I have a problem with my bones; I do not go because I will fall. I am sick, and I cannot walk.”

Theme 5: Miscommunication With Health Care Providers Leads to Distrust

Treatment Expectations.

Women expected their medical complaints to be resolved through proper treatment with health care providers but identified how difficulty communicating with providers could lead to distrust of the treatment they are provided with. For example, receiving medications for side effects and other health issues that were not their initial complaint or when the doctor could not identify the exact cause of their complaint negatively influenced women’s perceived quality of care. One participant stated, “The medicine that the doctor gives me does not work on me … Sometimes, I do not take medicine because it affects my stomach, and I have trouble in my stomach.” Another participant illustrated a negative experience with unmet treatment expectations with her health care provider and stated,

If you go to the doctor, they create stress for you. For example … they tell me, if you take this medicine and don’t feel better, come back, then why are you so lost and confused if you can’t give me good medicine. After that, they give you some antibiotics, and your stomach starts hurting, and tell you to drink lots of water. I don’t have time for that. Why are you giving me medicine that’s not good for me or causing me upset stomach or heart attack? Why are they giving me this in the beginning? That’s what worries me and stresses me.

Discussion

This focused ethnographic study advances the literature on the perspectives of older-aged Afghan refugee women who have been residing in the United States for over a decade, revealing ongoing stressors and challenges to health care in the post-migration setting. Women described sociocultural factors of family involvement and religion as influencing their health and health behaviors. Afghan women’s perceptions of health were generally defined in terms of overall well-being and ability to fulfill familial obligations, but also about their experiences of displacement due to the war (Bragin et al., 2022). Overall, Afghan women’s holistic health beliefs corroborate previous research with other Muslim groups’ ideas regarding health and disease that incorporate spiritual, physical, and psychosocial factors (Alwan et al., 2020; Padela & Zaidi, 2018). Providing culturally appropriate and effective health care will be critical to addressing new immigrants’ and refugees’ complex health issues and challenges.

Ongoing Post-Migration Stressors

Afghan women’s concerns about ongoing stress and depression support emerging research on post-migration stressors and their impact on the well-being of resettled refugees. In this study, women highlight struggles with barriers to health care, social isolation, financial difficulties, family concerns, and limited English language proficiency. These findings corroborate research regarding stressors and the high prevalence of mental health issues in the post-migration setting (Alexander et al., 2021). Our findings also suggest that despite residing in multi-generational households with seemingly available support, older Afghan women may still be at increased vulnerability to loneliness or the inability to socialize outside the house or with other family members due to chronic illness, pain, disability, language, and transportation issues. Struggling with chronic pain or disability may be a source of stress that impacts the ability to engage in cultural or religious practices, like performing prayers or ablution.

Chronic Disease and Mental Health Management

This study builds on emerging research and increased understanding of older refugees’ experiences living with chronic disease. Older Afghan women may be at increased risk for unmanaged chronic health conditions due to social isolation and higher dependency needs. The unmanaged pain may also indicate somatization of psychological symptoms and should be considered when addressing chronic health issues (Lanzara et al., 2019). Possible increased risk for social isolation, psychological distress, and chronic disease among resettled refugees’ decades following resettlement should be public health priorities (Johnson et al., 2019; Matlin et al., 2018). Therefore, collaborative efforts in the community to implement more intensive case management or home visits with older adults may address barriers to health care. Culturally tailored navigation or home-visitation programs may assist frail older adult women in managing chronic health issues, promoting social connectedness, and assisting in navigating health and social services (Johnson et al., 2019; Srivarathan et al., 2019).

Social and Cultural Factors

This study provides insights into the influence of cultural beliefs and values on Afghan women’s health. In previous research, “worries” or “living in a bad situation” as causes of illness was the most mentioned cause of illness identified by Afghan and Somali participants (Feldmann et al., 2007). Similarly, the cultural conceptions of “peace of mind,” family, and religion are significant domains of psychosocial well-being among Afghans in Afghanistan (Bragin et al., 2022). Family values were also a major influencing factor for participants in our study. Turning to family members for specific types of support was a factor for promoting healthy behaviors. The value placed on family and family involvement in women’s health care parallels other immigrant minority women. Prior research suggests that family reunification may promote resettled refugees’ well-being (Lobel & Jacobsen, 2021).

Religion, specifically Islam’s influence on Afghan women’s health beliefs and practices, permeated throughout women’s responses (Padela & Zaidi, 2018). For example, women emphasized the influence of Islam on eating healthy, avoiding alcohol, and emphasis on cleanliness as important healthy behaviors. This study offers insights on older-aged Afghan women with chronic health issues who described their concerns regarding their inability to perform prayer, perform the purification ritual, or fast during Ramadan. There is a need for culturally tailored social support groups and health education interventions for older adult Afghan women living with chronic health issues like cancer and diabetes integrated within the home or community setting (Miner et al., 2017).

Implications for the Afghan Diaspora

These findings have important implications for Afghans arriving in the United States whether their legal status as refugees, special immigrant visa holders, asylum seekers, or resettle under family reunification. In 2021, the U.S. military withdrew from Afghanistan, and over 130,000 Afghans were evacuated from the country, with tens of thousands eventually resettling in the United States (Cambridge University Press for The American Society of International Law, 2021). The Afghan Adjustment Act was recently introduced that could potentially provide at-risk Afghans temporary humanitarian parole in the United States the ability to apply for legal permanent residence (Congress.gov, 2021). As the Afghan refugee crisis continues, it is critical for high-income countries of resettlement to address unmet health needs and to promote the long-term health of this population.

Limitations

We note limitations to this study. A potential source of bias may be attributed to interviews conducted using a recording device. While we obtained consent to record interviews, participants may have responded to questions in a manner perceived to be favorable by the interviewer (who self-identified as a health care professional). Older-aged Afghan women who had been residing in the United States for many years were willing to participate. They may have been integrated more or had more trust or understanding of academic research. However, our study showed that interviews with community key informants help provide a community-level context to better understand their perspectives. Future research should incorporate the recruitment of more recently resettled older adults through gatekeepers and utilize a family-centered approach.

Conclusion

This study identifies the ways social and cultural factors of family, Islam, and ongoing stressors beyond the initial resettlement phase that influences Afghan women’s overall health and well-being. Our findings informs the development of future culturally tailored psychosocial interventions addressing chronic disease management and mental health concerns like depression, psychological distress, and social isolation integrated within mosques or the community setting. Programs at the interpersonal and organizational level may benefit from utilizing religion-informed and family-centered approaches. As patients and their families assume the role of primary manager of chronic illness, nurses must also understand the personal and cultural health beliefs that influence patients’ health choices, which may help providers improve the long-term health outcomes for refugee women aging in the United States.

Acknowledgments

The authors would like to thank the participants, their families, and Afghan community leaders for being a part of this study. We also would like to acknowledge the contribution and thank Dr. Carol Pavlish and Dr. Janet Mentes, for their mentorship and ongoing support.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported in part by the Sigma Theta Tau Gamma Chapter Research Award (recipient: Hafifa Siddiq) and the National Institute of Health (NIH)/Nursing Research (NINR) Ruth L. Kirschstein Institutional Research Training Grant: Health Disparities Research in Vulnerable Populations (Grant Number T32 NR007077). Dr. Siddiq acknowledges current research support through the Urban Health Institute at Charles R. Drew University (CDU) under Award Number S21 MD000103-12 (Carlisle, PI), the Clinician Research Education and Career Development (CRECD) program (R25 MD007610), and the UCLA/Charles R. Drew University Resource Center for Minority Aging Research Center for Health Improvement of Minority Elderly under Award Number P30-AG021684 (Magione & Duru, Co-PI).

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

  1. Afrouz R, Crisp BR, & Taket A (2022). Afghan women perceptions of gender roles, possibilities and barriers to change after settlement in Australia: A qualitative study. Qualitative Social Work. Advance online publication. 10.1177/14733250221076730 [DOI] [Google Scholar]
  2. Ajrouch K, Barr R, Daiute C, Huizink A, & Jose P (2020). A lifespan developmental science perspective on trauma experiences in refugee situations. Advances in Life Course Research, 45, 100342. 10.1016/j.alcr.2020.100342 [DOI] [PubMed] [Google Scholar]
  3. Alemi Q, James S, Cruz R, Zepeda V, & Racadio M (2014). Psychological distress in Afghan refugees: A mixed-method systematic review. Journal of Immigrant and Minority Health/Center for Minority Public Health, 16(6), 1247–1261. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Alemi Q, Montgomery S, Smith V, Stempel C, Koga PM, Taylor B, & Fisher C (2018). Examining help seeking patterns within modern and traditional resources for support in Afghanistan. Intervention, 16, 215–221. [Google Scholar]
  5. Alemi Q, Weller S, Montgomery S, & James S (2016). Afghan refugee explanatory models of depression: Exploring core cultural beliefs and gender variations. International Journal for the Analysis of Health, 31(2), 177–197. 10.1111/maq.12296 [DOI] [PubMed] [Google Scholar]
  6. Alexander N, Mathilde S, & Øivind S (2021). Post-migration stressors and subjective well-being in adult Syrian Refugees Resettled in Sweden: A gender perspective. Frontiers in Public Health, 9, 717353. 10.3389/fpubh.2021.717353 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Alwan RM, Schumacher DJ, Cicek-Okay S, Jernigan S, Beydoun A, Salem T, & Vaughn LM (2020). Beliefs, perceptions, and behaviors impacting healthcare utilization of Syrian refugee children. PLOS ONE, 15(8), Article e0237081. 10.1371/journal.pone.0237081 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Attum B, Hafiz S, Malik A, & Shamoon Z (2022, January). Cultural competence in the care of Muslim patients and their families. StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499933/ [PubMed] [Google Scholar]
  9. Batalova JBJ (2021, September 8). Afghan immigrants in the United States. Migrationpolicy.org. https://www.migrationpolicy.org/article/afghan-immigrants-united-states
  10. Bragin M, Akesson B, Ahmady M, Akbari S, Ayubi B, Faqiri R, Faiq Z, Oriya S, Zaffari R, Rasooli MH, Azizi BA, Barakzai F, Haidary Y, Jawadi S, Wolfson H, Ahmadi SJ, Karimi BA, & Sediqi S (2022). Peace, love, and justice: A participatory phenomenological study of psychosocial wellbeing in Afghanistan. International Social Work, 65, 457–479. [Google Scholar]
  11. Braun V, & Clarke V (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. 10.1191/1478088706qp063oa [DOI] [Google Scholar]
  12. Cambridge University Press for The American Society of International Law. (2021). U.S. Withdraws From Afghanistan as the Taliban Take Control. American Journal of International Law, 115(4), 745–753. 10.1017/ajil.2021.50 [DOI] [Google Scholar]
  13. Congress.gov. (2021). H.R. 8685: Afghan Adjustment Act. https://www.congress.gov/bill/117th-congress/house-bill/8685
  14. Debesay J, Nortvedt L, & Langhammer B (2022, January). Social inequalities and health among older immigrant women in the Nordic Countries: An integrative review. SAGE Open Nursing, 8, 23779608221084962. 10.1177/23779608221084962 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Feldmann CT, Bensing JM, & de Ruijter A (2007). Worries are the mother of many diseases: General practitioners and refugees in the Netherlands on stress, being ill and prejudice. Patient Education and Counseling, 65(3), 369–380. 10.1016/j.pec.2006.09.005 [DOI] [PubMed] [Google Scholar]
  16. Johnson S, Bacsu J, McIntosh T, Jeffry B, & Novik N (2019). Social isolation and loneliness among immigrant and refugee seniors in Canada: A scoping review. International Journal of Migration, Health, and Social Care, 15(3), 177–190. 10.1108/IJMHSC-10-2018-0067 [DOI] [Google Scholar]
  17. Koser K (2014). Transition and displacement. Excerpt From Transition, Crisis, and Mobility in Afghanistan: Rhetoric and Reality. https://www.fmreview.org/sites/fmr/files/FMRdownloads/en/afghanistan/koser.pdf
  18. Kumar GS, Wien SS, Phares CR, Slim W, Burke HM, & Jentes ES (2020). Health profile of adult Special immigrant visa holders arriving from Iraq and Afghanistan to the United States, 2009-2017: A cross-sectional analysis. PLOS MEDICINE, 17(5), Article e1003118. 10.1371/journal.pmed.1003118 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Lanzara R, Scipioni M, & Conti C (2019). A clinical-psychological perspective on somatization among immigrants: A systematic review. Frontiers in Psychology, 9, 2792. 10.3389/fpsyg.2018.02792 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Lau LS, & Rodgers G (2021). Cultural competence in refugee service settings: A scoping review. Health Equity, 5(1), 124–134. 10.1089/heq.2020.0094 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Lipson JG, & Omidian P (1992). Health issues of Afghan refugees in California. Western Journal of Medicine, 157(3), 271–275. [PMC free article] [PubMed] [Google Scholar]
  22. Lobel L, & Jacobsen J (2021). Waiting for kin: A Longitudinal study of family reunification and refugee mental health in Germany. Journal of Ethnic and Migration Studies, 47(13), 2916–2937. 10.1080/1369183X.2021.1884538 [DOI] [Google Scholar]
  23. Matlin SA, Depoux A, Schütte S, Flahault A, & Saso L (2018). Migrants’ and refugees’ health: Towards an agenda of solutions. Public Health Reviews, 39, 27. 10.1186/s40985-018-0104-9 [DOI] [Google Scholar]
  24. Mazumdar S, Chong S, Eagar S, Fletcher-Lartey S, Jalaludin B, & Smith M (2022). Exploring the use of hospital and community mental health services among newly resettled refugees. JAMA Network Open, 5(6), e2212449. 10.1001/jamanetworkopen.2022.12449 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Miner SM, Liebel D, Wilde MH, Carroll JK, Zicari E, & Chalupa S (2017). Meeting the needs of older adult refugee populations with home health services. Journal of Transcultural Nursing, 28(2), 128–136. 10.1177/1043659615623327 [DOI] [PubMed] [Google Scholar]
  26. Naja F, Shatila H, El Koussa M, Meho L, Ghandour L, & Saleh S (2019). Burden of non-communicable diseases among Syrian refugees: A scoping review. BMC Public Health, 19, 637. 10.1186/s12889-019-6977-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Padela AI, & Zaidi D (2018). The Islamic tradition and health inequities: A preliminary conceptual model based on a systematic literature review of Muslim healthcare disparities. Avicenna Journal of Medicine, 8(1), 1–13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Shirazi M, Bloom J, Shirazi A, & Popal R (2013). Afghan immigrant women’s knowledge and behaviors around breast cancer screening. Psycho-Oncology, 22(8), 1705–1717. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Siddiq H, Alemi Q, Mentes J, Pavlish C, & Lee E (2020). Preventive cancer screening among resettled refugee women from Muslim-Majority Countries: A systematic review. Journal of Immigrant and Minority Health, 22, 1067–1093. 10.1007/s10903-019-00967-6 [DOI] [PubMed] [Google Scholar]
  30. Siddiq H, Elhaija A, & Wells K (2022). An integrative review of community-based mental health interventions among resettled refugees from Muslim-majority countries. Community Mental Health Journal, 59, 160–174. 10.1007/s10597-022-00994-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Siddiq H, & Rosenberg J (2021). Clinicians as advocates amid refugee resettlement agency closures. Journal of Public Health Policy, 42(3), 477–492. 10.1057/s41271-021-00296-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Smith V (2009). Ethical and effective ethnographic research methods: A case study with Afghan refugees in California. Journal of Empirical Research on Human Research Ethics, 4(3), 59–72. [DOI] [PubMed] [Google Scholar]
  33. Srivarathan A, Jensen AN, & Kristiansen M (2019). Community-based interventions to enhance healthy aging in disadvantaged areas: Perceptions of older adults and health care professionals. BMC Health Services Research, 19, 7. 10.1186/s12913-018-3855-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Stempel C, Sami N, Koga PM, Alemi Q, Smith V, & Shirazi A (2016). Gendered sources of distress and resilience among Afghan refugees in Northern California: A Cross-sectional study. International Journal of Environmental Research and Public Health, 14(1), 25. 10.3390/ijerph14010025 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. United Nations High Commissioner on Refugees. (2021). UNHCR warns Afghanistan’s conflict taking the heaviest toll on displaced women and children. https://www.unhcr.org/en-us/news/briefing/2021/8/611617c55/unhcr-warns-afghanistans-conflict-taking-heaviest-toll-displaced-women.html
  36. Wall S (2014). Focused ethnography: A methodological adaptation for social research in emerging contexts. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research, 16(1), 1. [Google Scholar]
  37. Yun K, Hebrank K, Graber LK, Sullivan MC, Chen I, & Gupta J (2012). High prevalence of chronic non-communicable conditions among adult refugees: Implications for practice and policy. Journal of Community Health, 37, 1110–1118. 10.1007/s10900-012-9552-1 [DOI] [PMC free article] [PubMed] [Google Scholar]

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