Publication Date



refugee, health care providers, quality improvement, benefits, barriers


Background: Aurora Health Care is the major health care system providing care to refugees in Milwaukee, where half of Wisconsin’s refugee population resides. Like many other institutions caring for refugee patients, Aurora faces significant challenges when trying to address refugee health needs. Even with the assistance of medical interpreters, cultural differences, language barriers and limited patient health literacy, as well as lack of knowledge of refugee patients’ backgrounds, are major obstacles encountered by health care providers in this setting.

Purpose: This quality improvement study aims to assess Aurora providers’ perceptions of the benefits and barriers to working with refugee patient populations.

Methods: An online survey was distributed to health care providers and staff at two academic family practice clinics before and after a 5-session educational series. Each educational session delivered monthly focused on refugee cultural awareness. Mental health providers and former refugees working as case managers or interpreters provided education about the main refugee populations in Wisconsin and the refugee resettlement process. The survey assessed participants’ perceptions about providing health care to refugees. Participants were asked to respond to questions on a Likert scale from 1 to 7 (ie, strongly disagree to strongly agree) and to two questions comprised of rank choices investigating barriers to effective health care delivery. Responses to questions on Likert scale ≥ 5 were lumped into an agreement category, while all others were considered a disagreement. Fisher’s exact test was used to compare pre- and posteducation responses.

Results: Perception about new medical knowledge and cultural competency had statistically significant increase comparing pre- and postintervention data (P = 0.0474). Insufficient interpreter services and insufficient time for appointments were ranked the top barriers to providing health care services to refugees before and after intervention. Participants also ranked refugees’ poor understanding of the U.S. health care system as the biggest challenge in delivering care for refugee patients before and after intervention, followed by communication with resettlement agencies in the preintervention survey and cultural differences in the postintervention survey.

Conclusion: Promotion of cultural awareness and proficiency within groups delivering primary care to refugees can be a valuable tool when trying to overcome obstacles.




October 31st, 2017


November 2nd, 2017


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