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)
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
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
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
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
Editor's Notes
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.
