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Sarah Kowalczewski, MPH 2010


Rates of chronic illness, such as diabetes, obesity and cardiovascular disease, are increasing worldwide. Current prevention efforts include health promotion campaigns that encourage change to a healthier lifestyle. However, as New Zealand becomes increasingly multicultural, there is the risk that these campaigns will not be culturally relevant to minority ethnic groups and will fail to have an impact on them. Studies have demonstrated that migrants develop chronic diseases at rates the same as, or greater than, that of the host population with increasing length of stay. While refugees make up a small proportion of the total number of migrants to New Zealand, past trauma, poverty, educational disadvantages and language difficulties make them extremely vulnerable to health inequalities.

There is limited research around chronic illness of refugee groups. This dissertation aimed to review the current understanding of chronic illness in migrants and refugees and to examine the ways in which health promotion may be made more effective for this group. The particular focus of this study is the Afghan refugee community in Christchurch.

This research used qualitative methodology to explorer the beliefs and values of Afghan participants around the topics of health, illness and disease prevention. In-depth interviews were conducted in English with seven Afghan refugees living in Christchurch and two New Zealand health providers working with refugees. Interviews were audio taped, transcribed and analysed using thematic analysis.

After analysing the data, three main themes emerged. The first was the importance of collectivist values for the Afghan participants; support from the extended family being seen as especially critical for emotional and physical wellbeing. The second theme noted the importance placed on their cultural heritage by many participants, and how this could affect health beliefs and behaviours. The final theme to emerge was that most Afghan participants had a limited focus on long term health problems or prevention of chronic illness.

Developing culturally appropriate health promotion for refugees could help improve their long term health outcomes. By structuring health promotion that is in sympathy with the beliefs, values and priorities of a particular cultural group, health programmes may indirectly benefit the social and emotional health of the participants as well. Tailoring health promotion programmes to utilise the inherent strengths in a given culture and empowering community members to assist in their design and development, may improve its relevance and effectiveness. It is also important to improve communication both from agency to agency and from agency to community in order to share knowledge and prevent misunderstandings that could threaten a programme's success. It is hoped that the principles and findings in this study can be used to guide the development of future health promotion programmes for all ethnic minority groups, and Afghan refugees in particular.

Supervisors:Cheryl Brunton, Lee Thompson

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