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Perceptions of Health with Attention to Specific Bodily Systems Among Refugees in Erie, PA
Pashollari, F. [1]
Shinder, P. [1]
Kisiel, N. [1]
Butala, H. [1]
Hobbs, B. [1]
Thielman, N. [1]

Journal: Journal of Osteopathic Medicine Date: 2025/12, 125(12):Pages: A764–766. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyterbrill.com/document/doi/10.1515/jom-2025-2000/html)

Keywords:

cross sectional study [826]
patients [147]
perception [131]
refugees [1]
USA [1630]

Abstract:

Context: The United States has been a home for refugees worldwide. In 2024, there were a recorded 106,000 refugees that arrived in the United States as compared to 75,100 in 2023(1). Despite these growing numbers, it has yet to be determined if this migration influences any change in refugees’ health. This survey was set in Erie, Pennsylvania - the fourth highest receiving state for refugees in the United States; 4,445 people, or 4.4% of all incoming refugees(2). The survey focused on assessing new refugees’ perception of which bodily systems they report the most medical conditions or concerns, and their perception of their familiarity and willingness to incorporate osteopathic medicine within their healthcare. Refugee research has many gaps within it as there is limited funding, a heightened number of barriers, such as language or education, and access to assess their current standard of patient care- a reality confirmed by the United States Committee for Refugees and Immigrants (USCRI), one of the departments with which we worked with(3). Objective: The goal of this study was to determine which bodily systems were reported to need greater medical attention within the refugee population arriving in Erie, PA, USA. It was also to determine if a transition into the U.S. contributed to a difference in the quantity of diagnosed medical conditions. We hypothesized that systems pertaining to infectious diseases would be most affected due to the poor environmental conditions of prior refugee camps, conflict zones, or low-income countries of origin. Additionally, we aimed to assess the level of familiarity and interest in receiving osteopathic medical care. Here, we hypothesized that there would be low familiarity with osteopathic medicine due to the limitation of the field within the countries of origin, but that there would be interest to receive osteopathic care due to its minimalistic nature. Methods: This study occurred in the timeline of collection between the Fall of 2024 through the Winter of 2025. The design was a cross-sectional survey that utilized a sample group formed from refugees seeking the services of the Erie United States Committee for Refugees and Immigrants (USCRI) office and the Erie Health Department. All questions were written to avoid inquiring about identifiable information, categorizing volunteers by country of origin, age, gender, and education level. The surveys were translated into the following languages: English, Spanish, Arabic, Russian, Pashto, Dari/Farsi, and Swahili, these being the most representative languages of the current population groups. The survey also incorporated pictographs for the question pertaining to bodily systems to minimize the reliance on written communication. The surveys were physically printed to avoid any technological barrier and were provided to the liaisons at both organizations for distribution and collection. The two organizations collected the completed surveys in sealed envelopes to ensure anonymity. The questions that were asked were to note which bodily systems the refugees had medical conditions in the past five years, the timeline surrounding their medical condition’s potential resolution, and the acquisition of any new conditions. The bodily systems included pictograms for the following written words: heart, lungs, stomach/intestines, liver, kidney, skin, musculature, brain/nervous system, mental health, and other. The questions that were asked for the timeline were “Were these medical conditions/concerns resolved prior to your arrival in the United States?”, “If not, were these conditions treated in the United States since arriving?”, and “Have you had any new conditions since arriving in the United States?”, followed by “Yes, No, and Not Applicable” choices. Osteopathic research significance was highlighted with the incorporation of the questions “Doctors of Osteopathic Medicine treat patients using a holistic philosophy in which treatment of the body can be done using hands-on manipulation, with or without medication, to promote overall well-being. Have you heard of osteopathic medicine?”, and “Would you be interested in seeing a physician trained in Osteopathic medicine?”, followed by “Yes, No, and Not Applicable.” Survey completion was limited to consenting adult participants 18 years of age and older. To assess statistical quantitative outcomes, the question responses were counted and quantified within Excel and GraphPad Prism. Bar graphs were created to note the distribution of responses among all participants. Results: The response rate was 97%, or 98 participants indicating consent out of a total of 101 on the survey sheet, originating across 21 countries (including but not limited to Afghanistan, the Democratic Republic of the Congo, Ukraine, and Syria). The bodily systems that were marked as areas of high concern by our survey population were the gastrointestinal, pulmonary, musculoskeletal, and psychiatric systems: 13.9%, 8.9%, 8.9%, and 8.9% respectively. 57.4% of participants selected that their medical conditions were not resolved before they arrived in the USA. Since coming to the U.S., 37.6% noted that they had still not gotten their conditions treated, although 30.7% selected that they had received treatment. While 45.5% of our population had not attained new conditions since their arrival, 38.6% had been diagnosed with new conditions. Finally, 57.4% of our participants had not heard of osteopathic medicine, although following an explanation of the field, 61.4% indicated an interest in being seen by an osteopathic physician. Conclusion: The bodily systems in which the highest proportion of our participants reported concerns were the gastrointestinal, pulmonary, musculoskeletal, and psychiatric systems. In addition, the majority expressed interest in being seen by an osteopathic physician. External sources support these findings by showing evidence that the burden of respiratory diseases in refugees is exacerbated by poor living conditions(4), and refugees have high and persistent rates of PTSD and depression(5). Due to the pre-established screenings for long-standing infection or possible transmission within the gastrointestinal system(6), it is reasonable to see our highest percentage of concern stemming from the gastrointestinal system. Limitations include a potential selection bias as the population has resided in the USA for less than a year, reduced application to refugees within the United States as a whole, as the study was only conducted in Erie, PA, and a potential language barrier despite the efforts towards translation and pictograph incorporation. With this information, we gain insight from a vulnerable and underserved population in our country, who typically receive insufficient representation in survey research. We hope these findings can aid in future efforts from physicians or government agencies to incorporate appropriate screenings with heightened attention to these reported bodily system areas. We also hope that the survey itself can be utilized by any local community that may need more insight into gaps in care for their refugee population.

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