I reviewed a series of research papers and literature reviews under the lens of community-based participatory research, holistic health and well-being, and sampling within hidden populations to also be presented to the research team I work with in order to better their practice of a current research study being performed.
1. Introduction
Refugees, like many other hidden populations, are an underrepresented group in research and other statistics, leading to less holistic approaches to treatment and policies that are unhelpful or even harmful. Often, refugee research participants are people who may have power over refugees like healthcare workers, or other people who interact with refugees but are not self-identified refugees. The perceptions of a person described to be a refugee and policies that cater to refugees that fit their “type,” prevent many from excelling in their new environment. Many subgroups of refugee communities widen the experiences that any given refugee may hold, therefore requiring more individualized services and treatment methods to accommodate differing cultural backgrounds. It is important to recognize each refugee community’s needs to facilitate a trustworthy stream of communication, holistic services and resources, and allow the community to thrive.
The overall goal of our research review is to answer the question, “What does it mean for marginalized communities to thrive?” by conducting a community-led participatory study with new Americans in the San Diego region. I am specifically looking for research that discusses storytelling research methods utilizing community-based participatory research, further referred to as CBPR, with an emphasis on community thriving.
2. Methods
2.1. Inclusion and exclusion criteria
The focus was sampling methods utilizing CBPR approaches and including a holistic definition of health that prioritizes what it looks like for a community to thrive to inform research in San Diego and the greater San Diego region alongside PANA research.
Studies were prioritized for quantitative measures for analyzing sampling methods, but qualitative and mixed methods approaches were accepted when discussing holistic definitions of health and analyses of CBPR approaches.
Studies were excluded for including non-asylum-seeking or otherwise hidden populations as their participants.
Studies that were strictly literature reviews were excluded except for two literature reviews on refugee participation in CBPR and sampling, but reference lists of said excluded studies were considered if they proved relevant.
2.2. Search strategy
CBPR approaches to research and population sampling methods for hidden populations.
Studies within the sampling methods and CBPR categories were gathered using a few criteria – refugee or asylum-seeking or migrant, population sampling methods, or community-based participatory research (CBPR) – and were narrowed down to those on resilience or community thriving if search results were too extensive while using “hidden population” in replacement for refugee or asylum-seeking or migrant if search results were too narrow, using keywords or synonyms as required. Papers were added to Zotero, which the rest of the research team was able to access and incorporate found papers as well.
Two databases were searched on December 12, 2023:
WebofScience (2019-current).
Returned 18 results after titles and abstracts were screened.
Six results after full screen.
PubMed (2019-current).
Returned 24 results after titles and abstracts were screened.
Six results after full screen including one extra.
Two additional research papers were added to Zotero’s group folder by another researcher, which I analyzed as well.
Holistic definitions of health.
Studies within the holistic definitions of health category were gathered using search terms like holistic, positive, refugee, thrive, sample, and recruitment. Because so few results appeared, the search strategy was much shorter.
Two databases were searched on December 12, 2023
WebofScience (2019-current).
Returned 4 results after titles and abstracts were screened.
2 results after full screen.
PubMed (2019-current).
Returned 5 results after titles and abstracts were screened.
2 results after full screen.
2.3. Selection of studies.
The first elimination occurred during the preliminary search by titles and abstracts whereas those that seemed most irrelevant were excluded. The final review of the studies measured quality and compared them to find the most useful and relevant studies to the criteria and only the best fit were chosen.
A total of 14 research studies were chosen for CBPR and sampling methods. Two were literature reviews and one was a review of the methodology of a research study.
A total of 7 studies, with some overlap in CBPR and sampling methods, were chosen for the holistic definitions of health. 4 studies were found for holistic definitions of health using the search methods specifically.
3. Results
3.1. CBPR approaches to research.
Approaches to CBPR often included using a preliminary group of participants to develop surveys, questionnaires, as well as questions or topics for in-depth interviews and focus group discussions. Qualitative data was often preferred to be collected over primarily quantitative methods, or at least for the questions of quantitative research to be loose recommendations. Many studies incorporated online surveys or app interfaces that administer both surveys and information regarding resources that may be relevant to the participant (Sabri et al). Interaction with refugees using a CBPR approach may aim to “engage research participants in a process that is not only responsive to the community needs but also meaningful and useful to refugee survivors and capable of informing policy” (Bajwa et al.). Using a deductive analysis approach after data has been gathered ensures that themes reflect the stories of participants.
3.2. Population sampling methods for hidden populations.
Research approaches that I found would be best to accurately and respectfully gather data included using respondent-driven sampling, further RDS, one study that used community data collectors, further CDCs, and gathering lists or otherwise recruiting from a key person or community location after developing trust,
The majority of papers tended to use a method of RDS, a kind of snowball sampling that begins sampling with initial participants, or “seeds,” that are individually recruited by study personnel who then branch off and recruit participants, who will recruit more participants, et cetera. Sometimes, those seeds are given coupons or gift cards for completing the interview as well as successfully recruiting others. The idea of RDS is that after many generations of seeds are recruited, the sample will be broad and approximately randomized. Choosing seeds from different refugee communities will give an even broader sample by employing more social links.
CDCs are “local stakeholders in the refugee community” who are hired to make a robust contribution to the research study by assisting in ”the design, recruitment, implementation, data collection, analysis, and evaluation processes” of the project (Handal et al.). This process seemed the most collaborative with the refugee community, however, if not trained and applied carefully it could put a strong burden on the refugee CDCs. CDCs provided the research team with expertise involving social links for recruitment, feedback to survey questions, and a method in which to reach refugees in their primary language (Disney et al.).
Collaboration with key persons or community organizations is important for developing trust between researchers and community members. Other recruitment strategies included phone calls, flyers, going door-to-door, and using lists from organizations to gain access to the community (Nije-Carr et al., James et al., Sabri et al.).
3.3. Holistic definitions of health.
Highlighting research methods prioritizing a holistic definition of health, a few interesting papers included workshops to develop poster designs encouraging safe communities, occupational mapping and walking maps (Moore et al.). Most papers prioritized how mental health affects the overall feeling of health and well-being of the participant. Resilience and thriving have been put forth to replace interest in stress and trauma as these positive focuses can influence actions on improving care that counterbalances the adverse effects of life events (Babatunde-Sowole et al.).
One study was rooted in psychology. The Self-Reliance Index, further SRI, is a tool that is used to track self-reliance over time. A limitation of SRIs is that the refugee community is in constant change, reducing reliability. The SRI still is a culturally applicable tool for refugee research as it was able to “capture the complexities and nuances in self-reliance” (Seff et al.).
The perspectives of Karen women refugees were analyzed in a study where they found that doing and collectivism constructed their meaning of health (Lenderts et al.). Utilizing this qualitative approach in defining health and well-being for respective communities and identifying challenges in achieving health and well-being can assist in quantitative data collection.
4. Conclusions and Implications
This review informs the research team on different methods of CBPR and sampling on refugees or other hidden populations to then be transferred onto the research of refugees and incorporating holistic values of health to improve care and best identify actions for current research and future health policy. The best summary of
the approach would be to first utilize key informants of refugee communities in a qualitative discussion about the values of health and questions asked during quantitative or mixed-method research, then employ those same participants as seeds for RDS method sampling while referring to them for any community-related questions. These key informants can also be given information on resources to pass along to the community as they recruit participants to expand access to knowledge.
References
Babatunde‐Sowole, Olutoyin O., et al. “Resilience of African Migrant Women: Implications for Mental Health Practice.” International Journal of Mental Health Nursing, vol. 29, no. 1, 2020, pp. 92–101, https://doi.org/10.1111/inm.12663.
Bajwa, Jaswant, et al. “Psychological Capital and Life Satisfaction of Refugees in Canada: Evidence from a Community‐based Educational Support Program.” Journal of Community Psychology, vol. 47, no. 3, 2019, pp. 504–16,
Birkenstock, Lyena, et al. “Pivoting a Community-Based Participatory Research Project for Mental Health and Immigrant Youth in Philadelphia During COVID-19.” Health Promotion Practice, vol. 23, no. 1, Jan. 2022, pp. 32–34, https://doi.org/10.1177/15248399211033311.
Disney, Lindsey, et al. “Advancing Community-Based Participatory Research During the COVID-19 Pandemic: A Methods Commentary on the Lessons Learned from Working with Community Data Collectors on a Refugee Health Disparities Study.” Journal of Health Communication, vol. 28, no. sup1, Apr. 2023, pp. 2–6, https://doi.org/10.1080/10810730.2023.2187102.
Familiar, Itziar, et al. “Conflict-Related Violence and Mental Health among Self-Settled Democratic Republic of Congo Female Refugees in Kampala, Uganda – a Respondent Driven Sampling Survey.” Conflict and Health, vol. 15, no. 1, 2021, p. 42, https://doi.org/10.1186/s13031-021-00377-2.
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Handal, Alexis J., et al. “Measuring Latinx/@ Immigrant Experiences and Mental Health: Adaptation of Discrimination and Historical Loss Scales.” American Journal of Orthopsychiatry, vol. 93, no. 1, 2023, pp. 27–40, https://doi.org/10.1037/ort0000637.
James, Leah Emily, et al. “Development and Testing of a Community-Based Intervention to Address Intimate Partner Violence among Rohingya and Syrian Refugees: A Social Norms-Based Mental Health-Integrated Approach.” International Journal of Environmental Research and Public Health, vol. 18, no. 21, Nov. 2021, p. 11674, https://doi.org/10.3390/ijerph182111674.
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Lenderts, Jessica L., et al. “The Role of Culture in Shaping Health Perceptions and Behaviors of Resettled Karen Refugees.” Journal of Transcultural Nursing, vol. 32, no. 2, 2021, pp. 145–52, https://doi.org/10.1177/1043659620902836.
Moore, Temple, et al. “Finding Agency in Limbo: A Qualitative Investigation into the Impact of Occupational Engagement on the Mental Health and Wellbeing of Asylum Seekers in the UK.” Transcultural Psychiatry, vol. 59, no. 6, 2022, pp. 863–77, https://doi.org/10.1177/13634615221107202.
Njie-Carr, Veronica P. S., et al. “Methodological and Ethical Considerations in Research With Immigrant and Refugee Survivors of Intimate Partner Violence.” Journal of Interpersonal Violence, vol. 36, no. 19–20, 2021, pp. NP10790–808, https://doi.org/10.1177/0886260519877951.
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Sabri, Bushra, et al. “The WeWomen and OurCircle Randomized Controlled Trial Protocol: A Web-Based Intervention for Immigrant, Refugee and Indigenous Women with Intimate Partner Violence Experiences.” Contemporary Clinical Trials, vol. 76, 2019, pp. 79–84, https://doi.org/10.1016/j.cct.2018.11.013.
Seff, Ilana, et al. “Measuring Self-Reliance among Refugee and Internally Displaced Households: The Development of an Index in Humanitarian Settings.” Conflict and Health, vol. 15, no. 1, 2021, p. 56, https://doi.org/10.1186/s13031-021-00389-y.
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