Improving health outcomes for Syrian refugee women and children: an Appreciative Inquiry study on the role of the health visitor

Abstract

Syrian families can have poor health outcomes and face challenges accessing care. Few studies have considered the health visitor role in improving the health and wellbeing of Syrian women and children. The health needs of the women need to be understood within their cultural context, but these may not be familiar to health visitors. A two-cycle research study using Appreciative Inquiry was undertaken in Scotland. Twelve Syrian women from two support groups participated in Cycle 1 interviews and in co-creating a vignette that was used in Cycle 2. Eleven health visitors from three Health Board areas contributed to Cycle 2, participating in a telephone interview. Thematic analysis generated six themes related to the lived experience of Syrian women: ‘rabbits in the headlights’, ‘loss of home’, ‘reclaiming home’; and health visiting practice: ‘thrown in at the deep end’, ‘above and beyond’, and ‘you don’t know what you don’t know’. A range of health concerns and challenges impeded access to health care. These include complex systems, unclear professional roles, appointment delays and transport. Despite experiences of multiple loss and social isolation, the women showed resilience, although the language barrier often hampered integration. Health visitors had not been included in pre-arrival meetings for Syrian families and usually had limited knowledge of Syrian society and culture. As well as facilitating access to health care, through ‘bonds, bridges and links’, health visitors potentially could promote Syrian women’s ‘belonging’ and wellbeing. Training for health visitors should draw on an intersectionality framework in order to challenge homogenous and stereotypical notions of what it means to be a Syrian refugee woman and meet their care needs. This research may provide a constructive route for health visitors to better contribute to improved health and wellbeing for Syrian women and children and will inform health visitor education and practice.