Refugees may be reticent to talk to their doctor about depression, anxiety, experiences of violence and settlement needs, but a York University researcher hopes to change that using some of the latest technology – the iPad.
A new study led by Faculty of Health Professor Farah Ahmad, published in the August issue of BioMed Central’s Medical Informatics & Decision Making, looks at the use of computer tablets as a way to break down barriers and open doors to caring holistically to the often undetected mental and social needs of refugees. The results outlined in the journal article, “A Pilot with Computer-Assisted Psychosocial 
Risk-Assessment for Refugees”, have been promising.
Farah Ahmad
As part of a pilot trial, 49 Afghan refugees visiting a community health-care centre – Access Alliance Multicultural Health & Community Services – were randomly assigned to either a Computer-assisted Psychosocial Risk Assessment (CaPRA) group or the usual care group. Those in the CaPRA group each received an iPad tablet in their own language, Dari/Farsi or English, and were asked to fill out a psychosocial risk assessment questionnaire, including questions on substance use, exposure to personal violence, depressive symptoms, food and income insecurity, social network and coping.
There is a misperception that low-income individuals and refugees will have difficulty using computer tablets, says Ahmad. The study results back her up. They showed that those who completed the risk assessment on an iPad before seeing their doctor not only reported feeling comfortable using the technology, but 72 per cent then intended to see a psychosocial counselor, compared to 46 per cent in the control group.
In addition, the CaPRA participants couldn’t see any significant barriers to using the technology. And many of the participants felt the tool’s use should be broadened to include other communities. Both groups reported being satisfied by the visit.
Refugees experience multiple health and social needs, says Ahmad, of York’s School of Health Policy & Management. “Meeting the medical and social settlement needs of refugees can be challenging, but eHealth tools could build bridges between the two. Computer tablets are very friendly to use and they can save time for health-care providers, while making patients aware of all their care options.” The study pointed to the lack of awareness of available social services that many refugees have. Ahmad would like to see computer tablets used routinely in medical waiting rooms as a way to broach difficult subjects and provide information.
The study also unveiled the need fornewcomer refugees from Afghanistan to receive comprehensive care with particular attention to mental health issues with an understanding of their culturally sensitive nature. “The high rates of depressive symptoms coupled with the low self-rated health and exposure to violence in the last five years are notable in our study,” says Ahmad.
There are more than 11 million refugees around the world with Canada accepting 12,000 conventional refugees annually. These newly arrived refugees report multiple health and social needs, says Ahmad. “An integrated approach to care is needed in the countries of resettlement, including Canada.”
By having patients complete a risk assessment ahead of time, eliminated the need for doctors to ask cold questions about the patient’s psychosocial health – their answers were available for the doctor immediately. “It makes it easier for the doctor to broach delicate issues,” says Ahmad. “It also makes it easier for the patient to disclose on the computer rather than face-to-face when the questions catch them by surprise.”
Depending on the answers given, the computer program either automatically gave the patient more detailed questions or skipped those that didn’t apply. The participants also received feedback about available services based on their answers.
“To provide better health care, it is important to go beyond the individual to include the family and the psychosocial support resources,” says Ahmad.
The attractiveness of this kind of research project is that it taps into existing medical systems and helps improve them, says Ahmad. She adds that the use of computer tablets as an eHealth tool is a promising way to address the health and settlement needs of refugees by integrating medical and social care in the primary care health settings.
She hopes to be able to launch a larger study in the future.
The study was conducted in collaboration with Access Alliance Multicultural Health & Community Services in Toronto. Funding for the study came from York and the University of Toronto’s Connaught New Staff Matching Grants Program.
By Sandra McLean, YFile deputy editor
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