An Innovative Model of Culturally Tailored Health Promotion Groups for Cambodian Survivors of Torture
DOI:
https://doi.org/10.7146/torture.v24i1.109698Keywords:
Torture survivor, treatment, Cambodian, health literacy, preventionAbstract
Cambodians living in the U.S.A. suffer from depression, posttraumatic stress disorder (PTSD), and chronic medical disease at rates far in excess of national averages. The Harvard Program in Refugee Trauma’s Cambodian Health Promotion Program seeks to address this burden of disease by offering them culturally tailored health education in a group setting.
A health professional and a bicultural health educator co-facilitated a five-session health promotion group for Cambodian survivors of torture from 2007 to 2011. The program covered five major topics from Western and Cambodian worldviews. They included the meaning of health promotion, nutrition, exercise, stress management and sleep hygiene, and health practitioner-patient communication. The bicultural worker administered Pre and Post semi-structured Health Promotion Questionnaires. The data presented here are the results from 126 participants.
Changes between the Pre and Post health promotion groups demonstrated significant improvements in health status, lifestyle activities, sleep, and depression. Participants revealed greater confidence in communicating with their primary health care practitioner.
Culturally tailored Cambodian health promotion education administered in a small group setting may improve health and mental health behaviors.
Culturally tailored health promotion education in a small group setting may promote healing in survivors of torture. It is an intervention worthy of further research and development.
References
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34. Silove D, Manicavasagar V, Mollica R, Thai M, Khiek D, Lavelle J, et al. Screening for depression and PTSD in a Cambodian population unaffected by war: comparing the Hopkins Symptom Checklist and Harvard Trauma Questionnaire with the structured clinical interview. The Journal of nervous and mental disease. 2007 Feb;195(2):152-7. PubMed PMID: 17299303. Epub 2007/02/15. eng.
35. McHorney CA, Ware JE, Jr., Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical care. 1994 Jan;32(1):40-66. PubMed PMID: 8277801.
36. Mollica RF, Wyshak G, Lavelle J, Truong T, Tor S, Yang T. Assessing symptom change in Southeast Asian refugee survivors of mass violence and torture. The American journal of psychiatry. 1990 Jan;147(1):83-8. PubMed PMID: 2293793. Epub 1990/01/01. eng.
37. Garvin CC, Cheadle A, Chrisman N, Chen R, Brunson E. A community-based approach to diabetes control in multiple cultural groups. Ethnicity & disease. 2004 Summer;14(3 Suppl 1):S83-92. PubMed PMID: 15682776. Epub 2005/02/03. eng.
38. Liao Y, Tsoh JY, Chen R, Foo MA, Garvin CC, Grigg-Saito D, et al. Decreases in smoking prevalence in Asian communities served by the Racial and Ethnic Approaches to Community Health (REACH) project. American journal of public health. 2010 May;100(5):853-60. PubMed PMID: 20299646. Epub 2010/03/20. eng.
39. Trento M, Passera P, Borgo E, Tomalino M, Bajardi M, Cavallo F, et al. A 5-year randomized controlled study of learning, problem-solving ability, and quality of life modifications in people with type 2 diabetes managed by group care. Diabetes care. 2004 Mar;27(3):670-5. PubMed PMID: 14988283. Epub 2004/02/28. eng.
2. Edwards VJ, Holden GW, Felitti VJ, Anda RF. Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. The American journal of psychiatry. 2003 Aug;160(8):1453-60. PubMed PMID: 12900308.
3. Sareen J, Cox BJ, Stein MB, Afifi TO, Fleet C, Asmundson GJ. Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosomatic medicine. 2007 Apr;69(3):242-8. PubMed PMID: 17401056.
4. Sledjeski EM, Speisman B, Dierker LC. Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). Journal of behavioral medicine. 2008 Aug;31(4):341-9. PubMed PMID: 18553129. Pubmed Central PMCID: 2659854.
5. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine. 1998 May;14(4):245-58. PubMed PMID: 9635069. Epub 1998/06/23. eng.
6. Shmotkin D, Barilan YM. Expressions of Holocaust experience and their relationship to mental symptoms and physical morbidity among Holocaust survivor patients. Journal of behavioral medicine. 2002 Apr;25(2):115-34. PubMed PMID: 11977434.
7. Keinan-Boker L, Vin-Raviv N, Liphshitz I, Linn S, Barchana M. Cancer incidence in Israeli Jewish survivors of World War II. Journal of the National Cancer Institute. 2009 Nov 4;101(21):1489-500. PubMed PMID: 19861305.
8. Paratz ED, Katz B. Ageing Holocaust survivors in Australia. The Medical journal of Australia. 2011 Feb 21;194(4):194-7. PubMed PMID: 21401461.
9. Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun CA. Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA : the journal of the American Medical Association. 2005 Aug 3;294(5):571-9. PubMed PMID: 16077051. Epub 2005/08/04. eng.
10. Wong EC, Marshall GN, Schell TL, Elliott MN, Babey SH, Hambarsoomians K. The unusually poor physical health status of Cambodian refugees two decades after resettlement. Journal of immigrant and minority health / Center for Minority Public Health. 2011 Oct;13(5):876-82. PubMed PMID: 20878473.
11. Mossey JM, Shapiro E. Self-rated health: a predictor of mortality among the elderly. American journal of public health. 1982 Aug;72(8):800-8. PubMed PMID: 7091475. Pubmed Central PMCID: 1650365.
12. Centers for Disease Control and Prevention (U.S.). The power to reduce health disparities: voices from REACH communities. Atlanta, Ga.: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention; 2007. 85 p. p.
13. Mollica RF, Brooks R, Tor S, Lopes-Cardozo B, Silove D. The enduring mental health impact of mass violence: A community comparison study of Cambodian civilians living in Cambodia and Thailand. International Journal of Social Psychiatry. Epub 2013 Feb 7. PubMedPMID:23396287.
14. Mollica RF, McInnes K, Poole C, Tor S. Doseeffect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence. The British journal of psychiatry: the journal of mental science. 1998 Dec;173:482-8. PubMed PMID: 9926076.
15. Yang MS, Burr JA, Mutchler JE. The prevalence of sensory deficits, functional limitations, and disability among older Southeast Asians in the United States. Journal of aging and health. 2012 Oct;24(7):1252-74. PubMed PMID: 22948086.
16. Kinzie JD, Riley C, McFarland B, Hayes M, Boehnlein J, Leung P, et al. High prevalence rates of diabetes and hypertension among refugee psychiatric patients. The Journal of nervous and mental disease. 2008 Feb;196(2):108-12. PubMed PMID: 18277218. Epub 2008/02/16. eng.
17. Hinton DE, Hinton AL, Eng KT, Choung S. PTSD and key somatic complaints and cultural syndromes among rural Cambodians: the results of a needs assessment survey. Medical anthropology quarterly. 2012 Sep;26(3):383-407. PubMed PMID: 23259349.
18. Peterman JN, Wilde PE, Liang S, Bermudez OI, Silka L, Rogers BL. Relationship between past food deprivation and current dietary practices and weight status among Cambodian refugee women in Lowell, MA. American journal of public health. 2010 Oct;100(10):1930-7. PubMed PMID: 20724691. Epub 2010/08/21. eng.
19. Southeast Asian Subcommittee of the Asian American/Pacific Islander Work Group National Diabetes Education Program. U. S. Department of Health and Human Services’ National Diabetes Education Program; 2006. 11-8]. Available from: http://www.ndep.nih.gov/media/SilentTrauma.pdf.
20. Palinkas LA, Pickwell SM, Warnock F. Community-based health promotion for Cambodian refugees: a case study. Journal of immigrant health. 1999 Jan;1(1):53-5. PubMed PMID: 16228715. Epub 2005/10/18. eng.
21. Mollica RF. Healing invisible wounds: paths to hope and recovery in a violent world. Nashville: Vanderbilt University Press; 2009. p. 188-213.
22. Family Support Administration Office of Refugee Resettlement. Promoting Mental Health Services of Refugees: A handbook on model practices Washington, DC: U.S. Department of Health and Human Services; 1991. III.10-III.4]. Available from: http://aspe.hhs.gov/pic/reports/ acf/3928.pdf.
23. Grigg-Saito D, Och S, Liang S, Toof R, Silka L. Building on the strengths of a Cambodian refugee community through community-based outreach. Health promotion practice. 2008 Oct;9(4):415-25. PubMed PMID: 17494947. Epub 2007/05/15. eng.
24. WHO definition of Health. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
25. Eisenstat S, Siegel AL, Carlson K, Ulman K. Putting Group Visits Into Practice: A Practical Overview to Preparation, Implementation, and Maintenance of Group Visits at Massachusetts General Hospital. Boston, Massachusetts: Women’s Health Associates The John D. Stoeckle Center for Primary Care Innovation Massachusetts General Hospital; 2012. p. 6-7.
26. Frye BA. Use of cultural themes in promoting health among Southeast Asian refugees. American journal of health promotion : AJHP. 1995 Mar-Apr;9(4):269-80. PubMed PMID: 10150730. Epub 1995/02/07. eng.
27. Martin R. Sense of Humor. In: S. J. Lopez CRS, editor. Positive Psychological Assessment: A Handbook of Models and Measures. Washington, DC: American Psychological Association; 2003. p. 313-26.
28. Lavelle J, Tor S, Mollica RF, Allden K, Potts L. Harvard Guide to Khmer Mental Health: President and Fellows of Harvard College; 1996.
29. Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard Trauma Questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees.The Journal of nervous and mental disease. 1992 Feb;180(2):111-6.
30. 18 USC § 2340 - Definitions 1994. Available from: http://www.law.cornell.edu/uscode/ text/18/2340.
31. Mollica R, Wyshak G, Coelho R, Lavelle J. The Southeast Asian psychiatry patient: a treatment outcome study. Washington, DC: U.S. Office of Refugee Resettlement; 1985.
32. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behavioral science. 1974 Jan;19(1):1-15. PubMed PMID: 4808738. Epub 1974/01/01. eng.
33. Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J. Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. The American journal of psychiatry. 1987 Apr;144(4):497-500. PubMed PMID: 3565621. Epub 1987/04/01. eng.
34. Silove D, Manicavasagar V, Mollica R, Thai M, Khiek D, Lavelle J, et al. Screening for depression and PTSD in a Cambodian population unaffected by war: comparing the Hopkins Symptom Checklist and Harvard Trauma Questionnaire with the structured clinical interview. The Journal of nervous and mental disease. 2007 Feb;195(2):152-7. PubMed PMID: 17299303. Epub 2007/02/15. eng.
35. McHorney CA, Ware JE, Jr., Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical care. 1994 Jan;32(1):40-66. PubMed PMID: 8277801.
36. Mollica RF, Wyshak G, Lavelle J, Truong T, Tor S, Yang T. Assessing symptom change in Southeast Asian refugee survivors of mass violence and torture. The American journal of psychiatry. 1990 Jan;147(1):83-8. PubMed PMID: 2293793. Epub 1990/01/01. eng.
37. Garvin CC, Cheadle A, Chrisman N, Chen R, Brunson E. A community-based approach to diabetes control in multiple cultural groups. Ethnicity & disease. 2004 Summer;14(3 Suppl 1):S83-92. PubMed PMID: 15682776. Epub 2005/02/03. eng.
38. Liao Y, Tsoh JY, Chen R, Foo MA, Garvin CC, Grigg-Saito D, et al. Decreases in smoking prevalence in Asian communities served by the Racial and Ethnic Approaches to Community Health (REACH) project. American journal of public health. 2010 May;100(5):853-60. PubMed PMID: 20299646. Epub 2010/03/20. eng.
39. Trento M, Passera P, Borgo E, Tomalino M, Bajardi M, Cavallo F, et al. A 5-year randomized controlled study of learning, problem-solving ability, and quality of life modifications in people with type 2 diabetes managed by group care. Diabetes care. 2004 Mar;27(3):670-5. PubMed PMID: 14988283. Epub 2004/02/28. eng.
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2018-10-08
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Berkson, S. Y., Mollica, R., Tor, S., Lavelle, J., & Cosenza, C. (2018). An Innovative Model of Culturally Tailored Health Promotion Groups for Cambodian Survivors of Torture. Torture Journal, 24(1), 16. https://doi.org/10.7146/torture.v24i1.109698
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