Afghan Refugee Women's Experiences of Communication Apprehension and Fear of Physician in the Iranian Health Care System, during COVID-19 Pandemic, Rafsanjan, Iran (2020)
Zahra Hashemi1, Tabandeh Sadeghi2, Afsaneh Amiri3, Maryam Ghanbari4, Nasrin Shokrpour5*
1. PhD Candidate in English Literature, Dept. of General Subjects, School of Medicine, Head of International Relations Office, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
2. Associate Prof., Dept. of Pediatric Nursing, School of Nursing and Midwifery; Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
3. MA in Educational Research, International Relations Office Executive, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
4. General Physician, Payambar Azam Health Clinic, Rafsanjan, Iran.
5. Professor, English Dept, Shiraz University of Medical Sciences, Shiraz, Iran.
* Corresponding author: Nasrin Shokrpour; E-mail: shokrpourn@gmail.com
Abstract
Background: Information about the refugees' experiences in the health care system is needed to improve the quality of health care delivered. This study aimed to investigate the experiences of Communication Apprehension (CA) and Fear of Physician (FoP) in the Afghan refugee women referred to the Iranian health care clinics during the COVID-19 pandemic in the year 2020 in Rafsanjan, Iran.
Materials and Methods: In this descriptive cross-sectional study, conducted between March-July 2020, two hundred forty Afghan women in Rafsanjan, Iran, were selected using convenience sampling. Data collection included the demographic, Personal Report of Communication Apprehension (PRCA-24: score range of 24-120), and Fear of Physician (FoP: score range of 5-20) questionnaires. Data were analyzed using an Independent t-test, as well as ANOVA, Chi-square, and Fisher exact tests. The significance level was p<0.05.
Results: The mean age of the participants was 28.81 ± 7.21 years old, and their ages ranged from 16 to 60; further, 97.9% of them were married. Based on the results, the overall mean score of PRCA was 67.07±15.68. Moderate to severe communication apprehension was revealed in 199 participants (82.9%), while 235 participants (97.9%) had moderate to severe fear of physician.
Conclusion: Although many factors could contribute to CA and FoP, as the COVID pandemic had just spread and fear of this unknown virus was at its very peak during this study, the researchers assume that the high rate of CA and FoP level could be related to the COVID pandemic. It is suggested that educational workshops should be held for medical care providers to prevent further communication problems.
Keywords: Communication, Anxiety, Fear, Women, Refugees, COVID- 19
Introduction
The COVID-19 outbreak has had a significant impact on many aspects of individual and social life. The consequences of the COVID-19 crisis have led to the disruption of normal communication among health care providers and patients. Effective communication during a crisis plays an essential role in reducing uncertainties, thereby reducing the psychological impacts experienced by people [1]. As many researchers had predicted, the COVID-19 pandemic would likely continue to spread widely across the globe throughout 2020-2021 [2, 3]. Social distancing and visitor restrictions in health care facilities have been widely implemented to diminish the devastating impact of the disease. Although very effective in controlling the disease, these policies and practices have complicated communication among healthcare workers and patients [4].
Communication as a key factor for improving patient health is vital for the refugees [5]. Also, the life-saving care for non-communicable and chronic infectious diseases, including diabetes and HIV/AIDS, is another critical issue for refugees [6]. Communication barriers, specifically communication apprehension (CA), are factors that cause stress and put a high demand on both refugees and health care professionals. CA is an individual fear and anxiety associated with either real or anticipated communication with another person or persons [7, 8].
A study carried out in the European health care system indicates insufficient language knowledge as the main cause of communication barriers [11]. Refugees experience anxiety that is intensified as they are, in most cases, unable to return to the country of their origin, and this fact contributes to their mental distress [12]. Another factor that may act as a barrier to the refugees' communication with the healthcare team is the fear that care will be denied [13]. Based on the world health organization reports, refugee women are at higher risk of mental and physical health problems due to such factors as lack of social support, discrimination, and poverty [14, 15]. It has been reported that over half of the refugee population are women [16], most often with young children. Yet, they often remain underrepresented and marginalized in both care settings and at home, receiving insufficient consideration and support due to socio-cultural and language barriers [17]. Without the aid and support of their immediate families as wives and/or mothers, these women have to bear more burden in the process of immigration in order to support their family members and adjust to a new way of living [18].
Long before the outbreak of COVID-19, studies of communication problems had gained attention, and Richmond et al., among others, recommended that "future research should investigate the impact of physicians' engagement in positive communication behaviors on the patients' apprehension and medical outcomes" [19]. Another obstacle that has not received considerable attention and prevents adequate medical care is Fear of Physician (FoP) [20]. Richmond et al. found out that CA and FoP were positively related [19].
FoP is a common phenomenon and affects all people, no matter old or young. Usually, people who suffer from this difficulty ask fewer questions regarding their health care, thus losing their autonomy in their health care issues. Ahmed and Bates point out that this fear is sometimes so severe that patients avoid licensed physicians and refer to "informed sources of healthcare" [21]. Differences in communication skills, education, ethnicity, gender, language, and socioeconomic status, are the major causes of this fear [22]. FoP is also associated with a variety of negative relationships and clinical outcomes.
Refugees, especially minority women, have been studied regarding their level of CA; however, few studies have been conducted in the clinical setting and face-to-face contact with physicians and health care workers. The current study adds to this body of literature by exploring CA among the refugee women living in the South East of Iran, who are also of a low socioeconomic status (SES) due to political, social, and economic reasons. To the best of our knowledge, no earlier study has been conducted in the same scope in Iran. Thus, this study aims to investigate the experiences of Communication Apprehension (CA) and Fear of Physician (FoP) in the Afghan refugee women referred to the Iranian health care clinics during the COVID-19 pandemic in the year 2020 in Rafsanjan, Iran.
Materials and Methods
This was a descriptive cross-sectional study. The research population consisted of 237 Afghan women referred to two Family Health Centers (FHC) in the city of Rafsanjan, Iran, which are run under the supervision of the United Nations High Commission for Refugees (UNHCR) and Rafsanjan University of Medical Sciences. We calculated the study sample size by