Background:

Poor sleep is common among refugee groups worldwide. It can lead to an increased risk of heart disease, diabetes, cancer, and premature death. It can also worsen mental health disorders. Researchers have studied the mental health issues among refugees from Bhutan in the United States. Now they want to understand more about how difficulty sleeping may relate to their other health outcomes.

Objective:

To learn how the social and environmental conditions Bhutanese refugees affect their sleep health and health outcomes.

Eligibility:

Refugees aged 18 years and older of Bhutanese-Nepali or Bhutanese American descent. The participants must live in central Ohio. Also needed are people aged 18 years and older who interact with Bhutanese refugees in this region.

Design:

Participants will participate in a focus group discussion. The group will have 8 to 10 participants. It will last 60 to 90 minutes.

They will talk about their experiences as a refugee and their sleep health. Topics may include adjusting to a new culture; access to housing and health care; and experiences with differential treatment by members inside and outside of their group. The study team will audio record the discussion. They will not share the recording with anyone.

Participants will complete a short questionnaire. They will answer questions about their age, sex, language preferences, and how long they have lived in the United States.

Participants who are not refugees will take part in a virtual interview led by a member of the study team. Participants will share their experiences with adapting to a new culture, differential treatment, and other factors have affected refugees sleep. The interview will take about 1 hour.

Study Description:

This qualitative study seeks to examine the role of discrimination, acculturative stressors, and coping mechanisms in shaping the sleep health of Bhutanese refugees living in Central Ohio. Using focus group discussions (n=approximately 6) with Bhutanese refugees and key informant interviews (n=approximately 10) with community leaders, the study will examine associations between refugee-related stressors-such as trauma, discrimination, and acculturation challenges-and sleep health. It will also explore coping strategies employed in response to sleep difficulties, experiences of discrimination, and other stressors, and identify recommendations for enhanced community resources and support.

Objectives:

The primary objectives of this study include:

1. Investigate associations between stressors related to being a refugee (e.g., trauma, financial strain, discrimination, acculturation, political) and various sleep health dimensions.
2. Identify coping strategies used in response to difficulties with sleep, discriminatory experiences, and other stressors.
3. Determine recommendations regarding the types of support and resources needed by the Bhutanese refugee community to manage stressors and support sleep health.

Endpoints:

We will confirm that our study's primary objectives have been met once data saturation is achieved-that is, when no new themes, insights, or significant patterns emerge, indicating a comprehensive understanding of our three key research objectives. Additionally, we will evaluate whether the collected data contain sufficient depth, diversity of perspectives, and contextual detail to fully address our central research questions. This assessment will involve triangulation, using various data sources (e.g., Key Informant Interviews and Focus Group Discussions) to identify areas of thematic convergence.

• INCLUSION CRITERIA:

In order to be eligible to participate in a FGD for this study, an individual must meet all of the following criteria:

1. Adult (aged 18 years or older) living in Ohio, US
2. Self-identify as Bhutanese-Nepali or Bhutanese American
3. Identify as a refugee
4. Speak and understand English and/or Nepali.
5. Ability to understand and the willingness to provide informed consent and participate in the FGD

In order to be eligible to participate in a KII for this study, an individual must meet all of the following criteria:

1. Adult (aged 18 years or older)
2. Ability to speak and understand English; Familiarity with the lives and experiences of Bhutanese refugees living in Ohio, US
3. Ability to understand and the willingness to provide informed consent and participate in the virtual KII.

EXCLUSION CRITERIA:

Individuals who are unable to communicate in either English or Nepali will be excluded from FGD. Since Nepali is the primary language spoken by most Bhutanese refugees before relocation, and English is the dominant language in the United States, participants are expected to have sufficient proficiency in at least one of these languages.

Individuals who are unable to communicate in English will be excluded from KII. Given their leadership roles and interactions with the healthcare system, educational institutions, local government service providers, and nonprofit organizations in Ohio-where English is the primary language-participants are expected to have sufficient English proficiency. We will not exclude any participants that meet the inclusion criteria from participating in the study overall or in any of the study procedures.

Children (individuals under 18) are excluded from this study because the knowledge sought is not relevant to this population. This study investigates the relationship between sleep quality and experiences of discrimination among Bhutanese-Nepali refugees in Ohio, as well as the coping mechanisms adults use to manage discrimination-related stress, particularly as it pertains to sleep.

The constructs under investigation, including perceived discrimination, its psychosocial impact, and adaptive coping strategies, are anchored in the adult experience of resettlement and the stressors associated with adult social and occupational life. Children's experiences of discrimination, sleep patterns, and coping mechanisms differ substantially from those of adults in both nature and context, and findings from an adult sample would not be generalizable to a pediatric population. For these reasons, the inclusion of children would not yield scientifically meaningful data relevant to the study aims.

This study will enroll between 48-60 adults (18+ years) living in Ohio, US for Focus Group Discussions and 10 adults (18+ years) who work with or support Bhutanese Refugees living in Ohio.