This 4-year award supports career development and mentored research experience for Katherine Yun, MD MHS, a clinician-scientist focusing on health disparities and access to care for children in refugee and immigrant families, including children with special healthcare needs (SHCN). Through the K23 award, Dr. Yun will gain advanced training in qualitative research and research ethics, and she will expand her skills to include health measurement and the development of community-based interventions. This training will serve as the basis for future, large-scale interventions to promote the health of children in refugee and immigrant families. Dr. Yun proposes a comprehensive research program with the Bhutanese refugee community in Philadelphia that will allow for future comparative work across immigrant populations. The proposed research will empirically define, measure, and develop an intervention to promote healthcare navigation, meaning the skills and strategies used by parents to realize access to pediatric healthcare.
Aim 1 uses the New Immigrant Survey and National Survey of Children's Health to identify parental characteristics associated with realized access to care in order to develop a purposive sampling plan for Aim 2.
Aim 2 uses multiple qualitative methods to build a conceptual framework for healthcare navigation, using parents in the Bhutanese refugee community as key informants.
Aim 3 uses the conceptual framework to build and evaluate an instrument to measure healthcare navigation competency and to identify areas for support to improve individuals' ability to use health services.
Aim 4 uses mixed methods to adapt, pilot, and evaluate a single-arm community health worker intervention to promote mastery of these skills. The conceptual framework created in Aim 2 will be used to adapt the intervention protocol, and data on feasibility, acceptability, and effect sizes will be used to refine the intervention and power a future controlled trial. This work has the potential to impact the 30,000 children who enter the US as refugees each year; it also has significance for the 1.2 million publicly-insured, US children in immigrant families who have SHCN and continue to report difficulties obtaining necessary care. Dr. Yun is a junior investigator and Assistant Professor of Pediatrics with training in health services research, extensive experience with healthcare for refugee and immigrant children in the US, and existing partnerships with Philadelphia's Bhutanese community. She has assembled a multidisciplinary team of mentors and advisors led by David Rubin, MD MSCE (primary mentor), Frances Barg, PhD MEd (co-mentor), [and Leela Kuikel, MA (community co-mentor)]. Her career development program will include coursework; [a 1-year, NIH- supported mixed methods research training program;] directed reading; and mentored practical experience in methodologies from the disciplines of medical anthropology, biostatistics, psychometrics, and public health. The Division of General Pediatrics, the Department of Pediatrics, and the Children's Hospital of Philadelphia are committed to her success and the advancement of her career.

Public Health Relevance

Refugees in the US experience multiple vulnerabilities that compromise access to healthcare, including trauma, limited English proficiency, and lack of familiarity with the US health system; however, little has been done to address this problem. The proposed research will use interviews with and observations of Bhutanese refugee parents in Philadelphia to discover the skills and strategies that parents use to overcome these barriers and obtain healthcare for their children, including children with chronic health problems. This information will then be used to create a survey that measures these healthcare navigation skills and to develop a pilot program to teach other refugee parents these skills.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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National Institute of Child Health and Human Development Initial Review Group (CHHD)
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Lee, Karen
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Children's Hospital of Philadelphia
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Warden, Clara; Yun, Katherine; Semere, Wagahta (2018) Using the Children with Special Health Care Needs Screener with Immigrant Families: An Analysis of the National Survey of Children's Health. J Immigr Minor Health :
Dhar, Cherie Priya; Kaflay, Dilu; Dowshen, Nadia et al. (2017) Attitudes and Beliefs Pertaining to Sexual and Reproductive Health Among Unmarried, Female Bhutanese Refugee Youth in Philadelphia. J Adolesc Health 61:791-794
Yun, Katherine; Paul, Papia; Subedi, Parangkush et al. (2016) Help-Seeking Behavior and Health Care Navigation by Bhutanese Refugees. J Community Health 41:526-34
Yun, Katherine; Matheson, Jasmine; Payton, Colleen et al. (2016) Health Profiles of Newly Arrived Refugee Children in the United States, 2006-2012. Am J Public Health 106:128-35
Dawson-Hahn, Elizabeth; Pak-Gorstein, Suzinne; Matheson, Jasmine et al. (2016) Growth Trajectories of Refugee and Nonrefugee Children in the United States. Pediatrics 138:
Semere, Wagahta; Yun, Katherine; Ahalt, Cyrus et al. (2016) Challenges in Identifying Refugees in National Health Data Sets. Am J Public Health 106:1231-2
Yun, Katherine; Urban, Kailey; Mamo, Blain et al. (2016) Increasing Hepatitis B Vaccine Prevalence Among Refugee Children Arriving in the United States, 2006-2012. Am J Public Health 106:1460-2