Understanding employment barriers is key to improving immigrant health in Washington

Improving employment opportunities for Afghan refugees and immigrants is critical to supporting their health and well-being.

Those were some of the findings of new research led by University of Washington Master of Public Health student Nicole Chicoine, who explored why employment challenges persist amongst Afghan immigrant communities living in Seattle. Understanding the root causes of these challenges can improve immigrant health, as employment is intrinsically tied to access to health care, housing and food.

“Employment is a social determinant of health,” Chicoine said. “If we think about employment, it impacts so much of our life: what kind of job you can get, where you can live, and what health care we can have access to.”

The research was part of Chicoine’s practicum experience at the Porsesh Policy Research Institute, a Seattle-based community-centered research group which focuses on the health of immigrant communities.

Unique to Porsesh’s approach to research is how closely it is informed by the communities they are studying. Community members, such as those from the Afghan immigrant community, are involved in the creation of research questions, the wording of surveys, and the sharing of findings. This collaborative approach allows for research that more accurately reflects the needs of community members, which can in turn lead to policies or resources that will be most helpful to them, said Ehsan Shayegan, president and founder of Porsesh and Chicoine’s site supervisor.

“Our way of approaching research is different,” Shayegan said. “Researchers who go and collect data and do things in their own silos, that is an outdated approach because there is little humanity and credibility in that approach. After decades of conducting research in different parts of the globe, we learned that there is nuance that we miss in that siloed process that is so fundamental to the findings. In our research, we actively involve communities throughout the entire process: from design and implementation to dissemination.”

Chicoine designed a cross-sectional survey, which was taken by 76 people. Chicoine and  Shayegan also convened a focus group of community members and leaders representing Afghan immigrants living in Seattle to understand their employment barriers.

Chicoine found that language was the largest barrier to accessing employment, followed by the job application process and skill set matches.

While language classes are offered to new immigrants in Washington state, Chicoine learned that accessing them can be challenging. These classes often take place at community colleges and have long wait lists. Getting to the classes is challenging if new immigrants can’t obtain a driver’s license or don’t have access to public transportation. This shows that resources for driver’s education and more availability of language classes can be helpful for Afghan immigrants seeking to obtain employment, Shayegan said.

Another finding from Chicoine’s research was the prevalence of underemployment in the Afghan immigrant community, or obtaining employment that doesn’t match the level of experience or education someone has. One participant in a focus group shared how their training and work experience as a journalist in Afghanistan didn’t help them in getting a journalism job once they moved to the U.S.

Struggling to find employment can take a toll on mental health. While participants didn’t mention mental health as being a problem in the survey, it did come up in the focus group. A participant shared how he witnessed his wife struggling with mental health because the high cost of childcare meant she had to stay home with the children rather than work as she wanted to.

Researchers provided recommendations in the final pages of the report, including a need to expand affordable childcare, improve recognition of foreign credentials, and make culturally tailored resettlement classes available that focus on soft skill development, digital literacy, and job readiness.

Chicoine and Shayegan hope this research can help agencies in Washington better serve their community members by creating more tailored resources.

"This practicum research helped to shed light on how unemployment and underemployment impacts mental health among Afghan immigrants, emphasizing the need for policies that address the root causes of health inequities,” Chicoine said. “My hope is that through a better understanding of these barriers like limited access to language classes or childcare, and  through engaging directly with the community, we can drive meaningful change and equitable public health solutions for immigrant populations here in King County and Washington."

Chicoine was eager to participate in this practicum work because of its focus on immigrant health and communities that have not been historically prioritized in health care systems. In addition to obtaining her Online MPH, Chicoine is midway through her general surgery residency, and is currently completing a pediatric surgery research fellowship where she’s noticed how equity issues impact the communities and patients she serves. Chicoine hopes the practicum and her public health degree will help her better serve underrepresented communities that she’ll work with in the health care system.

“The practicum really highlighted to me the importance of doing community-based research, partnering with a community and helping to advocate for them,” Chicoine said. “I would love to do social determinants of health research and tie that into whichever community I end up working with in pediatric surgery.”

Shayegan said the work of researching and supporting immigrant health through Porsesh is continuing to be supported through student partnerships with the UW.

“We have never had such an incredibly talented scholar as Nicole, who was very efficient, very passionate, highly engaged and well aware of communities and nuances in research,” Shayegan said. “We are fortunate to be part of this collaboration with the University of Washington.”

Chicoine and Shayegan led the research, with support from other Porsesh team members: Rahul Alami and Hassan Javid assisted with the translation of the survey into Pashto. Sher Mehryar assisted with the translation of the survey into Dari/Farsi. Additionally, leaders and members from Hazara Community of Washington, Afghan American Cultural Association, and Kabul Washington Association all helped to collaborate and approve of the final content of the questionnaire. Shir Ahmad, Wahida Panjsheri, Nik Ahmadi served as resources for individuals who wished to participate but needed assistance in completion of the survey. Additionally community leaders from the organizations above and Setara Sahar helped to recruit participants for the survey.