Health Status of North Korean Refugees in Toronto: A Community Based Participatory Research Study

Abstract

Increasing numbers of North Koreans are fleeing their country due to economic insecurity and political persecution, with over 1000 North Koreans Refugee (NKR) claims in Canada in the past decade. There is little published on their health. Using a Community-Based Participatory Research (CBPR) methodology, we investigated NKR health status through a retrospective chart review of 1022 patients rostered at a Toronto refugee clinic between December 2011 and June 2014. The health status of 117 NKRs was compared to that of 905 other refugees seen during the same period. There were lower rates of chronic diseases, including obesity and elevated blood pressure, among NKRs. Conversely, some infectious diseases were more prevalent, including hepatitis B and chlamydia. Female NKRs had higher rates of abnormal cervical cytology. This study uniquely uses CBPR methodology to examine the health of NKRs, and can help guide targeted interventions in this population.

Appendix 1: Community Advisory Board Memorandum of Understanding

Purpose

• Project description A community-based research study aiming to understand the health status of North Korean refugees in Toronto, with a focus on those accessing care through a refugee clinic in Toronto, Ontario

• Project objectives (a) To inform clinical guidelines on primary care for North Korean refugees, (b) To increase health literacy and access to health care among North Koreans in Toronto

Guiding Principles

• The North Korean community in Toronto will be represented by a two member Community Advisory Board (CAB), which will be involved in all stages of the research planning, data collection, and knowledge transfer as long as members are available

• Meetings will be held every 2–4 weeks in a space that is considered safe for all attendees

• CAB members’ personal stories disclosed at meetings will not be shared outside the group

• Communication will be by telephone and e-mail based on individual preference

• The research group is committed to ethical research methodology

• The knowledge gained will be used for community action and advocacy

• Attention will be paid to capacity-building opportunities for members of the CAB

Roles and Responsibilities

• Community advisory board CAB member 1, CAB member 2 (names excluded for privacy)

• Principal investigators Dr. Meb Rashid, Dr. Rick Glazier

• Co-investigators Dr. Nikki Bozinoff, Dr. Katie Dorman, Dr. Vanessa Redditt

• Collaborators Justina Lee (Researcher), Younglee (Korean Canadian Women’s Association Director)

• Network Randall Baran-Chong (Han Voice), Christopher Kim (Han Voice), Elaine Cheng (Access Alliance)

Decision-Making Process

• Decisions making initially by consensus. If no decision by the end of a meeting; democratic vote

• Members who are unable to attend a meeting will have the opportunity to contribute questions and ideas in advance by telephone or e-mail

Access to and Dissemination of Data

• The Investigators will store clinical data securely using a secure hospital server and encrypted USB keys. Other data on the research process will be stored by the Investigators and shared with the participants in hard copy or electronically.

• The Principal Investigators own the raw data and are responsible for its secure storage after the completion of the research project

• The Investigators will submit report drafts to the Community Advisory Board and will incorporate feedback in final reports before publication. There may exist a gap between the position of the research team and that of the Community Advisory Board with respect to the interpretation of the results. In this case, the gap will be noted in the final report, as well as justification of the each position.

• The Investigators are entitled to publication and presentation of the methods and results of the study, provided that the Community Advisory Board is acknowledged for their role in the research project. In the event that the Investigators and Community Advisory Board co-author a publication or presentation, all will be stated as authors or credited in the publication, commensurate with the level of participation. Neither the Investigators nor Community Advisory Board members or collaborators shall publish material about the research project without permission and input from the other parties.

• This research will be presented at St. Michael’s Hospital and the University of Toronto, as part of Nikki Bozinoff and Katie Dorman’s Resident Academic Project, with prior input and participation from the Community Advisory Board.

Process Evaluation

• Time will be dedicated at the beginning of each meeting to review project progress and allow for individual “check-in” by each member