Increasing Functional Health Literacy among Refugees in Northern Nevada: A Quality Improvement Initiative Diane Anderson Touro University, Nevada DNP Project 1: In partial fulfillment of the requirements for the Doctor of Nursing Practice

 The Northern Nevada International Center (NNIC) works to support resettled refugees in the Reno, Nevada area and has assisted in resettling over 500 people since 2016 (Northern Nevada International Center [NNIC], n.d.). Most resettled refugees do not have functioning levels of health literacy (UNICEF. (n.d.). They are from a different country, a different culture, and have limited to no English (D. Shabrawy, personal communication, April 4, 2024) (H. Asumah, personal communication, April 18, 2024). They have a history of trauma, and many have untreated mental health issues (World Health Organization, 2022). Many are overwhelmed with all the changes of acclimating to their new home and struggle to access healthcare, understand health systems, and understand functional healthcare knowledge for their health maintenance and decisions, including how to navigate the U.S. healthcare system. This compiles with gaps in their healthcare coverage to create negative health outcomes for this population (D. Shabrawy, personal communication, April 4, 2024) (H. Asumah, personal communication, April 18, 2024). The literature shows that the challenges discussed above are consistently seen among refugee populations (The World Health Organization, 2021) (U.S. Department of Health and Human Services, n.d.-b) (U.S. Refugee Admission Programs - Domestic Cultural Orientation Objectives and Indicators, 2024) (UNICEF, n.d.), (World Health Organization, 2022). Cultural Orientation Resource Education (CORE) content, which is “funded by the U.S. Department of State, Bureau of Population, Refugees, and Migration (PRM), and administered by the International Rescue Committee” (U.S. Refugee Admission Programs - Domestic Cultural Orientation Objectives and Indicators, 2024), is provided for all people who resettle into the area through the NNIC organization (D. Shabrawy, personal communication, April 4, 2024). However, the NNIC organization reports that health literacy in navigating the U.S. healthcare system is functionally inadequate, creating negative repercussions that include delayed or omitted healthcare, misuse of U.S. healthcare facilities, exorbitant medical bills for refugees with subsequent long-standing personal credit score deductions, and costly time burden for NNIC employees and volunteers (D. Shabrawy, personal communication, April 4, 2024) (H. Asumah, personal communication, April 18, 2024). Organizational health literacy training and organizational health literacy resources, to be accomplished within 5 weeks in November 2024, is proposed to address this issue. Resolutions with implications include increasing functional health literacy including resettled refugees’ ability to navigate the U.S. healthcare system; thus, improving the self-sufficiency of resettled refugees, decreasing time, monetary, and facility resource waste, and improving health outcomes for patients and families in this population. A visual diagram was utilized to illustrate the scope of this problem through a SWOT analysis. See Appendix A