Perceptions of Health in the Denver Refugee Community: A Mixed-Methods Study

Refugees often face significant barriers to healthcare access and integration, contributing to poor health outcomes. Although perceptions of health are known predictors of self-reported health status, little is known about how refugees themselves conceptualize health. This study employed a community-engaged, transformative mixed-methods design to explore refugee health perceptions in the Denver-metro area. Data collection included 149 surveys and 27 interviews with refugees and asylum seekers conducted between November 2018 and March 2019. Hierarchical linear regression was used to assess associations between social determinants of health (SDoH) and self-reported health, while qualitative data were analyzed using a constant comparative approach. The final regression model explained 75.8% of the variance in self-reported health (R² = 0.758, p < 0.001). Significant predictors included country of origin (Burma: -3.419, p = 0.030; Somalia: -9.155, p < 0.001), age (1.901, p < 0.001), sex (male: -3.252, p < 0.001), and education level (-0.999, p < 0.001). Qualitative findings revealed themes such as health as the ability to live life and health as happiness, each shaped by cultural context, community connectedness, and perceptions of safety. Integrating these findings highlights how structural conditions and culturally rooted understandings of well-being intersect to shape refugee health after resettlement. This study underscores the need for public health and clinical interventions that center refugee-defined priorities and suggests future research should incorporate constructs, such as happiness and culturally grounded notions of safety, that emerged as central to health in this study.