The Effect of the “Refuah Shlema” Intervention Program for Ethiopian Immigrants on the Care and Health Status of Patients with Asthma and Diabetes

This report presents the findings of a second evaluation study of the “Refuah Shlema” intervention program for Ethiopian immigrants, which was initiated by JDC-Israel in cooperation with Clalit Health Services. The Gratzman Foundation, Mr. Al Engelberg, the National Insurance Institute, and the Detroit, Washington, D.C., and Palm Beach Jewish Federations helped fund the program. The Ministry of Health, the Ministry of Immigrant Absorption, Maccabi Healthcare Services, and Leumit Health Services were also partners in the program. Its goals were to improve communication between Ethiopian immigrant patients and the staff of primary care clinics, to improve the care of these patients, and to promote health. This was meant to be accomplished by (1) employing Ethiopian immigrant facilitators who were trained to promote health and be intercultural liaisons between patients and physicians; (2) changing attitudes among clinic staff; and (3) implementing health education activities by clinic staff and facilitators for Ethiopian immigrants.

The first evaluation study found that the intervention program improved communication between the general population of Ethiopian immigrant patients and physicians, and helped these patients understand the health plans and gain access to health services. The second evaluation study, whose findings are presented herein, examined the effect of the intervention program on (1)the treatment of illness among Ethiopian immigrant patients with diabetes or asthma; (2) health status; and (3) the patients’ relationship with service providers.

The study was conducted among Ethiopian immigrant patients with asthma or diabetes at two experimental clinics (where the intervention program had been implemented) and at two control clinics (where the intervention program had not been implemented) at two points in time: (a) prior to program implementation; (b) one year after program implementation.

These findings are more complex than those of the previous study. They indicate a slight improvement in the treatment of illness at the experimental clinics, including a decline in the rate of hospital admissions among patients with asthma and a trend of improvement in maintaining weight and engaging in physical exercise among patients with diabetes, and even an improvement in one aspect of living with diabetes. However, they did not identify any improvement in other aspects of quality of life with diabetes, or in asthma health status or general health status.

Moreover, they did not reveal an improvement in patient-physician communication at the experimental clinics. They did indicate that health status is significant to the physician-patient relationship: Patients who felt very ill, also felt their relationship with their physician was poor. The findings also indicated that for the chronically ill, especially those who believe their illness affects the quality and duration of their life, the “Refuah Shlema” program, which is not geared for treating illness, is insufficient. It may therefore be advantageous to integrate the work of the facilitator into a specific program for the treatment of illness. This could coordinate expectations regarding treatment, improve treatment, and ease the adjustment to living with illness.

Presentation of the findings to the steering committee and other forums led program organizers to discuss and begin to determine the priorities to be set when defining the role of the facilitator: a focus on assistance to the chronically ill, versus attention to a variety of problems, including helping Ethiopian immigrants obtain health services. They also discussed the professional support and resources that would be needed, if facilitators were to help care for the chronically ill.

This study is published by the National Insurance Institute and may be obtained through the Department of Special Projects of the National Insurance Institute, 13 Weizmann Boulevard, Jerusalem95437.