Dissertations & Theses (Open Access)

Date of Award


Degree Name

Doctor of Philosophy (PhD)


Melissa A. Valerio-Shewmaker

Second Advisor

David Cimeno Ruiz De Porras

Third Advisor

Dritana Marko


The goal of this study was to increase understanding of healthcare access among refugees by investigating the multilevel factors that facilitate or impede healthcare access among refugees who have resettled in Bexar County, Texas. The multilevel factors facilitating or impeding access to healthcare for refugees resettled in Bexar County were identified as follows: health literacy, level of educational attainment, proficiency (reading, writing and, speaking) in English, proficiency (reading, writing and speaking) in native language, translation services, public transportation, income level, a shortage of healthcare providers, navigation of the healthcare system, the fragmentation of the healthcare system, insurance status, staff shortages at RSO’s, funding shortages at RSO’s, and current policies. Specifically related to health literacy, the study showed that health literacy was low among the majority of respondents. The proposed included: 1) to establish a countywide refugee-focused coalition composed of a representative sample of individuals, politicians, refugee-serving organizations, faith-based institutions, businesses, and refugees; 2) to establish an annual Refugee Health Symposium that brings together a wide spectrum of people working on refugee issues to share research and discuss issues and trends; 3) to establish a cohesive system of refugee healthcare in San Antonio, Bexar County; and 4) to streamline healthcare access at the local level by looking at modifications to Carelink. As the number of refugees continues to grow across the world, it is expected that the U.S. will continue to play a critical role in resettling them and then addressing their various healthcare needs. Host cities, like San Antonio, Bexar County, Texas, will continue to play an integral role in assuring refugees attain self-sufficiency and become productive and healthy members of our society. Medical examinations and studies will need to continue in order to gain even more insight into the multilevel factors that affect healthcare access among resettled refugees. This cannot be done in silo, facilitating and impeding factors must be explored, and systemic change must be engaged in.