Date of Award

January 2020

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Amber Hromi-Fiedler



Refugees are among some of the most vulnerable populations in our world today. Food insecurity appears to be a consistent state among many refugee populations regardless of length of refugee status and setting. The primary study aims were to: a) identify factors influencing refugees’ ability to manage their chronic illnesses; b) describe food insecurity and dietary intake among refugees with chronic illnesses; c) understand the role food baskets play for this population.

A cross-sectional mixed methods study was conducted in two phases. Phase 1 consisted of 10 in-depth interviews with older adult refugees to identify factors influencing their management of chronic illnesses. Phase 2 included 40 surveys assessing food insecurity, coping mechanisms, dietary intake, and chronic illnesses across the same population of participants.

Eleven domains emerged during the coding of the in-depth interviews: (1) Health Condition, (2) Health Care Access, (3) Provider Counselling , (4) Dietary Practices , (5) Medication Access/Usage , (6) Support Network , (7) Food Insecurity , (8) Gardening, (9) Food Baskets, (10) Environment, (11) Job Insecurity. A significant difference was found across food insecurity status as 80% of Extreme Food Insecurity (EFI) participants reported receiving provider advice compared to just 45% of Very Extreme Food Insecurity (VEFI) participants. EFI participants differed significantly from VEFI participants averaging over one more reported dinner per week. When SSBs, sweets and snacks were combined into a single commodity food group, EFI participants consumed significantly more servings on average per week compared to VEFI participants. The most commonly practiced coping strategies were borrowing food and purchasing food on credit. Participants experiencing VEFI were significantly more likely to borrow foods than those experiencing EFI (75.0% vs. 40.0% respectively).

Our findings strongly support the distribution of food baskets in a culturally appropriate and meaningful manner. It is important that refugees, especially those with chronic illnesses who have special dietary considerations, are consulted on the food basket content. Within these refugee camps, modifications can be made to help refugees manage their chronic illness while also combating food insecurity.


This is an Open Access Thesis.

Open Access

This Article is Open Access