Sociocultural determinants of health-associated quality of life among Afghan refugees in Pakistan: evidence from a multi-stage cross-sectional study.

Background: In the past few decades, there has been a significant increase in the number of refugees worldwide. Every individual deserves access to the fundamental right to health, and migration can have a substantial beneficial or detrimental effect on one's health. Foreign invasions and political instability in Afghanistan affected neighboring countries with the large influx of refugees. Discrepancies in quality of life between the host and refugee populations may lead to health inequalities. Investigations in Pakistan on the quality of life of Afghan refugees were scarce despite more than four decades of refugee status. Therefore, this study was initiated to assess the sociocultural determinants influencing health-associated quality of life among Afghan refugees in Pakistan.

Methods: The Punjab province and Khyber Pakhtunkhwa province refugee populations were selected as the study population for cross-sectional research based on the inclusion criteria of majority refugee representation and female participation. Quantitative research methodology with pre-validated WHOQOL-BREF questionnaires was used for data collection via multi-stage probability sampling techniques. We collected data from 1,185 study participants and applied univariate and bivariate analyses. Inferential analyses included independent t-tests and ANOVA.

Results: The average scores for the entire sample of Afghan refugees were highest for the social domain (58.78 ± 22.74), followed by the physical domain (53.29 ± 19.46), the general health domain (50.44 ± 20.10), the environmental domain (48.43 ± 16.30), and the psychological domain (46.52 ± 14.78). Age, marital status, family setup, mother language, number of years in the host country, residence type, family monthly income, access to health care, current health status, chronic health illness, substance abuse (smoking), cultural compatibility, linguistic barriers, and social inclusion were non-significant with all the subdomains in the inferential analysis using the independent t-test and analysis of variance.

Conclusion: The Afghan refugees' average scores across all health-associated quality-of-life domains were lower than Pakistan's host population and the standard cutoff criteria (< 60 indicates poor quality of life). The development of a national policy to include refugees in health insurance programs seems essential to improve the health-associated quality of life among Afghan refugees in Pakistan.