Narrative Case Research Articles

Dialogue in the Dark Malaysia: reimagining an inclusive society through social innovation

Research methodology This case was developed via primary data collected from personal (one to one) interview with the CEO and founder of Dialogue in the Dark Malaysia (Dialogue Malaysia), Stevens Chan. With Stevens’ contact, the authors also conducted personal interviews with Kaye Chan (co-founder and wife of Stevens Chan), Lynn Foo (project manager since inception until early 2022) and Dr Foo Yin Fah (academic researcher in social entrepreneurship and advisor for Dialogue Malaysia). Secondary data included reports on visually impaired context in Malaysia, Dialogue Malaysia’s annual reports and online articles. Prior to the primary data collection, the authors obtained ethics approval from the University Human Ethics Committee (Project ID: 35461). Case overview/synopsis This case narrative focuses on Stevens Chan, a blind social entrepreneur who champions the empowerment of the disabled and marginalised community. Through a social franchising model, Stevens founded Dialogue in the Dark Malaysia in 2012. As a social start-up, Stevens showcases the strengths of blind and visually impaired individuals through transformative experiential encounters and reimagining future possibilities. Although there are constant challenges in securing financial and human capital, Stevens never lacks psychological capital, characterised by hope, self-efficacy, optimism and resilience. His vision is to educate society on the power of empathy (and not sympathy) and to create a holistic experience of celebrating diversity and inclusion through an innovative discovery centre, where the elderly and the disabled community (including the deaf, mute and those with mobility issues) share their lives with the public through fun activities. However, the future of this social enterprise is uncertain, and this case invites participants to embark on this journey with Stevens to uncover future pathways for growth and social impact. Complexity academic level The case is tailored for higher level undergraduates and entry-level and mid-level managers of executive education programs.

Mortal Man: How a Black male initiative changed me

AbstractIn this article, I use an autobiographical narrative case study to discuss my journey with my mental health and the ways that being a part of a Black men's initiative—first as a member, next as a peer mentor, and lastly, as the teaching assistant—helped me to undo some of the neglectful and toxic ways that I was avoiding my body, mind, and soul while pursuing my undergraduate degree. This article calls for campus leaders and administrators to understand and prioritize the need for Black men's initiatives. These initiatives create a crucial space for Black men at historically White institutions to access a culturally situated environment that can ultimately support their wellness.

Fundus Autofluorescence in Posterior and Panuveitis-An Under-Estimated Imaging Technique: A Review and Case Series.

Fundus autofluorescence (FAF) is a prompt and non-invasive imaging modality helpful in detecting pathological abnormalities within the retina and the choroid. This narrative review and case series provides an overview on the current application of FAF in posterior and panuveitis. The literature was reviewed for articles on lesion characteristics on FAF of specific posterior and panuveitis entities as well as benefits and limitations of FAF for diagnosing and monitoring disease. FAF characteristics are described for non-infectious and infectious uveitis forms as well as masquerade syndromes. Dependent on the uveitis entity, FAF is of diagnostic value in detecting disease and following the clinical course. Currently available FAF modalities which differ in excitation wavelengths can provide different pathological insights depending on disease entity and activity. Further studies on the comparison of FAF modalities and their individual value for uveitis diagnosis and monitoring are warranted.

Waking up with Alzheimer’s, or never quite waking up: A case study

ABSTRACT There is a paucity of literature demonstrating the efficacy of psychoanalytic psychotherapy for patients with Alzheimer’s or other dementias. This paper examines the challenges and richness of this kind of treatment for both patients and analyst through the use of a narrative case study.

Making meaning of one's own life story in words and images: A narrative case report of personal recovery from personality disorder through the interventions "An Empowering Story" and art therapy.

Understanding and processing life experiences are essential in the treatment of personality disorders to promote personal recovery and psychological wellbeing. In this qualitative case report, drafted in co-creation between the client, clinical psychologist, and art therapist, individual treatment consisted of two psychotherapeutic interventions, "An Empowering Story" and life-story-focused art therapy, in 12 parallel sessions for 24 weeks. Hilda, 68 years of age, had been diagnosed with an unspecified personality disorder and various traits of borderline personality disorder. She experienced emotional exhaustion following long-term mental health problems rooted in a traumatic early childhood. This affected her ability to manage her emotions and social relations, resulting in the sense that her life had no meaning. Hilda was invited to reconstruct her life experiences, divided into the past, turning point, and present/future, in a written and a painted life story. This allowed for the integration of traumatic as well as positive memories, enhanced self-compassion, and meaning making. She developed self-reflection and integration of internal conflicts leading to a better emotional balance and self-understanding. Art therapy emphasizes bottom-up regulatory processes, while narrative psychology supports top-down regulatory processes. The combined approach effectively integrated bottom-up, experiential, sensory experiences with top-down, cognitive emotion-regulation processes. The results suggest that psychotherapeutic interventions involving a multi-pronged, complementary, and thus more holistic approach can support personal recovery in personality disorders.

Problem-solving Ability of Fifth-graders in Mathematical Word Problem

This study aims to analyze the students’ problem-solving skills in solving the daily problems that deal with the operations of fractions. This research was conducted at a State Elementary School in Bandung City, West Java Province, Indonesia. The research method used was a qualitative approach with a narrative case study method. The participants in this study were 36 students of grade V. Data were collected from student test results, interviews, results between students and teachers. Data analysis was performed using interpretational analysis. The results show that the fifth-grade still have difficulty in understanding the problems. Other interesting findings were: (1) Some students still do not understand the rules or how to change mixed numbers into ordinary fractions or vice versa. (2) Some students still do not understand how to design and implement solving strategies. (3) Some students still do not understand the concepts and procedures of counting operations, such as addition, subtraction, multiplication, and division. (4) Some students do not conclude the final result from the answer to the story problem (5). Some students do not validate the question of the story problem, she/he just give answers to mathematical solutions.
 Keywords: problem-solving ability, mathematical word

Properties and Application of the Gummetal Wire for the Treatment of an Open Bite—Brief Narrative Review and Case Report

The swift integration of ‘Gummetal’ into the orthodontic armamentarium can be attributed to its distinct advantages as an entirely new Ti-Nb-based beta titanium alloy. Developed by Toyota Central R&D Labs and publicly revealed in April 2003, this innovative material is rapidly reshaping orthodontic practices. Its sui generis properties allow its use as a potential substitute for the Multi-Loop Edgewise Archwire (MEAW) method. Three-dimensional orthodontic movement using this new alloy could eliminate the disadvantages of the MEAW method, such as its technical complexity and patient discomfort. In our comprehensive review of the current literature, we examined relevant publications sourced from the PUBMED database and explored one seminal work on Gummetal from the journal literature. Characteristic properties of Gummetal, such as its exceptional flexibility, superelasticity, and malleability (approximately 10 times greater than conventional metals), enable seamless formation of bends without posing challenges, thereby allowing precise control over orthodontic force application. Also worthy of mention are Gummetal’s biocompatibility and non-toxic properties, along with its low coefficient of friction. The wire seems to be a relatively easy way to achieve good occlusion. Its usage does not require extensive experience in terms of manual skill, and it is not time consuming. Diligent usage of any prescribed plastics by the patient is crucial to prevent complications and ensure successful orthodontic outcomes.

Arthroscopic suture bridge fixation for acute bony Bankart with anterior glenohumeral instability: a case report and narrative review.

Anterior shoulder dislocations can result in acute glenoid rim fractures that compromise the bony stability of the glenohumeral joint. Adequate fixation of these fractures is required to restore stability, decrease shoulder pain, and facilitate return to activity. The double-row suture bridge is a relatively novel fixation technique, first described in 2009, that accomplishes internal fixation with sufficient stability using an all-arthroscopic technique to restore the glenoid footprint. A 40-year-old female with recurrent anterior shoulder instability in the setting of seizure disorder was found to have a bony Bankart lesion of 25% to 30% with a concomitant superior labral tear. The patient was treated with a double-row bony Bankart bridge and labral repair. At six months follow-up, she has progressed to a full recovery with no recurrence. A search was conducted in May 2023 in PubMed, EMBASE, and CINAHL with the search terms bony Bankart, bone Bankart, osseous Bankart, acute, bridge, suture bridge, double row. Double-row suture bridge repairs result in improvement in shoulder function as determined by ASES (93.5), QuickDASH (4.5), SANE (95.9), and SF-12 (55.6). The overall recurrence rate of anterior instability after a bony Bankart bridge repair is 8%. When examining the return to prior level of function, 81.4% of patients were able to do so with only 7.9% of patients reporting significant modifications to their activity level. In mid-term results, double row suture bridge demonstrates similar outcomes to other all-arthroscopic fixation methods of bony Bankart injuries. Importantly, bony Bankart bridge remains a viable option for critical glenoid lesions over the 20% cutoff used in other all arthroscopic techniques. Biomechanically, the double-row suture bridge offers distinct benefits over its single-row counterpart including increased compression, reduced displacement, and reduced step-off. Although there is limited data, the studies discussed and the demonstrative case show the potential benefit of all-arthroscopic double-row suture bridge fixation including increased compression, decreased displacement, and a lower complication rate in patients with large bony Bankart lesions traditionally requiring bony augmentation. However, more robust studies are necessary to determine the long-term success of the double-row suture bridge.

Safety and feasibility of instituting a robotic pancreas program in the Australian setting: a case series and narrative review.

Minimally invasive pancreatic resection has been gathering interest over the last decade due to the technical demands and high morbidity associated with these typically open procedures. We report our experience with robotic pancreatectomy within an Australian context. All patients undergoing robotic distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) at two Australian tertiary academic hospitals between May 2014 and December 2020 were included. Sixty-two patients underwent robotic pancreatectomy during the study period. Thirty-four patients with a median age of 68 years (range 42-84) were in the PD group whilst the DP group included 28 patients with a median age of 60 years (range 18-78). Thirteen patients (46.4%) in the DP group had spleen-preserving procedures. There were 13 conversions (38.2%) in the PD group whilst 0 conversions occurred in the DP group. The Clavien-Dindo grade ≥III complication rate was 26.4% and 17.9% in the PD and DP groups, respectively. Two deaths (5.9%) occurred within 90-days in the PD group whilst none were observed in the DP group. The median length of hospital stay was 11.5 days (range 4-56) in the PD group and 6 days (range 2-22) in the DP group. Robotic pancreatectomy outcomes at our institution are comparable with international literature demonstrating it is both safe and feasible to perform. With improved access to this platform, robotic pancreas surgery may prove to be the turning point for patients with regards to post-operative complications as more experience is obtained.

Life After Bars: A Narrative-Case Study of Ex-convicts

In the Philippines, ex-convicts face severe hurdles during reintegration, including public stigma, restricted work opportunities, insufficient support, and discriminatory behaviors, all of which impede a smooth return to society. This qualitative narrative case study investigates the psychological, social, and economic aspects of ex-convicts’ lives after jail. The Life Course Perspective is used as the study’s theoretical framework, acknowledging the importance of personal, societal, and historical elements in individual development. Six successfully reintegrated participants, each with a minimum five-year prison sentence, constituted the basis for in-depth interviews conducted in a quiet and secure atmosphere using snowball sampling. The study sought to explore ex-convicts’ issues, coping methods, life realizations, and viable therapeutic programs. The findings highlight the numerous challenges, such as societal stigma, economic constraints, and disrupted social bonds. Coping methods, which include spiritual rehabilitation and emotional acceptance, emerge as critical components of the reintegration process. Life realizations become transforming forces, characterized by a dedication to positive change and social contributions, which is frequently motivated by familial support and a desire to protect loved ones. For effective reintegration, the study underlines the importance of public acceptance, tailored interventions, and support networks. It finds that addressing these issues, as well as encouraging familial stability, boosting community involvement, and engaging employers, are critical to reducing recidivism and facilitating long-term rehabilitation. Recommendations urge for coordinated efforts from families, communities, and businesses, emphasizing the importance of a complete strategy to assisting ex-convicts on their path to successful society reintegration.

Iatrogenic Epileptogenicity Caused by CNS Drugs: A Short Case Series and Narrative Review.

Multiple medications are known to increase epileptogenicity in patients with and without an underlying seizure disorder. Paradoxically, some of these medications include anti-seizure medications (ASMs) and other medications, such as psychotropics, that act on the central nervous system (CNS). This article aims to discuss 3 clinical cases that highlight the gamut of epileptogenic reactivity secondary to CNS drugs ranging from increased epileptogenicity in the form of interictal epileptiform discharges (IEDs) without seizures, increased epileptogenicity on electroencephalogram (EEG) with associated non-epileptic movement disorders, and frank, de novo seizures. We also analyze the relevant literature on the impact of CNS medications on epileptogenicity.

Exploring Career Construction: A Single Narrative Case Study Guided by the Systems Theory Framework of Career Development (STFCD)

This narrative case study explores the career story of a single female medical professional in Pakistan and how the integration of the systems theory framework of career development (STFCD), the narrative approach and a constructivist worldview can help individuals in constructing or shaping careers within the unique Pakistani context. The study uses case study and narrative inquiry as merged methodological framework. Through conversational interviews and document analysis of the participant, the study examines the participant’s career experiences, choices and meaning-making processes. The findings shed light on the influence of various systems (individual, social and contextual) on the participant’s career trajectory, the construction of her career narrative and her active role in career decision-making. Additionally, these insights can inform how STFCD can help construct a person’s career journey. The career issues highlighted in the narrative of the participant may not be attributable to all women working in the same field or may be in commonality with other women regardless of their profession. Overall, this study contributes to a deeper understanding of career construction using STFCD in the Pakistani context and offers theoretical implications for women career development using a narrative approach.

Exploring the experiences of a person with dementia and their spouse who attended a telehealth music therapy programme: Two case examples from Ireland

ABSTRACT Introduction There is an increased need for accessible psychosocial interventions that support both people with dementia and their spouses. Recent research demonstrates the benefits of music therapy and caregiver-delivered music therapy for this population. This paper contributes to the emerging evidence base on telehealth music therapy for people with dementia outside of a COVID-19 era when in-person services were available. Method This exploratory phenomenological study explores the experiences of two couples who attended a six-week telehealth music therapy programme via two detailed case examples. Online semi-structured interviews with each couple were conducted pre and post intervention and analysed using Interpretative Phenomenological Analysis. Results Three shared themes emerged from the data analysis including (1) social isolation and lack of confidence linked to dementia diagnosis is worsened in rural locations, (2) song singing and song writing enables us to revisit happy memories, and (3) telehealth delivery increases access due to geographical location. The findings are presented in a narrative case study format to provide rich detailed descriptions of the music therapy programme and to illuminate the experiences of the participants. Discussion In both examples, telehealth delivery expanded access to music therapy (which was otherwise unavailable) and stimulated reminiscence which in turn encouraged meaningful engagement between the couple. The delivery of music therapy via telehealth, alongside in-person delivery, has the potential to expand access to music therapy to those who may not have access to or are no longer able to attend community support services due to geographical location, increased cognitive decline or reduced mobility. The successful delivery of telehealth music therapy is dependent on several factors including digital literacy, access to appropriate technological devices, caregiver support and level of cognitive decline.

The impact of a regionally based translational cancer research collaborative in Australia using the FAIT methodology

BackgroundTranslating research, achieving impact, and assessing impact are important aspirations for all research collaboratives but can prove challenging. The Hunter Cancer Research Alliance (HCRA) was funded from 2014 to 2021 to enhance capacity and productivity in cancer research in a regional centre in Australia. This study aimed to assess the impact and benefit of the HCRA to help inform future research investments of this type.MethodThe Framework to Assess the Impact from Translational health research (FAIT) was selected as the preferred methodology. FAIT incorporates three validated methodologies for assessing impact: 1) Modified Payback; 2) Economic Analysis; and 3) Narrative overview and case studies. All three FAIT methods are underpinned by a Program Logic Model. Data were collected from HCRA and the University of Newcastle administrative records, directly from HCRA members, and website searches.ResultsIn addition to advancing knowledge and providing capacity building support to members via grants, fellowships, scholarships, training, events and targeted translation support, key impacts of HCRA-member research teams included: (i) the establishment of a regional biobank that has distributed over 13,600 samples and became largely self-sustaining; (ii) conservatively leveraging $43.8 M (s.a.$20.5 M - $160.5 M) in funding and support from the initial $9.7 M investment; (iii) contributing to clinical practice guidelines and securing a patent for identification of stem cells for endometrial cell regeneration; (iv) shifting the treatment paradigm for all tumour types that rely on nerve cell innervation, (v) development and implementation of the world’s first real-time patient treatment verification system (Watchdog); (vi) inventing the effective ‘EAT’ psychological intervention to improve nutrition and outcomes in people experiencing radiotherapy for head and neck cancer; (vi) developing effective interventions to reduce smoking rates among priority groups, currently being rolled out to disadvantaged populations in NSW; and (vii) establishing a Consumer Advisory Panel and Consumer Engagement Committee to increase consumer involvement in research.ConclusionUsing FAIT methodology, we have demonstrated the significant impact and downstream benefits that can be achieved by the provision of infrastructure-type funding to regional and rural research collaboratives to help address inequities in research activity and health outcomes and demonstrates a positive return on investment.

Legal and Ethical Recommendations for Video Recording in the Operating Room: A Review of Literature

Background: One of the legal and ethical issues related to the medical profession and health centers is patients’ uncertainty regarding the type and quality of clinical care provided and the extent to which the health care providers comply with the necessary criteria in delivering health care. This study investigated the civil, criminal, and ethical aspects of using cameras in the operating room by describing a case that a legal complaint had filed regarding this issue and a review of the literature.Methods: The study was a case report and narrative review. First, we introduce a case that found out that the patient admitted for brain tumor surgery did not operate on him and requested to review the videos of the operating room. Then, we investigated this issue in the literature. Results: The purpose and outcome of using Closed-Circuit Television (CCTV) in the Operating Room (OR), may vary depending on the goals, needs, and expectations of different stakeholders. Some countries may use CCTV in the OR primarily for educational, research, or quality improvement purposes. In contrast, others may use CCTV in the OR mainly for security, surveillance, or legal purposes. Conclusion: The suggestion of recording the events done in the operating room environment using a CCTV can be an acceptable solution and as a legal document and evidence.

Nonfatal Emergency Department Visits Associated with Fall-Related Fractured Skulls of Infants Aged 0–4 Months

BackgroundChildren aged 0–4 years have the highest rate of emergency department (ED) visits for traumatic brain injury (TBI); falls are the leading cause. Infants younger than 2 years are more likely to sustain a fractured skull after a fall. ObjectiveThis study examined caregiver actions and products associated with ED visits for fall-related fractured skulls in infants aged 0–4 months. MethodsData were analyzed from the 2001–2017 National Electronic Injury Surveillance System-All Injury Program. Case narratives of infants aged 0–4 months who visited an ED for a fall-related skull fracture were examined to code caregiver actions preceding the fall. Product codes determined fall location and product type involved (e.g., flooring, bed, or stairs). All national estimates were weighted. ResultsThere were more than 27,000 ED visits (weighted estimate) of infants aged 0–4 months for a nonfatal fall-related fractured skull between 2001 and 2017. Most were younger than 2 months (46.7%) and male (54.4%). Falls occurred primarily in the home (69.9%) and required hospitalization (76.4%). Primary caregiver actions coded involved placing (58.6%), dropping (22.7%), and carrying an infant (16.6%). Floor surfaces were the most common product (mentioned in 24.0% of the cases). ConclusionsFall-related fractured skulls are a health and developmental concern for infants, highlighting the importance of a comprehensive assessment at the time of the injury to better understand adult actions. Findings indicated the need to develop prevention messages that include safe carrying and placement of infants.

Eye and Orbit Injuries Caused by Electric Scooters and Hoverboards in the United States.

To evaluate eye and orbital injuries in non-powered scooter, electric-scooter (e-scooter), and hoverboard riders in the United States (US) between 2014 and 2019. The National Electronic Injury Surveillance System (NEISS) was queried for head and neck injuries by body part codes related to non-powered scooters and powered scooters/hoverboards from 2014 to 2019. The NEISS complex sampling design was used to obtain US population projections of injuries and hospital admissions. Keywords were queried in case narratives to analyze trends in location, type, and mechanism of eye and orbit injuries. Since their introduction, a 586% (p=0.01) increase in e-scooter injuries and 866% (p<0.001) increase in hoverboard injuries were observed with an increase in hospital admissions seen in young adults (18-34) in urban areas (e-scooter: 5980% and hoverboard: 479%). Descriptive narratives of the trauma noted eye injuries in 242 unweighted NEISS cases with only 30 cases appropriately documented under body part code 77: eyeball. Eye injuries increased 96.9% during the study period (p=0.23). Specifically, the most common ophthalmic injuries reported included eyebrow (40.9%) and eyelid (11.3%) lacerations, periorbital contusions (18.7%), orbit fractures (6.6%), and corneal abrasions (5.1%). There was a significant increase in both head and neck injury cases and hospital admissions related to e-scooters. Eye and orbit injuries similarly increased but were underreported by body part code compared to injury narratives. Orbital fractures were reported more frequently in injuries from e-scooters than non-powered scooters.

Barriers: Location, Functionality, and Method of Access in Childhood Pool/Spa Submersion Incidents, United States, 2000-2017

Drowning is a leading cause of fatality among children in the United States, and residential pools/spas currently account for as much as 80% of these submersion incidents. This study reviewed narrative case reports obtained from the United States Consumer Product Safety Commission (CPSC) to understand barrier location, type, and functionality as methods of pool/spa access for childhood submersion incidents. Retroactive analysis of 1,523 fatal and non-fatal submersion incidents among children aged 13 years old and younger was conducted using the CPSC in depth investigation dataset from 2000-2017. Narrative descriptions were coded according to the attributes of barrier location, functionality, and method of access; to our knowledge, these characteristics of barriers have not been previously investigated to this depth. Outcomes indicate that consumer education campaigns should target households with swimming pools/spas and reiterate key findings that (1) submersion incidents occur even when barriers are present and (2) the importance of multiple layers of protection against unauthorized pool/spa access. Additionally, improved documentation of barriers is imperative to better understand and prevent drowning among children.

Cervical Spine Stenosis Causing Diaphragmatic Paralysis: A Case Study and Narrative Review of Clinical Presentations and Outcomes.

Case report and narrative review. To explore the therapeutic role of surgical and nonsurgical treatment of diaphragmatic paralysis secondary to spinal cord and nerve root compression. Phrenic nerve dysfunction due to central or neuroforaminal stenosis is a rare yet unappreciated etiology of diaphragmatic paralysis and chronic dyspnea. Surgical spine decompression, diaphragmatic pacing, and intensive physiotherapy are potential treatment options with varying degrees of evidence. The case of a 70-year-old male with progressive dyspnea, reduced hemi-diaphragmatic excursion, and C3-C7 stenosis, who underwent a microscopic foraminotomy is discussed. Literature review (MEDLINE, PubMed, Google Scholar) identified 19 similar reports and discussed alternative treatments and outcomes. Phrenic nerve root decompression and improvement in neuromonitoring signals were observed intraoperatively. The patient's postoperative course was uncomplicated, and after 15 months, he experienced significant symptomatic improvement and minor improvement in hemi-diaphragmatic paralysis and pulmonary function tests. All case reports of patients treated with spinal decompression showed symptomatic and/or functional improvement, while one of the 2 patients treated with physiotherapy showed improvement. More studies are needed to further describe the course and outcomes of these interventions, but early identification and spinal decompression can be an effective treatment. Level-4.

Mental health service utilization and help seeking behaviours of adult Cambodians living in Western countries: A systematic scoping review.

Health disparity and under-utilization of health services is prevalent among Asian refugees and migrants in Western countries and can profoundly impact health outcomes. Cambodians who survived extreme physical and emotional trauma during the genocides enacted by the Khmer Rouge regime in the 1970's are particularly vulnerable to poor mental health outcomes decades later. Understanding the experiences of help-seeking and service use by displaced Cambodians in Western countries may help to design more effective and culturally safe healthcare services. To identify characteristics or factors associated with help seeking behaviours and service utilization of displaced Cambodians with mental health issues living in Western countries. This review followed the Arksey & O'Malley methodological framework for scoping reviews. Articles for review were identified through searches of nine electronic databases and manual searches. Relevant articles were selected, and data was extracted and synthesized into key themes. This review included 15 articles. Most of the studies were conducted in the USA (n = 13) with one each conducted in Canada and New Zealand. Seven studies used qualitative interviews, five used a cross-sectional survey approach, two used a mixed-methods approach and one was a narrative review and case series. Key findings highlighted the impact of Cambodian cultural beliefs about mental health (guilt, shame and help-seeking stigma) on service utilization and the disconnect between Western models of service provision and preferred Cambodian ways of receiving support. Mental health services in Western countries are likely to be under-utilized by Cambodians due to a mismatch between health beliefs and Western models of care. Further investigation of the association between health beliefs and barriers to service utilization among adult Cambodian refugees is warranted.