Health and Hygiene

May 29, 2020

A group of nurses and doctors standing together during a meeting. IRC/EHeatherwick

Health and Hygiene

In the United States, refugees will need to understand the importance of maintaining personal health and hygiene. In some cases, refugees may find that American hygiene norms differ from those in other places they have lived. On this page, explore a variety of activities, complete lesson plans, and additional resources that address key messages in the Health & Hygiene Objectives & Indicators, and teach refugees basic U.S. healthcare principles, personal hygiene practices, and other health and hygiene norms in the United States.

Featured Resources

Health and Hygiene Chapter

Download PDF

Featured Resource

Health and Hygiene Chapter

Making Your Way is for resettlement agency trainers who provide Cultural Orientation domestically. Each of the eleven content chapters starts with a short lesson called The Basics that addresses particularly pressing information for that topic. The chapters contain two to six additional lesson plans, along with supplemental images, posters, and handouts. While the complete curriculum is 761 pages, we offer The Complete Basics, individual chapters, and supplemental materials as separate downloads.

This unit focuses on the following key points:

  • There are different health care services in the United States, and refugees should know where to go for which services.
  • Urgent and routine health care services are different from one another and are found in different places.
  • The local resettlement agency will schedule initial health screenings and immunizations and assist with obtaining other health care services as needed.
  • There are customs and laws in the United States regarding personal and public hygiene.

Activity Bank

Health Activities

Healthcare in the U.S. using Settle In website Resources

This activity is ideal for teaching the basics of healthcare in the U.S. It can be applied in-person and virtually.

  1. Ask participants: What was healthcare like in your country/ies of origin and/or protection? For example, what would you do if you had a cold? A medical emergency?
  2. Ask participants: What questions do you have about healthcare in the U.S.? Record responses.
  3. Share the Healthcare in the U.S. fact sheet, podcast, or video (available in multiple languages). Use the Healthcare in the U.S. Guided Worksheet to guide participants in learning about the following points: health screening, types of healthcare providers, healthcare rights, and coverage of medical costs.
  4. Check that participants’ questions from the start of the activity have been answered. If it is not possible to answer all the questions, communicate a plan for additional follow-up.

  • Provide localized context and materials about healthcare services as appropriate.
  • If using the video, the fact sheet can serve as a transcript for the interpreter.
  • If using the video or podcast, consider pausing at different sections of the content to conduct additional knowledge checks or answer questions.

U.S. Healthcare System Using the Settle In app

This activity is ideal for teaching the basics of healthcare in the U.S., including the 30 day health screening. It can be applied in-person and virtually.

  1. Ask participants: What was healthcare like in your country/ies of origin and/or protection?
  2. Ask participants: What questions do you have about healthcare in the U.S.? Record responses.
  3. Access Settle In (available in multiple languages) either through the mobile or desktop app.
  4. Select the “Health and Hygiene” chapter of Settle In and then select the lesson: U.S. Healthcare System.
  5. Work with participants and coach participants on completing the lesson on Settle In. Have participants complete the actions collectively, in pairs, or individually, either through a shared screen or on a digital device (laptop, tablet, or smartphone). As appropriate, monitor progress, have participants pause when necessary, and assist participants as needed in navigating the technology.
  6. Compare their proposed questions from the beginning of the activity with what they actually learned in completing the lesson. Provide additional information as necessary.

  • Computer or other digital device for using the Settle In app. If using desktop, access to reliable WiFi for the desktop version.

  • Provide localized context and materials about healthcare services as appropriate.
  • The mobile app can work offline once content has been downloaded when connected to WiFi.
  • Based on participants’ digital abilities and digital access, you can have participants complete the chapter and lesson either before class to help generate discussion or after class as a review.
  • If additional guidance on using technology during cultural orientation is needed, please reference CORE’s How to Integrate Digital Technology document or online course.

Seeing a Doctor Using the Settle In App

This activity is ideal for discussing how to manage healthcare and visiting a doctor. It can be applied in-person and virtually.

  1. Ask participants: What is an example of a routine health situation? What is an example of an urgent health situation?
  2. Before participants complete the Settle In lesson, ask them to predict what information they might learn in this lesson. Record responses.
  3. Access Settle In (available in multiple languages) either through the mobile or desktop app.
  4. Open the “Health and Hygiene” chapter of Settle In and then select the lesson: Seeing a Doctor.
  5. Work with participants and coach participants on completing the lesson on Settle In. Have participants complete the actions collectively, in pairs, or individually, either through a shared screen or on a digital device (laptop, tablet, or smartphone). As appropriate, monitor progress, have participants pause when necessary, and assist participants as needed in navigating the technology.
  6. Compare their predictions with what they actually learned in completing the lesson.

  • Computer or other digital device for using the Settle In app. If using desktop, access to reliable WiFi for the desktop version.

  • Provide localized context and materials about visiting the doctor as appropriate.
  • The mobile app can work offline once content has been downloaded when connected to WiFi.
  • Based on participants’ digital abilities and digital access, you can have participants complete the chapter and lesson either before class to help generate discussion or after class as a review.
  • If additional guidance on using technology during cultural orientation is needed, please reference CORE’s How to Integrate Digital Technology document or online course.

Urgent versus Routine Scenarios

This activity is ideal for reviewing health services and differences between urgent and routine health concerns. It can be applied in-person and virtually.

  1. Ask participants: What is an example of a routine health situation? What is an example of an urgent health situation?
  2. Explain to participants that you will provide scenarios. For each scenario, ask participants to identify if it is an urgent versus routine health issue.
  3. Provide scenarios from Urgent versus Routine Scenarios. You can either read each scenario or show the visual. Ask participants to identify if it is urgent or routine. Alternatively, participants can work in groups to categorize the scenarios.
  4. Ask participants to explain their answers. Ask participants: What should you do if it is an urgent health concern? Routine? Correct and provide additional information as necessary, including covering who is responsible for making health appointments.
  5. Ask participants: What health services are available in their community?

  • If conducting virtually, provide physical Cultural Orientation packet of materials ahead of time with images.
  • Review and adapt scenarios for local context as necessary.

Adapted from Making Your Way Curriculum – Unit on Health and Hygiene

Learn about Different Types of Medical Specialists 

This activity is ideal for newcomers to understand health insurance and different types of medical specialists.

  1. Before this activity, review the medical specialist worksheet. You may adjust or remove scenarios based on your local context.
  2. Ask participants: What was the process to see a medical specialist (or doctor) in your country?
  3. Review the key messages in the Health Insurance and Medical Specialists Talking Points with participants. Explain to participants:
    • Health insurance helps to cover the cost of doctor visits and other healthcare costs.
    • Refugee Medical Assistance is a type of health insurance available to refugees, Special Immigrant Visa (SIV) holders, and humanitarian parolees from Afghanistan and Ukraine.
    • Refugee Medical Assistance differs from state to state. In many cases, Refugee Medical Assistance is available for the first twelve months after arrival. Afterward, you will pay for this service.
    • Health insurance covers preventative care visits, including an annual appointment with your Primary Care Provider.
    • Primary Care Providers specialize in preventative and everyday care. They are the first medical professional to see when you have a problem. 
  4. Use the medical specialist worksheet to guide participants in a discussion about the types of medical specialists that their Primary Care Provider may refer them to. Share the following messages with participants:
    • Some health insurances require a referral from a Primary Care Provider to see a medical specialist. If your Primary Care Provider refers you to visit a medical specialist, ask them to find a medical specialist in-network. In-network refers to medical professionals that your health insurance agrees to pay for if you visit.
    • Without a referral, your health insurance may refuse to pay the cost of the medical specialist visit. The cost of the visit varies based on your insurance. Even with a referral and health insurance, you may be required to cover part of the cost or a copay. A copay is the negotiated amount you owe for a medical visit that insurance does not pay for.
    • If the medical specialist refers you for additional testing, confirm that your insurance covers it.
  • 5. Ask newcomers: Is there a type of medical specialist we did not discuss that you want more information about? For example, an obstetrician or gynecologist, who specialize in women’s reproductive health. If you prefer, you can also choose to speak to me at another time privately. Like all doctors, I will maintain your confidentiality by not sharing your personal medical information with your family members.

  • Invite a guest speaker to present on a specific medical specialty. When inviting a guest speaker, refer to CORE’s promising practice on including guests from the community for guidance.  
  • This activity teaches words that may be new to participants. To increase comprehension, say the names of each medical specialist in both English and the participant’s native language and ask questions throughout the activity to check understanding. 

Hygiene Activities

Comparative Hygiene Discussion

This activity is ideal to generate discussion on hygiene practices and norms in U.S. It can be applied in-person and virtually.

  1. Ask participants to define the term “hygiene.” Explain that hygiene includes personal cleanliness, maintaining the home, and respecting public spaces.
  2. Ask participants to consider hygiene practices in their countries of origin and/or protection. Ask them: What did it mean to be clean in these places? How did people keep their homes clean? What about public spaces? Why was it important to have proper hygiene? Record responses.
  3. As appropriate, provide participants with the Hygiene in the U.S. fact sheet or podcast. Use the Hygiene in the U.S. Guided Worksheet to guide participants in learning about hygiene in the U.S. If participants are already familiar with hygiene norms in the United States, invite them to share that information.
  4. Finally, ask participants to compare their countries of origin and/or protection with the United States. What is similar about hygiene? What is different?
  5. Ask if participants have any questions about hygiene practices in the United States. Address questions as time permits and make note of any questions that may require additional follow-up.

  • Create a safe and comfortable environment and ensure that participants know that it is okay to ask questions.
  • As possible, include information specific to different genders and consider delivering this activity as a part of a gender-segregated Cultural Orientation session.

Taken from CORE’s Hygiene Lesson Plan

Hygiene Scenarios

This activity is ideal for identifying positive and negative hygiene practices and benefits and consequences of practicing proper hygiene. It can be applied in-person and virtually.

  1. Provide participants with different scenarios (and corresponding images) from the Scenarios Activity Worksheet and either guide them through the discussion points, or have the participants work in groups to respond (depending on the group and the participants’ abilities and level).
  2. Review the responses of the scenarios together. As appropriate, document positive and negative hygiene practices, as well as a list of benefits and consequences of practicing proper hygiene in the United States.

  • If conducting the session virtually, provide a physical packet of Cultural Orientation materials ahead of time with images or use screen share of images.
  • You can adapt and alter scenarios, including images and/or use of realia, to best fit the context for the participants. For example, consider showing real hygiene products and asking participants when, how, and why they should use them.

Taken from CORE’s Hygiene Lesson Plan

Demonstration of Hygiene Products and Application

This activity is ideal for identifying and practicing proper hygiene. It can be applied in-person and virtually.

  1. Show participants different hygiene products (images or realia), either for personal use or for maintaining the home. For example, household cleaning items, dental care products, culturally appropriate hair and body products.
  2. Ask participants to identify the products and how they would use them.
  3. If appropriate, ask participants to demonstrate using selected products. Provide additional information as necessary.
  4. Ask participants: What are the benefits of using the products? What are the consequences of not using the products?

  • Images or physical hygiene products

  • If possible, work with community partners to create hygiene care packages that can be provided to participants following the session.
  • If possible, consider conducting certain aspects of personal hygiene in gender-segregated groups. For example, how to properly dispose of feminine products.

Create a Hygiene Checklist

This activity is ideal for reinforcing how participants can take responsibility for hygiene personally, at home, and in public. It can be applied in-person and virtually.

  1. Explain to participants that they have been asked to teach other refugees about hygiene in the U.S. Participants will need to create a checklist in order to complete this task. The checklist needs to have three sections: personal hygiene, keeping the home clean, and respecting public spaces.
  2. Ask participants to brainstorm the lists for each of the three checklists.
  3. Ask participants to consider the checklist and what could be potential barriers to practicing proper hygiene. Make the connection that proper hygiene has cost implications (personal hygiene products, home cleaning products, etc.) and should be included in their spending plans.
  4. As appropriate, provide participants with the Keeping Your Home Clean Checklist. Explain to participants how they can use the list at home for themselves and/or with their families.
  5. Ask participants if they have any questions. Address questions as time permits and make note of any questions that may require additional follow-up.

  • If conducting virtually, provide a physical Cultural Orientation packet of materials ahead of time with images or use screen share of checklist.
  • As time permits, you may want to show and/or provide additional information on cleaning products, including types and costs.
  • If possible, work with community partners to create hygiene care packages that can be provided to participants following the session.

Taken from CORE’s Hygiene Lesson Plan

Hygiene Using the Settle In app Activity

This activity is ideal for covering hygiene in the U.S. while also integrating digital technology. It can be applied in-person and virtually.

  1. Ask participants to define the term preventative healthcare. Explain to participants that preventative healthcare includes any actions that one can take to maintain and promote good health, and therefore prevent illness and/or diseases.
  2. Access Settle In (available in multiple languages) either through the mobile or desktop app.
  3. Open the “Health and Hygiene” chapter of Settle In and then select the lesson: Preventative Health.
  4. Before participants complete the lesson on Settle In, ask them to predict what information they might learn in this lesson. Record the responses.
  5. Work with participants and coach participants on completing the lesson. Have participants complete the actions collectively using one desktop or have participants work in pairs or individually to complete the lesson on tablets and/or smartphones. As appropriate, monitor progress and assist participants as needed in navigating the technology.
  6. Compare their predictions with what they actually learned in completing the lesson.

  • Computer or other digital device for using the Settle In app. If using desktop, access to reliable WiFi for the desktop version.

  • Based on participants’ digital abilities and digital access, you can have participants complete the chapter and lesson either before class to help generate discussion or after class as a review.
  • If additional guidance on using technology during cultural orientation is needed, please reference CORE’s How to Integrate Digital Technology document or online course.

Taken from CORE’s Hygiene Lesson Plan

COVID-19 Activities

Discussion on COVID-19

This activity is ideal for working with participants to define COVID-19, its symptoms, how it spreads, and why it should be taken seriously. It can be applied in-person and virtually.

  1. Ask participants: What do you know about COVID-19 (also called coronavirus)? If appropriate, ask: How does it compare to other illnesses you have encountered? Record the responses.
  2. Play the COVID-19: How to Protect Yourself and Stop the Spread of the Virus video, available in 15 different languages.
  3. Use the COVID-19: How to Protect Yourself Guided Worksheet to help guide participants to define COVID-19, its symptoms, and how it spreads.
  4. Compare information learned in the video and worksheet with information participants shared at the beginning of the activity.
  5. Discuss with participants: Why is it important for you to take COVID-19 seriously? What are the benefits of taking COVID-19 seriously? What are the potential consequences?

  • Instead of the video, use the COVID-19 Understanding Guidance and Rules fact sheet or podcast.
  • For one-on-one Cultural Orientation, customize the information as appropriate to the specific case.
  • As possible and appropriate, incorporate visuals to enforce understanding of COVID-19 symptoms and how it spreads.

Taken from CORE’s Resettling to the United States during the COVID-19 Pandemic Lesson Plan

COVID-19 Responsibilities Activity

This activity is ideal to articulate the importance of protecting oneself and others from COVID-19 and to share information about resettlement to the United States during the COVID-19 pandemic. It can be applied in-person and virtually.

  1. Ask participants: What steps can you take to protect yourself from COVID-19? What is the role of the Resettlement Support Center or Resettlement Agency during COVID-19? Record the responses.
  2. Provide participants with Resettling to the United States During the COVID-19 Pandemic fact sheet or podcast.
  3. Compare information from the fact sheet or podcast to answers provided by participants about protecting against COVID-19. Correct the responses as necessary.
  4. Use Responsibility Cards to reinforce information provided in the Resettling to the United States During the COVID-19 Pandemic fact sheet or podcast.
  5. Provide participants with the image on the responsibility card and ask: what action is happening in the image?
  6. Once participants identify the action, ask: Why is this action important in protecting yourself and others from COVID-19? Sample answers have been provided on the responsibility cards.
  7. Ask participants: What questions do you have about resettlement to the United States during COVID-19? Document questions and respond as appropriate. Questions may include: how to communicate with the Resettlement Support Center or Resettlement Agency, delivery of documents, and accessing specific services. Answers will vary.

  • If conducting virtually, provide physical Cultural Orientation packet of materials ahead of time, including as appropriate the fact sheet and Responsibility Cards.
  • Prior to conducting this activity, check the latest information and guidance on COVID-19 and adapt information based on the local context.

Taken from CORE’s Resettling to the United States during the COVID-19 Pandemic Lesson Plan

COVID-19 Scenarios Activity

This activity is ideal to explore local guidance on COVID-19 and reflect on how to find accurate and up-to-date information. It can be applied in-person and virtually.

  1. Ask participants: What is the current guidance on COVID-19 where you are located? Correct answers as necessary.
  2. If not provided previously, review with participants COVID-19 Understanding Guidance and Rules fact sheet or play the podcast podcast.
  3. Provide participants with scenarios found in the List of Scenarios. Discuss scenarios with participants, highlighting as appropriate local guidance on COVID-19. Scenarios and answers are based on the fact sheet mentioned above and podcast; however, scenarios also build on information shared in CORE’s COVID-19 How to Protect Yourself and Stop the Spread of the Virus video and Resettling to the United States During the COVID-19 Pandemic fact sheet or podcast.
  4. Ask participants: How would they find accurate and up-to-date information on COVID-19? Share how to find local information.

  • You may add additional scenarios or reduce the number of scenarios, as relevant for your given context.
  • You could change the scenarios into role plays.

Taken from CORE’s Resettling to the United States during the COVID-19 Pandemic Lesson Plan

Lesson Plans

Refugees need to understand the impact of hygiene on health, interpersonal relationships, and finding and keeping a job. These Lesson Plans address health and hygiene norms in the United States, and also address key messages related to resettlement during COVID-19.

Hygiene in the United States

Resettling to the United States during the COVID-19 Pandemic

Additional Resources

General:

Mental Health:

COVID-19: