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Martinez-Donate AP, Rangel G, Correa C, Bakely L, Gonzalez-Fagoaga JE, González AA, Amuedo-Dorantes C, Zhang X, Magis-Rodriguez C, Lê-Scherban F, Guendelman S, Parrado E. The next phases of the Migrante Project: Study protocol to expand an observatory of migrant health on the Mexico-U.S. border. Front Public Health 2023; 11:1032420. [PMID: 37139391 PMCID: PMC10150099 DOI: 10.3389/fpubh.2023.1032420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Background Mexican migrants traveling across the Mexico-United States (U.S.) border region represent a large, highly mobile, and socially vulnerable subset of Mexican nationals. Population-level health data for this group is hard to obtain given their geographic dispersion, mobility, and largely unauthorized status in the U.S. Over the last 14 years, the Migrante Project has implemented a unique migration framework and novel methodological approach to generate population-level estimates of disease burden and healthcare access for migrants traversing the Mexico-U.S. border. This paper describes the rationale and history of the Migrante Project and the protocol for the next phases of the project. Methods/design In the next phases, two probability, face-to-face surveys of Mexican migrant flows will be conducted at key crossing points in Tijuana, Ciudad Juarez, and Matamoros (N = 1,200 each). Both survey waves will obtain data on demographics, migration history, health status, health care access, COVID-19 history, and from biometric tests. In addition, the first survey will focus on non-communicable disease (NCD), while the second will dive deeper into mental health and substance use. The project will also pilot test the feasibility of a longitudinal dimension with 90 survey respondents that will be re-interviewed by phone 6 months after completing the face-to-face baseline survey. Discussion Interview and biometric data from the Migrante project will help to characterize health care access and health status and identify variations in NCD-related outcomes, mental health, and substance use across migration phases. The results will also set the basis for a future longitudinal extension of this migrant health observatory. Analyses of previous Migrante data, paired with data from these upcoming phases, can shed light on the impact of health care and immigration policies on migrants' health and inform policy and programmatic responses to improve migrant health in sending, transit, and receiving communities.
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Affiliation(s)
- Ana P. Martinez-Donate
- Department of Community Health & Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Gudelia Rangel
- Mexico Section of the U.S.-Mexico Border Health Commission, Tijuana, Baja California, Mexico
| | - Catalina Correa
- Department of Community Health & Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Leah Bakely
- Department of Community Health & Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | | | - Ahmed Asadi González
- School of Medicine and Psychology, Autonomous University of Baja California (UABC), Tijuana, Baja California, Mexico
| | | | - Xiao Zhang
- School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | | | - Félice Lê-Scherban
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Sylvia Guendelman
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
| | - Emilio Parrado
- Department of Sociology, University of Pennsylvania, Philadelphia, PA, United States
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Machado S, Tayyar E, Berry NS, Lavergne R, Wiedmeyer ML, Krüsi A, Goldenberg S. "It's not just about being here, but what brought you here": A qualitative study of the role of migration experiences in shaping im/migrant women's access to healthcare. Health Place 2022; 77:102888. [PMID: 35963165 DOI: 10.1016/j.healthplace.2022.102888] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 11/04/2022]
Abstract
This qualitative study aimed to understand how migration experiences shape im/migrant women's needs, desire for, and expectations of healthcare in the British Columbia (BC), Canada context. Interviews with 33 im/migrant women (December 2018-January 2020) highlighted that traumatic experiences across migration increased healthcare needs; insufficient prior health system information contributed to poor experiences; and comparative healthcare experiences across places shaped future healthcare expectations. We use the BC setting to demonstrate the need to abide by global commitments to protect people during migration, train providers in trauma-informed care, develop health assessments that center migration journeys, and appropriately fund im/migrant-serving community organizations.
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Affiliation(s)
- Stefanie Machado
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Elmira Tayyar
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
| | - Nicole S Berry
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Ruth Lavergne
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Andrea Krüsi
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
| | - Shira Goldenberg
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada; Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA.
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Velásquez-Jiménez CM, Sarmiento MI, Vargas S, Fandiño V, Puerto-de-Amaya MB, Ardila-Sierra A, Quintana E. Estrategia educativa intercultural para la prevención del cáncer de cuello cérvico uterino en el resguardo de Paujil, Amazonia Colombiana. REVISTA U.D.C.A ACTUALIDAD & DIVULGACIÓN CIENTÍFICA 2022. [DOI: 10.31910/rudca.v25.nsupl.1.2022.2159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Obach A, Hasen F, Cabieses B, D’Angelo C, Santander S. [Knowledge, access and use of the health system by migrant adolescents in Chile: results of an exploratory study]. Rev Panam Salud Publica 2020; 44:e175. [PMID: 33417659 PMCID: PMC7778462 DOI: 10.26633/rpsp.2020.175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To identify the knowledge, access, and use of the health system by migrant adolescents, and the barriers to access and use of the health system in that population in Chile. METHODS Observational, cross-sectional exploratory study applied in a participatory workshop with migrant adolescents (N=30) in three municipalities of the city of Santiago, Chile. Multimethods study. A baseline survey on the migration process and experiences in the health system was applied, with descriptive data analysis. From the qualitative point of view, discussion groups (n=5) and participatory workshops (n=2) were carried out with migrant adolescents. RESULTS Sixty percent of the adolescents said they did not know if they were registered in the health system, and half of them had not used it. Time of residence was identified as a relevant factor for the effective use of some health benefits. Administrative barriers to access the health system were recognized, such as immigration status, perception of obligatory adult companionship, and experiences of discrimination in care. Specific needs were identified in sexual and reproductive health, such as access to condoms, and mental health care from specialists. As facilitators of access and use, experiences of proper treatment and the presence of the health sector in schools were highlighted. CONCLUSIONS Lack of information about the health system and various barriers to access and use by migrant adolescents were identified. Based on the results, general recommendations are proposed for the country and the region to improve the health of migrant adolescents.
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Affiliation(s)
- Alexandra Obach
- Universidad del DesarrolloSantiagoChileUniversidad del Desarrollo, Santiago, Chile.
| | - Felipe Hasen
- Ministerio de Salud de ChileSantiagoChileMinisterio de Salud de Chile, Santiago, Chile
| | - Báltica Cabieses
- Universidad del Desarrollo, Santiago, Chile; Universidad de York, YorkReino UnidoUniversidad del Desarrollo, Santiago, Chile; Universidad de York, York, Reino Unido
| | - Cettina D’Angelo
- Ministerio de Salud de ChileSantiagoChileMinisterio de Salud de Chile, Santiago, Chile
| | - Sylvia Santander
- Ministerio de Salud de ChileSantiagoChileMinisterio de Salud de Chile, Santiago, Chile
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Apolot RR, Tetui M, Nyachwo EB, Waldman L, Morgan R, Aanyu C, Mutebi A, Kiwanuka SN, Ekirapa E. Maternal health challenges experienced by adolescents; could community score cards address them? A case study of Kibuku District- Uganda. Int J Equity Health 2020; 19:191. [PMID: 33131497 PMCID: PMC7604956 DOI: 10.1186/s12939-020-01267-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 01/15/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Approximately 34.8% of the Ugandan population is adolescents. The national teenage pregnancy rate is 25% and in Kibuku district, 17.6% of adolescents aged 12-19 years have begun child bearing. Adolescents mothers are vulnerable to many maternal health challenges including; stigma, unfriendly services and early marriages. The community score card (CSC) is a social accountability tool that can be used to point out challenges faced by the community in service delivery and utilization and ultimately address them. In this paper we aimed to document the challenges faced by adolescents during pregnancy, delivery and postnatal period and the extent to which the community score card could address these challenges. METHODS This qualitative study utilized in-depth interviews conducted in August 2018 among 15 purposively selected adolescent women who had given birth 2 years prior to the study and had attended CSC meetings. The study was conducted in six sub counties of Kibuku district where the CSC intervention was implemented. Research assistants transcribed the audio-recorded interviews verbatim, and data was analyzed manually using the framework analysis approach. FINDINGS This study found five major maternal health challenges faced by adolescents during pregnancy namely; psychosocial challenges, physical abuse, denial of basic human rights, unfriendly adolescent services, lack of legal and cultural protection, and lack of birth preparedness. The CSC addressed general maternal and new born health issues of the community as a whole rather than specific adolescent health related maternal health challenges. CONCLUSION The maternal health challenges faced by adolescents in Kibuku have a cultural, legal, social and health service dimension. There is therefore need to look at a multi-faceted approach to holistically address them. CSCs that are targeted at the entire community are unlikely to address specific needs of vulnerable groups such as adolescents. To address the maternal health challenges of adolescents, there is need to have separate meetings with adolescents, targeted mobilization for adolescents to attend meetings and deliberate inclusion of their maternal health challenges into the CSC.
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Affiliation(s)
- Rebecca R. Apolot
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Moses Tetui
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
- Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Evelyne B. Nyachwo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Linda Waldman
- Institute of Development Studies, Library Road, Brighton, BN1 9RE UK
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Christine Aanyu
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Suzanne N. Kiwanuka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Elizabeth Ekirapa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
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Fernández-Sánchez H. Transnational migration and Mexican women who remain behind: An intersectional approach. PLoS One 2020; 15:e0238525. [PMID: 32925976 PMCID: PMC7489560 DOI: 10.1371/journal.pone.0238525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore the scope, range, and nature of the existing literature on Mexican women who remain behind in their communities of origin while their partners migrate abroad. DESIGN A scoping review informed by an intersectionality framework was conducted over four months, January-April 2020. DATA SOURCES The electronic databases Medline, PsyINFO, Global Health, CINAHL, Gender Studies Database, Dissertations & Theses Global, LILACS, IBECS, and Sociological Abstracts were searched. REVIEW METHODS Articles were included if they focused on Mexican women who remain behind across transnational spaces. Two independent reviewers screened and selected articles. Data were analyzed and synthesized using descriptive statistics for quantitative data and content analysis for qualitative data. RESULTS A total of 19 articles were included for analysis; within those, the methods used included quantitative (n = 5), qualitative (n = 11), mixed methods (n = 2), and intervention (n = 1). Most studies lacked a theoretical framework (n = 10); the majority were empirical published studies (n = 11), and most used interviews (n = 12) and surveys (n = 6) to collect data. All of the articles studied cis-heterosexual Mexican women. Major areas identified were 1) research context, 2) gender roles, and 3) women's health. CONCLUSION Implications for practice and future research are discussed.
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Affiliation(s)
- Higinio Fernández-Sánchez
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
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Evaluating the health literacy demand and cultural appropriateness of online immunisation information available to refugee and migrant communities in Australia. Vaccine 2020; 38:6410-6417. [DOI: 10.1016/j.vaccine.2020.07.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 11/21/2022]
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Brandenberger J, Sontag K, Duchêne-Lacroix C, Jaeger FN, Peterhans B, Ritz N. Perspective of asylum-seeking caregivers on the quality of care provided by a Swiss paediatric hospital: a qualitative study. BMJ Open 2019; 9:e029385. [PMID: 31515424 PMCID: PMC6747639 DOI: 10.1136/bmjopen-2019-029385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study investigated the perspective of asylum-seeking caregivers on the quality of healthcare delivered to their children in a qualitative in-depth interview study. The health of asylum-seeking children is of key interest for healthcare providers, yet knowledge of the perspective of asylum-seeking caregivers when accessing healthcare is limited. SETTING The study took place in a paediatric tertiary care hospital in Basel, Switzerland. PARTICIPANTS Interviews were done with 13 asylum-seeking caregivers who had presented with their children at the paediatric tertiary care hospital. Nine female and four male caregivers from Tibet, Eritrea, Afghanistan, Syria, Iraq, Albania and Macedonia were included. A diverse sample was chosen regarding cultural and social background, years of residence in Switzerland and reasons for seeking care. A previously developed and pilot-tested interview guide was used for semistructured in-depth interviews between 36 and 92 min in duration. Data analysis and reporting was done according to Consolidated Criteria for Reporting Qualitative Research. The number of interviews was determined by saturation of data. RESULTS The interviewees described a mismatch of personal competencies and external challenges. Communication barriers and unfamiliarity with new health concepts were reported as challenges. These were aggravated by isolation and concerns about their child's health. The following factors were reported to strongly contribute to satisfaction of healthcare delivery: a respectful and trusting caregiver-provider relationship, the presence of interpreters and immediate availability of treatment. CONCLUSIONS A mismatch of personal competencies and external challenges importantly influences the caregiver-provider relationship. To overcome this mismatch establishment of confidence was identified as a key factor. This can be achieved by availability of interpreter services, sufficient consultation time and transcultural trainings for healthcare workers. Coordination between the family, the government's asylum system and the medical system is required to facilitate this process.
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Affiliation(s)
- Julia Brandenberger
- Migrant Health Services, Universitats-Kinderspital beider Basel (UKBB), Basel, Switzerland
- Department of Pediatric Emergency Medicine, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Katrin Sontag
- Department of Social Sciences, Subject Area Cultural Anthropology, University of Basel, Basel, Switzerland
| | | | - Fabienne Nicole Jaeger
- Professional Postgraduate Training Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Bernadette Peterhans
- Professional Postgraduate Training Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Nicole Ritz
- Migrant Health Services, Universitats-Kinderspital beider Basel (UKBB), Basel, Switzerland
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Valdez Tah AR. “Enfermarse aquí es un lujo”: prácticas y perspectivas en la atención de enfermedades entre inmigrantes yucatecos en el sur de California. Glob Health Promot 2019. [DOI: 10.1177/1757975919868169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Resumen: Este estudio se enfoca en cómo un grupo de inmigrantes originarios del estado de Yucatán, en México, y quienes viven en el sur de California, atienden las enfermedades que les aquejan y cómo articulan sus prácticas de atención con sus condiciones socioeconómicas, su estatus migratorio y acceso a los servicios de salud institucionales. La metodología elegida fue de corte cualitativo, a través de entrevistas se recopilaron datos etnográficos analizados con el software MAXQDA12. Las modalidades de las trayectorias en la búsqueda de atención son complejas al ser articulaciones a través de las cuales los entrevistados enfrentan las barreras estructurales para acceder a servicios médicos, y por constituirse al mismo tiempo como una síntesis dinámica de los sistemas de conocimiento científico y del saber popular. Las limitantes estructurales son mayormente prevalentes en el acceso de servicios médicos a partir del segundo nivel y son más profundas entre los participantes indocumentados. El trabajo reflexiona sobre el impacto estructural de la política pública en salud y de la política migratoria sobre las modalidades de atención, sobre las condiciones de salud de los participantes, y sobre las implicaciones de los hallazgos en las estrategias de promoción a la salud en el contexto de migración internacional.
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Brandenberger J, Tylleskär T, Sontag K, Peterhans B, Ritz N. A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries - the 3C model. BMC Public Health 2019; 19:755. [PMID: 31200684 PMCID: PMC6567460 DOI: 10.1186/s12889-019-7049-x] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migrants and refugees have important health needs and face inequalities in their health status. Health care delivery to this patient group has become a challenging public health focus in high income countries. This paper summarizes current knowledge on health care delivery to migrants and refugees in high-income countries from multiple perspectives. METHODS We performed a systematic literature review including primary source qualitative and quantitative studies between 2000 and 2017. Articles were excluded if the study setting was in low- or middle-income countries or focused on skilled migration. Quality assessment was done for qualitative and quantitative studies separately. Predefined variables were extracted in a standardized form. Authors were approached to provide missing information. RESULTS Of 185 identified articles, 35 were included in the final analysis. We identified three main topics of challenges in health care delivery: communication, continuity of care and confidence. All but one study included at least one of the three main topics and in 21/35 (60%) all three topics were mentioned. We further developed the 3C model and elaborated the interrelatedness of the three topics. Additional topics identified showed that the specific regional context with legal, financial, geographical and cultural aspects is important and further influences the 3C model. CONCLUSIONS The 3C model gives a simple and comprehensive, patient-centered summary of key challenges in health care delivery for refugees and migrants. This concept is relevant to support clinicians in their day to day practice and in guiding stakeholders in priority setting for refugee and migrant health policies.
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Affiliation(s)
- Julia Brandenberger
- University Children's Hospital Basel, Migrant Health Service, University of Basel, Spitalstr.33, Basel, Postbox CH 4031, Switzerland. .,Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland. .,University of Basel, P.O. Box, CH-4003,, Basel, Switzerland. .,Paediatric Emergency Department, Inselspital, University of Bern, Bern, Switzerland.
| | | | - Katrin Sontag
- University of Basel, P.O. Box, CH-4003,, Basel, Switzerland.,Department of Social Sciences, Subject Area Cultural Anthropology, University of Basel, Basel, Switzerland
| | - Bernadette Peterhans
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003,, Basel, Switzerland
| | - Nicole Ritz
- University Children's Hospital Basel, Migrant Health Service, University of Basel, Spitalstr.33, Basel, Postbox CH 4031, Switzerland.,University of Basel, P.O. Box, CH-4003,, Basel, Switzerland.,University Children's Hospital Basel, Pediatric Infectious Disease and Vaccinology, University of Basel, Basel, Switzerland.,Royal Children's Hospital Melbourne, Department of Pediatrics, University of Melbourne, Parkville, Australia
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León-Pérez G. Internal migration and the health of Indigenous Mexicans: A longitudinal study. SSM Popul Health 2019; 8:100407. [PMID: 31193502 PMCID: PMC6529827 DOI: 10.1016/j.ssmph.2019.100407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/04/2019] [Accepted: 05/07/2019] [Indexed: 12/25/2022] Open
Abstract
Rationale Indigenous peoples have historically comprised a substantial part of migration streams around the world, yet our understanding of the effects of migration on indigenous health is limited. Objective To explore the migration-indigenous health relationship by assessing the impact of internal migration on the self-rated health trajectories of indigenous Mexicans. Data and method Using three waves of data (2002-2012) from the Mexican Family Life Survey, I estimated linear growth curves to examine differences in initial self-rated health and changes in self-rated health between indigenous and non-indigenous respondents (N = 12,533). Then, I investigated whether migrating domestically during the study period shaped indigenous health trajectories. Results At the baseline interview (before migration), indigenous migrants reported significantly better self-rated health than indigenous non-migrants and than all non-indigenous respondents. In spite of their better initial health, indigenous migrants' health deteriorated substantially after migration, such that by the time of the last interview they reported the worst health. The self-rated health of all other groups improved during the same period. Conclusion Findings provide evidence of pre-migration health selection and post-migration health deterioration among Mexican indigenous migrants. These results suggest that internal migration is a risk factor that has an independent effect on indigenous health even after adjusting for personal, family, socioeconomic, and health care factors.
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Affiliation(s)
- Gabriela León-Pérez
- Department of Sociology, Virginia Commonwealth University, 827 West Franklin Street, Richmond, VA, 23284-2040, USA
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Maxwell AE, Young S, Moe E, Bastani R, Wentzell E. Understanding Factors that Influence Health Care Utilization Among Mixtec and Zapotec Women in a Farmworker Community in California. J Community Health 2019; 43:356-365. [PMID: 28975501 DOI: 10.1007/s10900-017-0430-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This paper examines health care utilization among indigenous immigrants from Oaxaca, Mexico, who have settled in a farmworker community in southern California. In 2016, two trained Spanish-Mixteco and Spanish-Zapoteco bi-lingual interviewers conducted in-depth interviews with 44 indigenous women residing in Oxnard, California on issues that affect health care utilization. Interviews were conducted in Mixteco, Zapoteco and Spanish and were coded to identify structural, cultural, and provider-related barriers to health care utilization. Five bi-lingual Spanish-Mixteco indigenous interpreters employed at local clinics were also interviewed. Many women reported lack of health insurance, inability to pay, language barriers, long waiting times, rushed encounters with providers, and seeking western medical care only after home remedies did not work. However, several women were able to access routine health care services, often with support from indigenous interpreters employed at clinics. Interviews with five interpreters found that they provided assistance with interpretation during medical encounters and appointment making. They also educated patients about upcoming exams, identified low-cost services and insurance programs available to patients, assisted with paperwork and occasionally educated physicians on behalf of their patients. In addition to addressing barriers to health care access our findings suggest the importance of identifying and leveraging community assets, such as indigenous navigators, when developing programs for such underserved communities. Our findings can inform best practice in settings that provide health care to indigenous populations and may also apply to settings that provide health care to other immigrant communities that have very limited familiarity and contact with western health care.
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Affiliation(s)
- Annette E Maxwell
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Sandra Young
- Mixteco/Indigena Community Organizing Project, PO Box 20543, Oxnard, CA, 93034, USA
| | - Emily Moe
- Department of Anthropology, University of Iowa, Iowa City, IA, USA
| | - Roshan Bastani
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA
| | - Emily Wentzell
- Department of Anthropology, University of Iowa, Iowa City, IA, USA
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Woods TM, Altman CE, Chávez S, Gorman BK. Gender, migration and perceptions of HIV risk in Mexico. CULTURE, HEALTH & SEXUALITY 2018; 20:1333-1346. [PMID: 29433405 DOI: 10.1080/13691058.2018.1434238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/26/2018] [Indexed: 06/08/2023]
Abstract
This study examines the role that duty plays in men's and women's perceptions of HIV-related risk in Mexico, and how gender and migration influence these perceptions. We draw on qualitative data from the 2014 Study of Health and Migration in Mexico (SHMM), which included 24 in-depth interviews with migrant men and non-migrant women living in a medium-sized city in Guanajuato, Mexico. While men report migrating out of responsibility to provide for their families, this sense of duty also had implications for their sexual health behaviours. Duty permeates how residents in this migrant-sending community described their perceptions of HIV risk, with men and women drawing consistently on three aspects of duty: fidelity, gendered sexual expectations, and the burden of HIV prevention. We argue that a strong sense of duty can prompt gender role expansion for migrant men and limit gender role expansion for non-migrant women.
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Affiliation(s)
- Tyler M Woods
- a Department of Sociology , Rice University , Houston , TX , USA
| | - Claire E Altman
- a Department of Sociology , Rice University , Houston , TX , USA
| | - Sergio Chávez
- a Department of Sociology , Rice University , Houston , TX , USA
| | - Bridget K Gorman
- a Department of Sociology , Rice University , Houston , TX , USA
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Mochache V, Lakhani A, El-Busaidy H, Temmerman M, Gichangi P. Pattern and determinants of contraceptive usage among women of reproductive age from the Digo community residing in Kwale, Kenya: results from a cross-sectional household survey. BMC WOMENS HEALTH 2018; 18:10. [PMID: 29310654 PMCID: PMC5759252 DOI: 10.1186/s12905-017-0497-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/15/2017] [Indexed: 11/22/2022]
Abstract
Background Contraceptive usage has been associated with improved maternal and child health (MCH) outcomes. Despite significant resources being allocated to programs, there has been sub-optimal uptake of contraception, especially in the developing world. It is important therefore, to granulate factors that determine uptake and utilization of contraceptive services so as to inform effective programming. Methods Between March and December 2015, we conducted a cross-sectional survey among women of reproductive age (WRA) from the Digo community residing in Kwale County, Kenya. The study aimed to describe the pattern and determinants of contraceptive usage in this population. Respondents were selected using stratified, systematic sampling and completed a household sexual and reproductive health (SRH) questionnaire. Results We interviewed 745 respondents from 15 villages in 2 out of 4 sub-counties of Kwale. Their median (interquartile range, IQR) age was 29 (23–37) years. 568 (76%) reported being currently in a marital union. Among these, 308 (54%) were using a contraceptive method. The total unmet need, unmet need for spacing and for limiting was 16%, 8% and 8%, respectively. Determinants of contraceptive usage were education [adjusted Odds Ratio, aOR = 2.1, 95% confidence interval, CI: 1.4–3.4, P = 0.001]; having children [aOR = 5.0, 95% CI: 1.7–15.0, P = 0.004]; having attended antenatal care (ANC) at last delivery [aOR = 4.0, 95% CI: 1.1–14.8, P = 0.04] as well as intention to stop or delay future birth [aOR = 6.7, 95% CI: 3.3–13.8, P < 0.0001]. Conclusions We found high levels of contraceptive usage among WRA from the Digo community residing in Kwale. To further improve uptake and utilization of contraception in this setting, programs should address demand-side factors including ensuring female educational attainment as well as promotion of ANC and skilled birth attendance. Electronic supplementary material The online version of this article (10.1186/s12905-017-0497-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vernon Mochache
- International Centre for Reproductive Health, Mombasa, Kenya. .,University of Ghent, Ghent, Belgium. .,, P.O. Box 3921, Nakuru, 20100, Kenya.
| | - Amyn Lakhani
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | | | - Marleen Temmerman
- International Centre for Reproductive Health, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,University of Nairobi, Nairobi, Kenya
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Priego-Hernández J. Sexual health in transition: A social representations study with indigenous Mexican young women. J Health Psychol 2015; 22:661-673. [DOI: 10.1177/1359105315611954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Martinez-Donate AP, Hovell MF, Rangel MG, Zhang X, Sipan CL, Magis-Rodriguez C, Gonzalez-Fagoaga JE. Migrants in transit: the importance of monitoring HIV risk among migrant flows at the Mexico-US border. Am J Public Health 2015; 105:497-509. [PMID: 25602882 PMCID: PMC4330846 DOI: 10.2105/ajph.2014.302336] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2014] [Indexed: 11/04/2022]
Abstract
We conducted a probability-based survey of migrant flows traveling across the Mexico-US border, and we estimated HIV infection rates, risk behaviors, and contextual factors for migrants representing 5 distinct migration phases. Our results suggest that the influence of migration is not uniform across genders or risk factors. By considering the predeparture, transit, and interception phases of the migration process, our findings complement previous studies on HIV among Mexican migrants conducted at the destination and return phases. Monitoring HIV risk among this vulnerable transnational population is critical for better understanding patterns of risk at different points of the migration process and for informing the development of protection policies and programs.
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Affiliation(s)
- Ana P Martinez-Donate
- Ana P. Martinez-Donate and Xiao Zhang are with the Department of Population Health Sciences, University of Wisconsin, Madison. Melbourne F. Hovell is with the Graduate School of Public Health, San Diego State University, San Diego, CA. Maria Gudelia Rangel and J. Eduardo Gonzalez-Fagoaga are with El Colegio de la Frontera Norte, Tijuana, Mexico. Carol L. Sipan is with the School of Social Sciences, University of California, Merced. At the time of the study, Carlos Magis-Rodriguez was with the Sexually Transmitted Infections Research Center, HIV/AIDS Program, Mexico City, Mexico
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Maxwell AE, Young S, Crespi CM, Vega RR, Cayetano RT, Bastani R. Social determinants of health in the Mixtec and Zapotec community in Ventura County, California. Int J Equity Health 2015; 14:16. [PMID: 25643835 PMCID: PMC4320817 DOI: 10.1186/s12939-015-0148-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/21/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION There are an estimated 165,000 indigenous Mexicans living in California, including Mixtec and Zapotec immigrant farm workers. Because many of these immigrants speak only their native non-written languages, there is little information about the needs of this community. An academic-community partnership research team developed a survey to assess basic needs that are known to be social determinants of health in the Mixtec and Zapotec community in Ventura County. METHODS In summer 2013, Spanish-Mixteco and Spanish-Zapoteco bilingual promotoras conducted surveys in Spanish, Mixteco and Zapoteco in the greater Oxnard area in Ventura County, California to assess the following basic needs: ability of adults and children to obtain health services; household needs regarding work opportunities, food, housing, transportation, safety and education; and discrimination. Independent variables included respondent characteristics such as age, gender, marital status, living part of the year in another city, and household characteristics such as Spanish spoken in the household, number of household members and number of health care providers/agencies used. Several sets of analyses examined the relationship between basic needs and independent variables. RESULTS Respondents (N = 989) reported insufficient employment opportunities (74%), food for the family (59%) or housing (48%), lack of transportation (59%), and discrimination or bullying (34%). Most reported access to medical care for children (90%), but only 57% of respondents were able to get health care for themselves. CONCLUSIONS Many basic needs in the Mixtec and Zapotec community in Ventura County are unmet. It will require many different resources and services to address the needs of this community and to overcome longstanding inequities that are experienced by immigrant farm workers. Our findings will guide the development of future health programs and will serve as a baseline to evaluate the impact of services to improve the health conditions in this community.
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Affiliation(s)
- Annette E Maxwell
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Sandra Young
- Mixteco/Indigena Community Organizing Project, PO Box 20543, Oxnard, CA, 93034, USA.
| | - Catherine M Crespi
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Roena Rabelo Vega
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Reggie T Cayetano
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Roshan Bastani
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, 650 Charles Young Drive South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
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Goldenberg SM, Chettiar J, Nguyen P, Dobrer S, Montaner J, Shannon K. Complexities of short-term mobility for sex work and migration among sex workers: violence and sexual risks, barriers to care, and enhanced social and economic opportunities. J Urban Health 2014; 91:736-51. [PMID: 25055750 PMCID: PMC4134448 DOI: 10.1007/s11524-014-9888-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite research on the health and safety of mobile and migrant populations in the formal and informal sectors globally, limited information is available regarding the working conditions, health, and safety of sex workers who engage in short-term mobility and migration. The objective of this study was to longitudinally examine work environment, health, and safety experiences linked to short-term mobility/migration (i.e., worked or lived in another city, province, or country) among sex workers in Vancouver, Canada, over a 2.5-year study period (2010-2012). We examined longitudinal correlates of short-term mobility/migration (i.e., worked or lived in another city, province, or country over the 3-year follow-up period) among 646 street and off-street sex workers in a longitudinal community-based study (AESHA). Of 646 sex workers, 10.84 % (n = 70) worked or lived in another city, province, or country during the study. In a multivariate generalized estimating equations (GEE) model, short-term mobility/migration was independently correlated with older age (adjusted odds ratio (AOR) 0.95, 95 % confidence interval (CI) 0.92-0.98), soliciting clients in indoor (in-call) establishments (AOR 2.25, 95 % CI 1.27-3.96), intimate partner condom refusal (AOR 3.00, 1.02-8.84), and barriers to health care (AOR 1.77, 95 % CI 1.08-2.89). In a second multivariate GEE model, short-term mobility for sex work (i.e., worked in another city, province, or country) was correlated with client physical/sexual violence (AOR 1.92, 95 % CI 1.02-3.61). In this study, mobile/migrant sex workers were more likely to be younger, work in indoor sex work establishments, and earn higher income, suggesting that short-term mobility for sex work and migration increase social and economic opportunities. However, mobility and migration also correlated with reduced control over sexual negotiation with intimate partners and reduced health care access, and mobility for sex work was associated with enhanced workplace sexual/physical violence, suggesting that mobility/migration may confer risks through less control over work environment and isolation from health services. Structural and community-led interventions, including policy support to allow for more formal organizing of sex work collectives and access to workplace safety standards, remain critical to supporting health, safety, and access to care for mobile and migrant sex workers.
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Affiliation(s)
- Shira M. Goldenberg
- />Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC CANADA
- />Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6 Canada
| | - Jill Chettiar
- />Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC CANADA
| | - Paul Nguyen
- />Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC CANADA
| | - Sabina Dobrer
- />Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC CANADA
| | - Julio Montaner
- />Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC CANADA
- />Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6 Canada
| | - Kate Shannon
- />Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC CANADA
- />Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6 Canada
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