Transnational health and treatment networks: Meaning, value and place in health seeking amongst southern African migrants in London

Access to healthcare services and confidence in healthcare professionals' management of malaria: the views of Francophone sub-Saharan African Immigrants living in western Canada

BACKGROUND

There is a paucity of knowledge about the healthcare attitudes and practices of French-speaking immigrants originating from Sub-Saharan Africa (FISSA) living in minority settings. The purpose of this study was to characterize FISSA healthcare experiences and confidence in the malaria-related knowledge of health professionals in Edmonton.

METHODS

A structured survey was used to examine a cohort of 382 FISSA (48% female; 52% male) living in Edmonton. FISSA general healthcare attitudes, experiences and satisfaction with the Canadian healthcare system were studied. Healthcare Competency Perception (HCP) was characterized by using an index score. Statistical analyses were performed to evaluate the impact of healthcare experiences and other outcomes.

RESULTS

Intriguingly, while only 42% of FISSA had a French-speaking family physician, 83% (197/238) of those who had received health care services in Alberta found that access to medical treatment was easy, and 77% (188/243) were satisfied with received care. Although 70% (171/243) of FISSA did not receive services in French, 82% (199/243) surprisingly reported having good levels of comprehension during their visits. Satisfaction with care was associated with having a family physician (p = 0.018) and having health insurance (p = 0.041). Nevertheless, confidence in the healthcare system's ability to treat malaria effectively was significantly lower, with only 39% (148/382) receiving a positive score on the HCP index.

CONCLUSION

This study provides an important insight into FISSA experience with and perception of the Alberta's healthcare system.

COVID-19 brought the water struggles in Ghana into our homes in Canada: Collective emotions and WASH struggles in distant locations during health emergencies

The COVID-19 pandemic has heightened and made visible the embodied consequences of water, sanitation and hygiene (WASH) inequalities and the relationalities of health in place. This paper combines insights from relational geographies and embodied epidemiology to explore psychosocial concerns among Ghanaian migrants in Canada due to their multiple and simultaneous roles in the WASH space in Ghana, particularly during the COVID-19 pandemic. We explored this using narratives from in-depth interviews with 27 participants (16 women and 11 men) residing in Ontario, Canada. The case of Ghana offers insight into how social ties with home communities could provide a safety net during emergencies but could also affect the psychosocial wellbeing of migrants. Results revealed four interrelated psychosocial stressors, including social stressors, financial stressors, stressors related to perceived inequality and stressors related to the fear of infection during WASH access. The paper underscores the urgent need for research to move beyond local health implications of WASH inequalities and begin to prioritize how these social inequalities are embodied at distant locations.

"Maybe it's an Indo thing": Transnational health experiences of Indonesian women living in Australia

Migrant health-seeking behaviour is understood to be influenced by transnationalism. This paper explores how transnationalism influences health seeking behaviour among Indonesian women living in Perth, Western Australia. Using a participatory action research approach, we conducted five focus groups with 21 women from Indonesia living in Perth. Transnational practices were common amongst Indonesian women. Transnational health-seeking (seeking Indonesian resources in Australia); transnational social support (between countries); and transnational healthcare (return to Indonesia) were common practices amongst Indonesian women. Transnational social networks were a critical source of health information and support. Findings suggest public health interventions may be improved through utilization of transnational social networks.

At the junctures of healthcare: a qualitative study of primary and specialist service use by Polish migrants in England

Background:

Polish people are the biggest migrant group in the UK and the scholarship shows that they are attentive to their healthcare needs and seek to fulfil them by using various services both within and outside the British public healthcare system. This article explores the role of junctures within healthcare systems in the connections migrants realize between healthcare systems and sectors. The article argues that in a transnational context, migrants enact these junctures by joining different levels of care within the same sector, between sectors and across national borders. In particular, the article explores how Polish migrants’ healthcare seeking practices within and beyond national borders are enacted given the features, availability and relationship between primary and specialist care for how they are articulated between private and public sectors.

Methods:

This article is based on the second phase of a mixed-methods study on how Polish people in the UK manage their health transnationally. The participants were purposefully sampled from survey respondents (first phase) who identified as having a long-term health condition or caring in a non-professional capacity for someone who is chronically ill. Thirty-two semi-structured audio-call interviews were conducted with Polish migrants living in England between June and August 2020. Transcripts were analysed by applying thematic coding.

Results:

Key findings include a mix of dissatisfaction and satisfaction with primary care and general satisfaction with specialist care. Coping strategies consisting in reaching specialist private healthcare provided a way to access specialist care at all or additionally, or to partially complement primary care. When Polish private specialists are preferred, this is due to participants’ availability of time and financial resources, and to the specialists’ capacity to fulfil needs unmet within the public healthcare sector in the UK.

Conclusion

Polish migrants join with their practices systems which are not integrated, and their access is limited by the constraints implied in accessing paid services in Poland. This shapes transnational healthcare practices as relating mostly to routine and ad-hoc access to healthcare. These practices impact not only the wellbeing of migrants and the development of the private market but also the public health provision of services.

A scoping review on the measurement of transnationalism in migrant health research in high-income countries

BACKGROUND

Migrants commonly maintain transnational ties as they relocate and settle in a new country. There is a growing body of research examining transnationalism and health. We sought to identify how transnationalism has been defined and operationalized in migrant health research in high income countries and to document which populations and health and well-being outcomes have been studied in relation to this concept.

METHODS

We conducted a scoping review using the methodology recommended by the Joanna Briggs Institute (JBI). We searched nine electronic databases; no time restrictions were applied. Studies published in English or French in peer-reviewed journals were considered. Studies were eligible if they included a measure of transnationalism (or one of its dimensions; social, cultural, economic, political and identity ties and/or healthcare use) and examined health or well-being.

RESULTS

Forty-seven studies, mainly cross-sectional designs (81%), were included; almost half were conducted in the United States. The majority studied immigrants, broadly defined; 23% included refugees and/or asylum-seekers while 36% included undocumented migrants. Definitions of transnationalism varied according to the focus of the study and just over half provided explicit definitions. Most often, transnationalism was defined in terms of social connections to the home country. Studies and measures mainly focused on contacts and visits with family and remittance sending, and only about one third of studies examined and measured more than two dimensions of transnationalism. The operationalization of transnationalism was not consistent and reliability and validity data, and details on language translation, were limited. Almost half of the studies examined mental health outcomes, such as emotional well-being, or symptoms of depression. Other commonly studied outcomes included self-rated health, life satisfaction and perceived discrimination.

CONCLUSION

To enhance comparability in this field, researchers should provide a clear, explicit definition of transnationalism based on the scope of their study, and for its measurement, they should draw from validated items/questions and be consistent in its operationalization across studies. To enhance the quality of findings, more complex approaches for operationalizing transnationalism (e.g., latent variable modelling) and longitudinal designs should be used. Further research examining a range of transnationalism dimensions and health and well-being outcomes, and with a diversity of migrant populations, is also warranted.

Continuity of care: The ongoing use of "bush medicine" as a transnational therapeutic health practice in Guyanese immigrant communities

Using in-depth interviews with Guyanese immigrants in North America this paper argues their therapeutic landscapes are produced transnationally and these transnational therapeutic landscapes impact their ongoing health practices in the country of settlement. The results reveal that the historical use of traditional "bush medicine" provided a resilient response to inaccessible biomedical healthcare in Guyana. However, the continued use of bush medicine in the countries of settlement is not a result of barriers to healthcare. Instead, continued use constitutes a transnational therapeutic health practice that is tied to historical use, perceived efficacy of treatments, and participants' perceptions of Guyana as a therapeutic landscape.

Transnational social networks, health, and care: a systematic narrative literature review

While transnational social ties and exchanges are a core concern within migration studies, health researchers have often overlooked their importance. Continuous and circular exchanges of information within transnational networks, also defined as social remittances, facilitate the diffusion of innovations, potentially driving contemporary social and cultural change. Influences on health, wellbeing, and care-seeking are important, but under-researched, dimensions for consideration. We undertook a systematic narrative evidence synthesis to describe the current state of knowledge in this area and to identify gaps and future directions for health researchers to take. Between April 2017 and May 2019, an iterative series of searches in Medline, Embase, PsycINFO and PubMed, plus backward and forward citation searches identified 1173 potential papers. Screening resulted in 36 included papers, eighteen focused on migrant populations and eighteen on those who remain behind. The top three health topics were health-seeking strategies, sexual and reproductive health issues, and healthcare support. And, while not always explicitly identified, mental health and wellbeing was a further prominent, cross-cutting theme. Articles on migrant populations were all conducted in the global North and 13 out of 18 used qualitative methods. Five main themes were identified: therapeutic effect of the continuing social relationships, disrupted social relationships, hybridisation of healthcare, facilitation of connections to healthcare providers, and factors encouraging or undermining transnational social exchanges. Papers concerned with those who remain behind were mainly focused on the global South and used a mix of qualitative and quantitative approaches. Four main themes were identified: transnational transfer of health-related advice, norms, and support; associations between migrant linkages and health behaviours/outcomes; transnational collective transfer of health knowledge; and power and resistance in exchanges. Findings suggest that transnational social exchanges can both support and undermine the health of migrants and those who remain behind. This review confirms that the volume and quality of research in this area must be increased so that health policy and practice can be informed by a better understanding of these important influences on the health of both migrants and those who remain behind.

Health-seeking behaviours of immigrants, asylum seekers and refugees in Europe: a systematic review of peer-reviewed articles

Purpose

Immigrants, asylum seekers and refugees living in Europe face a number of challenges in accessing or using health information and healthcare services available in their host countries. To resolve these issues and deliver the necessary services, providers must take a comprehensive approach to better understand the types of health information and healthcare services that these individuals need, seek and use. Therefore, the purpose of this paper is to develop that comprehensive approach.

Design/methodology/approach

In this paper, a systematic literature review of peer-reviewed publications was performed, with 3.013 articles collected from various databases. A total of 57 qualifying papers on studies conducted in Europe were included in the review after applying the predefined inclusion and exclusion requirements, screening processes and eliminating duplicates. The information seeking and communication model (ISCM) was used in the analysis.

Findings

The findings revealed that while many health information and healthcare services are accessible in Europe for immigrants, asylum seekers and refugees, many of these individuals are unaware of their existence or how to access them. While our findings do not specify what health-related information these groups need, use or seek, they do suggest the importance and value of providing mental health, sexual health and HIV, as well as pregnancy and childbirth information and services. Furthermore, according to our results, health information services should be fact-based, easy to understand and raise awareness about healthcare structure and services available in Europe for this vulnerable population.

Practical implications

This study has a range of practical implications, including (1) highlighting the need for mental health and behavioural health services and (2) stressing the value of addressing cultural context and religious values while investigating (health) information seeking of people with foreign background.

Originality/value

This is one of the first studies to systematically review and examine the behaviour of immigrants, asylum seekers and refugees in relation to health information and healthcare services in the European context.

Diasporic medical tourism: a scoping review of quantitative and qualitative evidence

Background

There is a growing recognition of the significance of the diasporic dimension of medical travel. Explanations of medical tourism are increasingly presented in a wider context of transnationalism, diaspora and migration. Yet diaspora and cross-border travellers rarely get through the broader narrative of medical travel.

Objective

Our aim in this scoping review was to extend the current knowledge on the emerging subject of diasporic travels for medical purposes. Specifically, we reviewed the existing literature on what is known about the determinants and motivational factors of diasporic medical tourism; its geographic scope and its quantitative estimation.

Methods

Using a scoping review methodology, we conducted the search in seven electronic databases. It resulted in 210 records retrieved. Ultimately, 28 research papers and 6 non-research papers (published between 2002 and 2019) met the following criteria: 1) focus on healthcare and health-related practices, 2) transnational perspective, 3) healthcare consumption in the country of origin (homeland) while being a resident of another country, 4) published in English.

Results

The findings from our review highlighted the importance of diasporic medical patients who had been researched and analysed on four continents. Even though quantitative evidence has been scarce, the data analysed in the scoping review pointed to the existence of non-negligible level of diasporic medical tourism in Northern America, and in Europe. Various motivational factors were enumerated with their frequency of occurrence: medical culture (12), time availability (“by the way of being home”) (9), communication (6), dissatisfaction with the current system (6), healthcare insurance status (5), quality of healthcare (5), second opinion (3), and value for money (3).

Conclusion

Diasporic medical tourists constitute an attractive segment of consumers that is still not well understood and targeted. They are part of transnational communities that cultivate the links between the two nations. They simultaneously participate in bi-lateral healthcare systems via return visits which impact the health systems of sending and receiving countries in a substantial way. In the current globalised, connected and migratory context, transnationalism seems to represent an answer to many local healthcare-related barriers. Sending and receiving countries have put in place an array of programmes and policies addressed to the diasporic medical travellers.

Predictors of Unmet Traditional, Complementary and Alternative Medicine Need Among Persons of Sub-Saharan African Origin Living in the Greater Toronto Area

Our study seeks to examine how chronic health status, insurance coverage and socioeconomic factors predict unmet traditional, complementary and alternative medicine (TCAM) needs among immigrants from sub-Saharan African origin living in the Greater Toronto Area (GTA). The data for the study comes from a cross-sectional questionnaire survey of 273 sub-Saharan African immigrants living in the GTA. ~ 21% of respondents surveyed had unmet TCAM needs in the 12-month period prior to the survey. Persons with chronic health conditions, lower socioeconomic status, and those with previous history of TCAM use before immigrating were more likely to have unmet TCAM need. The study suggests that the current TCAM healthcare environment in the GTA limits that ability of sub-Saharan immigrants to meet their healthcare needs, especially persons in most need of such treatments-persons with chronic health conditions and those of lower socioeconomic background.

The symbolic mediation of patient trust: Transnational health-seeking among Indian-Australians

This article explores whether this extension of treatment and medication possibilities, owing to greater transnational movement of goods and people, presents increasing challenges for maintaining patients' trust within nationally-bound healthcare systems, such as in Australia. We ran focus groups in Melbourne from June 2012 to June 2013 with 34 Indian migrants to Australia. Our findings illustrate discrepancies between the symbolic mediation of trust within Indian and Australian healthcare encounters. We find that Indian participants associated authoritative and decisive self-presentation by doctors with medical competence, conflicting with Western patient choice models which exalt patient autonomy and agency. We also find that trust in Indian healthcare encounters is mediated through the symbolic deployment of "strong medication" and the engendering of "hope" in patients. Australian doctors' failure to deploy these symbols in the same way contributes to distrust that Indian participants express towards Australian health professionals and healthcare systems. We conclude that in situations where patients have less familiarity with the symbolic repertoire shared by the majority of users of a national healthcare system, such as can be the case with recent migrants, difficulties and misunderstandings may arise in negotiating trust, providing a potential motivator for seeking alternatives transnationally.

Fear, Boldness, and Familiarity: The Therapeutic Landscapes of Undocumented Latina Immigrants in Atlanta, Georgia

Drawing from 56 semi-structured interviews, this article details how undocumented Latina immigrants living in Atlanta, Georgia, in 2013 cultivated health and well-being in an insecure environment. In addition to the myriad challenges that immigrants face in accessing health care in their new communities, undocumented immigrants living in Atlanta at that time faced the legal barrier presented by Georgia’s new “show me your papers” law, which imbued public space with the risk of deportation for those who are undocumented. This law complicated health care access by making the trip to the doctor’s office risky. Immigrants’ health care decisions were thus shaped by the “geography of fear” that permeated their new communities. This fear presented itself not only in public space but also in clinics and hospitals, where many immigrants feared – and sometimes received – bad treatment. Despite the obstacles fear and immigrant policing presented, many of the women I interviewed showed boldness in their health care decisions, staking their claim to medical attention where they saw fit. Additionally, many maintained transnational networks and continued with familiar health practices from home. Combined, these strategies worked to create complex and shifting “therapeutic landscapes” in an environment permeated by insecurity and fear.

Social dimensions of health across the life course: Narratives of Arab immigrant women ageing in Canada

The increase in ethnically and linguistically diverse older adults in Canada necessitates attention to their experiences and needs for healthy ageing. Arab immigrant women often report challenges in maintaining health, but little is known about their ageing experiences. This interpretive descriptive study uses a transnational life course framework to understand Arab Muslim immigrant women's experiences of engaging in health-promoting practices as they age in Canada. Women's stories highlight social dimensions of health such social connectedness, social roles and social support that are constructed and maintained within different migration contexts across the life course. Barriers and facilitators to healthy ageing in this population centred around five themes: (i) the necessity of staying strong, (ii) caring for self while caring for others, (iii) double jeopardy of chronic illnesses and loneliness, (iv) inadequate support within large social networks and (v) navigating access to health-supporting resources. The findings point to transnational connections and post-migration social support as major influencers in creating facilitators and barriers to healthy ageing for Arab Muslim immigrant women.

Transnationalism and health: A systematic literature review on the use of transnationalism in the study of the health practices and behaviors of migrants

Transnationalism explores social, economic and political processes that occur beyond national borders and has been widely used in migration studies. We conducted a systematic review to explore if and how transnationalism has been used to study migrants' health and what a transnational perspective contributes to understanding health practices and behaviors of transnational migrants. We identified 26 empirical studies published in peer-reviewed journals that included a transnational perspective to study migrants' health practices and behaviors. The studies describe the ways in which migrants travel back and forth between countries of destination to countries of origin to receive health care, for reasons related to cost, language, and perceptions of service quality. In addition, the use of services in countries of origin is related to processes of social class transformation and reclaiming of social rights. For those migrants who cannot travel, active participation in transnational networks is a crucial way to remotely access services through phone or email, and to acquire medical supplies and other health-related goods (traditional medicine, home remedies). We conclude with recommendations for future research in this area.

Evolutionary concept analysis of health seeking behavior in nursing: a systematic review

BACKGROUND

Although the research in health seeking behavior has been evolving, its concept remains ambiguous. Concept clarification, as a central basis of developing knowledge, plays an undeniable role in the formation of nursing sciences. As the initial step toward the development of theories and theoretical models, concept analysis is broadly used through which the goals can be used and tested. The aim of this study was to report an analysis of the concept of "health seeking behavior".

METHOD

Employing a rigorous evolutionary concept analysis approach, the concept of health seeking behavior was examined for its implications, use, and significance in the discipline of nursing between 2000 and 2012. After applying inclusion and exclusion criteria, a total of 40 articles and 3 books were selected for the final analysis.

RESULTS

The definition of attributes, antecedents, and consequences of health seeking behavior was performed through concept analysis. Core attributes (interactional, processing, intellectual, active, decision making based and measurable) were studied. The antecedents of concept were categorized as social, cultural, economic, disease pattern and issues related to health services. Health-seeking behavior resulted in health promotion and disease risk reduction. In addition, it led to predicting the future probable burden of the diseases, facilitation of the health status, early diagnosis, complete and effective treatment, and complication control.

CONCLUSION

Health-seeking behavior, as a multi-dimensional concept, relies on time and context. An awareness of health-seeking behavior attributes antecedents and consequences results in promoting the status, importance and application of this concept in the nursing profession.

Immigration, barriers to healthcare and transnational ties: A case study of South Korean immigrants in Toronto, Canada

The paper analyzes the healthcare-seeking behavior of South Korean immigrants in Toronto, Canada, and how transnationalism shapes post-migration health and health-management strategies. Built upon largely separate research areas in ethnicity and health, health geography, and transnationalism, the paper conceptualizes immigrant health as influenced by individual characteristics, the migration and resettlement experience, and place effects at both a local and a transnational scale. A mixed-method approach is used to capture insights into health status and experiences in accessing local and transnational healthcare among South Korean immigrants - a fast growing visible minority group in Canada. Statistical analysis of data from the Canadian Community Health Survey discloses patterns and trends in health and healthcare use among the Korean Canadian, overall foreign-born, and native-born populations. Focus groups reveal in-depth information on the decline of Korean immigrants' health status and the array of sociocultural, economic and geographic barriers in accessing healthcare in Canada, which gave rise to their transnational use of health resources in the home country. The transnational strategies included traveling to South Korea for medical examinations or treatment, importing medications from South Korea to Canada, and consulting health resources in South Korea by phone or email. The results provide timely knowledge on how a recent immigrant group adapts to Canada in the domain of health and adds a transnational perspective to the literature on ethnicity and health.

'I think that Polish doctors are better': newly arrived migrant children and their parents׳ experiences and views of health services in Scotland

Understanding users׳ perceptions and expectations of health care provision is key to informing practice, policy and health-related measures. In this paper, we present findings from a qualitative study conducted with recently migrated Eastern European children and their parents, reporting on their experiences of accessing health services post-migration. Unlike the case of adults, the experiences of newly migrated children have rarely been explored in relation to health services. We pay particular attention to three key areas: (1) migrant families׳ views of health service provision; (2) barriers to health service use; and (3) transnational use of health services. By using a social capital approach, we show how concerns about the Scottish health care practices enacted by migrant parents are adopted by children and are likely to impact on families׳ health beliefs and behaviours. The study highlights the important role of migrants׳ active participation as users of health services. We conclude that appropriate health services need to consider more carefully migrants׳ expectations and complex health care activities, in order to be fully inclusive and patient-centred.

The right to traditional, complementary, and alternative health care

BACKGROUND

State parties to human rights conventions and declarations are often faced with the seemingly contradictory problem of having an obligation to protect people from harmful practices while also having an obligation to enable access to culturally appropriate effective healing. As people increasingly migrate across the globe, previous distinctions between 'traditional' and 'complementary and alternative medicine' practices are being transcended. There are connections across transnational healing pathways that link local, national, and global movements of people and knowledge.

OBJECTIVE

This paper contributes to the development of the concept and practice of the right to health in all its forms, exploring the right to traditional, complementary, and alternative health (R2TCAH) across different contexts.

DESIGN

The paper draws on four settings - England, South Africa, Kenya, and Jordan - and is based on key informant interviews and a literature review undertaken in 2010, and updated in 2013. The paper begins by reviewing the international legal context for the right to health. It then considers legal and professional regulations from the global north and south.

RESULTS

Additional research is needed to establish the legal basis, compare regulatory frameworks, and explore patient and provider perspectives of regulation. This leads to being able to make recommendations on how to balance protection from harm and the obligation to ensure culturally appropriate services. Such an exploration must also challenge Western theories of human rights. Key concepts, such as individual harm, consent, and respect of the autonomy of the individual already established and recognised in international health law, could be adopted in the development of a template for future comparative research.

CONCLUSIONS

Exploration of the normative content of the right to health in all its forms will contribute to supporting traditional, complementary, and alternative health service users and providers in terms of access to information, non-discrimination, clarification of state obligations, and accountability.

Grandfathers, Google, and dreams: medical pluralism, globalization, and new healing encounters in Ghana

Across contemporary Africa, pluralistic medical fields are becoming increasingly complex, giving rise to newly emerging constellations of healing practices and a vast array of therapeutic possibilities. We present portraits of four 'traditional' healers in southern Ghana who selectively adapt, adopt, and modify elements of biomedical, 'local,' and 'exotic' healing practices in eclectic and creative ways, positioning themselves strategically in a highly pluralistic, contested, and globalized medical arena. Their practices are informed by 'traditional' knowledge, passed down through families and acquired through spiritually directed dreams, but also from medical textbooks, Google searches, 'scientific' experimentation, and interactions with the biomedical sector. The healers make use of modern information and communication technologies to increase their geographical reach, and respond to the opportunities and risks of an increasingly global but strongly differentiated therapeutic market. However, while apparently transgressing therapeutic boundaries, they are simultaneously drawing on a discourse of stabilizing and straddling those boundaries to legitimize their practices.

Locating the global governance of HIV and AIDS: exploring the geographies of transnational advocacy networks

Over the last two decades, HIV and AIDS have been framed as a "global problem". In the process, transnational advocacy networks have emerged as important actors, and particular places are recognised as key nodes in global HIV and AIDS governance. Using the example of London, UK, this paper examines how these networks are involved in local articulations of global governance and reveals that 'global' processes are inflected by the locations through which networks are routed. The example suggests the need for further analysis of the geographies through which HIV and AIDS is reconfiguring power relations at a variety of spatial scales.