Migration among temporary foreign workers: Examining health and access to health care among Filipina live-in caregivers

Exploring the association between sleep and health performance of migrant home care workers and elderly care recipients in Taiwan

This study, conducted in June and July 2022 through purposive sampling, aimed to explore the relationship between sleep and health performance in 33 pairs of elderly individuals and their migrant caregivers in southern Taiwan. Participants completed a structured questionnaire and wore an Actiwatch for seven days. Pearson correlation and independent t-test were used for analysis. Nearly 50% of foreign home care workers suffered from insomnia, and 80% of elderly care recipients with disabilities experienced sleep disorders. The number of chronic illnesses and/or dementia among the elderly and insomnia among care workers were associated with poor self-perceived health (r = -0.667, p < .001) and sleep disorders among the elderly (r = 0.368, p = .035). The problem of caregiving should be addressed. Future studies should increase the sample size and extend the duration of the study to enhance the generalizability of the findings.

Filipino Immigrants in Santa Cruz de Tenerife, Spain: Health and Access to Services

The Philippines is a source of labor for many countries. Roughly 10 million overseas Filipinos are working and living outside of the Philippines. This paper examines the association between sociodemographic characteristics (sex, age, educational level, and income) and self-rated physical and mental health, access to healthcare, and health habits among immigrant Filipinos living in Santa Cruz de Tenerife, Spain. Through convenience sampling, Filipino migrants (n = 103) aged 18 years and above participated in the online survey between October 2022 and March 2023. The data were analyzed using descriptive statistical analysis and chi-square. Almost all respondents self-rated their health as excellent and very good. Female respondents are more affected by mental health. Most are enrolled in the Universal Health System of Spain (public insurance). There is more utilization of private health insurance among respondents aged 60 years and above and high-wage earners. Cigarette smoking and alcohol drinking are associated with males. More than half of the respondents perform weekly exercise occasionally or never. These findings suggest a potential need for targeted interventions with an emphasis on the practice of preventive health and the promotion of healthy lifestyles, especially among financially disadvantaged migrants with lesser health access.

Structural Origins of Poor Health Outcomes in Documented Temporary Foreign Workers and Refugees in High-Income Countries: A Review

Despite growing evidence of racial and institutional discrimination on minoritized communities and its negative effect on health, there are still gaps in the current literature identifying health disparities among minoritized communities. This review aims to identify health barriers faced by relatively less studied migrant subgroups including documented temporary foreign workers and refugees residing in high-income Organisation for Economic Co-operation and Development (OECD) countries focusing on the structural origins of differential health outcomes. We searched Medline, CINAHL, and Embase databases for papers describing health barriers for these groups published in English between 1 January 2011 and 30 July 2021. Two independent reviewers conducted a title, abstract, and full text screening with any discrepancies resolved by consensus or a third reviewer. Extracted data were analyzed using an inductive thematic analysis. Of the 381 articles that underwent full-text review, 27 articles were included in this review. We identified housing conditions, immigration policies, structural discrimination, and exploitative labour practices as the four major emerging themes that impacted the health and the access to healthcare services of our study populations. Our findings highlight the multidimensional nature of health inequities among migrant populations and a need to examine how the broader context of these factors influence their daily experiences.

Overlooked by nurses: A scoping review on health stressors, problems and coping of migrant domestic workers

AIM

The first scoping review is to map and synthesize the stressors, problems and coping strategies surrounding the health issues of migrant domestic workers.

DESIGN

Scoping review using Arksey and O'Malley's five-stage framework.

METHODS

Ten electronic databases were systematically searched by keywords for literature published between January 1995 and December 2019. Data were extracted into tables and collated and summarized into themes for presentation.

RESULTS

Twenty-seven reports were included in the final review. Analysis revealed that stressors to health included abuse, poor health service accessibility, ongoing financial hardship despite demanding working conditions and social isolation. Physical and mental health problems were identified for which migrant domestic workers largely depended on social networks and religion to cope with stressors and health problems. Training para-professional peer leaders of migrant domestic workers by community nurses and including them in interprofessional teams is a possible way for nurses to promote their health and well-being.

Determinants of COVID-19 Vaccine Uptake among Female Foreign Domestic Workers in Hong Kong: A Cross-Sectional Quantitative Survey

Globally, minority groups and non-citizens may not be sufficiently included in the COVID-19 vaccine coverage. This study seeks to understand determinants of vaccine uptake among female foreign domestic workers (FDWs) in Hong Kong. We conducted a cross-sectional study of female FDWs (n = 581) from June to August 2021. Respondents completed an online survey obtaining sociodemographic, employment, and health status information. Based upon the socio-ecological model, we obtained individual, interpersonal, and socio-structural factors that may be associated with COVID-19 vaccine uptake. Multivariable logistic regression analysis was used to examine factors associated with having received at least one dose of a COVID-19 vaccine. At the individual level, agreeing that taking COVID-19 vaccines can contribute to COVID-19 control in Hong Kong (OR 6.11, 95% CI 2.27–16.43) was associated with increased vaccine uptake, while being worried of severe side-effects from vaccination (OR 0.29, 95% CI 0.16–0.55) was associated with decreased uptake. At the interpersonal level, those being encouraged by their employer (OR 2.05, 95% CI 1.06–3.95) and family members (OR 2.27, 95% CI 1.17–4.38) were more likely to be vaccinated, while at the socio-structural level, believing vaccination would violate religious beliefs (OR 0.19, 95% CI 0.06–0.65) was associated with decreased uptake. The government can formulate a multi-level approach according to our findings to target the remaining unvaccinated FDW population.

Effects of Acceptance and Commitment Therapy (ACT) on Mental Health and Resiliency of Migrant Live-in Caregivers in Canada: Pilot Randomized Wait List Controlled Trial

Background

Temporary migrant live-in caregivers constitute a vulnerable stream of temporary foreign workers in Canada. This is because the majority are racialized women from the Global South, the gendered nature of caregiving work has historically been undervalued, and their working and living spheres are intertwined which makes application of labor laws and surveillance almost impossible. Their invisible position in the fabric of Canadian society along with their precarious employment and immigration status place their mental health at jeopardy. There is a paucity of research about psychological support for this population.

Objective

Our pilot study Women Empowerment—Caregiver Acceptance and Resilience E-Learning (WE2CARE) aimed to assess the efficacy of a 6-week online delivery of a psychological intervention based on acceptance and commitment therapy (ACT) in reducing psychological distress and promoting resiliency among live-in care givers in the Greater Toronto Area.

Methods

A pilot randomized wait list controlled design was used. Participants were recruited by two community peer champions working with community health organizations serving migrant live-in caregivers. A total of 36 participants were recruited and randomly assigned to the intervention and wait list control groups; 7 dropped out of the study due to competing life priorities. Standardized self-reported surveys were administered online pre-, post-, and 6-week postintervention to assess mental distress (DASS-21), psychological flexibility (AAQ-2), mindfulness (CAMS-R), and Multi-System Model of Resilience (MSMR-I). Independent and dependent t tests were used to compare study outcomes at pre, post, and 6-week follow-up across and within both arms of the study. Linear mixed effects models were created for each outcome of interest from baseline to postintervention among intervention and control participants. Self-reported impact of the WE2CARE intervention was examined using independent t tests across the study arms.

Results

Average age of participants was 38 years. Many were born in the Philippines (23/29, 79%). The data on the impact of the psychological intervention showed a lower level of depression, anxiety, and stress among the intervention group compared with the control. However, the differences were not significant due to small sample size and COVID-19 crisis (6.94 vs 9.50, P=.54; 6.94 vs 10.83, P=.20; 7.76 vs 10.33, P=.44, respectively). There was a significant improvement in mindful qualities and external resilience, particularly in life satisfaction and accessible support among the intervention group (37.18 vs 32.92, t22=2.35, P=.03; 20.29 vs 16.5, t21=2.98, P=.007; 8.47 vs 6.75, t14=2.41, P=.03; 7.59 vs 5.33, t16=.008, respectively).

Conclusions

WE2CARE is among the first studies exploring the efficacy of online delivery of ACT in addressing mental health challenges among live-in caregivers. While there are increased web-based ACT interventions, few use group videoconferencing to promote peer connection and mutual support. WE2CARE showed promising results in reducing psychological distress and promoting mindfulness and resiliency. The intervention highly motivated participants to engage collectively in building social support networks.

International Registered Report Identifier (IRRID)

RR2-10.2196/preprints.31211

Structure as Depressant: Theorizing Narratives of Mental Health among Migrant Domestic Workers

Articulating that domestic workers in Singapore are marked by their subalternity, erased from the hegemonic discursive spaces in spite of their visibility as objects in the neoliberal economy, this manuscript draws on the culture-centered approach to conceptualize listening as a structurally transformative anchor to theorizing mental health. The narratives offered by workers reveal critical insights into the way structure functions to create conditions of mental health suffering in the performance of precarious domestic work, intricately tied to the erasure of voice. The material violence on the bodies of workers relates to the everyday challenges to mental health. A lack of access to infrastructures of information and communication add to the conditions of marginality. In listening to these storied descriptions of suffering in precariousness, we hear voices revealing limited alternatives to mental health care in poor working conditions, with workers entrapped in a cycle of stress, worry, and fear.

Implementation of an Internet-Based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada: Protocol

Background

Psychological distress, isolation, feelings of powerlessness, and limited social support are realities faced by temporary migrant live-in caregivers in Canada. Furthermore, they experience multiple barriers in accessing mental health services due to their long work hours, limited knowledge of health resources, precarious employment, and immigration status.

Objective

The Women Empowerment - Caregiver Acceptance & Resilience E-Learning (WE2CARE) project is a pilot intervention research project that aims to promote the mental well-being and resiliency of migrant live-in caregivers. The objectives include exploring the effectiveness of this program in achieving the following: (1) reducing psychological distress (depression, anxiety, and stress); (2) promoting committed actions of self-care; and (3) building mutual support social networks. Further, participants’ satisfaction with the intervention and their perceived barriers to and facilitators of practicing the self-care strategies embedded in WE2CARE will be examined.

Methods

A total of 36 live-in caregivers residing in the Greater Toronto Area will be recruited and randomly assigned to either the intervention or waitlist control group. The intervention group will receive a 6-week web-based psychosocial intervention that will be based on Acceptance and Commitment Therapy (ACT). Standardized self-reported surveys will be administered online preintervention, postintervention, and at 6 weeks postintervention to assess mental distress (Depression, Anxiety and Stress Scale), psychological flexibility (Acceptance and Action Questionnaire), mindfulness (Cognitive and Affective Mindfulness Scale – Revised), and resilience (Multi-System Model of Resilience Inventory). In addition, two focus groups will be held with a subset of participants to explore their feedback on the utility of the WE2CARE program.

Results

WE2CARE was funded in January 2019 for a year. The protocol was approved by the research ethics boards of Ryerson University (REB 2019-036) and the University of Toronto (RIS37623) in February and May 2019, respectively. Data collection started upon ethics approval and was completed by May 2020. A total of 29 caregivers completed the study and 20 participated in the focus groups. Data analyses are in progress and results will be published in 2021.

Conclusions

WE2CARE could be a promising approach to reducing stress, promoting resilience, and providing a virtual space for peer emotional support and collaborative learning among socially isolated and marginalized women. The results of this pilot study will inform the adaptation of an ACT-based psychological intervention for online delivery and determine its utility in promoting mental health among disadvantaged and vulnerable populations.

International Registered Report Identifier (IRRID)

DERR1-10.2196/31211

Working Conditions as Risk Factors for Depressive Symptoms among Spanish-Speaking Au Pairs Living in Germany-Longitudinal Study

Previous studies have shown poor working conditions and poor mental health among au pairs. However, there are limited longitudinal approaches to these conditions. Therefore, the main objectives of this study were to assess the occurrence of depressive symptoms longitudinally and to analyze the association between sociodemographic characteristics, working conditions and violence at work with depressive symptoms over time among Spanish-speaking au pairs living in Germany. A prospective cohort study was performed with three measurement intervals, which included 189 participants. Depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9). Generalized Estimating Equation (GEE) models were implemented to estimate the association between predictors and depressive symptoms. Au pairs who worked >40 h per week were more than three times more likely to experience depression than those who did not (OR: 3.47; 95% CI: 1.46-8.28). In addition, those exposed to physical violence were almost five times more likely to suffer from depression (OR: 4.95; 95% CI: 2.16-9.75), and au pairs who had bad schedule adaptation to social and family commitments had twice the risk of depression than those who did not (OR: 2.24; 95% CI: 0.95-5.28). This knowledge could be of interest for future au pairs, host families, au pair agencies and policy makers. Together, they could improve awareness and monitoring of au pair working conditions.

Predictors of Migrant Live-in Care Workers' Burden/Burnout and Job Satisfaction When Caring for Frail Older Persons in Israel

OBJECTIVES

To clarify how work characteristics affect migrant live-in care workers' burden/burnout as well as their job satisfaction.

METHODS

Data from 116 migrant live-in care workers were collected in 2013-2014 in Tel Aviv and Jerusalem through structured interviews about their job satisfaction and their degree of burden/burnout. Due to the conceptual and empirical similarity (zero-order correlation and joint internal reliability), of burden and burnout, the 2 were combined into one variable. These outcome measures were examined in connection with the older person's level of disability, care workers' relationship with the older person, and their employment conditions.

RESULTS

According to the regression models, work characteristics (care recipients' functional status and care workers' relationship with the care recipient) had a direct impact on burden/burnout. Employment-related variables (employment conditions and satisfaction with those conditions) had an indirect effect. A combination of work characteristics (relationship with the older person) together with the care worker's response to employment conditions (satisfaction with employment conditions) had a direct influence on the care workers' job satisfaction. Problematic employment conditions had an indirect effect.

DISCUSSION

The results suggest that fostering better relationships and improving employment conditions could help reduce care workers' burden/burnout as well as improve their degree of satisfaction.

Major Depressive Syndrome (MDS) and its Association with Time of Residence among Spanish Speaking Au-Pairs Living in Germany

The number of au-pairs in Germany is on the rise. In 2017, about 13,500 au-pairs were living in German families, almost half of them originating from non-European Union (EU) countries and many of them from Spanish speaking countries. Knowledge about mental health among au-pairs in Germany is limited. Therefore, the main objective of this study was to assess the prevalence of Major Depressive Syndrome (MDS) and its potential association with time of residence among Spanish speaking au-pairs living in Germany via an exploratory analysis. This study included a sample of 409 Spanish speaking au-pairs living in Germany. We classified the au-pairs into those who lived less than three weeks in Germany (newcomer au-pairs) and those who lived more than three weeks (experienced au-pairs). The participants were recruited by an online survey (Facebook and Instagram) from August 2018 to June 2019. Socio-demographic characteristics, time of residence in Germany and the level of education were assessed. MDS was assessed by the Patient Health Questionnaire depression module (PHQ-9). Poisson regression models were calculated to evaluate the association between time of residence in Germany and prevalence of MDS. Most of the participants were female (91%). Almost half of them came from Colombia (48%) and were in the age range between 22–24 years (40%). Prevalence of MDS was 8% among newcomers and 19% among experienced au-pairs (p = 0.002). Differences remained statistically significant after adjustment for potential confounders (age, level of education and time of residence in Germany) (prevalence ratio 2.25; 95% confidence interval: 1.22–4.14). In conclusion, au-pairs may develop mental symptoms during their time abroad. Future prospective studies should aim at identifying potential risk factors and preventive measures.