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Middlemiss L. What are the political and ethical challenges that health professionals face in providing care to undocumented migrants? How should they respond to these challenges? Med Confl Surviv 2024; 40:285-294. [PMID: 39148464 DOI: 10.1080/13623699.2024.2382826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
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Těšinová JK, Dobiášová K, Jelínková M, Tulupova E, Koščík M. Professionals' and Intercultural Mediators' Perspectives on Communication With Ukrainian Refugees in the Czech Healthcare System. Health Expect 2024; 27:e14171. [PMID: 39150347 PMCID: PMC11328340 DOI: 10.1111/hex.14171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/15/2024] [Accepted: 07/23/2024] [Indexed: 08/17/2024] Open
Abstract
INTRODUCTION A growing body of research is examining how healthcare systems are responding to the increasing numbers of migrants and the resulting superdiversity of patients. The aim of this article is to identify and explain communication barriers in the provision of healthcare to Ukrainian war refugees in the Czech Republic from the perspectives of healthcare professionals and intercultural mediators. METHODS The exploratory case study is based on a qualitative analysis of semi-structured interviews with frontline health professionals: 20 with doctors and 10 with nurses. The second source of data is two focus groups aimed at capturing communication problems from the perspective of intercultural mediators who accompany refugees to health facilities. The interview transcripts and FGs were analysed using six-stage thematic coding. RESULTS The survey identified five main themes related to barriers to communication: (1) language barriers and interpreting, (2) cultural barriers, (3) differing expectations of health and the healthcare systems in the Czech Republic and Ukraine, (4) prejudices and negative attitudes and unethical behaviour towards refugees and migrants and (5) lack of awareness of patient rights. CONCLUSIONS The arrival of large numbers of migrants has highlighted deficiencies in the system that may affect other vulnerable groups and the general population. These include the lack of general communication skills and legal awareness among many health professionals, which are barriers to the development of patient-centred care. The involvement of intercultural mediators fundamentally improves communication between health professionals and (not only) migrant patients. Nevertheless, it is necessary to legally anchor and define the position of intercultural mediators within the healthcare system. PATIENT OR PUBLIC CONTRIBUTION Collaboration with intercultural mediators who interpreted the extensive experiences of Ukrainian refugee patients and also have personal experience as migrant or migrant-origin patients contributed to shaping research questions, facilitating study participation and enriching evidence interpretation. Researchers with multicultural backgrounds and experience with working with people from refugee backgrounds were involved in the study design and analysis.
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Affiliation(s)
- Jolana Kopsa Těšinová
- Institute of Public Health and Medical Law, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karolína Dobiášová
- Institute of Public Health and Medical Law, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marie Jelínková
- Institute of Social Sciences, Faculty of Social Sciences, Charles University, Prague, Czech Republic
| | - Elena Tulupova
- Institute of Public Health and Medical Law, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Koščík
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Reda S, Weishaar H, Akhter S, Karo B, Martínez J, Singh A, Jackson C. Health service providers' views on barriers and drivers to childhood vaccination of FDMN/Rohingya refugees: a qualitative study in Cox's Bazar, Bangladesh. Front Public Health 2024; 12:1359082. [PMID: 39045160 PMCID: PMC11265221 DOI: 10.3389/fpubh.2024.1359082] [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: 01/04/2024] [Accepted: 05/29/2024] [Indexed: 07/25/2024] Open
Abstract
Background Despite established vaccination programs, vaccine-preventable diseases persist among about 900,000 Forcibly Displaced Myanmar Nationals (FDMN)/Rohingya refugees in the world's largest refugee settlement in Bangladesh. Health service providers (HSPs) play a key role in the delivery of childhood vaccination programs. This study explored their views on individual and context barriers and drivers to childhood vaccination in this setting. Methods Informed by the theoretical framework of the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavior change, this qualitative study collected data through eight focus group discussions (FGDs) with community health workers (CHWs) and vaccinators in selected camps with high or low vaccination coverage rates, and through 11 in-depth interviews (IDIs) with key informants working in strategic, management, and administrative roles. Findings Barriers and drivers were evident across all COM factors for HSPs and caregivers. Among HSPs, knowledge around vaccination acted both as a barrier and driver, while communication skills and confidence in vaccination served as drivers. Caregivers' lack of awareness of vaccination, concerns and mistrust were described as main barriers. Context barriers included information system deficiencies, family dynamics, HSPs' working conditions, and vaccination site accessibility. Context drivers included effective communication, mobilization, and incentives. Differences between high and low coverage camps in Cox's Bazar included variations in HSPs' knowledge, communication strategies, incentive use, and stakeholder collaboration. Discussion For better vaccination coverage in the camps, context-related changes regarding collaboration, health workforce and the use of incentives seem necessary. Caregivers' mistrust toward vaccination needs to be considered under the social and historical background of the Rohingya community, and further addressed with targeted communication and campaigning.
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Affiliation(s)
- Sarah Reda
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Heide Weishaar
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Sadika Akhter
- School of Health and Social Development, Deakin University, Burwood, VIC, Australia
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Basel Karo
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Jorge Martínez
- World Health Organization Emergency Sub-Office, Cox's Bazar, Bangladesh
| | - Aarti Singh
- World Health Organization Emergency Sub-Office, Cox's Bazar, Bangladesh
| | - Cath Jackson
- Valid Research Ltd, Wetherby, Leeds, United Kingdom
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Nenko I, Baranowska B, Szlendak B, Sahraoui N, Węgrzynowska M. "We were left to our own devices": Midwives' experiences of providing maternity care to Ukrainian women in Poland after the outbreak of the full-scale war in Ukraine. Women Birth 2024; 37:101629. [PMID: 38901366 DOI: 10.1016/j.wombi.2024.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/27/2024] [Accepted: 05/25/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND After the outbreak of the full-scale war in Ukraine, about 2 million people sought protection in Poland. Providing high-quality care for migrants and refugees, especially in times of significant arrivals, can be particularly challenging. AIM To learn about the experiences and strategies of midwives providing maternity care to Ukrainian migrant women in Poland after the outbreak of the full-scale war in Ukraine. METHODS Five focus group interviews with 32 midwives providing maternity care in Poland were conducted. The interviews were thematically analysed. RESULTS We identified the barriers experienced by midwives in providing high quality care to migrants to be mainly on the individual and interpersonal levels and levels of management and organization. First, at the individual and interpersonal level, we have identified: fear for life and well-being related to the threat of war in a neighbouring country, depleting resources and post-pandemic fatigue, language barriers, lack of knowledge on caring for women fleeing war. Second, at the management and organizational level we have identified: lack of organizational support, and interpreting services. In the first months after the outbreak of the full-scale war in Ukraine, most strategies to improve the provision of maternity care for women fleeing the war took the form of grassroots initiatives by the staff of individual care units. CONCLUSIONS The Polish health care services need systemic solutions prepared jointly by state and local authorities and taking into account the voices of midwives to support the provision of high-quality care to migrant population.
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Affiliation(s)
- Ilona Nenko
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Beata Szlendak
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Nina Sahraoui
- Centre for Sociological and Political Research, Paris, France
| | - Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland.
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Yeo S, Stewart HLN, Mohan R, Poudel-Tandukar K, Aldulaimi S, DiVito B, Alaofè H. "Nobody does checkups back there": A qualitative study of refugees' healthcare needs in the United States from stakeholders' perspectives. PLoS One 2024; 19:e0303907. [PMID: 38833462 PMCID: PMC11149854 DOI: 10.1371/journal.pone.0303907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/03/2024] [Indexed: 06/06/2024] Open
Abstract
The number of refugees globally grew to 35.3 million in 2022, and many refugees are exposed to various health risks along their migration journey. As a result, they may arrive in host communities with numerous health issues, including communicable diseases and chronic and mental health conditions. Navigating the healthcare system in a host country proves to be a significant challenge for them, leading to delayed care. This qualitative study explored the convolute healthcare needs of refugees in the United States by soliciting insights from stakeholders involved in refugee resettlement and healthcare. In-depth interviews were conducted with fifteen stakeholders who work closely with refugees, including healthcare providers, cultural/clinical health navigators supporting refugees, staff from refugee resettlement agencies and governmental entities, and researchers studying refugee health. Following informed consent, interviews were audio-recorded, transcribed verbatim, and imported into MAXQDA 2022 (VERBI Software) for thematic analysis. The results revealed key themes, including the heterogeneity of refugee populations, limited awareness of preventive healthcare, high prevalence and suboptimal management of chronic conditions, complexity of the healthcare system, lack of follow-up, and language barriers. Further research is warranted concerning the long-term health of refugee populations in the United States. Additionally, more tailored programs involving peer educators are recommended to support refugee communities in navigating the complex healthcare system in the host country.
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Affiliation(s)
- Sarah Yeo
- The University of Arizona Cancer Center, Tucson, Arizona, United States of America
| | - Hannah L. N. Stewart
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Ragha Mohan
- Department of Public Health Sciences, West Chester University of Pennsylvania, West Chester, Pennsylvania, United States of America
| | - Kalpana Poudel-Tandukar
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Sommer Aldulaimi
- Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Brittany DiVito
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, United States of America
| | - Halimatou Alaofè
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
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Borg TM, Solomon S, Alfarrouh R, Barazi W, Abu Sittah G, Sommerlad B, Ghanem A. Simulation Training Approach for Cleft Lip and Palate Repair in Low-Income Countries. Cleft Palate Craniofac J 2024; 61:706-711. [PMID: 36330704 DOI: 10.1177/10556656221136650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND During periods of civil strife, the need for trauma care and lack of sufficient cleft surgeons causes an increase in children left untreated with cleft lip and palate deformities. During the Syrian war, some cleft care was provided through visiting charities, with surgeries performed both in Syria and neighboring countries. There is a need to increase the number of adequately trained cleft surgeons available in such regions so that care can be achieved beyond mission trips. METHODOLOGY Cleft lip and palate repair workshops were delivered to 50 doctors in Syria. Pre-workshop, trainees received supplementary learning material. During the workshop, attendees received didactic teaching followed by 2 simulation sessions. Pre- and post-workshop, attendees completed questionnaires regarding their confidence and ability to perform cleft lip and palate repair. RESULTS Pre-workshop, 96% of workshop attendees had never independently performed cleft lip repair while 100% of attendees had not previously performed cleft palate repair. The mean pre-workshop confidence score was 2.452. Post-workshop, the mean confidence score was 3.503. Confidence rating scores significantly improved (P < .001). CONCLUSION The workshop delivered in Syria, together with this cleft lip and palate simulator provides an effective training tool that may support surgical training globally, particularly those in low-income countries. Further support is needed by charity organizations to ensure the continued delivery of such training.
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Affiliation(s)
- Tiffanie-Marie Borg
- Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Middlesbrough, UK
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Sara Solomon
- Department of Surgery, Queen's Hospital, Romford, London, UK
| | - Rik Alfarrouh
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Wael Barazi
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Ghassan Abu Sittah
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | | | - Ali Ghanem
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
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Hellerslia V, Caldas LM. From refugee to pharmacist: Insights for better care. CURRENTS IN PHARMACY TEACHING & LEARNING 2024; 16:202-206. [PMID: 38177018 DOI: 10.1016/j.cptl.2023.12.027] [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: 05/23/2023] [Revised: 11/30/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE This reflection utilizing Gibb's model offers insight into the lived experience of a Vietnamese child refugee who, many years later, found herself working as a pharmacist with Afghan refugees. DESCRIPTION Through this piece, the author describes her childhood experience with the United States (US) healthcare system as a refugee, her experience as a pharmacist caring for refugees, and explores her thoughts and feelings about the experience. ANALYSIS/INTERPRETATION The author evaluates the positive and negative aspects of the situation and analyzes the experience to make sense of the situation. CONCLUSIONS After reflecting on what she learned through her experience combined with findings in the literature, the author offers recommendations to pharmacists as they care for refugees, emphasizing the need for trauma-informed care for refugees with limited English language skills who are trying to navigate the complex US healthcare system. IMPLICATIONS This piece offers insights for pharmacists caring for refugees on how to offer better care.
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Affiliation(s)
- Van Hellerslia
- Temple University School of Pharmacy, 3307 North Broad Street, Philadelphia, PA 19001, United States.
| | - Lauren M Caldas
- Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States.
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Birtan D, Akpinar A. Ethical challenges in organ transplants for refugees in a healthcare system. Nurs Ethics 2024:9697330241230528. [PMID: 38321969 DOI: 10.1177/09697330241230528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Several ethical issues are associated with providing living organ transplantation services, and there is limited information on these issues faced by the teams providing service to refugees or asylum seekers. AIM To determine the challenges healthcare professionals face in organ transplant centers providing services to Syrians under temporary protection status and discern whether these difficulties align with ethical issues in living organ transplantation. RESEARCH DESIGN This study employed a qualitative design and conducted individual semi-structured, in-depth interviews with 18 transplant team members in Istanbul between September and November 2022. Data analysis was based on Braun and Clarke's thematic analysis. PARTICIPANTS AND RESEARCH CONTEXT The participants comprised 18 healthcare professionals, including 6 physicians and 12 nurses working in organ transplant teams in Istanbul. ETHICAL CONSIDERATIONS The University's Ethics Committee provided approval. Participants were informed regarding confidentiality and signed an informed consent form. RESULTS Three themes emerged from the data on ethical issues faced by organ transplantation services to Syrians: (a) beneficence or double equipoise, (b) autonomy, and (c) justice. Transplant teams experience problems related to preserving double equipoise in the provision of living donor organ transplantation because of language barriers, poor socioeconomic conditions, and cultural factors, which increases transplant teams' individual and indirect social burden. Although problems arise from the language barrier when obtaining informed consent in the autonomy theme, institutional and national policies in preventing donor abuse have a comforting effect. Health workers had the least problems with the justice theme, wherein national health policies are determined. CONCLUSION Fewer issues related to autonomy and justice were reported in providing organ transplantation services to Syrians, with the most intense reported issues being maintaining double equipoise. The results revealed the need to develop institutional, national, and international policies with individual solutions to prevent difficulties healthcare professionals face in this process.
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Affiliation(s)
- Deniz Birtan
- Kocaeli University
- İstanbul University-Cerrahpaşa
| | - Aslihan Akpinar
- Department of History of Medicine and Ethics, School of Medicine, Kocaeli University, Kocaeli
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Reboe-Benjamin M, Brindamour M, Leis K, Hanson J, Verity-Anderson L, Gomez M, Baerg M, Leis A. Refugees' Care Experiences, Self-Reported Health Outcomes and Transition to Mainstream Health Care After One Year at the Refugee Engagement and Community Health (REACH) Clinic. J Immigr Minor Health 2024; 26:101-109. [PMID: 37668808 PMCID: PMC10771348 DOI: 10.1007/s10903-023-01534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/06/2023]
Abstract
This study reports how refugees experienced care at an integrated clinic during their first year in Canada and how they transitioned to a community physician. A survey was completed by 75 Government Assisted Refugees followed at the REACH clinic between 2018 and 2020; 16 agreed to an additional interview. Regression modelling explored the relationship between "perceived health status at one year" and several independent variables. Qualitative thematic analysis provided context. Tailored access to care and enhanced communication through interpretation contributed to satisfaction with clinic services. A significant positive relationship was found between their perceived health status and frequency of visits (p < 0.042), and "doctors' advice about how to stay healthy" (p < 0.039). Interview findings highlighted the important role of settlement agencies, timing for a successful transition and physicians' support resources. While refugees benefit from attending integrated clinics, these should also prepare the care transition to community physicians. Targeted government funding and continued medical education could enhance refugees' transition experience.
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Affiliation(s)
- Monique Reboe-Benjamin
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Mahli Brindamour
- Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Refugee Engagement and Community Health (REACH) Clinic liaison the Saskatoon Community Clinic, Saskatoon, SK, Canada
| | - Karen Leis
- Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jacelyn Hanson
- Refugee Engagement and Community Health (REACH) Clinic liaison the Saskatoon Community Clinic, Saskatoon, SK, Canada
| | - Lori Verity-Anderson
- Refugee Engagement and Community Health (REACH) Clinic liaison the Saskatoon Community Clinic, Saskatoon, SK, Canada
| | - Maria Gomez
- Saskatoon Open Door Society, Saskatoon, SK, Canada
| | - Melanie Baerg
- Health & Case Coordination at Global Gathering Place, Saskatoon, SK, Canada
| | - Anne Leis
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
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Tafesse W, Jemutai J, Mayora C, Margini F. Scoping Review of Health Economics Research on Refugee Health in Sub-Saharan Africa. Value Health Reg Issues 2024; 39:98-106. [PMID: 38064761 DOI: 10.1016/j.vhri.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 09/15/2023] [Accepted: 10/27/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Most refugees and internally displaced people (IDP) stay in low- and middle-income settings. A substantial proportion are hosted by countries in sub-Saharan African (SSA), which puts significant pressure on limited government healthcare budgets. As health economics may guide more optimal healthcare decision making, we scope the health economics literature on forcibly displaced populations in SSA to identify the nature and range of health economics evidence. METHODS We conducted a scoping review of peer-reviewed and gray literature in English published from 2000 to 2021. Our search terms comprised a combination of keywords related to refugees, SSA, and health economics. We followed a stepwise methodology consisting of the identification and selection of studies, extraction and charting of data. RESULTS We identified 29 health economics studies on refugees and IDPs in SSA covering different providers, interventions, and delivery platforms. Twenty-one articles studied the determinants of health, followed by 5 on the supply of healthcare and 2 concerned with economic evaluation and the demand for healthcare, respectively. We found an equal division of articles focusing on refugees and IDPs, as well as by settlement type. Mental health was the most frequently studied health area and Uganda was the most studied destination country. CONCLUSIONS The health economics literature on refugees in SSA remains limited. Our scoping review encourages future research to study a larger variety of healthcare systems and health economic topics such as economic evaluations, health financing and whole health systems to support resource allocation decisions and sustainable long-term solutions.
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Affiliation(s)
- Wiktoria Tafesse
- Centre for Health Economics, University of York, York, England, UK.
| | | | - Chrispus Mayora
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Central Region, Kampala, Uganda
| | - Federica Margini
- UNICEF Tanzania Country Office, Kinondoni, Dar es Salaam, Tanzania
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Kaur K, Mutanda D, Almond P, Pandey A, Young P, Levitan T, Bibby-Jones AM. A co-produced service evaluation of ethnic minority community service user experiences of a specialist mental health service during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:1107. [PMID: 37848874 PMCID: PMC10583414 DOI: 10.1186/s12913-023-10115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND For ethnic minority communities in the UK, the COVID-19 pandemic amplified existing health inequalities and created other consequential disadvantages like increased vulnerability to COVID-19, higher rates of hospital admissions, increased mortality and poorer mental health outcomes. While longer-term impacts of COVID-19 are considered, it is crucial for NHS mental health services to understand the specific barriers and needs of ethnic minority communities to provide consistent and equitable access to mental health services. These aspects were the focus of a service evaluation of a Sussex-wide mental health service conducted in co-production with experts-by-experience, public members, health professionals and researchers from ethnic minority communities. METHODS Co-designed creative workshops (n = 13) and semi-structured qualitative interviews (n = 13) were used to explore experiences of accessing specialist mental health services during the COVID-19 pandemic. Participants were: Sussex Partnership NHS Foundation Trust (SPFT) service users recruited between October 2021 and January 2022; aged 16+; from ethnic minority community backgrounds. Data was analysed using Thematic Analysis. RESULTS The analysis yielded five overarching themes contextualising service users' experiences: (1) limited awareness of SPFT mental health services; (2) effects of COVID-19 in gaining access to SPFT; (3) SPFT reaching out to ethnic minorities; (4) being supported, 4a) hiding my mental health status from friends and families, 4b) lack of ethnic diversity in services, and 4c) better provision of information and support services, (5) relationship between childhood experiences and current mental health. These findings led to seven key recommendations for future service developments within SPFT. CONCLUSIONS Although this evaluation was set in the context of COVID-19, findings have highlighted specific mental health service needs for ethnic minorities that are applicable beyond the confines of the pandemic. Many benefited from online sessions seen as more inclusive. Mental health advocates, outreach and joint working with communities could help further reduce stigmatising attitudes and improve engagement with mental health services. Improved service awareness of the impact of childhood or historical traumas experienced by ethnic minority communities on current mental health, the role of cultural awareness training and availability of culturally adapted therapies is also needed. Many service improvement recommendations provided could impact all service users.
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Affiliation(s)
- Kiranpal Kaur
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | - Palo Almond
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | - Paris Young
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Tony Levitan
- Sussex Partnership NHS Foundation Trust, Worthing, UK
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Luig T, Ofosu NN, Chiu Y, Wang N, Omar N, Yip L, Aleba S, Maragang K, Ali M, Dormitorio I, Lee KK, Yeung RO, Campbell-Scherer D. Role of cultural brokering in advancing holistic primary care for diabetes and obesity: a participatory qualitative study. BMJ Open 2023; 13:e073318. [PMID: 37709303 PMCID: PMC10921915 DOI: 10.1136/bmjopen-2023-073318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Diabetes and obesity care for ethnocultural migrant communities is hampered by a lack of understanding of premigration and postmigration stressors and their impact on social and clinical determinants of health within unique cultural contexts. We sought to understand the role of cultural brokering in primary healthcare to enhance chronic disease care for ethnocultural migrant communities. DESIGN AND SETTING Participatory qualitative descriptive-interpretive study with the Multicultural Health Brokers Cooperative in a Canadian urban centre. Cultural brokers are linguistic and culturally diverse community health workers who bridge cultural distance, support relationships and understanding between providers and patients to improve care outcomes. From 2019 to 2021, we met 16 times to collaborate on research design, analysis and writing. PARTICIPANTS Purposive sampling of 10 cultural brokers representing eight different major local ethnocultural communities. Data include 10 in-depth interviews and two observation sessions analysed deductively and inductively to collaboratively construct themes. RESULTS Findings highlight six thematic domains illustrating how cultural brokering enhances holistic primary healthcare. Through family-based relational supports and a trauma-informed care, brokering supports provider-patient interactions. This is achieved through brokers' (1) embeddedness in community relationships with deep knowledge of culture and life realities of ethnocultural immigrant populations; (2) holistic, contextual knowledge; (3) navigation and support of access to care; (4) cultural interpretation to support health assessment and communication; (5) addressing psychosocial needs and social determinants of health and (6) dedication to follow-up and at-home management practices. CONCLUSIONS Cultural brokers can be key partners in the primary care team to support people living with diabetes and/or obesity from ethnocultural immigrant and refugee communities. They enhance and support provider-patient relationships and communication and respond to the complex psychosocial and economic barriers to improve health. Consideration of how to better enable and expand cultural brokering to support chronic disease management in primary care is warranted.
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Affiliation(s)
- Thea Luig
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Nicole N Ofosu
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Yvonne Chiu
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Nancy Wang
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Nasreen Omar
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Lydia Yip
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Sarah Aleba
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Kiki Maragang
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Mulki Ali
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Irene Dormitorio
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Karen K Lee
- Division of Preventive Medicine, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Roseanne O Yeung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Denise Campbell-Scherer
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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Nieto-Martínez R, De Oliveira-Gomes D, Gonzalez-Rivas JP, Al-Rousan T, Mechanick JI, Danaei G. Telehealth and cardiometabolic-based chronic disease: optimizing preventive care in forcibly displaced migrant populations. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:93. [PMID: 37667387 PMCID: PMC10478318 DOI: 10.1186/s41043-023-00418-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/15/2023] [Indexed: 09/06/2023]
Abstract
The number of migrants, which includes forcibly displaced refugees, asylum seekers, and undocumented persons, is increasing worldwide. The global migrant population is heterogeneous in terms of medical conditions and vulnerability resulting from non-optimal metabolic risk factors in the country of origin (e.g., abnormal adiposity, dysglycemia, hypertension, and dyslipidemia), adverse travel conditions and the resulting stress, poverty, and anxiety, and varying effects of acculturation and access to healthcare services in the country of destination. Therefore, many of these migrants develop a high risk for cardiovascular disease and face the significant challenge of overcoming economic and health system barriers to accessing quality healthcare. In the host countries, healthcare professionals experience difficulties providing care to migrants, including cultural and language barriers, and limited institutional capacities, especially for those with non-legal status. Telehealth is an effective strategy to mitigate cardiometabolic risk factors primarily by promoting healthy lifestyle changes and pharmacotherapeutic adjustments. In this descriptive review, the role of telehealth in preventing the development and progression of cardiometabolic disease is explored with a specific focus on type 2 diabetes and hypertension in forcibly displaced migrants. Until now, there are few studies showing that culturally adapted telehealth services can decrease the burden of T2D and HTN. Despite study limitations, telehealth outcomes are comparable to those of traditional health care with the advantages of having better accessibility for difficult-to-reach populations such as forcibly displaced migrants and reducing healthcare associated costs. More prospective studies implementing telemedicine strategies to treat cardiometabolic disease burden in migrant populations are needed.
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Affiliation(s)
- Ramfis Nieto-Martínez
- Precision Care Clinic Corp., Saint Cloud, FL, USA.
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela.
| | - Diana De Oliveira-Gomes
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Juan P Gonzalez-Rivas
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
- International Clinical Research Centre (ICRC), St Anne's University Hospital Brno (FNUSA), Brno, Czech Republic
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Jeffrey I Mechanick
- The Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Goodarz Danaei
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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Akca A, Ayaz-Alkaya S. Determinants of attitudes towards refugees and intercultural sensitivity of nursing students: A descriptive and correlational study. NURSE EDUCATION TODAY 2023; 124:105772. [PMID: 36889047 DOI: 10.1016/j.nedt.2023.105772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/09/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The number of refugees, asylum seekers, and migrants is increasing worldwide. It is crucial to determine attitudes and intercultural sensitivities of nursing students towards refugees and individuals from different cultures. These nursing students will be providing healthcare in the future to these diverse communities. OBJECTIVES To determine the attitudes towards refugees and intercultural sensitivity of nursing students and to identify the determinants of these parameters. DESIGN The study was conducted with a descriptive and correlational design. SETTINGS Nursing departments of two universities in Ankara, Turkey. PARTICIPANTS The population of the study consisted of nursing students at two universities (N = 1530). A total of 905 students were included in the study. METHODS Data were obtained by a personal information form, the Attitudes Towards Refugees Scale, and the Intercultural Sensitivity Scale. Linear regression analysis was used to analyze the data obtained from the scales. RESULTS The participants' mean Attitudes Towards Refugees Scale score was 82.49 ± 16.66 and the Intercultural Sensitivity Scale score was 91.31 ± 11.15. Caring for refugees, intercultural sensitivity, interaction engagement, and respect for cultural differences were associated with attitudes towards refugees. Academic level, income, place of residence, and attitude towards refugees were associated with intercultural sensitivity. CONCLUSIONS Most of the nursing students displayed a negative attitude towards refugees, although they presented a high level of intercultural sensitivity. Integration of refugee-related topics into the nursing education curriculum and designing education programs are recommended to increase awareness and positive attitudes, and to improve cultural competence of nursing students.
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Affiliation(s)
- Ayşegül Akca
- Ankara Yildirim Beyazit University, Faculty of Health Sciences, Nursing Department, Ankara, Turkey
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15
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Baskaran A, Marogi E, Bitar R, Attarian H, Saadi A. Improving Sleep Health Among Refugees: A Systematic Review. Neurol Clin Pract 2023; 13:e200139. [PMID: 36936393 PMCID: PMC10022726 DOI: 10.1212/cpj.0000000000200139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/05/2022] [Indexed: 03/15/2023]
Abstract
Purpose of Review Sleep disorders among refugees are common yet understudied. Interventions are difficult in resource-limited settings where most of these populations live. A systematic review of sleep disorders in refugee populations is warranted to identify prevalence, comorbidities, and the limitations of the current state of sleep health among refugees. Recent Findings Sleep disturbances, particularly insomnia and nightmares, occur with a higher prevalence among refugees. Diseases associated with insomnia in this population included fibromyalgia, posttraumatic stress disorder, depression, and anxiety. Risk factors include trauma, migration, lower socioeconomic status, lower educational level, and settlement in areas with a high influx of new residents or proximity to conflict. Only a few partially successful therapies were identified. Summary This review identifies the high prevalence of the disturbed sleep in this population and its risk factors. It proposes ways of increasing awareness of it in this vulnerable population as a first step toward remediation.
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Affiliation(s)
- Archit Baskaran
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
| | - Emily Marogi
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
| | - Ricardo Bitar
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
| | - Hrayr Attarian
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
| | - Altaf Saadi
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
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Kaseje N, Munezero FB. Handbook of Refugee Health: a timely guide to effective provision of refugee health services. BMJ 2023; 380:165. [PMID: 36720489 DOI: 10.1136/bmj.p165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Neema Kaseje
- Surgical Systems Research Group, Kisumu, Kenya
- Kigali Citizen Polyclinic, Kigali, Rwanda
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17
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Trauma Care for Forced Migrants. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2040050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Ever since World War II, forced migrations have increased exponentially, shaping our world, economies, and political discussions. When the United Nations formed the United Nations High Commissioner for Refugees (UNHCR) in 1950, it could not predict the escalation of forced migration from civil unrest, personal persecution, war, and recently, climate crises. As forced migrations increase, we must understand the emotional trauma involved, and how to mitigate it. This study examined how providers of refugee services understand, assess, and treat trauma in the forced migration population. This paper is based on qualitative data collected from social work providers who work with forced migrants. Transcribed interviews were analyzed through content analysis regarding assessment and treatment approaches. The findings show that the lack of trauma-informed care was prevalent among the participants. This was reflected in the participants’ experiences. Three main themes emerged: (1) trauma was misdiagnosed; (2) few were trained in evidence-based practices to manage trauma; and (3) providers felt isolated in their work as if working in silos. These themes and their implications are discussed.
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Abi Zeid Daou KR. Refugee mothers mental health and social support needs: A systematic review of interventions for refugee mothers. EUROPES JOURNAL OF PSYCHOLOGY 2022; 18:337-349. [PMID: 36348821 PMCID: PMC9632558 DOI: 10.5964/ejop.4665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/22/2021] [Indexed: 11/20/2022]
Abstract
Refugee mothers endure and are at risk for depression, post-traumatic stress, suicidality, and anxiety. There is a gap in the literature regarding interventions for refugee mothers’ mental health and well-being. Interventions involving refugee mothers rarely provide adequate support for refugee mothers’ specific mental health needs and challenges. This paper presents empirical evidence to contextualize the risks refugee mothers face, such as gender-based violence, mental health challenges, and language barriers. Then, the paper provides a critical systematic review of interventions conducted with refugee mothers. The critical systematic review suggests that creating and providing a safe space, being a linguistic liaison, community-building, and advocating for refugee mothers’ needs are emergent protective factors for refugee mothers. Finally, based on the review, recommendations for future interventions followed.
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Healthcare Management: A Bibliometric Analysis Based on the Citations of Research Articles Published between 1967 and 2020. Healthcare (Basel) 2022; 10:healthcare10030555. [PMID: 35327034 PMCID: PMC8954756 DOI: 10.3390/healthcare10030555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/21/2022] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study is to analyse the trends manifested in research literature from the field of healthcare management, with emphasis on bibliometric features and different influencing factors. For this, a search was conducted of nine academic databases between January and May 2021. Article features were registered in our database after first applying the validation criteria used for their inclusion. Then, data regarding the publication of the included articles were collected. The analysis focused on trends over time, topic, and journals in which they were published. Moreover, the effect of some factors on the citation of articles was analysed. Our results showed that the 250 analysed articles were published in 139 journals, and many of were by researchers affiliated with universities in the United States. Over time, the publication of analysed articles and their number of citations registered a continuous increase. The most common topics of focus were healthcare management systems and their challenges. In our study, we identified factors that significantly affect citation number, such as number of years since publication, the number of words in the title, and the number of authors of an article. In addition, major gaps were identified, as were new unresolved challenges that can trigger new research ideas.
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20
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Dubus N. Resiliency with Forced Migrants: A Qualitative Study of Providers and Forced Migrants through a ResiliencePerspective. Behav Sci (Basel) 2022; 12:bs12020027. [PMID: 35200279 PMCID: PMC8869212 DOI: 10.3390/bs12020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/31/2021] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
In the last ten years, the world has experienced unprecedented, forced migration due to civil unrest, political persecution, and the ever-growing climate crisis. This is a qualitative study of the professional experiences of social workers (n = 73) working with forced migrants (n = 34) and the lived experiences of forced migrants in several countries: Germany, Greece, Iceland, Mexico, Switzerland, and the United States. Social workers reported that most of their interventions involved short-term case management that focused on securing initial housing and healthcare. Cognitive Behavioral Therapy (CBT) was the primary intervention for behavioral health issues. The recipients of these services were appreciative of the pragmatic approach of case management as it helped them meet concrete needs. When resiliency enhancing interventions were used, recipients reported a greater sense of self-control, greater optimism for the future, and less anxious symptoms. The resiliency model used is discussed. This is a possible universal approach to working with forced migrants.
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Affiliation(s)
- Nicole Dubus
- School of Social Work, College of Health and Human Science, San Jose State University, San Jose, CA 95192, USA
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21
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Tan ST, Low PTA, Howard N, Yi H. Social capital in the prevention and management of non-communicable diseases among migrants and refugees: a systematic review and meta-ethnography. BMJ Glob Health 2021; 6:e006828. [PMID: 34952855 PMCID: PMC8710856 DOI: 10.1136/bmjgh-2021-006828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/05/2021] [Indexed: 12/31/2022] Open
Abstract
Globally, the burden of non-communicable diseases (NCDs) falls disproportionately on underserved populations. Migrants and refugees are particularly vulnerable due to economic instability and systemic poverty. Despite the myriad of health risks faced by migrants and refugees, access to appropriate healthcare is hindered by structural, cultural and socioeconomic barriers. We conducted a systematic review and meta-ethnography to obtain critical insight into how the interplay of social capital and structural factors (eg, state policies and socioeconomic disadvantage) influences the prevention and treatment of NCDs in migrant and refugee populations. We included 26 studies of 14 794 identified articles, which reported qualitative findings on the structure and functions of social capital in NCD prevention and management among migrants and refugees. We synthesised findings, using the process outlined by Noblit and Hare, which indicated that migrants and refugees experienced weakened social networks in postmigration settings. They faced multiple barriers in healthcare access and difficulty navigating healthcare systems perceived as complex. Family as the core of social capital appeared of mixed value in their NCD prevention and management, interacting with cultural dissonance and economic stress. Community organisations were integral in brokering healthcare access, especially for information diffusion and logistics. Healthcare providers, especially general practitioners, were important bridges providing service-user education and ensuring a full continuum of quality care. While social capital reduced immediate barriers in healthcare access for NCD prevention and management, it was insufficient to address structural barriers. System-level interventions appear necessary to achieve equitable healthcare access in host countries. PROSPERO registration number: CCRD42020167846.
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Affiliation(s)
- Sok Teng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Pei Ting Amanda Low
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Natasha Howard
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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22
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Adhikari M, Kaphle S, Dhakal Y, Duwadi S, Subedi R, Shakya S, Tamang S, Khadka M. Too long to wait: South Asian migrants' experiences of accessing health care in Australia. BMC Public Health 2021; 21:2107. [PMID: 34789215 PMCID: PMC8596381 DOI: 10.1186/s12889-021-12132-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migrants settling in a new country experience multiple complexities in navigating health care systems and adapting to a new way of life in the host country. In South Asia, migrating to another country for better life opportunities has been an ongoing trend and migration to Australia has significantly increased in recent years. Lower utilisation of health services and higher risks of chronic diseases among South Asian migrants poses a continuing challenge for the Australian health care system and little is known about why this demographic group does not access health services at the same rate. This study aimed to explore factors influencing access to health care by South Asian migrants in Australia. METHODS Using a mixed-method design, we conducted 62 online survey and 14 in-depth interviews with participants from four South Asian countries: Nepal, India, Bhutan, and Sri Lanka. Participants were recruited using a purposive snowball sampling approach following a standard ethical approval process. Survey data were analysed descriptively in SPSS and interview data were recorded, transcribed, and analysed thematically. RESULTS South Asian migrants experienced various complexities while accessing health services in Australia. The findings of this study highlighted a number of negative factors influencing their experiences of accessing health care: long waiting times for public health care, the expense of private health care, and communication problems due to socio-cultural differences. South Asian migrants also expressed their concern for a greater investment of resources into public health care to enable them to access quality and affordable care in these settings. CONCLUSIONS Given limited evidence available to help understand factors leading to the lower utilisation of health care and higher risks of chronic diseases among South Asian migrants, this study plays an important role in highlighting social, cultural, financial, and institutional factors that are critical to designing appropriate health-care strategies. This study recommends incorporating a collaborative and culturally competent model of care to increase access to health care and thereby help reduce existing disparities in health outcomes among South Asian migrant populations.
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Affiliation(s)
- Manju Adhikari
- LA GRANDEE International College, Pokhara Metropolitan City, Province 4 Nepal
| | | | - Yamuna Dhakal
- Central Queensland University, Melbourne, VIC Australia
| | - Sabina Duwadi
- Central Queensland University, Melbourne, VIC Australia
| | - Rajan Subedi
- Central Queensland University, Melbourne, VIC Australia
| | - Sonu Shakya
- Central Queensland University, Melbourne, VIC Australia
| | - Sunil Tamang
- Central Queensland University, Melbourne, VIC Australia
| | - Mukesh Khadka
- Central Queensland University, Melbourne, VIC Australia
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Ljunggren C, Carlson E, Isma GE. Drama with a focus on professional communication - A phenomenographic study. Nurse Educ Pract 2021; 52:103022. [PMID: 33721577 DOI: 10.1016/j.nepr.2021.103022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 02/12/2021] [Accepted: 03/02/2021] [Indexed: 10/22/2022]
Abstract
The nursing program is intended to prepare students for future occupational life. One role for nurses in the nursing occupation includes being prepared to communicate well in various patient situations. The aim of this study was to describe variations in nursing students' conceptions of a drama workshop to practically illustrate communication in nurses' work. This qualitative study was conducted at a university in southern Sweden. Interviews with 15 nursing students were conducted and the data were analyzed using a phenomenographic approach. Four descriptive categories were identified through the analysis: 'Conceptions in relation to the development of empathy', 'Conceptions in relation to "my" learning', 'Conceptions in relation to personal development of professional identity' and 'Conceptions in relation to the understanding of applying pedagogy through drama as a method'. This study illustrates that the use of drama in nursing education can increase nursing students' understanding of professional communication relating to the care of patients. To use drama as an educational method provides opportunities to develop nurses' professional identity and professional role. Moreover, drama can act as a teaching strategy that increases the understanding of theory through practical exercises.
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Affiliation(s)
- Cecilia Ljunggren
- Faculty of Health and Society, Department of Care Science, Malmo University, Sweden.
| | - Elisabeth Carlson
- Faculty of Health and Society, Department of Care Science, Malmo University, Sweden
| | - Gabriella E Isma
- Faculty of Health and Society, Department of Care Science, Malmo University, Sweden
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24
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The Impact of Middle Eastern Crisis on Cleft Care: Evaluation of Demographic and Perioperative Data in Syrian Refugees With Cleft Lip and Palate. J Craniofac Surg 2021; 31:1668-1671. [PMID: 32604304 DOI: 10.1097/scs.0000000000006649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The cleft lip and palate (CL/P) define a heterogeneous group of congenital deformities, which are morphologically highly diverse, with a complex and multifactorial etiology. Affected children may experience social problems due to negative effects on speech, hearing, facial appearance, as well as negative psychological effects on the parents. In 2011, after the civil war began in Syria, a great wave of immigration began to Turkey and other neighboring countries. Refugees may not be able to receive optimal health care because of cultural differences, socioeconomic status, language problems, and psychosocial problems. To increase awareness about this issue, the authors investigated the demographic, perioperative, and post-operative data of Syrian refugee patients with CL/P who were admitted to our cleft center between January 2016 and May 2019. Sixty-eight refugees with CL/P were detected as the result of the screening. Unlike the protocol the authors follow in our center, cleft lip repair was performed at an average of 7.6 months and cleft palate repair was performed at an average of 28.7 months of age. The rate of fistula was found 26.2%.The civil war in Syria has caused the repair of the patients with cleft lip and palate at a later age, hampered the follow-up and treatment, and caused more complications. Considering the demographic, social, economic and cultural characteristics of the patients, it was demonstrated that the necessary health precautions and infrastructure should be provided on the pillar of plastic surgery.
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25
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Gemignani M, Giliberto M. Constructions of burnout, identity, and self-care in professionals working toward the psychosocial care of refugees and asylum seekers in Italy. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2021. [DOI: 10.1080/10720537.2019.1700853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Marco Gemignani
- Department of Psychology, Universidad Loyola, Seville, Spain
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26
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Sweileh WM. Bibliometric analysis of scientific publications on "sustainable development goals" with emphasis on "good health and well-being" goal (2015-2019). Global Health 2020; 16:68. [PMID: 32723366 PMCID: PMC7385333 DOI: 10.1186/s12992-020-00602-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/23/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Global progress in the United Nations' Sustainable Development Goals (SDGs) requires significant national and international research efforts and collaboration. The current study aimed to provide policymakers, academics, and researchers with a snapshot of global SDGs-related research activity. METHOD This was a cross-sectional descriptive bibliometric study. SciVerse Scopus was used to retrieve SDGs-related research publications for the period from 2015 to 2019. RESULTS In total, 18,696 documents were found. The Sustainability journal ranked first (n = 1008; 5.4%) in the number of SDGs-related publications. The World Health Organization was the most active institution in publishing SDGs-related documents (n = 581; 1.3%). Most of the retrieved documents belonged to SDG 17 (partnership) followed by SDG 13 (climate action), and SDG 12 (responsible consumption and production), while SDG 7 (affordable and clean energy) had the least number of publications. The European region (n = 9756; 52.2%) had the highest research contribution while the Eastern Mediterranean region (n = 1052; 5.6%) had the least contribution. After exclusion of SDG 17, the SDG 3 (good health and well-being) was the top researched SDG for the African region, the Eastern Mediterranean regions, and the South-Eastern Asian region. For the region of the Americas, European region, and the Western Pacific region, the SDG 13 (climate action) was the most researched. The SDG 7 (affordable and clean energy) was the least researched in the African region, the region of the Americas, the European region, and the South-East Asian region. In the Eastern Mediterranean region, SDG 10 (reduced inequality) was the least researched while in the Western Pacific region, SDG 5 (gender inequality) was the least researched. The most researched targets of SDG 3 were targets 7 (sexual and reproductive health services) and 8 (universal health coverage) while the least researched targets were 5 (substance use disorders) and 9 (death from hazardous materials). International research collaboration within SDG 3 between high- and low-income countries was inadequate. CONCLUSION The analysis presented in the current study are useful for researchers, institutes, governments, funding agencies, and policy-makers. Countries in Africa, the Middle East, and South-East Asia need to increase their funding and research collaboration in the field of SDGs.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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Seagle EE, Dam AJ, Shah PP, Webster JL, Barrett DH, Ortmann LW, Cohen NJ, Marano NN. Research ethics and refugee health: a review of reported considerations and applications in published refugee health literature, 2015-2018. Confl Health 2020; 14:39. [PMID: 32577125 PMCID: PMC7305588 DOI: 10.1186/s13031-020-00283-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/02/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Public health investigations, including research, in refugee populations are necessary to inform evidence-based interventions and care. The unique challenges refugees face (displacement, limited political protections, economic hardship) can make them especially vulnerable to harm, burden, or undue influence. Acute survival needs, fear of stigma or persecution, and history of trauma may present challenges to ensuring meaningful informed consent and establishing trust. We examined the recently published literature to understand the application of ethics principles in investigations involving refugees. Methods We conducted a preliminary review of refugee health literature (research and non-research data collections) published from 2015 through 2018 available in PubMed. Article inclusion criteria were: participants were refugees, topic was health-related, and methods used primary data collection. Information regarding type of investigation, methods, and reported ethics considerations was abstracted. Results We examined 288 articles. Results indicated 33% of investigations were conducted before resettlement, during the displacement period (68% of these were in refugee camps). Common topics included mental health (48%) and healthcare access (8%). The majority (87%) of investigations obtained consent. Incentives were provided less frequently (23%). Most authors discussed the ways in which community stakeholders were engaged (91%), yet few noted whether refugee representatives had an opportunity to review investigational protocols (8%). Cultural considerations were generally limited to gender and religious norms, and 13% mentioned providing some form of post-investigation support. Conclusions Our analysis is a preliminary assessment of the application of ethics principles reported within the recently published refugee health literature. From this analysis, we have proposed a list of best practices, which include stakeholder engagement, respect for cultural norms, and post-study support. Investigations conducted among refugees require additional diligence to ensure respect for and welfare of the participants. Development of a refugee-specific ethics framework with ethics and refugee health experts that addresses the need for stakeholder involvement, appropriate incentive use, protocol review, and considerations of cultural practices may help guide future investigations in this population.
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Affiliation(s)
- Emma E Seagle
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, MS EO3, Atlanta, GA 30333 USA.,CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, Georgia USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee USA
| | - Amanda J Dam
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, MS EO3, Atlanta, GA 30333 USA.,Eagle Global Scientific, LLC, Atlanta, Georgia USA
| | - Priti P Shah
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, MS EO3, Atlanta, GA 30333 USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee USA
| | - Jessica L Webster
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, MS EO3, Atlanta, GA 30333 USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee USA
| | - Drue H Barrett
- Office of Scientific Integrity, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Leonard W Ortmann
- Office of Scientific Integrity, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Nicole J Cohen
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, MS EO3, Atlanta, GA 30333 USA
| | - Nina N Marano
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, MS EO3, Atlanta, GA 30333 USA
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