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McKeon G, Curtis J, Rostami R, Sroba M, Farello A, Morell R, Steel Z, Harris M, Silove D, Parmenter B, Matthews E, Jamaluddin J, Rosenbaum S. Co-designing a Physical Activity Service for Refugees and Asylum Seekers Using an Experience-Based Co-design Framework. J Immigr Minor Health 2024; 26:674-688. [PMID: 38605213 PMCID: PMC11289061 DOI: 10.1007/s10903-024-01587-5] [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] [Accepted: 02/17/2024] [Indexed: 04/13/2024]
Abstract
People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or 'touchpoints' including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing.
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Affiliation(s)
- Grace McKeon
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia.
- School of Population Health, University of New South Wales, Sydney, Australia.
| | - Jackie Curtis
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | - Reza Rostami
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Monika Sroba
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | | | - Rachel Morell
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | - Zachary Steel
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- St. John of God Health Care North Richmond Hospital, North Richmond, NSW, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Derrick Silove
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Belinda Parmenter
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Evan Matthews
- Centre for Health Behaviour Research South East Technological University, Waterford, Ireland
| | | | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
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Bauer L, Wienke A, Führer A. Compassionate Othering: the construction of refugee patients in medical students' narratives - a qualitative study using story completion. BMC MEDICAL EDUCATION 2024; 24:703. [PMID: 38937730 PMCID: PMC11212417 DOI: 10.1186/s12909-024-05684-9] [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: 08/17/2023] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Refugees remain a marginalized population and are exposed to a variety of discriminatory processes, among them Othering which categorizes people as belonging or not-belonging according to certain ascribed characteristics. We explored how the narrative construction of refugee patients by medical students constitutes a form of Othering. METHODS Using story completion, 124 5th year medical students at the Martin- Luther- University Halle-Wittenberg in October 2019 wrote a fictional story in response to a story stem situated in a medical practice. In a comparative approach, one patient presenting with abdominal pain lacks further characterization (version A) and the other is a refugee (version B). The stories were coded using qualitative content analysis by Mayring with a focus on content and narrative strategies (plot structure and perspective). RESULTS We identified four themes: characters, medical condition, access to care and provision of substandard care. The stories were predominantly framed with a medical or an interaction-based plot structure and written from a process-oriented perspective. The themes in version B, supported by their use of narrative strategies, were largely contextualized within the patients' history of migration. An empathic depiction of patient B and the students' compassion for the patients facing substandard care were key motifs as well. CONCLUSION The perception of the version B patients predominantly as refugees establishes their construction as an Other. The students' compassion acts as a representation of societal inequalities and remains an inept response without the tools to counter underlying discriminatory structures. Based on a discourse of deservingness, compassion alone therefore perpetuates Othering and highlights the need for structural competency training in medical school.
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Affiliation(s)
- Lena Bauer
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
| | - Andreas Wienke
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Amand Führer
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
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Bacher J, Stadler C, Unternaehrer E, Brunner D. Testing the effectiveness of the culturally adapted skills training START NOW to reduce mental health problems in adolescent refugees: study protocol for a randomized controlled trial. Front Public Health 2024; 12:1408026. [PMID: 38919921 PMCID: PMC11196762 DOI: 10.3389/fpubh.2024.1408026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/30/2024] [Indexed: 06/27/2024] Open
Abstract
Background Adolescent refugees are particularly vulnerable to mental health problems, as they experience many risk factors associated with their resettlement at crucial stages of their physical and emotional development. However, despite having a greater healthcare needs than others, they face significant barriers to accessing healthcare services. Therefore, this study aims to test the effectiveness of a low-threshold, culturally adapted version of the skills training START NOW - START NOW Adapted - in reducing mental health problems among adolescent refugees. Methods We will recruit 80 adolescent refugees (15-18 years) with symptoms of anxiety and depression or high perceived stress in Northwestern Switzerland. They will be randomly assigned to one of two study groups: an intervention group, receiving START NOW Adapted, and a control group, receiving treatment as usual (TAU). The intervention will last 10 weeks and will consist of one-hour sessions per week provided by a trained facilitator with the same cultural background, in the respective language. Assessments to collect depressive and anxious symptoms, perceived stress, social-ecological resilience, and emotion recognition abilities will be conducted pre-intervention, post-intervention (11 weeks later) and at the 3-month follow-up. Multilevel models will be computed with primary and secondary outcome measures as dependent variables. An effect of at least moderate size will be considered clinically relevant. Discussion This randomized controlled trial aims to investigate the effectiveness of a culturally adapted version of START NOW, providing valuable insights to improve current health promotion for adolescent refugees in Switzerland (or rather lack thereof). Ultimately, the effects of START NOW may facilitate integration and promote healthy development while decreasing costs associated with treating migration- or conflict-related trauma.Clinical trial registration: ClinicalTrials.gov, identifier: NCT06324864.
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Affiliation(s)
- Janine Bacher
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Basel, Switzerland
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Costello RS, Downing MG, Ponsford J. The experience of traumatic brain injury in a culturally and linguistically diverse sample in Australia. Disabil Rehabil 2024; 46:2069-2078. [PMID: 37237438 DOI: 10.1080/09638288.2023.2216473] [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: 07/05/2022] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE Individuals from culturally and linguistically diverse (CALD) backgrounds experience poorer outcomes following traumatic brain injury (TBI), including poorer quality of life. The reasons for these poorer outcomes are unclear. Therefore, this study aimed to qualitatively investigate the experience of injury, rehabilitation, and recovery amongst individuals from a CALD background following TBI. MATERIALS AND METHODS Fifteen semi-structured interviews were conducted, and qualitatively analysed using reflexive thematic analysis. RESULTS It was demonstrated that: (a) the cognitive and behavioural consequences of TBI were accompanied by stigma and loss of independence; (b) participants held many beliefs related to their TBI, ranging from bad luck to acceptance. Participants' personal values and beliefs provided strength and resilience, with many viewing the injury as a positive event in their lives; (c) participants were appreciative of the high standard of care they received in hospital and rehabilitation, although communication barriers were experienced; (d) many participants identified with Australian culture, and few believed their cultural background negatively impacted their experience of TBI; (e) external support, particularly from family, was considered central to recovery. CONCLUSION These findings offer insight into the challenges CALD individuals face and factors that may facilitate their recovery and improve functional outcomes.
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Affiliation(s)
- Reannon S Costello
- Monash Epworth Rehabilitation Research Centre (MERRC) and School of Psychological Sciences, Monash University, Australia
| | - Marina G Downing
- Monash Epworth Rehabilitation Research Centre (MERRC) and School of Psychological Sciences, Monash University, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | - Jennie Ponsford
- Monash Epworth Rehabilitation Research Centre (MERRC) and School of Psychological Sciences, Monash University, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
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Im H, George N, Swan LET. Gendered Health Outcome Among Somali Refugee Youth in Displacement: A Role of Social Support and Religious Belief. J Immigr Minor Health 2024; 26:341-350. [PMID: 37733168 DOI: 10.1007/s10903-023-01546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
This study examines the factors influencing physical health status, specifically focusing on the gender differences in risk and promotive factors affecting health outcomes among Somali refugee youth displaced in Nairobi, Kenya (n = 227). A survey was used to assess participants' physical health along with psychosocial factors, somatic symptoms, and demographic characteristics. The study shows that religious belief and somatic symptoms among the total sample were significant predictors in influencing the outcome of physical health. A moderated mediation analysis and logistic regression analyses also revealed gender differences in associated factors as well as health status; female participants reported higher somatic symptoms, associated with a decline in physical health, whereas the protective effect of social support and religious belief promote was found only among male counterparts. Future studies and interventions would be benefited from a gender-specific approach to health promotion and coping mechanisms in this population.
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Affiliation(s)
- Hyojin Im
- Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, USA.
| | - Nicole George
- Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, USA
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, USA
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Coumans JVF, Wark S. A scoping review on the barriers to and facilitators of health services utilisation related to refugee settlement in regional or rural areas of the host country. BMC Public Health 2024; 24:199. [PMID: 38229057 PMCID: PMC10792843 DOI: 10.1186/s12889-024-17694-9] [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: 08/29/2023] [Accepted: 01/07/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Healthcare access and equity are human rights. Worldwide conflicts, violence, and persecution have increased the number of people from refugee or refugee-like backgrounds. Because urban areas are already densely populated, governments have aimed to increase refugee resettlement in rural and/or regional areas. Because of the complex healthcare needs of refugees, this creates challenges for healthcare service providers. Identifying barriers to accessing healthcare in rural areas is therefore important to better inform policy settings and programmes that will provide culturally appropriate patient-centred care to the refugee community. METHODS This review scoped 22 papers written in English between 2018 and July 2023 from five countries (Australia, New Zealand, Germany, Bangladesh, and Lebanon) in order to provide an overview of the barriers and possible solutions to facilitate refugees' access to healthcare. RESULTS The reviewed literature summarised the perceptions of at least 3,561 different refugees and 259 rural health service providers and/or administrators and identified major challenges. These include communication (illiteracy in the resettlement country language and lack of a suitable interpreter), lack of cultural awareness of health services, discrimination, and access difficulties (transportation, availability of health specialist services, cost). As a consequence, it was identified that improving access to affordable housing, employment through credential recognition, competence-level education for children, facilitating language training, and adapting health information would increase resettlement and encourage access to healthcare. CONCLUSIONS Refugees face significant barriers to accessing and engaging with healthcare services. This impacts their integration into rural communities and increases the prevalence of psychosocial issues like feelings of loneliness, low self-esteem, a lack of autonomy, and a lack of empowerment over informed decision-making, especially for women, jobless men, and the elderly. These findings support the need for additional support for refugees and healthcare providers to improve language proficiency and cultural competency. Policymakers need to improve the availability and accessibility of employment, housing accessibility, and service mobility. Additionally, more research is needed to assess the efficacy of emerging innovative programmes that aim to close the gap by delivering culturally appropriate patient-centred care to refugee communities in rural areas.
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Affiliation(s)
- J V F Coumans
- School of Rural Medicine, University of New England, Armidale, NSW, 2351, Australia.
| | - S Wark
- School of Rural Medicine, University of New England, Armidale, NSW, 2351, Australia
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Crankshaw TL, Freedman J, Mutambara VM, Rajah Y. "I still don't know how someone gets pregnant": determinants of poor reproductive health among young female refugees in South Africa. BMC Womens Health 2024; 24:10. [PMID: 38172790 PMCID: PMC10765558 DOI: 10.1186/s12905-023-02847-6] [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: 07/14/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Studies exploring the sexual and reproductive health (SRH) of refugee women have focused primarily on first generation refugees in humanitarian and crisis settings. There is a paucity of research exploring the reproductive health of girls and young women who are born to refugee parents in a host country or who have migrated with their parents at a very young age and who have since reached sexual maturity. We conducted a qualitative study which aimed to explore the reproductive health and rights' needs and challenges amongst young refugee women in South Africa. METHODS The study was carried out in the city of eThekwini (Durban) in South Africa in 2021 and 2022. A total of 35 semi-structured, in person interviews were conducted amongst young refugee women between the ages of 18 and 24 years living in the city centre. RESULTS Twenty-five participants were 17 years or younger on arriving in South Africa, one of whom was born in South Africa. Eleven of these women had experienced one or more pregnancies while living in South Africa and all of these women had experienced at least one unintended pregnancy. Participants had poor reproductive health knowledge of the role of menstruation and how conception occurs. Economic, social, and legal insecurities intersected in complex ways as determinants of poor reproductive health outcomes. Despite availability, contraceptive use was poor and linked to lack of knowledge, myths and unwanted side effects. There were negative economic and social impacts for young refugee women experiencing early pregnancies irrespective of whether they were intended or not. Being unable to conceive or experiencing an unintended pregnancy negatively impacted sexual relationships which were entered primarily for material support. Desire for confidentiality shaped lack of access to legal termination of pregnancy in the public health sector. CONCLUSION Participants experienced specific vulnerabilities resulting from their position as refugees despite length of stay in South Africa. It is important to better understand these specificities in the design of programmes and policies aimed at ensuring positive health outcomes for these young women. Peer education amongst refugee communities may be an important tool in the provision of culturally acceptable SRH education.
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Affiliation(s)
- Tamaryn L Crankshaw
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
| | - Jane Freedman
- Centre for Sociological and Political Research (CRESPPA), Université Paris 8, Paris, France
| | - Victoria M Mutambara
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
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Fitzharris L, McGowan E, Broderick J. Barriers and facilitators to refugees and asylum seekers accessing non hospital based care: A mixed methods systematic review protocol. HRB Open Res 2023; 6:15. [PMID: 38606304 PMCID: PMC11007367 DOI: 10.12688/hrbopenres.13671.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 04/13/2024] Open
Abstract
Context Social exclusion is characterised by and represents a form of disadvantage and marginalisation of vulnerable groups of people in society, who cannot fully participate in the normal activities of daily living. People who are socially excluded such as asylum seekers and refugees have complex healthcare needs and tend to present more to the acute hospital setting as emergency presentations. Little is known about barriers and facilitators experienced by this group to accessing nonhospital based care. Objectives This mixed methods systematic review, will critically examine the concept of barriers and facilitators for refugees and asylum seekers to accessing non hospital based care. Methods This methodological review will follow the Joanna Briggs Institute guidance for conducting mixed methods reviews. The following databases will be searched: Central Medline, PubMed, Embase, CINAHL, and the Cochrane Library. Relevant grey literature will be included. Title and abstract screening, followed by full-text screening will be undertaken independently by two reviewers. The Joanna Briggs Institute extraction tool will be adapted for data extraction. Discussion This mixed method review will comprehensively evaluate quantitative and qualitative data, synthesise both barriers and facilitators and follow a systematic approach through establishing use of mixed methods research across asylum seekers and refugees, and how they affect accessing non-hospital based care. It will explore conceptual models of access to healthcare and how they influence these factors.
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Affiliation(s)
- Laura Fitzharris
- School of Medicine, Trinity Centre for Health Sciences, St. James Hospital, Dublin, D08W9RT, Ireland
| | - Emer McGowan
- School of Medicine, Trinity Centre for Health Sciences, St. James Hospital, Dublin, D08W9RT, Ireland
| | - Julie Broderick
- School of Medicine, Trinity Centre for Health Sciences, St. James Hospital, Dublin, D08W9RT, Ireland
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Moon SH, Kim M. Multiple mediation effect of coping styles and self-esteem in the relationship between spousal support and pregnancy stress of married immigrant pregnant women. PeerJ 2023; 11:e16295. [PMID: 37941934 PMCID: PMC10629385 DOI: 10.7717/peerj.16295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/23/2023] [Indexed: 11/10/2023] Open
Abstract
Background The purpose of this study was to identify the total, direct, and indirect influence of spousal support on pregnancy stress among married immigrant pregnant women. The study aimed to determine the relative magnitudes of specific mediating effects of coping styles and self-esteem. Method A cross-sectional correlational survey was conducted in Jeonnam with 206 married immigrant pregnant women. Data were collected from September 7 to November 7 in 2019. A self-report questionnaire was used to measure spousal support, pregnancy stress, coping styles, and self-esteem. The study employed a linear multiple regression analysis to examine the potential multi-mediating effects. The effect size was set at 0.15, the significance level at 0.05, and the power at 0.95. Through the analysis, the researchers explored the mediating mechanisms among the variables and identified the presence of multi-mediating effects. Results The effect sizes (b) and statistical significance (p) for the predictors were as follows: problem-focused coping (b = 0.13, p = 0.001), emotion-focused coping (b = 0.11, p = 0.004), and self-esteem (b = 0.10, p < 0.001). Emotion-focused coping (b = 0.26, p = 0.001) and self-esteem (b = -0.20, p = 0.035) had a significant impact on pregnancy stress. The total effect of spousal support on pregnancy stress was significant at -0.25 (p < 0.001), and the direct effect was also significant at -0.26 (p < 0.001). We observed significant mediating effects for emotion-focused coping and self-esteem. Conclusions As a result of this study, the self-esteem of married immigrant pregnant women can have a protective effect by preventing the aggravation of pregnancy stress in the relationship between spousal support and pregnancy stress. Meanwhile, the emotion-focused coping style can balance out the effect of self-esteem. Therefore, in order to alleviate the stress of pregnancy for women, it is necessary to provide intervention to help improve self-esteem with spousal support. In addition, nursing professionals should help them use appropriate coping styles.
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Affiliation(s)
- So-hyun Moon
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Miok Kim
- Department of Nursing, College of Nursing, Dankook University, Cheonan, Chungnam, Republic of Korea
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Mengesha Z, Weber D, Smith M, Harris P, Haigh F. 'Fragmented care': Asylum seekers' experience of accessing health care in NSW. Health Promot Int 2023; 38:daad123. [PMID: 37864803 DOI: 10.1093/heapro/daad123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023] Open
Abstract
Medicare is central to accessing health care in Australia, yet many asylum seekers are ineligible for this scheme. In NSW, Medicare ineligible asylum seekers have some access to public health care under the Medicare Ineligible Asylum Seekers - Provision of Specified Public Health Services policy. This policy was updated in November 2020 to clarify services where a fee waiver applies for asylum seekers without Medicare. We examined the experiences of Medicare ineligible asylum seekers in accessing health care in New South Wales (NSW) in light of the revised policy. Employing qualitative methods, we conducted semi-structured interviews with asylum seekers (n = 7) and service providers (n = 6) in South Western Sydney. The interviews were analysed using thematic analysis and the socio-ecological model was used to interpret the data. Participants identified that chronic and mental health conditions are the main health issues for asylum seekers. Factors across the four levels of the socio-ecological model were identified as influencing the health care of asylum seekers, including a lack of awareness about health care rights at the individual level, support from relatives and friends at the interpersonal level, providers' lack of awareness of fee waivers at the organizational level and limited access to primary health care at the policy level. The results imply that Medicare ineligible asylum seekers in NSW do not have optimal access to health care which may worsen existing health disparities. Educational initiatives that improve service providers' and asylum seekers' awareness of the revised policy are needed to improve asylum seeker health equity in NSW.
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Affiliation(s)
- Zelalem Mengesha
- Centre for Health Equity Training, Research & Evaluation (CHETRE); UNSW Australia Research Centre for Primary Health Care & Equity; A Unit of Population Health; member of the Ingham Institute, Sydney, NSW, Australia
| | - Danielle Weber
- NSW Refugee Health Service, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Mitchell Smith
- NSW Refugee Health Service, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Patrick Harris
- Centre for Health Equity Training, Research & Evaluation (CHETRE); UNSW Australia Research Centre for Primary Health Care & Equity; A Unit of Population Health; member of the Ingham Institute, Sydney, NSW, Australia
| | - Fiona Haigh
- Health Equity Research Development Unit, UNSW Sydney; A unit of Clinical Services Integration and Population Health, Sydney Local Health District, Sydney, NSW, Australia
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James PB, Gatwiri K, Mwanri L, Wardle J. Impacts of COVID-19 on African Migrants' Wellbeing, and Their Coping Strategies in Urban and Regional New South Wales, Australia: a Qualitative Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01806-z. [PMID: 37768537 DOI: 10.1007/s40615-023-01806-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
AIM As the COVID-19 pandemic response continues to evolve, the need to protect more vulnerable populations in society becomes more apparent. Studies are still emerging on how different population groups have been impacted by the COVID-19 pandemic. Our study explored the impact of COVID-19 for African migrants in New South Wales, Australia, and their coping strategies. METHODS We employed inductive, exploratory qualitative interpretive research design using individual semi-structured in-depth interviews with 21 African migrants. RESULTS COVID-19 lockdowns disrupted the African sense of community. Social isolation, financial insecurity due to joblessness, or reduced working hours led to stress, frustration, anxiety, sadness, loneliness, and depression. On the other hand, COVID-19 lockdowns allowed for more family time, reflecting, and appreciating the gift of life and personal intellectual growth. Despite such challenges, there was much community support, especially from religious organisations. Support from government agencies was available, but access was hampered by misinformation, digital literacy, and immigration status. Holding on to religion and faith was a key coping mechanism, followed by indulging in self-care practices such as healthy eating, exercise, Yoga, meditation, sleep, and limited interaction with social media. CONCLUSION The COVID-19 lockdown disrupted the collectivist culture of African migrants and had untoward socioeconomic impacts that affected their wellbeing, many of which reflect an exacerbation of pre-existing inequities. To ensure that African migrant COVID-19-related health and wellbeing needs are met, the African migrant community must be actively involved in every facet of the NSW COVID-19 and other future outbreak response efforts.
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Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, 2480, Australia.
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Kathomi Gatwiri
- Centre for Children & Young People, Faculty of Health, Southern Cross University, Gold Coast, Australia
| | - Lillian Mwanri
- Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, 5000, Australia
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, 2480, Australia
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Doherty P, Wheeler E, Mochache V, Mark TJ, Luttah G, Bero B, Clancy E, Cockroft M, Omar A, Robins G, Penrose-Theis K, Todd A. Considerations for Program Managers to Improve Sexual and Reproductive Health Services for Displaced Populations. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300036. [PMID: 37640482 PMCID: PMC10461700 DOI: 10.9745/ghsp-d-23-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/25/2023] [Indexed: 08/31/2023]
Abstract
Delivering sexual and reproductive health services to migrating and displaced populations is complex. The authors provide 4 recommendations drawing on their experience across Africa and Asia.
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Affiliation(s)
| | - Erin Wheeler
- International Rescue Committee, New York, NY, USA
| | | | - Taban John Mark
- International Planned Parenthood Federation, Juba, South Sudan
| | | | | | - Ellen Clancy
- MSI Reproductive Choices, London, United Kingdom
| | | | - Ahmed Omar
- Options Consultancy Services, Nairobi, Kenya
| | - Ginny Robins
- MSI Reproductive Choices, London, United Kingdom
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Marchetti F, Preziosi J, Zambri F, Tambascia G, Di Nolfi A, Scardetta P, Splendore F, Colaceci S, Coia M, Caredda E, Masi L, De Luca V, Perra A, Giusti A. Health needs and perception of health care quality among Asylum Seekers and Refugees in an Italian local health authority: A qualitative study. Front Public Health 2023; 11:1125125. [PMID: 37124798 PMCID: PMC10130403 DOI: 10.3389/fpubh.2023.1125125] [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: 12/15/2022] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Abstract
Background Migrants, Asylum Seekers and Refugees (ASRs) represent a vulnerable diversified population with increased risks of developing health problems, and in the hosting countries several barriers often hamper their access to the health services. Gathering information about ASRs' experiences and perceptions of host country health care systems may contribute to improve the quality of health care provided. The aim of this study was to explore the health needs in their bio-psycho-social meaning, and the quality of health care as perceived from the ASRs' perspective. Methods The qualitative descriptive study was conducted as part of the Project "G-START - testing a governance model of receiving and taking care of the Asylum Seekers and Refugees." Through purposeful and snowball sampling, four Focus Groups conducted in English, Italian and French were carried out between July and August 2019, involving 50 ASRs hosted by four reception centers located on the territory pertaining to an Italian Local Health Authority covering a general population of 500.000 people. The analysis of data was categorical, and was performed using N-Vivo software. Results The macro-categories emerged were the ASRs' bio-psycho-social health needs, including mental health, sexual and reproductive health, food and nutrition, knowledge of the health care system, need for inclusion; healthcare services access, including barriers before and after the access and the ability of the local health system to respond to existing and evolving demands; strengths of the healthcare and reception systems, and suggestions for improving them in the future. Discussion and conclusions ASRs present vulnerabilities and specific health needs, and the health care system is not always able to guarantee access or to respond to these needs. Several obstacles have been highlighted, such as linguistic barriers and lack of cultural mediation, bureaucratic and administrative barriers, lack of knowledge of the Italian health care system. An effective reorganization of services driven by a more detailed output analysis of the target population needs, together with the use of cultural mediation, peer to peer education and support, and the training of health professionals are recommended to ensure a more accessible, equitable and effective health care system at local level.
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Affiliation(s)
- Francesca Marchetti
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Jessica Preziosi
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Francesca Zambri
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Gabriella Tambascia
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Annachiara Di Nolfi
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Paola Scardetta
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Flavia Splendore
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Sofia Colaceci
- Saint Camillus International University of Health and Medical Sciences (UniCamillus), Rome, Italy
| | - Maura Coia
- Department of Prevention, Local Health Authority “Roma 5”, Rome, Italy
| | - Emanuele Caredda
- Department of Prevention, Local Health Authority “Roma 5”, Rome, Italy
- General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | - Loredana Masi
- Maternal and Child Department, Local Health Authority “Roma 5”, Rome, Italy
| | - Vittorio De Luca
- Department of Mental Health and Addiction, Local Health Authority “Roma 5”, Rome, Italy
| | - Alberto Perra
- Department of Prevention, Local Health Authority “Roma 5”, Rome, Italy
| | - Angela Giusti
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
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14
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Poza-Méndez M, Bas-Sarmiento P, Erahmouni I, Fernández-Gutiérrez M. Assessment of health literacy among migrant populations in Southern Spain: A cross-sectional study. Nurs Open 2023; 10:2600-2610. [PMID: 36480226 PMCID: PMC10006600 DOI: 10.1002/nop2.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022] Open
Abstract
AIM The aim of this study was to measure of health literacy in the migrant population and establish a type of immigrant profile with a higher risk of presenting low levels of health literacy. DESIGN A cross-sectional descriptive study. METHODS Health literacy was measured in a total of 278 immigrants using HLS-EU-Q16. An inferential descriptive and multiple regression analysis was carried out. RESULTS 65.1% having inadequate and problematic health literacy. Significant correlations were found between health literacy and length of stay in Spain (r = .398), age (r = .178p) and perceived social status (r = .151). Participants with shorter length of stay (β = .405 1), without health sciences education (β = .205) and low education level (β = .182) had limited health literacy.
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Affiliation(s)
- Miriam Poza-Méndez
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain
| | - Pilar Bas-Sarmiento
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz, INIBICA, Cádiz, Spain.,The University Research Institute for Sustainable Social Development (INDESS), Cádiz, Spain
| | | | - Martina Fernández-Gutiérrez
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz, INIBICA, Cádiz, Spain.,The University Research Institute for Sustainable Social Development (INDESS), Cádiz, Spain
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15
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Saunders SL, Sutcliffe KL, McOrist NS, Levett KM. The associations between women who are immigrants, refugees, or asylum seekers, access to universal healthcare, and the timely uptake of antenatal care: A systematic review. Aust N Z J Obstet Gynaecol 2023; 63:134-145. [PMID: 36480342 DOI: 10.1111/ajo.13632] [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: 09/02/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends that antenatal care (ANC) commence before 12 weeks' gestation to reduce the risk of obstetric and perinatal complications. Immigrants, refugees, and asylum seekers are at higher risk for late or non-initiation of ANC, and exclusion from universal healthcare (UHC) may be a contributing factor. AIMS The aims were to synthesise evidence regarding uptake of ANC and to examine if this is associated with inadequate access to UHC and to evaluate the link between ANC and the risk of pregnancy outcomes in the immigrant, refugee and asylum seeker population. METHODS The review was performed according to meta-analysis of observational studies in epidemiology (MOOSE) guidelines. Five databases were systematically searched. Abstracts were screened against inclusion criteria, and eligible papers underwent data extraction by two independent reviewers per paper. The ROBINS-I tool was used to assess risk of bias. RESULTS Twelve studies were included in the final review. All studies reported that ANC was delayed for women who were classified as immigrants, refugees, and asylum seekers as per the WHO recommendations, and this was statistically significant compared to controls in 11 of 12 studies (P < 0.05). Findings regarding ANC uptake and pregnancy complications were too heterogeneous to conclusively report an association. CONCLUSION Immigrants, refugees and asylum seekers who are excluded from UHC present significantly later to ANC than receiving-country-born women with full access to UHC. The link between delayed ANC due to inadequate UHC access and pregnancy complications remains unclear due to the heterogeneous nature of the studies.
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Affiliation(s)
- Samantha L Saunders
- The University of Notre Dame, Sydney, Auburn Clinical School, Faculty of Medicine, Auburn, New South Wales, Australia
- Gosford Hospital, Gosford, NSW, Australia
| | - Kerry L Sutcliffe
- The University of Notre Dame, Sydney, Auburn Clinical School, Faculty of Medicine, Auburn, New South Wales, Australia
| | - Nathan S McOrist
- The University of Notre Dame, Sydney, Auburn Clinical School, Faculty of Medicine, Auburn, New South Wales, Australia
- Gosford Hospital, Gosford, NSW, Australia
| | - Kate M Levett
- The University of Notre Dame, Sydney, Auburn Clinical School, Faculty of Medicine, Auburn, New South Wales, Australia
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
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16
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Davison R, Hobbs M, Quirk F, Guppy M. General practitioners' perspectives on the management of refugee health: a qualitative study. BMJ Open 2023; 13:e068986. [PMID: 36963788 PMCID: PMC10039989 DOI: 10.1136/bmjopen-2022-068986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE To explore general practitioners' (GPs) perceptions of the challenges and facilitators to managing refugee healthcare needs in regional Australia. SETTING A regional community in Australia involved in the resettlement of refugees. PARTICIPANTS Nine GPs from five practices in the region. DESIGN A qualitative study based on semistructured interviews conducted between September and November 2020. RESULTS The main challenges identified surrounded language and communication difficulties, cultural differences and health literacy and regional workforce shortages. The main facilitators were clinical and community supports, including refugee health nurses and trauma counselling services. Personal benefits experienced by GPs such as positive relationships, satisfaction and broadening scope of practice further facilitated ongoing healthcare provision. CONCLUSIONS Overall, GPs were generally positive about providing care to refugees. However, significant challenges were expressed, particularly surrounding language, culture and resources. These barriers were compounded by the regional location. This highlights the need for preplanning and consultation with healthcare providers in the community both prior to and during the settlement of refugees as well as ongoing support proportional to the increase in settlement numbers.
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Affiliation(s)
- Rachel Davison
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Megan Hobbs
- New England Institute of Healthcare and Research, University of New England, Armidale, New South Wales, Australia
| | - Frances Quirk
- New England Institute of Healthcare and Research, University of New England, Armidale, New South Wales, Australia
- Fife, University of St Andrews School of Medicine, St Andrews, Fife, UK
| | - Michelle Guppy
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
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17
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Fitzharris L, McGowan E, Broderick J. Barriers and facilitators to refugees, asylum seekers and people experiencing homelessness accessing non hospital based care: A mixed methods systematic review protocol. HRB Open Res 2023. [DOI: 10.12688/hrbopenres.13671.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Context: Social exclusion is characterised by and represents a form of disadvantage and marginalisation of vulnerable groups of people in society, who cannot fully participate in the normal activities of daily living. Socially excluded groups consist of, but are not limited to the following groups: people experiencing homelessness, asylum seekers and refugees. People from socially excluded groups have complex healthcare needs including infectious and non-communicable diseases. People from socially excluded groups tend to present more to the acute hospital setting as emergency presentations. Little is known about barriers and facilitators experienced by these groups to accessing non hospital based care. Objectives: This mixed methods systematic review, will critically examine the concept of barriers and facilitators for refugees, asylum seekers and people experiencing homelessness, to accessing non hospital based care. Methods: This methodological review will follow the Joanna Briggs Institute guidance for conducting mixed methods reviews. The following databases will be searched: Central Medline, PubMed, Embase, CINAHL, and the Cochrane Library. Relevant grey literature will be included. Title and abstract screening, followed by full-text screening will be undertaken independently by two reviewers. The Joanna Briggs Institute extraction tool will be adapted for data extraction. Discussion: This mixed method review will comprehensively evaluate quantitative and qualitative data, synthesise both barriers and facilitators and follow a systematic approach through establishing use of mixed methods research across a number of marginalised groups, and how they affect accessing non hospital based care. It will explore conceptual models of access to healthcare and how they influence these factors.
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18
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Ramos AA. Considerations in designing trauma-focused interventions for displaced Afghan women. Front Glob Womens Health 2023; 3:893957. [PMID: 36909736 PMCID: PMC9996057 DOI: 10.3389/fgwh.2022.893957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 12/21/2022] [Indexed: 02/25/2023] Open
Abstract
In light of the 2021 United States military withdrawal from Afghanistan, as well as the humanitarian crises of mass displacement and subsequent health system strain that have ensued, practitioners worldwide will need to develop a more nuanced understanding of the adverse life experiences that women from Afghanistan frequently endorse. As they bear a disproportionate impact of constraints within Afghan society, and as patriarchal systems affect most of their life domains, women from Afghanistan may present with high levels of baseline trauma upon resettlement, and health systems may seek to attenuate this distress; However, the nature of these traumatogenic events may shape women's receptivity to psychosocial interventions, particularly those which are at least partially rooted in Western modalities. In the absence of sufficient literature on evidence-based interventions for this population, a diversity of ethnographic and clinical literature is synthesized, including literature on interventions alleged to be compatible with Afghan norms. As it will be essential to support Afghan women's mental health following social reorganization on a massive scale, considerations arising from the interdisciplinary literature are offered so that they may inform the development of structured, trauma-focused interventions and so that the health systems with which they interface may be better prepared to serve them.
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19
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Mwanri L, Miller E, Walsh M, Baak M, Ziersch A. Social Capital and Rural Health for Refugee Communities in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2378. [PMID: 36767745 PMCID: PMC9915238 DOI: 10.3390/ijerph20032378] [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: 11/22/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Refugee resettlement significantly contributes to Australia's migration programs, with recent policy directives prioritising rural resettlement. As a result, the cultural diversity of populations of several Australian rural towns has substantially expanded. Newcomers may encounter challenges becoming part of closed social networks and accessing the resources they need for a healthy life in resettlement. However, there are also benefits that stem from positive integration for newcomers and for receiving populations. As part of a larger study, which aimed to explore facilitators and barriers to successful resettlement in a rural setting, the objective of this paper was to show how social ties were important for participants' health, both facilitating access to resources, including health services, and connecting people to health-promoting living conditions. In-depth individual interviews with 44 participants from refugee communities originally from Africa and South-East Asia, settled in a rural South Australian town, were conducted. Participants were invited to the study through snowball sampling via known connections between the researchers and key people within the communities. Interview transcripts were analysed using framework thematic analysis. The findings demonstrate how participants drew on connections within their cultural communities, reflecting collectivist cultural values. These social ties were key to enabling access to resources for health. These included emotional resources, such as a sense of belonging, as well as physical and practical resources, including food, housing, and/or accessing services. Several participants were also working towards a career in the health industry. Populations from refugee communities in rural towns are growing, not only with the continuation of new arrivals to these towns, but also as the settled populations expand their families and communities. Effective health service provision in these locations needs to serve these growing communities, and there is scope for services to tap into community networks to assist with this.
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Affiliation(s)
- Lillian Mwanri
- Centre for Public Health Research, Equity and Human Flourishing, Torrens University Australia, Adelaide Campus, Adelaide, SA 5000, Australia
| | - Emily Miller
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Moira Walsh
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Melanie Baak
- UniSA Education Futures, University of South Australia, Adelaide, SA 5072, Australia
| | - Anna Ziersch
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
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20
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Shortland T, McGranahan M, Stewart D, Oyebode O, Shantikumar S, Proto W, Malik B, Yau R, Cobbin M, Sabouni A, Rudge G, Kidy F. A systematic review of the burden of, access to services for and perceptions of patients with overweight and obesity, in humanitarian crisis settings. PLoS One 2023; 18:e0282823. [PMID: 37093795 PMCID: PMC10124894 DOI: 10.1371/journal.pone.0282823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 02/23/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION Excess body weight causes 4 million deaths annually across the world. The number of people affected by humanitarian crises stands at a record high level with 1 in 95 people being forcibly displaced. These epidemics overlap. Addressing obesity is a post-acute phase activity in non-communicable disease management in humanitarian settings. Information is needed to inform guidelines and timing of interventions. The objective of this review was to explore the prevalence of overweight and obesity in populations directly affected by humanitarian crises; the cascade of care in these populations and perceptions of patients with overweight and obesity. METHODS Literature searches were carried out in five databases. Grey literature was identified. The population of interest was non-pregnant, civilian adults who had experience of humanitarian crises (armed conflict, complex emergencies and natural disasters). All study types published from January 1st, 2011, were included. Screening, data extraction and quality appraisal were carried out in duplicate. A narrative synthesis is presented. RESULTS Fifty-six reports from forty-five studies were included. Prevalence estimates varied widely across the studies and by subgroups. Estimates of overweight and obesity combined ranged from 6.4% to 82.8%. Studies were heterogenous. Global distribution was skewed. Increasing adiposity was seen over time, in older adults and in women. Only six studies were at low risk of bias. Body mass index was the predominant measure used. There were no studies reporting cascade of care. No qualitative studies were identified. CONCLUSION Overweight and obesity varied in crisis affected populations but were rarely absent. Improved reporting of existing data could provide more accurate estimates. Worsening obesity may be prevented by acting earlier in long-term crises and targeting risk groups. The use of waist circumference would provide useful additional information. Gaps remain in understanding the existing cascade of care. Cultural norms around diet and ideal body size vary.
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Affiliation(s)
- Thomas Shortland
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Majel McGranahan
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Daniel Stewart
- National Public Health Specialty Training Programme, South West Training Scheme, Bristol, United Kingdom
| | - Oyinlola Oyebode
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Saran Shantikumar
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - William Proto
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Bassit Malik
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Roger Yau
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Maddie Cobbin
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Gavin Rudge
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Farah Kidy
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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21
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Aljadeeah S, Kielmann K, Michielsen J, Payedimarri AB, Ravinetto R. Access to medicine among asylum seekers, refugees and undocumented migrants across the migratory cycle: a scoping review protocol. BMJ Open 2022; 12:e068917. [PMID: 36600327 PMCID: PMC9743384 DOI: 10.1136/bmjopen-2022-068917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Migration creates new health vulnerabilities and exacerbates pre-existing medical conditions. Migrants often face legal, system-related, administrative, language and financial barriers to healthcare, but little is known about factors that specifically influence migrants' access to medicines and vaccines. This scoping review aims to map existing evidence on access to essential medicines and vaccines among asylum seekers, refugees and undocumented migrants who aim to reach Europe. We will consolidate existing information and analyse the barriers that limit access at the different stages of the migratory phases, as well as policies and practices undertaken to address them. METHODS We follow the Arksey and O'Malley framework for knowledge synthesis of research, as updated by Levac et al. For reporting the results of our search and to synthetise evidence, we will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended reporting guideline for scoping reviews. This scoping review consists of five iterative stages. Bibliographic databases (PubMed, CINAHL, Cochrane Database of Systematic Reviews and Scopus) and grey literature databases (Open Grey, Grey Literature Report and Google Scholar, Web of Science Conference Proceedings, non-governmental organisations and United Nations agency websites) will be searched for relevant studies. DISSEMINATION AND ETHICS This review will be disseminated through a peer-reviewed article in a scientific open-access journal and conference presentations. Furthermore, findings will be shared at workshops of research and operational stakeholders for facilitating translation into research and operational practices. Since it consists of reviewing and collecting data from publicly available materials, this scoping review does not require ethics approval.
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Affiliation(s)
- Saleh Aljadeeah
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Karina Kielmann
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Joris Michielsen
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Anil Babu Payedimarri
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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22
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Santoso D, Asfia SK, Mello MB, Baggaley RC, Johnson CC, Chow EP, Fairley CK, Ong JJ. HIV prevalence ratio of international migrants compared to their native-born counterparts: A systematic review and meta-analysis. EClinicalMedicine 2022; 53:101661. [PMID: 36147629 PMCID: PMC9486043 DOI: 10.1016/j.eclinm.2022.101661] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People on the move, including international migrants, may face health inequities that expose them to a higher risk for HIV than native-born populations. We conducted a systematic review to calculate the HIV prevalence ratio of international migrants compared with native-born populations. METHODS We searched five databases between January 2010 and March 2022. Using random-effects meta-analysis, we calculated the pooled HIV prevalence ratios (PR) by comparing the HIV prevalence of migrants with native-born populations. Our research protocol is registered in the International prospective register of systematic reviews (PROSPERO, CRD42021250867). FINDINGS In total, 5,121 studies were screened, and 38 were included in the final analysis: 7,121,699 migrants and more than 270 million natives were included in the analysis. The pooled PR for any foreign-born migrants was 1·70 (95% CI 1·11 - 2·61, I2 =99·67%, n = 33 studies), refugees was 2·37 (95% CI 0·33-16·99, I2 =99·5%, n = 5), undocumented people was 3·98 (95% CI 0·11-143·01, I2 =94·6%, n = 3), whilst asylum seekers was 54·79 (95% CI 17·23-174·23, I2 =90·2%, n = 2). Meta-regression revealed that population type (adjusted R-squared 11.5%), region of origin (11.3%) and migrant type (10.8%) accounted for heterogeneity more than country-income (2.4%) and study setting (2.3%). INTERPRETATION Although it was not possible to assess if HIV infection occurred in the country of origin or destination, the HIV prevalence ratio was higher among migrants than in native-born populations. Inclusive health policies and strategies for delivering HIV testing, prevention and treatment services for migrant populations tailored to their needs are urgently needed. FUNDING J.J.O. and E.P.F.C. are supported by the Australian National Health and Medical Research Council (NHMRC) Emerging Leader Fellowship (GNT1193955 and GNT1172873, respectively).
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Affiliation(s)
- Devy Santoso
- Central Clinical School, Monash University, Melbourne, Australia
| | | | - Maeve B. Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel C. Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl C. Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Eric P.F. Chow
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - Jason J. Ong
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Corresponding author at: 580 Swanston Street, Carlton, Victoria 3053, Australia.
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23
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Waterman LZ, Pillay M, Katona C. The mass release of migrants from UK immigration detention during the COVID-19 pandemic: what can be learned? BJPsych Bull 2022; 46:261-266. [PMID: 34847981 PMCID: PMC9768526 DOI: 10.1192/bjb.2021.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Convincing international evidence demonstrates that immigration detention adversely affects mental health. During the COVID-19 outbreak, additional concerns were raised about the safety and appropriateness of immigration detention. Consequently, several hundred migrants were released en masse from UK immigration detention centres, and few new detentions took place. Over 70% fewer migrants were held in detention centres in June 2020 compared with December 2019. This large 'natural experiment' has demonstrated that detaining fewer migrants is possible and it provides an opportunity to review the necessity for large-scale detention for the purpose of immigration control, as well as its impact on health inequalities. Additionally, given that detainee release arrangements had already been considered unsafe prior to the pandemic, clinicians and service providers should take into consideration that many of those released may not be receiving adequate post-release continuity of care.
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Affiliation(s)
- Lauren Z Waterman
- South London and Maudsley NHS Foundation Trust, London, UK.,King's College London, UK.,North Central London Clinical Commissioning Group, UK.,Royal College of Psychiatrists Working Group on the Health of Refugees and Asylum Seekers, London, UK
| | - Mishka Pillay
- Royal College of Psychiatrists Working Group on the Health of Refugees and Asylum Seekers, London, UK.,One Strong Voice, London, UK.,Freedom from Torture, London, UK
| | - Cornelius Katona
- Royal College of Psychiatrists Working Group on the Health of Refugees and Asylum Seekers, London, UK.,Helen Bamber Foundation, University College London, UK
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24
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Mattelin E, Fröberg F, Korhonen L, Khanolkar AR. Health and health-related behaviours in refugees and migrants who self-identify as sexual or gender minority - A National population-based study in Sweden. EClinicalMedicine 2022; 52:101641. [PMID: 36313143 PMCID: PMC9596319 DOI: 10.1016/j.eclinm.2022.101641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To examine health and health-related behaviors in migrant and refugee individuals who identify as sexual or gender minority, and in comparison to their heterosexual peers. METHODS The study included 168,952 individuals (aged 16-84 years, males: 45·9%, sexual or gender minorities: 3·1%) who answered the Swedish National Public Health Survey in 2018 and 2020. Participants were grouped into Swedish-and Western-born (White) heterosexual, White sexual- or gender minority, migrant heterosexual, migrant sexual- or gender minority, refugee heterosexual, and refugee sexual- or gender minority. Outcomes included mental health (for example suicidal ideation, wellbeing), general health, risky behaviors (risk alcohol use, risk gambling, and substance use), and experiences of violence. Associations between 1) sexual- or gender -ethnic identities and 2) gender-ethnic identities and all outcomes were analyzed using logistic and linear regression adjusting for sex, age, and educational level. FINDINGS Being a sexual- or gender minority, regardless of ethnic minority status, was associated with worse general health and mental ill-health compared to heterosexual peers including suicidal ideation in refugee sexual- or gender minority individuals (OR 2·42, 95 % CI 1·44-4·08). Ethnic minorities (heterosexual and sexual- or gender minority migrants and refugees) had lower odds of drug and risk alcohol use compared to White heterosexual peers but higher odds of risk gambling (1·88, 1·49-2·37 for refugee heterosexuals). Transgender refugees had high odds for risk gambling (8·62, 1·94-38·40) and exposure to physical violence (7·46, 2·97-18·70). INTERPRETATION In this national population-based study, sexual and gender minority individuals have worse mental and general health regardless of ethnic minority status. We did not find evidence for worse health in sexual- or gender minority refugees in comparison to migrant, and White sexual- or gender minorities and their heterosexual peers. Transgender individuals (White and ethnic minority) experienced significantly higher levels of physical violence. Public health policy should emphasize preventive measures to reduce exposure to violence and discrimination in sexual- and gender minority individuals, increase access and use of mental healthcare services and sensitise healthcare professionals about higher rates of health and related issues faced by sexual- and gender minority individuals including those with multiple minority identities. FUNDING We received no external funding for this study and hence the funder had no role in the study design, data collection, data analysis, data interpretation, writing of the manuscript and the decision to submit.
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Affiliation(s)
- Erica Mattelin
- Barnafrid, Swedish National Center on Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Corresponding author.
| | - Frida Fröberg
- Barnafrid, Swedish National Center on Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Korhonen
- Barnafrid, Swedish National Center on Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Amal R. Khanolkar
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Population Health Sciences, School of Life Course & Population Sciences, King's College London, London, United Kingdom
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Aljadeeah S, Michielsen J, Ravinetto R, Hargreaves S, Wirtz VJ, Razum O, Gobbi F, Kielmann K. Facilitating access to medicines and continuity of care for Ukrainian refugees: exceptional response or the promise of more inclusive healthcare for all migrants? BMJ Glob Health 2022; 7:bmjgh-2022-010327. [PMID: 36008046 PMCID: PMC9422850 DOI: 10.1136/bmjgh-2022-010327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Saleh Aljadeeah
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Joris Michielsen
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Sally Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Veronika J Wirtz
- Department of Global Health, Boston University Scool of Public Health, Boston, Massachusetts, USA
| | - Oliver Razum
- Department of Epidemiology & International Publich Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Federico Gobbi
- Center for Tropical Diseases, Ospedale Sacro Cuore - Don Calabria, Negrar, Verona, Italy
| | - Karina Kielmann
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Tzogiou C, Spycher J, Bize R, Sanchis Zozaya J, Blaser J, Pahud Vermeulen B, Felappi A, Bodenmann P, Marti J. Detecting and describing heterogeneity in health care cost trajectories among asylum seekers. BMC Health Serv Res 2022; 22:978. [PMID: 35907845 PMCID: PMC9339203 DOI: 10.1186/s12913-022-08346-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 07/14/2022] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND The mechanism underlying the health care cost trajectories among asylum seekers is not well understood. In the canton of Vaud in Switzerland, a nurse-led health care and medical Network for Migrant Health ("Réseau santé et migration" RESAMI) has established a health care model focusing on the first year after arrival of asylum seekers, called the "community health phase". This model aims to provide tailored care and facilitate integration into the Swiss health care system. The aim of this study is to explore different health care cost trajectories among asylum seekers during this phase and identify the associated factors. METHODS We detected different patterns of health care cost trajectories using time-series clustering of longitudinal data of asylum seekers in the canton of Vaud in Switzerland. These data included all adult asylum seekers and recipients of emergency aid who entered the canton between 2012 and 2015 and were followed until 2018. The different clusters of health care cost trajectories were then described using a multinomial logistic regression model. RESULTS We identified a concave, an upward trending, and a downward trending cluster of health care cost trajectories with different characteristics being associated with each cluster. The likelihood of being in the concave cluster is positively associated with coming from the Eastern Mediterranean region or Africa rather than Europe and with a higher share of consultations with an interpreter. The likelihood of being in the upward trending cluster, which accrued the highest costs, is positively associated with 20-24-year-olds rather than older individuals, coming from Europe than any other region and having a mental disorder. In contrast to the other two clusters, the likelihood of being in the downward trending cluster is positively associated with having contacted the RESAMI network within the first month after arrival, which might indicate the potential of early intervention. It is also positively associated with older age and living in a group lodge. CONCLUSIONS Asylum seekers are heterogeneous in terms of health care cost trajectories. Exploring these differences can help point to possible ways to improve the care and supporting services provided to asylum seekers. Our findings could indicate that early and patient-centered interventions might be well-suited to this aim.
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Affiliation(s)
- Christina Tzogiou
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401, Winterthur, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - Jacques Spycher
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté) University of Lausanne, Lausanne, Switzerland
| | - Raphaël Bize
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté) University of Lausanne, Lausanne, Switzerland
| | - Javier Sanchis Zozaya
- Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Brigitte Pahud Vermeulen
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Andrea Felappi
- Fondation AACTS (Addiction, Community Action, Social Work), Vevey, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté) University of Lausanne, Lausanne, Switzerland
| | - Joachim Marti
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté) University of Lausanne, Lausanne, Switzerland
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Nkhoma G, Lim CX, Kennedy GA, Stupans I. Attitudes and Knowledge of, and Preferences for Learning about Cultural Competence: A Study of Pharmacy Students from One Australian Pharmacy Program. PHARMACY 2022; 10:pharmacy10030066. [PMID: 35736780 PMCID: PMC9230435 DOI: 10.3390/pharmacy10030066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 02/01/2023] Open
Abstract
Culturally and linguistically diverse populations, particularly asylum seekers, face challenges in accessing healthcare services. Pharmacists need to be capable of identifying and responding appropriately to the needs of diverse population groups. The aims of this study were to clarify student pharmacists’: knowledge of, and attitudes to, asylum seekers; their understanding of themselves with regard to cultural competence; their exposure to culturally and linguistically diverse clinical settings; their potential receptivity to learning opportunities directed towards cultural competence; and the extent to which they interpreted the current curriculum as improving their cultural competence. Pharmacy students’ viewpoints and perspectives were essential as emerging pharmacy professionals. This study employed mixed methods and convenience sampling. There were no significant (p > 0.05) associations between demographics and any of the survey items. Five themes emerged from the interviews: namely, exposure, formal vs. informal, positive views, conflict, and sufficiency. Pharmacy curriculum should ideally provide sufficient knowledge to meet culturally diverse healthcare consumers’ needs, especially asylum seekers. The most efficacious models for teaching cultural competence are as yet still undetermined. Interactive learning in cultural competence was recommended as essential.
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Affiliation(s)
- Gloria Nkhoma
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
- Correspondence:
| | - Chiao Xin Lim
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
| | - Gerard A. Kennedy
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
- Institute of Health and Wellbeing, Federation University, P.O. Box 663, Ballarat, VIC 3353, Australia
- Institute for Breathing and Sleep, Austin Health, 145 Studley Rd., Heidelberg, VIC 3084, Australia
| | - Ieva Stupans
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
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Agbata EN, Buitrago-Garcia D, Nunez-Gonzalez S, Hashmi SS, Pottie K, Alonso-Coello P, Arevalo-Rodriguez I. Quality assessment of systematic reviews on international migrant healthcare interventions: a systematic review. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Malone B, Kim E, Jennings R, Pacheco RA, Kieu A. COVID-19 Vaccine Distribution in a Community With Large Numbers of Immigrants and Refugees. Am J Public Health 2022; 112:393-396. [PMID: 35196045 PMCID: PMC8887164 DOI: 10.2105/ajph.2021.306608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/04/2022]
Abstract
Refugee and immigrant populations are extremely vulnerable to the consequences of the COVID-19 pandemic. COVID-19 vaccination is a critical tool in mitigating these consequences, but these same communities often lack access to COVID-19 vaccines. We describe the efforts of a community-based primary care clinic in Clarkston, Georgia to provide access to COVID-19 vaccines in a culturally sensitive manner to address this health disparity and vaccine hesitancy.
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Affiliation(s)
- Brett Malone
- Brett Malone, Esther Kim, Rachel Jennings, and Rainer A. Pacheco are with Ethne Health, Clarkston, GA. Alexander Kieu is a family medicine physician at Kanad Hospital, Al Ain, Abu Dhabi
| | - Esther Kim
- Brett Malone, Esther Kim, Rachel Jennings, and Rainer A. Pacheco are with Ethne Health, Clarkston, GA. Alexander Kieu is a family medicine physician at Kanad Hospital, Al Ain, Abu Dhabi
| | - Rachel Jennings
- Brett Malone, Esther Kim, Rachel Jennings, and Rainer A. Pacheco are with Ethne Health, Clarkston, GA. Alexander Kieu is a family medicine physician at Kanad Hospital, Al Ain, Abu Dhabi
| | - Rainer A Pacheco
- Brett Malone, Esther Kim, Rachel Jennings, and Rainer A. Pacheco are with Ethne Health, Clarkston, GA. Alexander Kieu is a family medicine physician at Kanad Hospital, Al Ain, Abu Dhabi
| | - Alex Kieu
- Brett Malone, Esther Kim, Rachel Jennings, and Rainer A. Pacheco are with Ethne Health, Clarkston, GA. Alexander Kieu is a family medicine physician at Kanad Hospital, Al Ain, Abu Dhabi
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Davidson N, Hammarberg K, Romero L, Fisher J. Access to preventive sexual and reproductive health care for women from refugee-like backgrounds: a systematic review. BMC Public Health 2022; 22:403. [PMID: 35220955 PMCID: PMC8882295 DOI: 10.1186/s12889-022-12576-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Globally, the number of forcibly displaced women is growing. Refugee and displaced women have poorer health outcomes compared to migrant and host country populations. Conflict, persecution, violence or natural disasters and under-resourced health systems in their country of origin contribute to displacement experiences of refugee and displaced women. Poor health outcomes are further exacerbated by the migration journey and challenging resettlement in host countries. Preventive sexual and reproductive health (SRH) needs of refugee and displaced women are poorly understood. The aim was to synthesise the evidence about access to preventive SRH care of refugee and displaced women. Methods A systematic review of qualitative, quantitative and mixed methods studies of women aged 18 to 64 years and health care providers' (HCPs’) perspectives on barriers to and enablers of SRH care was undertaken. The search strategy was registered with PROSPERO in advance of the search (ID CRD42020173039). The MEDLINE, PsycINFO, Embase, CINAHL, and Global health databases were searched for peer-reviewed publications published any date up to 30th April 2020. Three authors performed full text screening independently. Publications were reviewed and assessed for quality. Study findings were thematically extracted and reported in a narrative synthesis. Reporting of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Results The search yielded 4083 results, of which 28 papers reporting 28 studies met inclusion criteria. Most related to contraception and cervical or breast cancer screening. Three main themes and ten subthemes relating to SRH care access were identified: interpersonal and patient encounter factors (including knowledge, awareness, perceived need for and use of preventive SRH care; language and communication barriers), health system factors (including HCPs discrimination and lack of quality health resources; financial barriers and unmet need; HCP characteristics; health system navigation) and sociocultural factors and the refugee experience (including family influence; religious and cultural factors). Conclusions Implications for clinical practice and policy include giving women the option of seeing women HCPs, increasing the scope of practice for HCPs, ensuring adequate time is available during consultations to listen and develop refugee and displaced women’s trust and confidence, strengthening education for refugee and displaced women unfamiliar with preventive care and refining HCPs’ and interpreters’ cultural competency. More research is needed on HCPs’ views regarding care for refugee and displaced women. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12576-4.
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Schober T, Zocher K. Health-Care Utilization of Refugees: Evidence from Austria. INTERNATIONAL MIGRATION REVIEW 2022. [DOI: 10.1177/01979183211061091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
European countries have experienced significant inflows of migrants in the past decade, including many refugees from regions engaged in armed conflicts. Although previous research on migrant health has largely focused on economic migration, empirical evidence on refugee health is sparse. This article uses administrative data from Austria to differentiate between economic migrants and refugees and to analyze both groups’ health-care expenditures in comparison to natives. We contribute to the literature on migrant health in several dimensions. First, we follow economic migrants and refugees over the first five years after arrival and show different health-care expenditure patterns among migration groups. In contrast to patterns for economic migrants, we find substantially higher health-care expenditures for refugees compared to natives, especially in the first year after arrival. This difference is not explained by specific diseases or individual refugee groups, indicating refugees’ generally inferior health status in the first years of settlement. Second, we focus on the health effects of granting asylum and find that the expenditure differences decrease after a positive asylum decision. In the last part, by using refugees’ quasi-random placement as a natural experiment, we show that the local health-care sector's characteristics do not have a significant effect on expenditure levels. The findings highlight the importance of distinguishing between migrant groups in the analysis of health-care utilization and show that the time spent in the host country, as well as legal status, have a substantial impact on migrants’ health-care utilization.
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Affiliation(s)
- Thomas Schober
- Department of Economics, Christian Doppler Laboratory for Aging, Health, and the Labor Market, Johannes Kepler University Linz, Linz, Austria
| | - Katrin Zocher
- Department of Economics, Christian Doppler Laboratory for Aging, Health, and the Labor Market, Johannes Kepler University Linz, Linz, Austria
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OUP accepted manuscript. Health Promot Int 2022:6573374. [DOI: 10.1093/heapro/daac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Policies and initiatives/programs that promote health and self-care in asylum seekers living in high income countries: a narrative review. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2021. [DOI: 10.1108/ijhrh-09-2021-0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to identify health-care entitlements that exist for asylum seekers with chronic non-communicable disease (CNCD) that promote their health and self-care, and to explore health policies, initiatives and programmes with the potential to foster self-care in this populace.
Design/methodology/approach
Narrative review of literature conducted by searching EMBASE, CINAHL, WEB OF SCIENCE and PSYCINFO databases for articles published from 2010 to 2021. Included articles focussed on policies, programmes or initiatives with the potential to promote health in adult asylum seekers residing in high-income countries. Studies inclusive of other migrant groups such as undocumented migrants and those with mental health conditions were excluded. Eleven studies fitting the inclusion criteria were assessed against the study objectives.
Findings
Free access to health-care services and pharmaceutical products, free access to food banks and supermarket model food banks, English and cooking lessons, community integration training sessions and culturally competent health-care workers were found to promote health and self-care. There is little research on self-care and health promotion in adult asylum seekers with CNCD. CNCDs represent high burden of disease in asylum seekers but have a low priority in reported research.
Originality/value
This narrative review is the first to explicitly focus on asylum seekers in high-income countries with CNCD, excluding mental health conditions, and to explore initiatives, programmes and policies that enhance health promotion to facilitate self-care in this populace.
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Shorey S, Ng ED, Downe S. Cultural competence and experiences of maternity health care providers on care for migrant women: A qualitative meta-synthesis. Birth 2021; 48:458-469. [PMID: 34363236 DOI: 10.1111/birt.12581] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The United Nations Sustainable Development Goals 2030 aim to reduce health care inequity and maternal and infant mortality rates amongst marginalized populations. To provide adequate and culturally relevant maternity care for minority ethnic groups, it is imperative to examine health care providers' views on care for migrant women. We reviewed published accounts of views and experiences of maternity health care providers providing maternity care for migrant women as a way of exploring their cultural competency. METHOD A qualitative meta-synthesis was conducted. Systematic searches were conducted in five electronic databases from inception dates through February 2021. Qualitative data were analyzed using a framework thematic analysis based on Campinha-Bacote's five-component cultural competency model. FINDINGS Eleven studies were included. Findings were presented according to Campinha-Bacote's model: cultural awareness, cultural knowledge (personal responsibility, familial role and cultural influence, the influence of social and system factors, conflicting maternity care expectations), cultural encounter (language and communication), and cultural desire (establishing trust and going the extra mile, resources to boost culturally competent care). DISCUSSION Our findings can inform the design of high-quality behavioral change, health care management, sociological, and other relevant studies, along with reviews of what matters to service users about cultural responsiveness. Our data also suggest that health system constraints can exacerbate the lack of cultural competency. Improving the quality of care for migrant communities will necessitate a joint effort between health care organizations, health care providers, policymakers, and researchers in developing and implementing more culturally relevant maternity care policies and management interventions.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Esperanza Debby Ng
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
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P Iqbal M, Walpola R, Harris-Roxas B, Li J, Mears S, Hall J, Harrison R. Improving primary health care quality for refugees and asylum seekers: A systematic review of interventional approaches. Health Expect 2021; 25:2065-2094. [PMID: 34651378 PMCID: PMC9615090 DOI: 10.1111/hex.13365] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 09/07/2021] [Accepted: 09/19/2021] [Indexed: 12/30/2022] Open
Abstract
Background It has been widely acknowledged that refugees are at risk of poorer health outcomes, spanning mental health and general well‐being. A common point of access to health care for the migrant population is via the primary health care network in the country of resettlement. This review aims to synthesize the evidence of primary health care interventions to improve the quality of health care provided to refugees and asylum seekers. Methods A systematic review was undertaken, and 55 articles were included in the final review. The Preferred Reporting Items for Systematic Reviews was used to guide the reporting of the review, and articles were managed using a reference‐management software (Covidence). The findings were analysed using a narrative empirical synthesis. A quality assessment was conducted for all the studies included. Results The interventions within the broad primary care setting could be organized into four categories, that is, those that focused on developing the skills of individual refugees/asylum seekers and their families; skills of primary health care workers; system and/or service integration models and structures; and lastly, interventions enhancing communication services. Promoting effective health care delivery for refugees, asylum seekers and their families is a complex challenge faced by primary care professionals, the patients themselves and the communication between them. Conclusion This review highlights the innovative interventions in primary care promoting refugee health. Primary care interventions mostly focused on upskilling doctors, with a paucity of research exploring the involvement of other health care members. Further research can explore the involvement of interprofessional team members in providing effective refugee/migrant health. Patient or Public Contribution Patient and public involvement was explored in terms of interventions designed to improve health care delivery for the humanitarian migrant population, that is, specifically refugees and asylum seekers.
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Affiliation(s)
- Maha P Iqbal
- School of Population Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ramesh Walpola
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ben Harris-Roxas
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,South Eastern Sydney Research Collaboration Hub (SEaRCH), Population and Community Health, South Eastern Sydney Local Health District, Darlinghurst, New South Wales, Australia
| | - Jiadai Li
- School of Population Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Mears
- Hunter New England Medical Library, New Lambton, New South Wales, Australia
| | - John Hall
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation; Level 6, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Strømme EM, Igland J, Haj-Younes J, Kumar BN, Fadnes LT, Hasha W, Diaz E. Chronic pain and mental health problems among Syrian refugees: associations, predictors and use of medication over time: a prospective cohort study. BMJ Open 2021; 11:e046454. [PMID: 34548344 PMCID: PMC8458374 DOI: 10.1136/bmjopen-2020-046454] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study aims to examine associations, predictors and pharmacological treatment of chronic pain and mental health problems among Syrian refugees in a longitudinal perspective. DESIGN Prospective cohort study. SETTING We collected survey data among Syrian refugees in Lebanon granted resettlement to Norway (self-administered questionnaires) and at follow-up 1 year after arrival in Norway (structured telephone interviews). PARTICIPANTS Adult Syrian refugees attending mandatory pretravel courses in Lebanon in 2017-2018 were invited to participate. In total, 353 individuals participated at both time points. PRIMARY AND SECONDARY OUTCOMES We examined the cross-sectional associations between pain, mental health and migration-related exposures at baseline and follow-up and assessed whether associations changed significantly with time. Furthermore, we investigated the longitudinal association between mental health at baseline and pain at follow-up. We also evaluated temporal changes in use of analgesics and psychotropic drugs. RESULTS While most refugees reported improved health from the transit phase in Lebanon to the early resettlement phase in Norway, a few had persisting and intertwined health problems. Most migration-related stressors were more closely associated with chronic pain and mental health problems after resettlement as compared with the transit phase. In parallel, poor mental health was associated with chronic pain in the follow-up (adjusted risk ratio (ARR) 1.5 (1.0, 2.2)), but not at baseline (ARR 1.1 (0.8, 1.5)). Poor mental health at baseline was a statistically significant predictor of chronic pain at follow-up among those not reporting chronic pain at baseline. At both timepoints, one in four of those with chronic pain used analgesics regularly. None with mental health problems used antidepressants daily. CONCLUSIONS Providers of healthcare services to refugees should be attentive to the adverse effect of postmigration stressors and acknowledge the interrelations between pain and mental health. Possible gaps in pharmacological treatment of pain and mental health problems need further clarification.
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Affiliation(s)
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jasmin Haj-Younes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Lars T Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Wegdan Hasha
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
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Willey S, Desmyth K, Truong M. Racism, healthcare access and health equity for people seeking asylum. Nurs Inq 2021; 29:e12440. [PMID: 34312941 DOI: 10.1111/nin.12440] [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: 04/17/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/03/2023]
Abstract
People seeking asylum are at risk of receiving poorer quality healthcare due, in part, to racist and discriminatory attitudes, behaviours and policies in the health system. Despite fleeing war and conflict; exposure to torture and traumatic events and living with uncertainty; people seeking asylum are at high-risk of experiencing long-term poor physical and mental health outcomes in their host country. This article aims to raise awareness and bring attention to some common issues people seeking asylum face when seeking healthcare in high-income countries where the health system is dominated by a Western biomedical view of health. Clinical case scenarios are used to highlight instances of racist healthcare policies and practices that create and maintain ongoing health disparities; limited access to culturally and linguistically appropriate health services, and lack of trauma-informed approaches to care. Nurses and midwives can play an important role in countering racism in healthcare settings; by identifying and calling out discriminatory practice and modelling tolerance, respect and empathy in daily practice. We present recommendations for individuals, organisations and governments that can inform changes to policies and practices that will reduce racism and improve health equity for people seeking asylum.
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Affiliation(s)
- Suzanne Willey
- Monash Nursing and Midwifery, Monash University Peninsula Campus, Frankston, VIC, Australia
| | - Kath Desmyth
- Victorian Refugee Health Program, Cohealth, Footscray, VIC, Australia
| | - Mandy Truong
- Monash Nursing and Midwifery, Monash University Clayton Campus, Clayton, VIC, Australia
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Dawkins B, Renwick C, Ensor T, Shinkins B, Jayne D, Meads D. What factors affect patients' ability to access healthcare? An overview of systematic reviews. Trop Med Int Health 2021; 26:1177-1188. [PMID: 34219346 DOI: 10.1111/tmi.13651] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This overview aims to synthesise global evidence on factors affecting healthcare access, and variations across low- and middle-income countries (LMICs) vs. high-income countries (HICs); to develop understanding of where barriers to healthcare access lie, and in what context, to inform tailored policies aimed at improving access to healthcare for all who need it. METHODS An overview of systematic reviews guided by a published protocol was conducted. Medline, Embase, Global Health and Cochrane Systematic Reviews databases were searched for published articles. Additional searches were conducted on the Gates Foundation, WHO and World Bank websites. Study characteristics and findings (barriers and facilitators to healthcare access) were documented and summarised. The methodological quality of included studies was assessed using an adapted version of the AMSTAR 2 tool. RESULTS Fifty-eight articles were included, 23 presenting findings from LMICs and 35 presenting findings from HICs. While many barriers to healthcare access occur in HICs as well as LMICs, the way they are experienced is quite different. In HICs, there is a much greater emphasis on patient experience; as compared to the physical absence of care in LMICs. CONCLUSIONS As countries move towards universal healthcare access, evaluation methods that account for health system and wider cultural factors that impact capacity to provide care, healthcare finance systems and the socio-cultural environment of the setting are required. Consequently, methods employed in HICs may not be appropriate in LMICs due to the stark differences in these areas.
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Affiliation(s)
- Bryony Dawkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Tim Ensor
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Bethany Shinkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Jayne
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Murray K, Khawaja NG, Schweitzer RD, Baldwin L, Bentley S. Provider perspectives on services for people seeking asylum in Australia: best practices and challenges. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1921555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Kate Murray
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Nigar G. Khawaja
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Robert D. Schweitzer
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Louise Baldwin
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Sharon Bentley
- School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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Reuveny R. Climate-related migration and population health: social science-oriented dynamic simulation model. BMC Public Health 2021; 21:598. [PMID: 33771138 PMCID: PMC7996123 DOI: 10.1186/s12889-020-10120-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/23/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Social science models find the ecological impacts of climate change (EICC) contribute to internal migration in developing countries and, less so, international migration. Projections expect massive climate-related migration in this century. Nascent research calls to study health, migration, population, and armed conflict potential together, accounting for EICC and other factors. System science offers a way: develop a dynamic simulation model (DSM). We aim to validate the feasibility and usefulness of a pilot DSM intended to serve as a proof-of-concept and a basis for identifying model extensions to make it less simplified and more realistic. METHODS Studies have separately examined essential parts. Our DSM integrates their results and computes composites of health problems (HP), health care (HC), non-EICC environmental health problems (EP), and environmental health services (ES) by origin site and by immigrants and natives in a destination site, and conflict risk and intensity per area. The exogenous variables include composites of EICC, sociopolitical, economic, and other factors. We simulate the model for synthetic input values and conduct sensitivity analyses. RESULTS The simulation results refer to generic origin and destination sites anywhere on Earth. The effects' sizes are likely inaccurate from a real-world view, as our input values are synthetic. Their signs and dynamics are plausible, internally consistent, and, like the sizes, respond logically in sensitivity analyses. Climate migration may harm public health in a host area even with perfect HC/ES qualities and full access; and no HP spillovers across groups, conflict, EICC, and EP. Deviations from these conditions may worsen everyone's health. We consider adaptation options. CONCLUSIONS This work shows we can start developing DSMs to understand climate migration and public health by examining each case with its own inputs. Validation of our pilot model suggests we can use it as intended. We lay a path to making it more realistic for policy analysis.
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Affiliation(s)
- Rafael Reuveny
- School of Public and Environmental Affairs, Indiana University, Bloomington, USA.
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Barghadouch A, Norredam M. Psychosocial Responses to Healthcare: A Study on Asylum-Seeking Families' Experiences in Denmark. J Immigr Minor Health 2021; 24:551-555. [PMID: 33759026 DOI: 10.1007/s10903-021-01183-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 11/28/2022]
Abstract
Much work has gone into unpacking the range of individual, interpersonal and structural barriers that prevent asylum-seekers from accessing healthcare. In this Brief Communication, we disentangle asylum-seeking families' psychosocial responses when accessing healthcare as crucial dimensions of the access experience. Drawing on semi-structured interviews with 11 asylum-seeking families in Denmark, we present examples from three specific healthcare encounters between families and healthcare professionals in the Danish asylum system. We demonstrate how unfamiliarity with the healthcare system, interpersonal miscommunication and cultural insensitivity among professionals evoke specific emotions that undermine participants' trust in the healthcare system and affect their future motivation for healthcare seeking and ultimately also their healthcare seeking behavior. We argue for an urgent need to recognize the pivotal role of such psychosocial responses in shaping healthcare access for asylum-seeking families. Focusing on these responses is an important next step in overcoming barriers in access to healthcare, which have been described in literature for years.
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Affiliation(s)
- Amina Barghadouch
- Department of Public Health, Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Marie Norredam
- Department of Public Health, Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
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Scott HM, Wallis N. Maternity care for refugees living in Greek refugee camps: What are the challenges to provision? Birth 2021; 48:114-121. [PMID: 33354804 DOI: 10.1111/birt.12522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Over a two-year period between 2015 and 2016, unprecedented numbers of people arrived in Greece fleeing conflict, persecution, and poverty. With new arrivals every day, there is a significant unmet need for health care provision, posing a challenge to the Greek Healthcare System. For pregnant refugees, a known vulnerable group, this has resulted in a complex partnership of shared maternity care between humanitarian organizations, the Greek national health care system, and European multi-state initiatives. Our aim was to understand the challenges to providing maternity care services in Greek refugee camps as perceived by health care providers. METHODS A qualitative study comprising observation and semi-structured interviews with health care providers working with pregnant refugees was conducted in five refugee camps in May 2017. Interviews were transcribed and analyzed with thematic coding. RESULTS Twenty-one health care providers were interviewed and field notes taken from observational study of services in five refugee camps. Health care providers describe difficult cross-cultural communication to be their biggest challenge to caring for pregnant refugee women. The limited availability of female only safe spaces is also identified as a barrier. Lastly, the overburdened Greek public health system limits their ability to provide care. CONCLUSIONS Our research supports other literature describing difficult communication and the overburdened Greek health system as significant health care barriers for pregnant refugees in Greece. There is limited literature examining the role of "safe space," and further research is needed. Stakeholders providing maternity care to refugees should look to tackle these key issues as they seek to provide care to this population.
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Browne DT, Smith JA, Basabose JDD. Refugee Children and Families During the COVID-19 Crisis: A Resilience Framework for Mental Health. JOURNAL OF REFUGEE STUDIES 2021; 34:feaa113. [PMCID: PMC7928793 DOI: 10.1093/jrs/feaa113] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/15/2020] [Indexed: 05/21/2023]
Abstract
Children and families are undergoing unprecedented stress as a result of the COVID-19 pandemic, in part, due to the disruption of daily life arising from mandated social distancing protocols. As such, the purpose of the present report is to raise awareness surrounding resilience-challenging and resilience-promoting factors for refugee children and families during the COVID-19 crisis. Issues surrounding family life, parenting, and potential for family conflict are described. Also, cultural and linguistic factors are discussed, which may limit access to information about the pandemic and, accordingly, uptake of public health recommendations. Throughout our analysis, a trauma-informed framework is utilized, whereby potential for pandemic-related disruption in triggering previous traumatic stress is considered. Furthermore, using a developmental resilience framework and building upon the inherent strengths of families and children, suggestions for developing evidence-based programming and policy are reviewed. Responses should be: (1) multilevel, (2) trauma informed, (3) family focused, (4) culturally and linguistically sensitive, and (5) access oriented. The present analysis can serve as a timely guide for informing program design and policy in the context of public health, social services, mental health, health care, resettlement services, and other refugee-serving organizations.
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Affiliation(s)
- Dillon Thomas Browne
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Jackson Andrew Smith
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Jean de Dieu Basabose
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada and Sanctuary Refugee Health Centre, 310 King Street East, Kitchener, ON N2G 2L3, Canada
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Barriers to Accessing Medicines among Syrian Asylum Seekers and Refugees in a German Federal State. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020519. [PMID: 33435189 PMCID: PMC7827681 DOI: 10.3390/ijerph18020519] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/23/2020] [Accepted: 01/06/2021] [Indexed: 11/28/2022]
Abstract
In Germany, asylum seekers and refugees (AS&Rs) face challenges when accessing healthcare services including medicines. The aim of this study was to explore the barriers to accessing medicines among Syrian AS&Rs in the state of North Rheine-Westphalia, and to provide an understanding of their perspectives towards taking medicines that contain alcohol or pork products. This study is based on a cross-sectional survey using a combination of sampling methods. We used descriptive statistics to analyze quantitative data. Participants’ answers to an open-ended question yielded qualitative data that were categorized based on the thematic areas they discussed or addressed. Among the 1641 respondents, language barriers had more of an effect on the access to medicines than any other factor studied. The effect of language barriers on access to medicines was more pronounced for female participants, those who were older than 50 years, and participants who had chronic diseases in comparison to the other groups of participants. Male participants and those younger than 50 years of age showed more acceptance towards taking medicines that contain alcohol or pork products. Based on our results, we recommend providing more support for AS&Rs to learn the German language, particularly for female refugees, older refugees, and those with chronic diseases or disabilities. We also recommend providing translated medical leaflets for patients who wish to receive them in their native language. Healthcare providers should try to consider the special conditions of AS&Rs patients and take into account their perspectives about treatments and diseases.
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Parajuli J, Horey D. Barriers to and facilitators of health services utilisation by refugees in resettlement countries: an overview of systematic reviews. AUST HEALTH REV 2020; 44:132-142. [PMID: 30654856 DOI: 10.1071/ah18108] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/11/2018] [Indexed: 12/11/2022]
Abstract
Objective The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic? Refugee health after resettlement is poor, yet health service use is low. What does this paper add? Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals' knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners? The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees.
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Affiliation(s)
- Jamuna Parajuli
- Department of Public Health, La Trobe University, Bundoora, Vic. 3086, Australia; and Corresponding author.
| | - Dell Horey
- Department of Public Health, La Trobe University, Bundoora, Vic. 3086, Australia; and College of Science, Health and Engineering, La Trobe University, Bundoora, Vic. 3086, Australia.
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Asfaw BB, Beiersmann C, Keck V, Nikendei C, Benson-Martin J, Schütt I, Lohmann J. Experiences of psychotherapists working with refugees in Germany: a qualitative study. BMC Psychiatry 2020; 20:588. [PMID: 33308187 PMCID: PMC7733283 DOI: 10.1186/s12888-020-02996-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 12/03/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite a high burden of mental health problems among refugees, there is limited knowledge about effective mental health care provision for this group. Although substantial efforts in understanding the complexity of cross-cultural psychotherapy - which in the context of this study we use to refer to therapy with client and therapist of different cultural backgrounds - have been made, there remains a dearth of research exploring barriers for effective cross-cultural psychotherapy. This study aimed at narrowing this gap in knowledge by exploring major challenges encountered by psychotherapists in cross-cultural psychotherapy and strategies which have proven useful in overcoming such challenges. METHODS We employed a qualitative study design, conducting semi-structured in-depth interviews with 10 purposely selected psychotherapists working with refugees in Germany. Respondents were from varying theoretical background and had varying levels of experience. Data were analyzed using a thematic approach, following a mix of deductive and inductive coding. RESULTS Respondents reported three main challenges in their cross-cultural practice: different or unrealistic expectations of clients towards what psychotherapy would offer them; challenges grounded in different illness explanatory models; and communication challenges. In dealing with these challenges, respondents recommended psychoeducation to overcome issues related to problematic expectations towards psychotherapy; "imagining the real", identifying "counter magic" and other client-appropriate resources to deal with issues related to clients' foreign illness attributions; and translators in dealing with communication barriers, though the latter not univocally. CONCLUSIONS Results show that psychotherapy with refugees can be very successful, at least from the psychotherapist perspective, but also poses significant challenges. Our findings underline the importance of developing, testing, and institutionalizing structured and structural approaches to training psychotherapists in cross-cultural therapy at scale, to accommodate the rising mental health care need of refugees as a client group.
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Affiliation(s)
- Baye Berihun Asfaw
- Department of Psychology, College of Social Sciences and Humanities, University of Gonder, P.O. Box: 196, Gonder, Ethiopia.
| | - Claudia Beiersmann
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Verena Keck
- Department of Social and Cultural Anthropology, Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Janine Benson-Martin
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Gesundheitsamt Enzkreis, Pforzheim, Germany
| | | | - Julia Lohmann
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Niedermaier A, Freiberg A, Tiller D, Wienke A, Führer A. Outpatient health care utilization and health expenditures of asylum seekers in Halle (Saale), Germany - an analysis of claims data. BMC Health Serv Res 2020; 20:961. [PMID: 33081775 PMCID: PMC7576695 DOI: 10.1186/s12913-020-05811-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/09/2020] [Indexed: 12/21/2022] Open
Abstract
Background Asylum seekers are a vulnerable group with special needs in health care due to their migration history and pre-, peri- and postmigratory social determinants of health. However, in Germany access to health care is restricted for asylum seekers by law and administrative regulations. Methods Using claims data generated in the billing process of health care services provided to asylum seekers, we explore their utilization of health care services in the outpatient sector. We describe the utilization of outpatient specialties, prevalences of diagnoses, prescribed drugs and other health care services, as well as total costs of health care provision. Results The estimated prevalence for visiting an ambulatory physician at least once per year was 67.5% [95%-Confidence-Interval (CI): 65.1–69.9%], with a notably higher prevalence for women than men. The diagnoses with the highest one-year prevalence were “Acute upper respiratory infections” (16.1% [14.5–18.0%]), “Abdominal and pelvic pain” (15.6% [13.9–17.4%]) and “Dorsalgia” (13.8% [12.2–15.5%]). A total of 21% of all prescriptions were for common pain killers. Women received more diagnoses across most diagnosis groups and prescribed drugs from all types than men. Less than half (45.3%) of all health care costs were generated in the outpatient sector. Conclusion The analysis of claims data held in a municipal social services office is a novel approach to gain better insight into asylum seekers’ utilization of health services on an individual level. Compared to regularly insured patients, four characteristics in health care utilization by asylum seekers were identified: low utilization of ambulatory physicians; a gender gap in almost all services, with higher utilization by women; frequent prescription of pain killers; and a low proportion of overall health care costs generated in the outpatient sector. Further research is needed to describe structural and individual factors producing these anomalies.
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Affiliation(s)
- Andreas Niedermaier
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
| | - Anna Freiberg
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel Tiller
- IT-Department, Data Integration Center, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Amand Führer
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Führer A, Niedermaier A, Kalfa V, Mikolajczyk R, Wienke A. Serious shortcomings in assessment and treatment of asylum seekers' mental health needs. PLoS One 2020; 15:e0239211. [PMID: 33027307 PMCID: PMC7540848 DOI: 10.1371/journal.pone.0239211] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The prevalence of psychological complaints is known to be very high in populations of asylum seekers. Despite this, data on the health care system's ability to adequately meet these high-risk populations' mental health needs are scarce. This article investigates how well the German outpatient health care system is able to detect and adequately treat them. METHODS To this end, we combined data from a cross-sectional survey with billing data from the local social welfare office from the year 2015. Using descriptive statistics, the data of the cross-sectional study are used to quantify the psychological health care needs of asylum seekers while the secondary data analysis indicates the actual access to and extent of psychological treatment. RESULTS In the cross-sectional study, 54% of patients were screened positive for symptoms of depression, 41% for symptoms of anxiety disorder and 18% for symptoms of Posttraumatic Stress Disorder. In total, 59% were screened positive for at least one of these three disorders. However, when contrasting these screening-based prevalences with the prevalences based on data from the health care system, a mismatch becomes apparent: According to the social welfare office's billing data, only 2.6% of asylum seekers received the diagnosis of depression, 1.4% were diagnosed with anxiety disorder and 2.9% with Posttraumatic Stress Disorder (PTSD). In combination, 4.9% were diagnosed with at least one of these three disorders. Overall, less than one tenth of asylum seekers with symptoms of depression, anxiety or PTSD received the corresponding diagnosis by the health care system. Among those who were diagnosed, about 45% received no treatment at all, while 38% were treated with drugs alone. Only 1% of all patients received psychotherapy. CONCLUSIONS Psychological complaints are very common among asylum seekers, yet only a small proportion of this population receives the corresponding diagnoses and treatment. While various factors can contribute to these shortcomings, there is an urgent need to systematically address this deficit and introduce measures to improve mental health care for this high-risk population.
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Affiliation(s)
- Amand Führer
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Niedermaier
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Vivian Kalfa
- Psychosocial Centre for Refugees and Victims of Torture (PSZ), Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Hugelius K, Semrau M, Holmefur M. Perceived Needs Among Asylum Seekers in Sweden: A Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4983. [PMID: 32664366 PMCID: PMC7399818 DOI: 10.3390/ijerph17144983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/29/2022]
Abstract
The health and well-being of asylum seekers in high-income countries is a concern from both individual and community perspectives. This study aims to describe the perceived needs of adult asylum seekers in Sweden. A mixed methods study was conducted that combined a non-randomized descriptive cross-sectional assessment of perceived serious needs using the Humanitarian Emergency Settings Perceived Needs Scale (HESPER) Web with 85 adult asylum seekers and focus group discussions with 14 adult asylum seekers in Sweden. Descriptive and comparative statistics were used for the quantitative part, and thematic analysis for the qualitative part. The total number of perceived serious needs reported by respondents ranged from zero to 13 needs per person with a mean of four needs (SD 2.71). The most commonly perceived serious needs were related to income or livelihood, separation from loved ones, being displaced from home, distress, and concerns about accessing adequate health care services. Many of the perceived needs appeared to be related to experiences of being dependent, in limbo, and vulnerable. Addressing people's current perceived needs can contribute to resilience and well-being and therefore should be considered in health care systems that cater to immigrants.
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Affiliation(s)
- Karin Hugelius
- School of Health Sciences, Orebro University, 70182 Orebro, Sweden
| | - Maya Semrau
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
| | - Marie Holmefur
- School of Health Sciences, Orebro University, 70182 Orebro, Sweden
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Mårtensson L, Lytsy P, Westerling R, Wångdahl J. Experiences and needs concerning health related information for newly arrived refugees in Sweden. BMC Public Health 2020; 20:1044. [PMID: 32611334 PMCID: PMC7331281 DOI: 10.1186/s12889-020-09163-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Owing to communication challenges and a lack of knowledge about the health care system, refugees may be at risk of having limited health literacy, meaning that they will have problems in achieving, understanding, appraising and using health information or navigating in the health care system. The aim of this study was to explore experiences and needs concerning health related information for newly arrived refugees in Sweden. METHODS A qualitative design with a focus group methodology was used. The qualitative content analysis was based on seven focus group discussions, including 28 Arabic and Somali speaking refugees. RESULTS Four categories emerged. 'Concrete instructions and explanations' includes appreciation of knowledge about how to act when facing health problems. 'Contextual knowledge' comprises experienced needs of information about the health care system, about specific health risks and about rights in health issues. 'A variation of sources' describes suggestions as to where and how information should be given. 'Enabling communication' includes the wish for more awareness among professionals from a language and cultural point of view. CONCLUSION Concrete instructions and explanations are experienced as valuable and applicable. Additional information about health issues and the health care system is needed. Information concerning health should be spread by a variety of sources. Health literate health organizations are needed to meet the health challenges of refugees, including professionals that emphasize health literacy.
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Affiliation(s)
- L Mårtensson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, PO Box 455, 405 30, Göteborg, Sweden.
| | - P Lytsy
- Department of Public Health and Caring Sciences, Uppsala University, Science Park, Box 564, 751 22, Uppsala, Sweden.,Division of Insurance Medicine, Department of Clinical Neuroscience, The Karolinska Institute, Stockholm, 17177, Sweden
| | - R Westerling
- Department of Public Health and Caring Sciences, Uppsala University, Science Park, Box 564, 751 22, Uppsala, Sweden
| | - J Wångdahl
- Department of Public Health and Caring Sciences, Uppsala University, Science Park, Box 564, 751 22, Uppsala, Sweden
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