The maternal and child healthcare needs of new immigrants in Taipei

Comprehensive Comparisons of Family Health Between Families With One Immigrant Parent and Native Families in Taiwan: Nationwide Population-Based Cohort Study

BACKGROUND

Mothers and children in families with one immigrant parent have been reported to be healthier than those in native families; however, the health of the fathers in these families has rarely been discussed in literature.

OBJECTIVE

We aimed to comprehensively compare the health of all the family members between families with one immigrant parent (native fathers, immigrant mothers, and their children) and native families (native fathers, native mothers, and their children).

METHODS

We conducted a cohort study by using the Taiwan Maternal and Child Health Database to recruit live-born children and their parents from 2004 to 2016. Overall, we identified 90,670 fathers, 91,270 mothers, and 132,457 children in families with one immigrant parent and 1,666,775 fathers, 1,734,104 mothers, and 2,637,191 children in native families and followed up with them from 2004 to 2017. The outcomes comprised common physical and mental disorders, catastrophic illnesses, mortality, and child adversities and accidents. The covariates comprised the child's year of birth, parental age, low-income status, and physical or mental disorder status. Logistic regression was performed to compare the risks of the outcomes between families with one immigrant parent and native families.

RESULTS

The parents in families with one immigrant parent were more likely to be of low-income status and were older than the parents in native families. After adjusting for the covariates, fathers in families with one immigrant parent were found to have higher risks of physical and mental disorders, catastrophic illness, and mortality than fathers in native families. Conversely, mothers in families with one immigrant parent had lower risks of physical and mental disorders, catastrophic illness, and mortality than mothers in native families. Finally, the children in families with one immigrant parent generally had better physical and mental health but higher risks for leukemia, liver diseases, autism spectrum disorder, and road traffic accidents than children in native families.

CONCLUSIONS

The health status of the members of families with one immigrant parent was nonhomogeneous, and the poorer general health of fathers in such families suggests health inequalities in families with one immigrant parent.

Medical use and costs for native fathers and children from transnational marriage families in Taiwan from 2004 to 2017

Objectives

This is the first study to examine health care utilization in terms of medical use and costs in native fathers and children from transnational families.

Methods

Taiwan National Health Insurance Research Database was used to compare the annual medical use and inflation-adjusted medical cost for ambulatory care from 2004 to 2017 between native fathers and children from transnational and native families.

Results

Native fathers from transnational families had lower annual medical use (-0.23 visits) but higher total medical costs (New Taiwan dollars, NT$, 966), especially in dialysis and psychiatry, compared with those from native families. Unlike fathers from transnational families, their children were observed to consistently have lower medical use (-1.35 visits) and costs (NT$ -636), compared with those from native families.

Conclusions

There was different medical use and costs in transnational marriage families, possibly as a result of features in transnational marriage families. These findings provide insight for future health care policies to address the different health care utilization by exploring the unmet needs and barriers relating to children and fathers from transnational families.

Language and Culture Backgrounds of Mothers and Child Development: A Nationwide Study on the Incidence of Developmental Delays in Children Born to Immigrant Mothers in Taiwan

Background: Transnational marriages are common as a result of globalization, and immigrant mothers face various degrees of differences in language and culture backgrounds. Mothers have great influences on the development of their children, but the effects of immigrant mothers' language and culture backgrounds on developmental delays (DD) are seldom studied. To evaluate the potential effects of immigrant mothers' language and culture backgrounds on DD of their children, we conducted a nationwide study in Taiwan.

Methods: We analyzed the data from the national registry of DD in Taiwan from 2010 to 2013 and compared the incidence of DD in young children born to mothers from China, Vietnam, and Indonesia, where most of the immigrant mothers in Taiwan come from. Amongst the three countries, China is the closest to Taiwan in terms of language and culture, followed by Vietnam, and then Indonesia.

Results: We identified 4,604 patients of DD in children under 7 years old. The incidence rates showed an increasing trend among children born to mothers from China, Vietnam, and Indonesia (p < 0.01 in all years). Using children born to mothers from Vietnam, whose incidence rate of DD was in the middle amongst the three groups, as the reference, we found the incidence rate ratios in children born to mothers from China ranged from 0.65 to 0.73, and those in children born to mothers from Indonesia ranged from 1.04 to 1.26.

Conclusions: The findings support the important role of mothers' language and culture backgrounds in the development of children.

Learning strengths from cultural differences: a comparative study of maternal health-related behaviors and infant care among Southern Asian immigrants and Taiwanese women

Background

Many studies have indicated that most immigrant women come from underdeveloped countries, and this can have negative effects on their lives, children’s adaptation to school, and medical care utilization. However, there is insufficient literature about differences in infant caretaking, pre-postpartum health care, and health outcome between immigrant and native Taiwanese populations. The aim of this study was to investigate the differences between Southern Asia immigrants and Taiwanese women in their access to medical care, postnatal growth, and infant care throughout the first six months postpartum.

Methods

Comparative and descriptive designs were applied. Immigrant women were eligible if they visited three suburban settings of the Outpatient Department of Obstetrics and Gynecology and the Outpatient Department of Pediatrics in Northern Taiwan during the period up to six months postpartum.

Results

Immigrant women appeared to have a lower frequency of antenatal examinations and obtained less health information from health care providers. However, they did not differ significantly from native Taiwanese women in maternal body size, postnatal growth curves, exclusive breastfeeding rates or vaccination awareness at the 6^th month postpartum.

Conclusions

Learning strengths from cultural differences between immigrant and native women and closing the gaps in health inequality are important issues. Despite the limitation of small sample size, the present findings can be used as references to help health care providers to develop further health policies in Taiwan.

The development and psychometric testing of East Asian Acculturation Scale among Asian immigrant women in Taiwan

OBJECTIVE

This is a report of development and psychometric testing of the East Asian Acculturation Measure-Chinese version (EAAM-C) scale.

DESIGN

An instrument validation design with a cross-sectional survey was conducted. The process was carried in two phases. In Phase 1, Barry's East Asian Acculturation Measure was translated and back translated to evaluate its content, face validity, and feasibility validity. In Phase 2, the 16-item EAAM-C was pilot-tested among 485 female immigrants for test-retest reliability, internal consistency, theoretically-supported construct validity and concurrent validity.

RESULTS

The pilot work and the survey results indicated the tools possessed adequate content and face validity. The Cronbach's Alphas for the EAAM-C was 0.72, and 0.76-0.79 for its subscales, and the correlation of test-retest reliability (at 3 weeks) was 0.75. After dropping one item, four theoretically-supported factors which explained 61.82% of the variance were abstracted using exploratory factor analysis: assimilation, integration, separation, and marginalization. Based on the underlying four-factor theoretical structures of the EAAM, the confirmatory factor analysis of the EAAM-C was further examined. The analysis revealed that the four-factor model was an acceptable fit for the data which demonstrated adequate finding in its construct validity. These factors were inter-correlated, and showed statistically significant correlation with the Chinese Health Questionnaire, indicating adequate concurrent validity.

CONCLUSIONS

The scale shows acceptable validity and consistency, and suggests that immigrant acculturation is a complex construct. This quick evaluation instrument can be applied to assess clients' acculturation and in further developing certain interventions to improve their health.

Factors associated with intensiveness of use of child preventive health services in Taiwan: a comparative study between cross-cultural immigrant families and native-born families

OBJECTIVES

To compare intensiveness of use of child preventive health services (CPHS) between cross-cultural immigrant families and native-born families in Taiwan and to explore factors associated with differences in intensiveness of CPHS use.

DESIGN

Cross-cultural immigrant families were defined as families where the mother was an immigrant from another southeast Asian country. In native-born families, both parents were Taiwanese-born. Data were collected from 318 immigrant mothers and 340 native-born mothers of children aged 7 years or younger in a cross-sectional survey in central Taiwan. A social determinants framework of health inequities was constructed, and ordinal logistic regression models were used to examine the effect of four domains of intermediary determinants on the relationship between family type and underuse of CPHS: CPHS-related factors, medical-related factors, maternal acculturation factors, and sociodemographic/socioeconomic characteristics.

RESULTS

Cross-cultural immigrant families were less likely to intensively use CPHS than native-born families. This difference appeared to be mediated by the greater likelihood of having an older child or a lower educated father in cross-cultural families.

CONCLUSION

Findings of this study highlight the importance of promoting health behaviors and combating health inequities and social inequalities for cross-cultural immigrant families in Taiwan from a sociodemographic/socioeconomic and political context.

Maternal mental health and child development in Asian immigrant mothers in Taiwan

BACKGROUND/PURPOSE

Marriages between Taiwanese men and immigrant women are common in Southern Taiwan. However, little is known about the adjustment of these women to life in Taiwan and their children's development as a result of cross-national marriage. This study evaluated the psychological status and adjustment of the foreign-born mothers in Taiwan, and assessed the influence of their immigrant motherhood on child development.

METHODS

Ninety-four immigrant mothers (41 Chinese, 37 Vietnamese, and 16 Southeast Asian women) and their 104 children born in Taiwan were enrolled in this study. Information was obtained by a clinical interview for medical history and sociodemographics, and five standardized self-administered questionnaires for maternal general mental health, maternal depression, maternal cognitive functioning, home environment, and child development.

RESULTS

Chinese mothers were significantly more educated and less likely to marry via referral agencies than mothers from Vietnam and other countries in Southeast Asia. Husbands of Chinese mothers significantly better educated, less likely to have physical illnesses, and were closer in age to their wives than husbands in the other two groups. Immigrant mothers had high rates of psychological distress (70%) and marked depression (24%). Longer residency in Taiwan predicted a higher likelihood of maternal depression, especially in the Southeast Asian mothers. Chinese mothers had the highest degree of cognitive functioning and provided a better home environment for their children. Childhood developmental delay was predicted by older child age and parental marriage via referral agencies.

CONCLUSION

This study highlights the need to give continuous psychosocial support to immigrant mothers and to identify early developmental delays among their children.