1
|
Peñuela-O'Brien E, Wan MW, Edge D, Berry K. Health professionals' experiences of and attitudes towards mental healthcare for migrants and refugees in Europe: A qualitative systematic review. Transcult Psychiatry 2022; 60:176-198. [PMID: 34986056 PMCID: PMC10074763 DOI: 10.1177/13634615211067360] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Migrants living in Europe constitute over half of the world's international migrants and are at higher risk of poor mental health than non-migrants, yet also face more barriers in accessing and engaging with services. Furthermore, the quality of care received is shaped by the experiences and attitudes of health professionals. The aim of this review was to identify professionals' attitudes towards migrants receiving mental healthcare and their perceptions of barriers and facilitators to service provision. Four electronic databases were searched, and 23 studies met the inclusion criteria. Using thematic synthesis, we identified three themes: 1) the management of multifaceted and complex challenges associated with the migrant status; 2) professionals' emotional responses to working with migrants; and 3) delivering care in the context of cultural difference. Professionals employed multiple strategies to overcome challenges in providing care yet attitudes towards this patient group were polarized. Professionals described mental health issues as being inseparable from material and social disadvantage, highlighting a need for effective collaboration between health services and voluntary organizations, and partnerships with migrant communities. Specialist supervision, reflective practice, increased training for professionals, and the adoption of a person-centered approach are also needed to overcome the current challenges in meeting migrants' needs. The challenges experienced by health professionals in attempting to meet migrant needs reflect frustrations in being part of a system with insufficient resources and without universal access to care that effectively stigmatizes the migrant status.
Collapse
Affiliation(s)
- E Peñuela-O'Brien
- Division of Psychology and Mental Health, School of Health Sciences, 5292University of Manchester.,9022Greater Manchester Mental Health NHS Foundation Trust
| | - M W Wan
- Division of Psychology and Mental Health, School of Health Sciences, 5292University of Manchester
| | - D Edge
- Division of Psychology and Mental Health, School of Health Sciences, 5292University of Manchester.,9022Greater Manchester Mental Health NHS Foundation Trust
| | - K Berry
- Division of Psychology and Mental Health, School of Health Sciences, 5292University of Manchester.,9022Greater Manchester Mental Health NHS Foundation Trust
| |
Collapse
|
2
|
Ponce-Blandón JA, Romero-Castillo R, Jiménez-Picón N, Palomo-Lara JC, Castro-Méndez A, Pabón-Carrasco M. Lived Experiences of African Migrants Crossing the Strait of Gibraltar to Europe: A Cross-Cultural Approach to Healthcare from a Qualitative Methodology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9379. [PMID: 34501968 PMCID: PMC8431138 DOI: 10.3390/ijerph18179379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The migratory flow from the African continent to Europe is intense and the European countries should apply a humanitarian, health and social response to this emerging problem. Migrants coming from Africa to Europe are a very vulnerable population. Healthcare professionals should be prepared for answering their needs from a transcultural approach, which requires a better understanding of this phenomenon. Thus, the aim of this study was to improve nursing and healthcare professionals' awareness and better understanding of migrant life experiences during the migration journey. An exploratory descriptive qualitative research was conducted. In-depth interviews were conducted involving four key informants and content analysis were performed with the transcriptions. RESULTS Three themes merged: life situations in their countries of origin; motivations that led them to undertake the migratory journey; and experiences they lived during the migratory journey. The results described the dramatic experience and motivations for crossing the strait of Gibraltar from Africa to Europe, including feelings, fears, hopes and lived experiences. The determination of immigrants to fight for a better life opportunity and the physical damage and psychological consequences they suffer were revealed. CONCLUSIONS This study would help healthcare professionals to better understand this complex reality and deliver culturally adapted care. Knowledge of the starting reality of these populations can help health professionals to incorporate a cross-cultural approach that improves the relational, ethical and affective competences to provide quality care to the migrant population, as well as the development of health measures to fight against inequalities suffered by these population groups.
Collapse
Affiliation(s)
- José Antonio Ponce-Blandón
- Red Cross Nursing University Center, University of Seville, 41009 Seville, Spain; (N.J.-P.); (J.C.P.-L.); (M.P.-C.)
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain;
| | - Rocío Romero-Castillo
- Red Cross Nursing University Center, University of Seville, 41009 Seville, Spain; (N.J.-P.); (J.C.P.-L.); (M.P.-C.)
| | - Nerea Jiménez-Picón
- Red Cross Nursing University Center, University of Seville, 41009 Seville, Spain; (N.J.-P.); (J.C.P.-L.); (M.P.-C.)
| | - Juan Carlos Palomo-Lara
- Red Cross Nursing University Center, University of Seville, 41009 Seville, Spain; (N.J.-P.); (J.C.P.-L.); (M.P.-C.)
| | - Aurora Castro-Méndez
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain;
| | - Manuel Pabón-Carrasco
- Red Cross Nursing University Center, University of Seville, 41009 Seville, Spain; (N.J.-P.); (J.C.P.-L.); (M.P.-C.)
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain;
| |
Collapse
|
3
|
Lu J, Jamani S, Benjamen J, Agbata E, Magwood O, Pottie K. Global Mental Health and Services for Migrants in Primary Care Settings in High-Income Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8627. [PMID: 33233666 PMCID: PMC7699722 DOI: 10.3390/ijerph17228627] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022]
Abstract
Migrants are at a higher risk for common mental health problems than the general population but are less likely to seek care. To improve access, the World Health Organization (WHO) recommends the integration of mental health services into primary care. This scoping review aims to provide an overview of the types and characteristics of mental health services provided to migrants in primary care following resettlement in high-income countries. We systematically searched MEDLINE, EMBASE, PsycInfo, Global Health, and other databases from 1 January 2000 to 15 April 2020. The inclusion criteria consisted of all studies published in English, reporting mental health services and practices for refugee, asylum seeker, or undocumented migrant populations, and were conducted in primary care following resettlement in high-income countries. The search identified 1627 citations and we included 19 studies. The majority of the included studies were conducted in North America. Two randomized controlled trials (RCTs) assessed technology-assisted mental health screening, and one assessed integrating intensive psychotherapy and case management in primary care. There was a paucity of studies considering gender, children, seniors, and in European settings. More equity-focused research is required to improve primary mental health care in the context of global mental health.
Collapse
Affiliation(s)
- Jia Lu
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada;
| | - Shabana Jamani
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada; (S.J.); (J.B.)
| | - Joseph Benjamen
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada; (S.J.); (J.B.)
| | - Eric Agbata
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada; (E.A.); (O.M.)
| | - Olivia Magwood
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada; (E.A.); (O.M.)
- Interdisciplinary School of Health Sciences, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
| | - Kevin Pottie
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada; (E.A.); (O.M.)
- Department of Family Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
| |
Collapse
|
4
|
Iriarte-Roteta A, Lopez-Dicastillo O, Mujika A, Ruiz-Zaldibar C, Hernantes N, Bermejo-Martins E, Pumar-Méndez MJ. Nurses' role in health promotion and prevention: A critical interpretive synthesis. J Clin Nurs 2020; 29:3937-3949. [PMID: 32757432 DOI: 10.1111/jocn.15441] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Role confusion is hampering the development of nurses' capacity for health promotion and prevention. Addressing this requires discussion to reach agreement among nurses, managers, co-workers, professional associations, academics and organisations about the nursing activities in this field. Forming a sound basis for this discussion is essential. AIMS AND OBJECTIVES To provide a description of the state of nursing health promotion and prevention practice expressed in terms of activities classifiable under the Ottawa Charter and to reveal the misalignments between this portrayal and the ideal one proposed by the Ottawa Charter. METHODS A critical interpretive synthesis was conducted between December 2018 and May 2019. The PubMed, CINAHL, Scopus, PsychINFO, Web of Science and Dialnet databases were searched. Sixty-two papers were identified. The relevant data were extracted using a pro-forma, and the reviewers performed an integrative synthesis. The ENTREQ reporting guidelines were used for this review. RESULTS Thirty synthetic constructs were developed into the following synthesising arguments: (a) addressing individuals' lifestyles versus developing their personal skills; (b) focusing on environmental hazards versus creating supportive environments; (c) action on families versus strengthening communities; (d) promoting community partnerships versus strengthening community action; and (e) influencing policies versus building healthy public policy. CONCLUSIONS There are notable misalignments between nurses' current practice in health promotion and prevention and the Ottawa Charter's actions and strategies. This may be explained by the nurses' lack of understanding of health promotion and prevention and political will, research methodological flaws, the predominance of a biomedical perspective within organisations and the lack of organisational prioritisation for health promotion and prevention.
Collapse
Affiliation(s)
| | - Olga Lopez-Dicastillo
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | - Agurtzane Mujika
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | | | - Naia Hernantes
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain
| | - Elena Bermejo-Martins
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain
| | - María J Pumar-Méndez
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| |
Collapse
|
5
|
Abstract
Migrants pose many challenges to recipient countries, including preparedness and resilience of health systems and provision of access to health services. Refugees and asylum seekers comprise a heterogenous group with significant and complex health needs, including the physical and mental consequences of violence. Physicians are often on the frontline in providing care for these unassisted, vulnerable and often maligned and misunderstood population groups. The need to adopt an effective and compassionate medical approach is imperative, including an awareness of unconscious biases and differences in gender roles, decision-making, and social taboos. In addition to practical steps to promote and build a trusting relationship between patient and physician during consultations, physicians require a broad knowledge of anthropology, history, sociology, and drivers of migration such as conflict, resource scarcity and climate change for a better understanding of their patients.
Collapse
Affiliation(s)
- Patrícia Deps
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, Espírito Santo, BR
- Paris-Saclay University (UVSQ), Laboratory of Anthropology, Archaeology & Biology (LAAB), Montigny-Le-Bretonneux, FR
| | - Philippe Charlier
- Paris-Saclay University (UVSQ), Laboratory of Anthropology, Archaeology & Biology (LAAB), Montigny-Le-Bretonneux, FR
- Department of Research and Higher Education, Musée du quai Branly - Jacques Chirac, Paris, FR
| |
Collapse
|
6
|
Wahlström E, Harder M, Granlund M, Holmström IK, Larm P, Golsäter M. School nurses' self-assessed cultural competence when encountering children of foreign origin: A cross-sectional study. Nurs Health Sci 2019; 22:226-234. [PMID: 31729131 DOI: 10.1111/nhs.12663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 09/30/2019] [Accepted: 10/20/2019] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to investigate associations between school nurses' self-assessed cultural competence in health visits with children of foreign origin and demographic variables, by using a cross-sectional design. A Web-based questionnaire assessing cultural competence and demographic variables was distributed to a nationally representative sample (n = 816) of school nurses in Sweden. Data were analyzed using regression analysis. School nurses assessed themselves as culturally aware and moderately culturally competent, but not as culturally knowledgeable, culturally skilled, or comfortable in cultural encounters. Cultural competence was related to education in cultural diversity, how often nurses encounter children of foreign origin, and nurses' country of origin. In total, these variables explained 23.6% of the variation in school nurses' cultural competence. Because school nurses regard themselves as moderately culturally competent, a foundation for promoting children's health on equal terms in school health care exists. However, education in cultural diversity combined with other additional strategies is needed to further strengthen school nurses' cultural knowledge, skills, and comfort level in encounters with children of foreign origin.
Collapse
Affiliation(s)
- Emmie Wahlström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Maria Harder
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Mats Granlund
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Larm
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Marie Golsäter
- School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Child Health Services and Futurum, Region Jönköping County, Jönköping, Sweden
| |
Collapse
|
7
|
Sabone MB, Mogobe KD, Matshediso E, Shaibu S, Ntsayagae EI, Corless IB, Cuca YP, Holzemer WL, Dawson-Rose C, Soliz Baez SS, Rivero-Mendz M, Webel AR, Eller LS, Reid P, Johnson MO, Kemppainen J, Reyes D, Nokes K, Wantland D, Nicholas PK, Lingren T, Portillo CJ, Sefcik E, Long-Middleton E. A qualitative description of service providers' experiences of ethical issues in HIV care. Nurs Ethics 2018. [PMID: 29514575 DOI: 10.1177/0969733017753743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. PURPOSE This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. RESEARCH DESIGN A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. PARTICIPANTS AND CONTEXT This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. ETHICAL CONSIDERATIONS Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. FINDINGS HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. DISCUSSION The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. CONCLUSION Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Paula Reid
- University of North Carolina at Wilmington, USA
| | | | | | | | | | | | | | - Teri Lingren
- Rutgers, The State University of New Jersey, USA
| | | | | | | |
Collapse
|
8
|
Willey SM, Cant RP, Williams A, McIntyre M. Maternal and child health nurses work with refugee families: Perspectives from regional Victoria, Australia. J Clin Nurs 2018; 27:3387-3396. [PMID: 29356230 DOI: 10.1111/jocn.14277] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore service provision for Victorian regional refugee families from the perspective of maternal and child health nurses. BACKGROUND Increasingly, more families from a refugee background are resettling in regional Victoria. The refugee journey has significant effect on families. Refugee families with infants and young children can be provided with support by maternal and child health services; however, many families experience barriers to ongoing engagement with this service. DESIGN This descriptive study used focus group and questionnaire. A purposive sample of 26 maternal and child health nurses was drawn from six municipalities throughout regional Victoria, where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio-recorded narratives were transcribed, prior to inductive thematic analysis. METHODS This descriptive study used focus group and questionnaire. A purposive sample of 26 Maternal and Child Health nurses was drawn from six municipalities throughout regional Victoria where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio-recorded narratives were transcribed verbatim, prior to inductive thematic analysis. RESULTS Participating nurses were experienced nurses, averaging 12 years in the service. Four major themes emerged from thematic analysis: "How to identify women from a refugee background"; "The Maternal and Child Health nurse role when working with families from a refugee background"; "Interpreting issues"; and "Access to other referral agencies." Nurses worked to develop a relationship with families, attending to a complex mix of issues which were complicated by language barriers. Nurses found their role in supporting refugee families required additional time and more home visits. CONCLUSIONS To provide best practice, maternal and child health nurses need (i) ongoing professional development; (ii) time, flexibility and creativity to build relationships with refugee families and (iii) better access to services that enhance communication, such as interpreting services and translated resources. RELEVANCE TO CLINICAL PRACTICE Nurses require ongoing professional development to help them address the multifaceted needs of families of refugee background. With limited resources available in regional areas, accessing further education can be challenging. Distance education models and organisational support could provide nurses with educational opportunities aimed at improving service provision and clinical practice.
Collapse
Affiliation(s)
- Suzanne M Willey
- Nursing & Midwifery, Monash University, Peninsula Campus, Frankston, Vic., Australia
| | - Robyn P Cant
- Nursing & Midwifery, Monash University, Clayton Campus, Clayton, Vic., Australia
| | - Allison Williams
- Nursing & Midwifery, Monash University, Clayton Campus, Clayton, Vic., Australia
| | - Meredith McIntyre
- Nursing & Midwifery, Monash University, Peninsula Campus, Frankston, Vic., Australia
| |
Collapse
|
9
|
Dotevall C, Winberg E, Rosengren K. Nursing students' experiences with refugees with mental health problems in Jordan: A qualitative content analysis. NURSE EDUCATION TODAY 2018; 61:155-161. [PMID: 29207287 DOI: 10.1016/j.nedt.2017.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/26/2017] [Accepted: 11/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study was to describe Jordanian nursing students' experience of caring for refugees with mental health problems. BACKGROUND According to refugees' experiences of crisis, a well-educated staff is needed to provide high quality of care due to mental health problems. Therefore, health professionals play an important role in creating an environment that promotes human rights regardless of ethnic origin. SETTINGS, PARTICIPANTS, METHOD The study comprised eight interviews and was analysed using content analysis, a qualitative method that involves an inductive approach, to increase our understanding of nursing students' perspective and thoughts regarding caring for refugees with mental health problems. RESULTS The results formed one category: to be challenged by refugees' mental health issues and three subcategories: managing refugees' mental health needs, affected by refugees' mental health, and improve mental healthcare for refugees. CONCLUSION Language problems could be managed by using interpreters to decrease cultural clashes to facilitate equal healthcare. In addition, well-educated (theoretical knowledge) and trained (practical knowledge) nursing students have potential to fulfil refugees' care needs regardless of ethnicity or background by using nursing interventions built on communication skills and cultural competences (theory, practice) to facilitate high quality of healthcare.
Collapse
Affiliation(s)
- Camilla Dotevall
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - Elin Winberg
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - Kristina Rosengren
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Sweden.
| |
Collapse
|
10
|
Robertshaw L, Dhesi S, Jones LL. Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research. BMJ Open 2017; 7:e015981. [PMID: 28780549 PMCID: PMC5629684 DOI: 10.1136/bmjopen-2017-015981] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To thematically synthesise primary qualitative studies that explore challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries. DESIGN Systematic review and qualitative thematic synthesis. METHODS Searches of MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science. Search terms were combined for qualitative research, primary healthcare professionals, refugees and asylum seekers, and were supplemented by searches of reference lists and citations. Study selection was conducted by two researchers using prespecified selection criteria. Data extraction and quality assessment using the Critical Appraisal Skills Programme tool was conducted by the first author. A thematic synthesis was undertaken to develop descriptive themes and analytical constructs. RESULTS Twenty-six articles reporting on 21 studies and involving 357 participants were included. Eleven descriptive themes were interpreted, embedded within three analytical constructs: healthcare encounter (trusting relationship, communication, cultural understanding, health and social conditions, time); healthcare system (training and guidance, professional support, connecting with other services, organisation, resources and capacity); asylum and resettlement. Challenges and facilitators were described within these themes. CONCLUSIONS A range of challenges and facilitators have been identified for health professionals providing primary healthcare for refugees and asylum seekers that are experienced in the dimensions of the healthcare encounter, the healthcare system and wider asylum and resettlement situation. Comprehensive understanding of these challenges and facilitators is important to shape policy, improve the quality of services and provide more equitable health services for this vulnerable group.
Collapse
Affiliation(s)
- Luke Robertshaw
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Surindar Dhesi
- Department of Earth and Environmental Sciences, School of Geography, University of Birmingham, Birmingham, UK
| | - Laura L Jones
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
11
|
Ansar A, Johansson F, Vásquez L, Schulze M, Vaughn T. Challenges in access to health care among involuntary migrants in Germany. A case study of migrants' experiences in Oldenburg, Lower Saxony. INTERNATIONAL MIGRATION 2017. [DOI: 10.1111/imig.12326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anas Ansar
- Carl von Ossietzky University; Oldenburg
| | | | | | | | | |
Collapse
|
12
|
Riggs E, Yelland J, Szwarc J, Wahidi S, Casey S, Chesters D, Fouladi F, Duell-Piening P, Giallo R, Brown S. Fatherhood in a New Country: A Qualitative Study Exploring the Experiences of Afghan Men and Implications for Health Services. Birth 2016; 43:86-92. [PMID: 26616739 DOI: 10.1111/birt.12208] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fathers of refugee background are dealing with multiple, interrelated stressors associated with forced migration and establishing their lives in a new country. This has implications for the role of men in promoting the health and well-being of their families. METHODS Afghan community researchers conducted interviews with 30 Afghan women and men who had recently had a baby in Australia. Interviews and focus groups were conducted with health professionals working with families of refugee background. RESULTS Fourteen men, 16 women, and 34 health professionals participated. Afghan men reported playing a major role in supporting their wives during pregnancy and postnatal care, accompanying their wives to appointments, and providing language and transport support. Although men embraced these roles, they were rarely asked by health professionals about their own concerns related to their wife's pregnancy, or about their social circumstances. Perinatal health professionals queried whether it was their role to meet the needs of men. CONCLUSION There are many challenges for families of refugee background navigating maternity services while dealing with the challenges of settlement. There is a need to move beyond a narrow conceptualization of antenatal and postnatal care to encompass a broader preventive and primary care approach to supporting refugee families through the period of pregnancy and early years of parenting. Pregnancy and postnatal care needs to be tailored to the social and psychological needs of families of refugee background, including men, and incorporate appropriate language support, in order to improve child and family health outcomes.
Collapse
Affiliation(s)
- Elisha Riggs
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Vic., Australia
| | - Jane Yelland
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Vic., Australia
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Brunswick, Vic., Australia
| | - Sayed Wahidi
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, Brunswick, Vic., Australia
| | - Donna Chesters
- Victorian Foundation for Survivors of Torture, Brunswick, Vic., Australia
| | - Fatema Fouladi
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | | | - Rebecca Giallo
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Vic., Australia.,School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
| |
Collapse
|
13
|
Suphanchaimat R, Kantamaturapoj K, Putthasri W, Prakongsai P. Challenges in the provision of healthcare services for migrants: a systematic review through providers' lens. BMC Health Serv Res 2015. [PMID: 26380969 DOI: 10.1186/s12913-015-1065-z.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, cross-border migration has gained significant attention in high-level policy dialogues in numerous countries. While there exists some literature describing the health status of migrants, and exploring migrants' perceptions of service utilisation in receiving countries, there is still little evidence that examines the issue of health services for migrants through the lens of providers. This study therefore aims to systematically review the latest literature, which investigated perceptions and attitudes of healthcare providers in managing care for migrants, as well as examining the challenges and barriers faced in their practices. METHODS A systematic review was performed by gathering evidence from three main online databases: Medline, Embase and Scopus, plus a purposive search from the World Health Organization's website and grey literature sources. The articles, published in English since 2000, were reviewed according to the following topics: (1) how healthcare providers interacted with individual migrant patients, (2) how workplace factors shaped services for migrants, and (3) how the external environment, specifically laws and professional norms influenced their practices. Key message of the articles were analysed by thematic analysis. RESULTS Thirty seven articles were recruited for the final review. Key findings of the selected articles were synthesised and presented in the data extraction form. Quality of retrieved articles varied substantially. Almost all the selected articles had congruent findings regarding language andcultural challenges, and a lack of knowledge of a host country's health system amongst migrant patients. Most respondents expressed concerns over in-house constraints resulting from heavy workloads and the inadequacy of human resources. Professional norms strongly influenced the behaviours and attitudes of healthcare providers despite conflicting with laws that limited right to health services access for illegal migrants. DISCUSSION The perceptions, attitudes and practices of practitioners in the provision of healthcare services for migrants were mainly influenced by: (1) diverse cultural beliefs and language differences, (2) limited institutional capacity, in terms of time and/or resource constraints, (3) the contradiction between professional ethics and laws that limited migrants' right to health care. Nevertheless, healthcare providers addressedsuch problems by partially ignoring the immigrants'precarious legal status, and using numerous tactics, including seeking help from civil society groups, to support their clinical practice. CONCLUSION It was evident that healthcare providers faced several challenges in managing care for migrants, which included not only language and cultural barriers, but also resource constraints within their workplaces, and disharmony between the law and their professional norms. Further studies, which explore health care management for migrants in countries with different health insurance models, are recommended.
Collapse
Affiliation(s)
- Rapeepong Suphanchaimat
- International Health Policy Program (IHPP), Ministry of Public Health of Thailand, Tiwanon road, Nonthaburi, 11000, Thailand. .,Banphai Hospital, Banphai district, Khon Kaen, 40110, Thailand.
| | - Kanang Kantamaturapoj
- Department of Social Sciences, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, 73170, Thailand.
| | - Weerasak Putthasri
- International Health Policy Program (IHPP), Ministry of Public Health of Thailand, Tiwanon road, Nonthaburi, 11000, Thailand.
| | - Phusit Prakongsai
- International Health Policy Program (IHPP), Ministry of Public Health of Thailand, Tiwanon road, Nonthaburi, 11000, Thailand.
| |
Collapse
|
14
|
Suphanchaimat R, Kantamaturapoj K, Putthasri W, Prakongsai P. Challenges in the provision of healthcare services for migrants: a systematic review through providers' lens. BMC Health Serv Res 2015; 15:390. [PMID: 26380969 PMCID: PMC4574510 DOI: 10.1186/s12913-015-1065-z] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 09/12/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In recent years, cross-border migration has gained significant attention in high-level policy dialogues in numerous countries. While there exists some literature describing the health status of migrants, and exploring migrants' perceptions of service utilisation in receiving countries, there is still little evidence that examines the issue of health services for migrants through the lens of providers. This study therefore aims to systematically review the latest literature, which investigated perceptions and attitudes of healthcare providers in managing care for migrants, as well as examining the challenges and barriers faced in their practices. METHODS A systematic review was performed by gathering evidence from three main online databases: Medline, Embase and Scopus, plus a purposive search from the World Health Organization's website and grey literature sources. The articles, published in English since 2000, were reviewed according to the following topics: (1) how healthcare providers interacted with individual migrant patients, (2) how workplace factors shaped services for migrants, and (3) how the external environment, specifically laws and professional norms influenced their practices. Key message of the articles were analysed by thematic analysis. RESULTS Thirty seven articles were recruited for the final review. Key findings of the selected articles were synthesised and presented in the data extraction form. Quality of retrieved articles varied substantially. Almost all the selected articles had congruent findings regarding language andcultural challenges, and a lack of knowledge of a host country's health system amongst migrant patients. Most respondents expressed concerns over in-house constraints resulting from heavy workloads and the inadequacy of human resources. Professional norms strongly influenced the behaviours and attitudes of healthcare providers despite conflicting with laws that limited right to health services access for illegal migrants. DISCUSSION The perceptions, attitudes and practices of practitioners in the provision of healthcare services for migrants were mainly influenced by: (1) diverse cultural beliefs and language differences, (2) limited institutional capacity, in terms of time and/or resource constraints, (3) the contradiction between professional ethics and laws that limited migrants' right to health care. Nevertheless, healthcare providers addressedsuch problems by partially ignoring the immigrants'precarious legal status, and using numerous tactics, including seeking help from civil society groups, to support their clinical practice. CONCLUSION It was evident that healthcare providers faced several challenges in managing care for migrants, which included not only language and cultural barriers, but also resource constraints within their workplaces, and disharmony between the law and their professional norms. Further studies, which explore health care management for migrants in countries with different health insurance models, are recommended.
Collapse
Affiliation(s)
- Rapeepong Suphanchaimat
- International Health Policy Program (IHPP), Ministry of Public Health of Thailand, Tiwanon road, Nonthaburi, 11000, Thailand.
- Banphai Hospital, Banphai district, Khon Kaen, 40110, Thailand.
| | - Kanang Kantamaturapoj
- Department of Social Sciences, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, 73170, Thailand.
| | - Weerasak Putthasri
- International Health Policy Program (IHPP), Ministry of Public Health of Thailand, Tiwanon road, Nonthaburi, 11000, Thailand.
| | - Phusit Prakongsai
- International Health Policy Program (IHPP), Ministry of Public Health of Thailand, Tiwanon road, Nonthaburi, 11000, Thailand.
| |
Collapse
|
15
|
Development of a standardized job description for healthcare managers of metabolic syndrome management programs in Korean community health centers. Asian Nurs Res (Korean Soc Nurs Sci) 2014; 8:57-66. [PMID: 25030494 DOI: 10.1016/j.anr.2014.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/13/2013] [Accepted: 11/11/2013] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study aimed to develop a job description for healthcare managers of metabolic syndrome management programs using task analysis. METHODS Exploratory research was performed by using the Developing a Curriculum method, the Intervention Wheel model, and focus group discussions. Subsequently, we conducted a survey of 215 healthcare workers from 25 community health centers to verify that the job description we created was accurate. RESULTS We defined the role of healthcare managers. Next, we elucidated the tasks of healthcare managers and performed needs analysis to examine the frequency, importance, and difficulty of each of their duties. Finally, we verified that our job description was accurate. Based on the 8 duties, 30 tasks, and 44 task elements assigned to healthcare managers, we found that the healthcare managers functioned both as team coordinators responsible for providing multidisciplinary health services and nurse specialists providing health promotion services. In terms of importance and difficulty of tasks performed by the healthcare managers, which were measured using a determinant coefficient, the highest-ranked task was planning social marketing (15.4), while the lowest-ranked task was managing human resources (9.9). CONCLUSION A job description for healthcare managers may provide basic data essential for the development of a job training program for healthcare managers working in community health promotion programs.
Collapse
|
16
|
Nishikawa M, Niiya K, Okayasu M. Addressing practical issues related to nursing care for international visitors to Hiroshima. Rev Esc Enferm USP 2014; 48:299-307. [PMID: 24918890 DOI: 10.1590/s0080-6234201400002000015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 12/13/2013] [Indexed: 11/22/2022] Open
Abstract
When nine million foreigners visited Japan in 2013, the federal government set a goal to attract an additional two and a half million visitors including medical tourists by 2020. This research investigates the attitudes and concerns of Japanese nurses when they are in a situation dealing with foreign patients. The data were collected from March through September 2010, from 114 nurses at three hospitals, in close proximity to popular tourist destinations in Hiroshima. A questionnaire was developed for this research, named Mari Meter, which included a section to write answers to an open question for the nurses to express their opinions. These responses were examined statistically and by word analysis using Text Mining Studio. Japanese nurses expressed greatest concern about payment options, foreign language skills, and issues of informed consent, when dealing with foreigners. The results confirm that, in order to provide a high quality of patient care, extra preparation and a greater knowledge of international workers and visitors are required by nursing professionals in Japan.
Collapse
Affiliation(s)
- Mariko Nishikawa
- Faculty of Nursing, Department of Nursing, Hiroshima International University, Hiroshima, Japan,
| | - Kiyoka Niiya
- Faculty of Nursing, Department of Nursing, Faculty of Nursing, Hiroshima International University, Hiroshima, Japan,
| | - Masako Okayasu
- Faculty of Nursing, Department of Nursing, University of Shimane, Shimane, Japan,
| |
Collapse
|
17
|
Wikberg A, Eriksson K, Bondas T. Immigrant New Mothers in Finnish Maternity Care: An Ethnographic Study of Caring. INTERNATIONAL JOURNAL OF CHILDBIRTH 2014. [DOI: 10.1891/2156-5287.4.2.86] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE: To illuminate experiences and perceptions of caring in the maternity care culture of immigrant new mothers in Finland.DESIGN: This is a descriptive interpretive ethnography.PARTICIPANTS AND SETTING: Seventeen new mothers from different cultures on a maternity ward in a medium-sized hospital in Finland.METHODS: Focused ethnographic analysis and interpretation of interviews, observations, and field notes were used.FINDINGS: Caring was part of the positive experience of childbearing and beneficial for the health and well-being of the immigrant new mothers. Negative experiences of health care impaired their well-being. The resources of Finnish maternity care and cultural knowledge of the nurses facilitated the caring. The policy and attitude of Finnish society encouraged childbearing. The immigration regulations affected support during childbearing negatively and tended to caused loneliness. The Finnish maternity care was not fully adapted to the mothers’ wishes to understand the organization of Finnish maternity care, to communicate, to breastfeed, and to have family-centered care, a flexible length of stay in the hospital, and extended support after childbirth.CONCLUSION: Caring improves the childbearing experience and the well-being and health of new immigrant mothers; therefore, caring needs to be emphasized in maternity care, health care administration, and nursing education.
Collapse
|
18
|
Kemppainen V, Tossavainen K, Turunen H. Nurses' roles in health promotion practice: an integrative review. Health Promot Int 2012; 28:490-501. [DOI: 10.1093/heapro/das034] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
19
|
Riggs E, Davis E, Gibbs L, Block K, Szwarc J, Casey S, Duell-Piening P, Waters E. Accessing maternal and child health services in Melbourne, Australia: reflections from refugee families and service providers. BMC Health Serv Res 2012; 12:117. [PMID: 22587587 PMCID: PMC3424108 DOI: 10.1186/1472-6963-12-117] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 05/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Often new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH) service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0-6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers. METHODS We used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7 years in Australia (range one month-18 years). Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers. RESULTS Four themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making phone bookings. Service users and providers reported that continuity of nurse and interpreter is preferred for increasing client-provider trust and ongoing engagement. CONCLUSIONS Although participants who had children born in Melbourne had good initial access to, and experience of, using MCH services, significant barriers remain. A systems-oriented, culturally competent approach to service provision would improve the service utilisation experience for parents and providers, including formalising links and notifications between settlement services and MCH services.
Collapse
Affiliation(s)
- Elisha Riggs
- The Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, The University of Melbourne, Melbourne, Australia
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Elise Davis
- The Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, The University of Melbourne, Melbourne, Australia
| | - Lisa Gibbs
- The Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, The University of Melbourne, Melbourne, Australia
| | - Karen Block
- The Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, The University of Melbourne, Melbourne, Australia
| | - Jo Szwarc
- The Victorian Foundation for the Survivors of Torture (Foundation House), Melbourne, Australia
| | - Sue Casey
- The Victorian Foundation for the Survivors of Torture (Foundation House), Melbourne, Australia
| | - Philippa Duell-Piening
- The Victorian Foundation for the Survivors of Torture (Foundation House), Melbourne, Australia
| | - Elizabeth Waters
- The Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, The University of Melbourne, Melbourne, Australia
| |
Collapse
|