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Ward A, Andrews L, Black A, Williamson AE. Communicating effectively with inclusion health populations: 2022 ICCH symposium. PATIENT EDUCATION AND COUNSELING 2023; 117:107977. [PMID: 37708698 DOI: 10.1016/j.pec.2023.107977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To describe communication strategies for clinical practice that allow practitioners to work more effectively with marginalised population groups and to discuss how to incorporate these into medical practice. METHODS Active practitioners working in inclusion health and people with lived experience of homelessness and the asylum-seeking process shared their perspectives in the symposium at the 2022 International Conference on Communication in Healthcare (ICCH) and a subsequent conference on empathy in healthcare. The views of attendees were sought. SYMPOSIUM DISCUSSION We describe the perspectives shared at the symposia under two main themes: communication needs in people experiencing homelessness and migrant populations, and trauma-informed practice. CONCLUSIONS People experiencing homelessness have more communication challenges compared to the general adult population. Migrant, refugee, and asylum-seeking populations also face the complexity of negotiating unfamiliar healthcare, legal and social systems with the added burden of language barriers. Trauma-informed practice provides a useful framework that can improve communication with these groups.
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Affiliation(s)
- Andy Ward
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK.
| | | | - Anna Black
- Department of General Practice and Primary Care, University of Glasgow, UK
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Górriz AB, Etchezahar E, Pinilla-Rodríguez DE, Giménez-Espert MDC, Prado-Gascó V. Cross-cultural validation of the Mood Questionnaire in three Spanish-speaking countries Argentina, Ecuador, and Spain. The Journal of Social Psychology 2021; 161:216-232. [PMID: 32654614 DOI: 10.1080/00224545.2020.1791029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study validates the Mood Questionnaire for adults in three Spanish-speaking countries: Argentina, Ecuador, and Spain. It then analyzes the influence of gender and cultural differences on mood, and whether there is a relationship between mood, emotional intelligence, and the Avoidance of Responsibility. A convenience sample of 1048 adults, with a middle-class socioeconomic background, was selected from three Spanish-speaking countries (Spain, Argentina, and Ecuador). The psychometric properties of the Mood Questionnaire are adequate, which is particularly interesting given the need for transcultural tools to evaluate moods. Moreover, the mood was associated with avoidance of responsibility and emotional intelligence. In addition, differences in mood were observed according to country and gender. These findings are interesting because the Spanish version of the Mood Questionnaire has been validated for children but not for adults, and it compares three Spanish-speaking countries. The use of this diagnostic tool with Spanish adults can be justified according to these results.
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Richard L, Richardson G, Jaye C, Stokes T. Providing care to refugees through mainstream general practice in the southern health region of New Zealand: a qualitative study of primary healthcare professionals' perspectives. BMJ Open 2019; 9:e034323. [PMID: 31892670 PMCID: PMC6955505 DOI: 10.1136/bmjopen-2019-034323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To explore the perspectives of primary healthcare (PHC) professionals providing care to refugees through mainstream general practice. DESIGN Qualitative exploratory design with semistructured interviews subjected to inductive thematic analysis. SETTING AND PARTICIPANTS Nine general practices enrolled in the Dunedin Refugee Resettlement Programme, in New Zealand (NZ)'s southern health region. Participants included nine general practitioners and six practice nurses. RESULTS Three analytical constructs were identified: relational engagement with refugees, refugee healthcare delivery and providers' professional role shaped by complexity. Building meaningful relational connections involved acknowledging refugees' journeys by getting to know them as people. This was instrumental for the development of an empathetic understanding of the complex human trajectories that characterise refugees' journeys to NZ. Participants encountered challenges in providing care to refugees with respect to time-limited consultations, variable use of interpreter services, fragmentation of care between agencies and need for improved health infrastructure to ensure a fluid interface between PHC, secondary care and community support services. The current business model of NZ general practice was perceived to interfere with value-driven care and discouraged tailoring of care to specific patient groups, raising concerns about the 'fit' of mainstream general practice to address the complex healthcare needs of refugees. Meeting the needs of refugees across the social determinants of health involved a lot of 'behind the scenes work' particularly in the absence of shared information systems and the lack of well-established referral pathways to connect refugees to services beyond the health sector. This led to providers feeling overwhelmed and uncertain about their ability to provide appropriate care to refugees. CONCLUSIONS This study provides rich context-specific findings that enhance PHC responsiveness to the needs of refugees in NZ.
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Affiliation(s)
- Lauralie Richard
- General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Georgia Richardson
- General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Chrystal Jaye
- General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Murphy D, Ndegwa D, Kanani A, Rojas-Jaimes C, Webster A. Mental health of refugees in inner-London. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.26.6.222] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
What follows is an attempt to describe the provision of mental health care for refugees (including asylum seekers). Our views are based on our work with refugees in inner-London and on consultation with service providers.
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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: 119] [Impact Index Per Article: 17.0] [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.
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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
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Vitale A, Ryde J. Promoting male refugees’ mental health after they have been granted leave to remain (refugee status). INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2016. [DOI: 10.1080/14623730.2016.1167102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cheng IH, Drillich A, Schattner P. Refugee experiences of general practice in countries of resettlement: a literature review. Br J Gen Pract 2015; 65:e171-6. [PMID: 25733438 PMCID: PMC4337305 DOI: 10.3399/bjgp15x683977] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 09/09/2014] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Refugees and asylum seekers often struggle to use general practice services in resettlement countries. AIM To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. DESIGN AND SETTING Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. METHOD Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker's personal experiences of general practice services were identified, coded, and analysed. RESULTS From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor-patient relationships, and problems with the cultural acceptability of medical care. CONCLUSION The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management.
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Affiliation(s)
- I-Hao Cheng
- Southern Academic Primary Care Research Unit (Monash University School of Primary Health Care, South Eastern Melbourne Medicare Local, Monash Health), Dandenong, Victoria, Australia
| | - Ann Drillich
- Department of General Practice, School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia
| | - Peter Schattner
- Department of General Practice, School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia
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The lower quality of preventive care among forced migrants in a country with universal healthcare coverage. Prev Med 2014; 59:19-24. [PMID: 24262974 DOI: 10.1016/j.ypmed.2013.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/04/2013] [Accepted: 11/08/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the association between socio-demographic factors and the quality of preventive care and chronic care of cardiovascular (CV) risk factors in a country with universal health care coverage. METHODS Our retrospective cohort assessed a random sample of 966 patients aged 50-80years followed over 2years (2005-2006) in 4 Swiss university primary care settings (Basel/Geneva/Lausanne/Zürich). We used RAND's Quality Assessment Tools indicators and examined recommended preventive care among different socio-demographic subgroups. RESULTS Overall patients received 69.6% of recommended preventive care. Preventive care indicators were more likely to be met among men (72.8% vs. 65.4%; p<0.001), younger patients (from 71.0% at 50-59years to 66.7% at 70-80years, p for trend=0.03) and Swiss patients (71.1% vs. 62.7% in forced migrants; p=0.001). This latter difference remained in multivariate analysis adjusted for gender, age, civil status and occupation (OR 0.68; 95% CI 0.54-0.86). Forced migrants had lower scores for physical examination and breast and colon cancer screening (all p≤0.02). No major differences were seen for chronic care of CV risk factors. CONCLUSION Despite universal healthcare coverage, forced migrants receive less preventive care than Swiss patients in university primary care settings. Greater attention should be paid to forced migrants for preventive care.
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Jensen NK, Norredam M, Priebe S, Krasnik A. How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark. BMC FAMILY PRACTICE 2013; 14:17. [PMID: 23356401 PMCID: PMC3568406 DOI: 10.1186/1471-2296-14-17] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022]
Abstract
Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. Methods The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. Results One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. Conclusion General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this study suggest that the development of conversational models for general practitioners including points to be aware of in the treatment of refugee patients may serve as a support in the management of refugee patients in primary care.
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Affiliation(s)
- Natasja Koitzsch Jensen
- The Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark.
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Stagg HR, Jones J, Bickler G, Abubakar I. Poor uptake of primary healthcare registration among recent entrants to the UK: a retrospective cohort study. BMJ Open 2012; 2:bmjopen-2012-001453. [PMID: 22869094 PMCID: PMC4400681 DOI: 10.1136/bmjopen-2012-001453] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Uptake of healthcare among migrants is a complex and controversial topic; there are multiple recognised barriers to accessing primary care. Delays in presentation to healthcare services may result in a greater burden on costly emergency care, as well as increased public health risks. This study aimed to explore some of the factors influencing registration of new entrants with general practitioners (GPs). DESIGN Retrospective cohort study. SETTING Port health screening at Heathrow and Gatwick airports, primary care. PARTICIPANTS 252 559 new entrants to the UK, whose entry was documented by the port health tuberculosis screening processes at Heathrow and Gatwick. 191 had insufficient information for record linkage. PRIMARY OUTCOME MEASURE Registration with a GP practice within the UK, as measured through record linkage with the Personal Demographics Service (PDS) database. RESULTS Only 32.5% of 252 368 individuals were linked to the PDS, suggesting low levels of registration in the study population. Women were more likely to register than men, with a RR ratio of 1.44 (95% CI 1.41 to 1.46). Compared with those from Europe, individuals of nationalities from the Americas (0.43 (0.39 to 0.47)) and Africa (0.74 (0.69 to 0.79)) were less likely to register. Similarly, students (0.83 (0.81 to 0.85)), long-stay visitors (0.82 (0.77 to 0.87)) and asylum seekers (0.46 (0.42 to 0.51)) were less likely to register with a GP than other migrant groups. CONCLUSIONS Levels of registration with GPs within this selected group of new entrants, as measured through record linkage, are low. Migrant groups with the lowest proportion registered are likely to be those with the highest health needs. The UK would benefit from a targeted approach to identify the migrants least likely to register for healthcare and to promote access among both users and service providers.
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Affiliation(s)
- Helen R Stagg
- TB Section, Respiratory Diseases Department, Health Protection Services,
Health Protection Agency, Colindale, UK
| | - Jane Jones
- Travel and Migrant Health Section, Respiratory Diseases Department,
Health Protection Services, Health Protection Agency, Colindale, UK
| | | | - Ibrahim Abubakar
- TB Section, Respiratory Diseases Department, Health Protection Services,
Health Protection Agency, Colindale, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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Buetow SA, Mintoft B. When should patient intuition be taken seriously? J Gen Intern Med 2011; 26:433-6. [PMID: 21104452 PMCID: PMC3055972 DOI: 10.1007/s11606-010-1576-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 10/14/2010] [Accepted: 10/29/2010] [Indexed: 11/29/2022]
Abstract
As a style of information processing, intuition involves implicit perceptual and cognitive processes that can be quickly and automatically executed without conscious mental will, such that people know more than they can describe. Patient intuition can influence patient and clinician decision-making and behavior. However, physicians may not always see patient intuition as credible or important, and its management in the clinical setting is poorly understood. This paper takes a step toward suggesting conditions under which patient intuition should be taken seriously. These conditions relate to the credibility or accuracy of the intuitive beliefs held by the patient, and their significance to the patient. Credibility may be increased when the intuitions of patients (1) reflect their individualized knowledge, (2) can complement the common absence of scientific evidence in managing health problems, and (3) can quickly and effectively process key information in complex cognitive tasks. Even intuitions that lack credibility can be subjectively rational and meaningful to patients, and help to shape the decisions they and clinicians make.
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Affiliation(s)
- Stephen A Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
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Taylor K. Asylum seekers, refugees, and the politics of access to health care: a UK perspective. Br J Gen Pract 2009; 59:765-72. [PMID: 19732492 PMCID: PMC2751919 DOI: 10.3399/bjgp09x472539] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 10/31/2008] [Accepted: 01/23/2009] [Indexed: 10/31/2022] Open
Abstract
The UK government has recently consulted on proposals to prohibit access to health care for some asylum seekers. This discussion paper considers the wider ethical, moral, and political issues that may arise from this policy. In particular, it explores the relationship between immigration and health and examines the impact of forced migration on health inequalities. It will be argued that it is both unethical and iniquitous to use health policy as a means of enforcing immigration policy. Instead, the founding principle of the NHS of equal access on the basis of need should be borne in mind when considering how to meet the needs of this population.
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Affiliation(s)
- Keith Taylor
- Dundee University Medical School, Dundee, Scotland.
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Djuretic T, Crawford MJ, Weaver TD. Role of qualitative research to inform design of epidemiological studies: A cohort study of mental health of migrants from the former Yugoslavia. J Ment Health 2009. [DOI: 10.1080/09638230701496394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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MacFarlane A, Glynn LG, Mosinkie PI, Murphy AW. Responses to language barriers in consultations with refugees and asylum seekers: a telephone survey of Irish general practitioners. BMC FAMILY PRACTICE 2008; 9:68. [PMID: 19102735 PMCID: PMC2637872 DOI: 10.1186/1471-2296-9-68] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 12/22/2008] [Indexed: 11/17/2022]
Abstract
Background Refugees and asylum seekers experience language barriers in general practice. Qualitative studies have found that responses to language barriers in general practice are ad hoc with use of both professional interpreters and informal interpreters (patients' relatives or friends). However, the scale of the issues involved is unknown. This study quantifies the need for language assistance in general practice consultations and examines the experience of, and satisfaction with, methods of language assistance utilized. Methods Data were collected by telephone survey with general practitioners in a regional health authority in Ireland between July-August 2004. Each respondent was asked a series of questions about consulting with refugees and asylum seekers, the need for language assistance and the kind of language assistance used. Results There was a 70% (n = 56/80) response rate to the telephone survey. The majority of respondents (77%) said that they had experienced consultations with refugees and asylum seekers in which language assistance was required. Despite this, general practitioners in the majority of cases managed without an interpreter or used informal methods of interpretation. In fact, when given a choice general practitioners would more often choose informal over professional methods of interpretation despite the fact that confidentiality was a significant concern. Conclusion The need for language assistance in consultations with refugees and asylum seekers in Irish general practice is high. General practitioners rely on informal responses. It is necessary to improve knowledge about the organisational contexts that shape general practitioners responses. We also recommend dialogue between general practitioners, patients and interpreters about the relative merits of informal and professional methods of interpretation so that general practitioners' choices are responsive to the needs of patients with limited English.
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Affiliation(s)
- Anne MacFarlane
- Department of General Practice, National University of Ireland, Galway, Ireland.
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Johnson DR, Ziersch AM, Burgess T. I don't think general practice should be the front line: Experiences of general practitioners working with refugees in South Australia. AUSTRALIA AND NEW ZEALAND HEALTH POLICY 2008; 5:20. [PMID: 18687150 PMCID: PMC2531177 DOI: 10.1186/1743-8462-5-20] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 08/08/2008] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Many refugees arrive in Australia with complex health needs. In South Australia (SA), providing initial health care to refugees is the responsibility of General Practitioners (GPs) in private practice. Their capacity to perform this work effectively for current newly arrived refugees is uncertain. The aim of this study was to document the challenges faced by GPs in private practice in SA when providing initial care to refugees and to discuss the implications of this for policy relating to optimising health care services for refugees. METHODS Semi-structured interviews with twelve GPs in private practice and three Medical Directors of Divisions of General Practice. Using a template analysis approach the interviews were coded and analysed thematically. RESULTS Multiple challenges providing care to refugees were found including those related to: (1) refugee health issues; (2) the GP-refugee interaction; and (3) the structure of general practice. The Divisions also reported challenges assisting GPs to provide effective care related to a lack of funding and awareness of which GPs required support. Although respondents suggested a number of ways that GPs could be assisted to provide better initial care to refugees, strong support was voiced for the initial care of refugees to be provided via a specialist refugee health service. CONCLUSION GPs in this study were under-resourced, at both an individual GP level as well as a structural level, to provide effective initial care for refugees. In SA, there are likely to be a number of challenges attempting to increase the capacity of GPs in private practice to provide initial care. An alternative model is for refugees with multiple and complex health care needs as well as those with significant resettlement challenges to receive initial health care via the existing specialist refugee health service in Adelaide.
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Affiliation(s)
- David R Johnson
- Discipline of General Practice, University of Adelaide, SA, Australia.
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Bodenmann P, Althaus F, Burnand B, Vaucher P, Pécoud A, Genton B. Medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system. BMC Public Health 2007; 7:310. [PMID: 17974001 PMCID: PMC2194697 DOI: 10.1186/1471-2458-7-310] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 10/31/2007] [Indexed: 11/10/2022] Open
Abstract
Background Medical care for asylum seekers is a complex and critical issue worldwide. It is influenced by social, political, and economic pressures, as well as premigration conditions, the process of migration, and postmigration conditions in the host country. Increasing needs and healthcare costs have led public health authorities to put nurse practitioners in charge of the management of a gatekeeping system for asylum seekers. The quality of this system has never been evaluated. We assessed the competencies of nurses and physicians in identifying the medical needs of asylum seekers and providing them with appropriate treatment that reflects good clinical practice. Methods This cross-sectional descriptive study evaluated the appropriateness of care provided to asylum seekers by trained nurse practitioners in nursing healthcare centers and by physicians in private practices, an academic medical outpatient clinic, and the emergency unit of the university hospital in Lausanne, Switzerland. From 1687 asylum seeking patients who had consulted each setting between June and December 2003, 450 were randomly selected to participate. A panel of experts reviewed their medical records and assessed the appropriateness of medical care received according to three parameters: 1) use of appropriate procedures to identify medical needs (medical history, clinical examination, complementary investigations, and referral), 2) provision of access to treatment meeting medical needs, and 3) absence of unnecessary medical procedures. Results In the nurse practitioner group, the procedures used to identify medical needs were less often appropriate (79% of reports vs. 92.4% of reports; p < 0.001). Nevertheless, access to treatment was judged satisfactory and was similar (p = 0.264) between nurse practitioners and physicians (99% and 97.6% of patients, respectively, received adequate care). Excessive care was observed in only 2 physician reports (0.8%) and 3 nurse reports (1.5%) (p = 0.481). Conclusion Although the nursing gatekeeping system provides appropriate treatment to asylum seekers, it might be improved with further training in recording medical history and performing targeted clinical examination.
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Affiliation(s)
- Patrick Bodenmann
- Medical Outpatient Clinic, Department of Ambulatory Care and Community Medicine, University of Lausanne, Rue du Bugnon 44, 1011 Lausanne, Switzerland.
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Anderson J, Chaturvedi A, Cibulskis M. Simulation tools for developing policies for complex systems: Modeling the health and safety of refugee communities. Health Care Manag Sci 2007; 10:331-9. [DOI: 10.1007/s10729-007-9030-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bhatia R, Wallace P. Experiences of refugees and asylum seekers in general practice: a qualitative study. BMC FAMILY PRACTICE 2007; 8:48. [PMID: 17711587 PMCID: PMC2001193 DOI: 10.1186/1471-2296-8-48] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 08/21/2007] [Indexed: 12/02/2022]
Abstract
BACKGROUND There has been much debate regarding the refugee health situation in the UK. However most of the existing literature fails to take account of the opinions of refugees themselves. This study was established to determine the views of asylum seekers and refugees on their overall experiences in primary care and to suggest improvements to their care. METHODS Qualitative study of adult asylum seekers and refugees who had entered the UK in the last 10 years. The study was set in Barnet Refugee Walk in Service, London. 11 Semi structured interviews were conducted and analysed using framework analysis. RESULTS Access to GPs may be more difficult for failed asylum seekers and those without support from refugee agencies or family. There may be concerns amongst some in the refugee community regarding the access to and confidentiality of professional interpreters. Most participants stated their preference for GPs who offered advice rather than prescriptions. The stigma associated with refugee status in the UK may have led to some refugees altering their help seeking behaviour. CONCLUSION The problem of poor access for those with inadequate support may be improved by better education and support for GPs in how to provide for refugees. Primary Care Trusts could also supply information to newly arrived refugees on how to access services. GPs should be aware that, in some situations, professional interpreters may not always be desired and that instead, it may be advisable to reach a consensus as to who should be used as an interpreter. A better doctor-patient experience resulting from improvements in access and communication may help to reduce the stigma associated with refugee status and lead to more appropriate help seeking behaviour. Given the small nature of our investigation, larger studies need to be conducted to confirm and to quantify these results.
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Affiliation(s)
- Ravi Bhatia
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Holborn Union Building, Archway Campus, Highgate Hill, London, N19 5LW, UK
| | - Paul Wallace
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Holborn Union Building, Archway Campus, Highgate Hill, London, N19 5LW, UK
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Laporte A, Croxford R, Coyte PC. Can a publicly funded home care system successfully allocate service based on perceived need rather than socioeconomic status? A Canadian experience. HEALTH & SOCIAL CARE IN THE COMMUNITY 2007; 15:108-19. [PMID: 17286672 DOI: 10.1111/j.1365-2524.2006.00672.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The present quantitative study evaluates the degree to which socioeconomic status (SES), as opposed to perceived need, determines utilisation of publicly funded home care in Ontario, Canada. The Registered Persons Data Base of the Ontario Health Insurance Plan was used to identify the age, sex and place of residence for all Ontarians who had coverage for the complete calendar year 1998. Utilisation was characterised in two dimensions: (1) propensity - the probability that an individual received service, which was estimated using a multinomial logit equation; and (2) intensity - the amount of service received, conditional on receipt. Short- and long-term service intensity were modelled separately using ordinary least squares regression. Age, sex and co-morbidity were the best predictors (P < 0.0001) of whether or not an individual received publicly funded home care as well as how much care was received, with sicker individuals having increased utilisation. The propensity and intensity of service receipt increased with lower SES (P < 0.0001), and decreased with the proportion of recent immigrants in the region (P < 0.0001), after controlling for age, sex and co-morbidity. Although the allocation of publicly funded home care service was primarily based on perceived need rather than ability to pay, barriers to utilisation for those from areas with a high proportion of recent immigrants were identified. Future research is needed to assess whether the current mix and level of publicly funded resources are indeed sufficient to offset the added costs associated with the provision of high-quality home care.
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Affiliation(s)
- Audrey Laporte
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Gagnon AJ, Wahoush O, Dougherty G, Saucier JF, Dennis CL, Merry L, Stanger E, Stewart DE. The childbearing health and related service needs of newcomers (CHARSNN) study protocol. BMC Pregnancy Childbirth 2006; 6:31. [PMID: 17190589 PMCID: PMC1797193 DOI: 10.1186/1471-2393-6-31] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 12/26/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refugee and asylum-seeking women in Canada may have significant harmful childbearing health outcomes and unmet health and social care needs. The most vulnerable of these women are: those who have left their countries by force (e.g., war, rape or abuse histories), are separated from their families, have limited knowledge of the host country languages, and are visible minorities. Asylum-seekers face additional stresses related to their unknown future status and are marginalized with regards to access to provincial health care systems. The prevalence and severity of health issues in this population is not known nor is the extent of response from social service and health care systems (including variation in provincial service delivery). Understanding the magnitude of health and social concerns of newcomers requires data from a representative sample of childbearing refugee and asylum-seeking women resettling in Canada to permit comparisons to be made with non-refugee immigrant and Canadian-born women. Our research questions are: (1) Do refugee or asylum-seeking women and their infants, experience a greater number or a different distribution of harmful health events during pregnancy, at birth, and during the postpartum period than non-refugee immigrant or Canadian-born women? (2) Are the harmful health events experienced postpartum by asylum-seeking women and their infants, addressed less often (compared to refugees, non-refugee immigrants, and Canadian-born women) by the Canadian health care system as delivered in each of the three major receiving cities for newcomers? METHODS/DESIGN This is a four-year multi-site prospective cohort study (pregnancy to 4 months postpartum). We will seek to recruit 2400 women [200 in each of 4 groups (refugees, asylum-seekers, non-refugee immigrants, and Canadian-born) from 1 of 12 postpartum hospital units across the 3 largest receiving cities for newcomers to Canada - Montreal, Toronto, and Vancouver]. DISCUSSION Knowledge of the extent of harmful health events occurring to asylum-seeking, refugee, immigrant, and Canadian-born women, and the response of the health care system to those events and group differences, if they exist, will inform immigration and health policy makers as well as providers of services.
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Affiliation(s)
- Anita J Gagnon
- School of Nursing, McGill University, 3506 University St., Montreal, Quebec H3A 2A7, Canada
- Department of Obstetrics and Gynecology, McGill University Health Centre, 687, Pine Ave. West, Room F2.27, Montreal, QC H3A 1A1, Canada
| | - Olive Wahoush
- School of Nursing, McMaster University, 1200 Main Street West, 2JRec. Rm 2J34a, Hamilton, ON L8N 3Z5, Canada
| | - Geoffrey Dougherty
- Faculty of Medicine, Pediatrics, McGill University, 2300 Tupper Street, Rm A216, Montreal, Quebec H3H 1P3, Canada
- Division of General Pediatrics, MGill University Health Centre, 2300 Tupper Street, Rm A216, Montreal, Quebec H3H 1P3, Canada
| | - Jean-François Saucier
- Department of Psychiatry, Centre hospitalier universitaire de mère enfant, L'Hôpital Sainte-Justine, 3180 Ellendale Avenue, Montreal, QC, H3S1W3, Canada
| | - Cindy-Lee Dennis
- School of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Lisa Merry
- School of Nursing, McGill University, 3506 University St., Montreal, Quebec H3A 2A7, Canada
- Department of Obstetrics and Gynecology, McGill University Health Centre, 3506 University St., Montreal, Quebec H3A 2A7, Canada
| | - Elizabeth Stanger
- Vancouver Coastal Health, 2733 Heather Street, Heather Pavilion – Room B213, Vancouver BCV5Z 1M9, Canada
| | - Donna E Stewart
- University Health Network, University of Toronto, 200 Elizabeth St., EN-7-229, Toronto, ON M5G 2C4, Canada
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Shaw MTM, Leggat PA. Medical screening and the health of illegal immigrants in Australia. Travel Med Infect Dis 2006; 4:255-8. [PMID: 16905455 DOI: 10.1016/j.tmaid.2005.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2005] [Accepted: 06/06/2005] [Indexed: 11/28/2022]
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Feldman R. Primary health care for refugees and asylum seekers: a review of the literature and a framework for services. Public Health 2006; 120:809-16. [PMID: 16876836 DOI: 10.1016/j.puhe.2006.05.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2005] [Accepted: 05/16/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This paper aims to provide a framework for primary health care services to meet the recognized health needs of refugees and asylum seekers that can be used in planning and evaluating services for this group. REVIEW Primary care services for refugees and asylum seekers are reviewed and presented in terms of a tripartite framework of gateway, core and ancillary services. Gateway services facilitate entry into primary care by identifying unregistered patients and carrying out health assessments. They are typically undertaken by nurse-led outreach services and specialist health visitors. Core services provide full registration and may be provided by dedicated practices or by mainstream practices, with or without additional support. Ancillary services are those that supplement and support core services' ability to meet the additional health needs of this group. They include language and information services, close links with community-based organizations, specialist mental health services and services for survivors of torture and organized violence, as well as targeted health promotion and training of health workers. CONCLUSIONS The framework can be used for education and training, planning and commissioning, and to provide criteria for comparison and evaluation. The paper suggests that a lack of published evaluations and reports about interventions for refugees and asylum seekers constrains further policy development that could build on the strengths of such interventions. It also stresses the importance of ancillary services to successful mainstream provision.
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Affiliation(s)
- R Feldman
- Faculty of Arts and Human Sciences, London South Bank University, 103 Borough Road, London SE1 0AA, UK.
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Reeves M, de Wildt G, Murshali H, Williams P, Gill P, Kralj L, Rushby M. Access to health care for people seeking asylum in the UK. Br J Gen Pract 2006; 56:306-8. [PMID: 16611529 PMCID: PMC1832248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
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Williams PE, Turpin G, Hardy G. Clinical psychology service provision and ethnic diversity within the UK: a review of the literature. Clin Psychol Psychother 2006. [DOI: 10.1002/cpp.497] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Procter NG. 'They first killed his heart (then) he took his own life'. Part 1: A review of the context and literature on mental health issues for refugees and asylum seekers. Int J Nurs Pract 2005; 11:286-91. [PMID: 16255740 DOI: 10.1111/j.1440-172x.2005.00537.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This is the first in a two-part series of papers examining mental health issues for refugees and asylum seekers. Beginning with the suicide of an asylum seeker in Scotland, the paper emphasizes mental health issues for adult and child asylum seekers, stress and memory, suicide, self-harm, risk and protective factors, compulsory health treatments and the prevention of mental illness. It sets the scene for the second paper by drawing implications for nursing practice in the community. Although most literature on refugee and asylum seeker mental health exists outside of nursing scholarship, a majority of the issues reviewed in this paper are mutual challenges for all in the health and helping professions. Nurses interested in refugee and migration issues face two intertwined challenges: that of how to assist migrants with their diverse mental health needs and how, at the same time, to contribute to a society that can promote mental health for all by taking on both the difficulties and opportunities posed by cultural diversity.
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Affiliation(s)
- Nicholas G Procter
- School of Nursing and Midwifery, University of South Australia--City East Campus, North Terrace, Adelaide, South Australia, Australia.
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Lawrence J, Kearns R. Exploring the 'fit' between people and providers: refugee health needs and health care services in Mt Roskill, Auckland, New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2005; 13:451-61. [PMID: 16048533 DOI: 10.1111/j.1365-2524.2005.00572.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The needs of refugees and the struggles on the part of service providers to address this diverse population have received limited attention within the academic literature. This paper profiles Hauora o Puketapapa/Roskill Union and Community Health Centre (HoP), which is a non-profit, community owned and operated health clinic designed to deliver accessible, affordable and appropriate primary health care services to low-income groups in the Mt Roskill area of Auckland, New Zealand. The clinic's locality has undergone considerable demographic change over recent years with the arrival of refugees from diverse backgrounds. This situation has resulted in new sets of health needs and expectations which need to be addressed. The study took place in 2002-2003 and employed qualitative methods. In-depth interviews with community representatives, clinic users and health service staff members revealed that refugees face considerable barriers in accessing and utilising health services. Similarly, we found that health practitioners face the daunting task of endeavouring to meet these needs in an effective and culturally appropriate manner within a limited funding environment. We conclude that, despite these challenges, HoP has successfully established itself as a well-regarded place of primary health care. In so doing, it has strengthened the capacity of the local community to respond to the changing policy environment. However, long-term sustainability issues remain unless resourcing issues are adequately addressed.
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Affiliation(s)
- Jody Lawrence
- School of Geography and Environmental Science, The University of Auckland, New Zealand.
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Millett C, Zelenyanszki C, Binysh K, Lancaster J, Majeed A. Population mobility: characteristics of people registering with general practices. Public Health 2005; 119:632-8. [PMID: 15885722 DOI: 10.1016/j.puhe.2004.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2004] [Revised: 09/24/2004] [Accepted: 09/24/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to examine the characteristics of patients joining general practitioners' (GP) lists, and the time taken to register after a move of residence. STUDY DESIGN Questionnaire study. METHODS Staff in six London general practices administered the questionnaire to 642 newly registering adults. RESULTS Nearly 40% of participants took longer than 6 months to re-register with a GP after a change of address. About one in eight participants (13%) took longer than 1 year and one in 14 (7%) took longer than 3 years to register. The overall median time to register after a move was 4 months. The amount of time taken to register appeared to be influenced by a number of factors, including gender, age and geographical location. CONCLUSIONS Population mobility and the time taken to register with a new GP is likely to have a major impact on access to health care and the effectiveness of local preventative health programmes. Primary care trusts need to encourage their local residents to register with a GP soon after a change of address, and develop initiatives to encourage participation in preventative health programmes amongst mobile groups. Additional measures to strengthen primary care provision, such as walk-in centres, may be required in areas with the highest levels of population turnover.
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Affiliation(s)
- C Millett
- Lambeth Primary Care Trust, 1 Lower Marsh, London SE1 7NT, UK.
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Doyal L, Anderson J. ‘My fear is to fall in love again…’ How HIV-positive African women survive in London. Soc Sci Med 2005; 60:1729-38. [PMID: 15686805 DOI: 10.1016/j.socscimed.2004.08.041] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Many studies are now documenting the circumstances of people living with HIV/AIDS in different parts of the world. We know an increasing amount about the experiences of women who make up the majority of those infected in countries in sub-Saharan Africa. However, very few researchers have examined the lives of female migrants from the region living with HIV. This article begins to fill that gap by exploring the situation of 62 women from different parts of Africa receiving treatment from the National Health Service in London. It is based on a qualitative study carried out between 2001 and 2002 using semi-structured interviews. The analysis explores the ways in which the women's lives are shaped in complex ways by their sex and gender, by their status as migrants and by their seropositivity. It examines the nature of their survival strategies, focusing mainly on the management of information, the use of health services and the importance of spirituality in their lives. The article concludes by highlighting the paradox whereby these women have access to treatment that would be unavailable in their own countries but their survival depends on them remaining in a country which few regard as 'home'.
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Affiliation(s)
- Lesley Doyal
- School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
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Parmentier H, Golding S, Ashworth M, Rowlands G. Community pharmacy treatment of minor ailments in refugees. J Clin Pharm Ther 2005; 29:465-9. [PMID: 15482391 DOI: 10.1111/j.1365-2710.2004.00591.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate a scheme offering pharmacy referrals for minor ailments in a refugee community. To determine if minor ailments could be managed by pharmacists offering over-the-counter (OTC) medication, free of charge, to refugees exempt from prescription charges. DESIGN Refugees presenting with minor illnesses were offered a voucher. This voucher could be taken to the pharmacist, who, after a consultation, could exchange the voucher for appropriate OTC medication. SETTING A refugee community in south London. OUTCOME MEASURES The presenting minor ailment and corresponding medication as recorded by the pharmacist. RESULTS A total of 200 vouchers were distributed to 184 refugees over a 5-month period resulting in the dispensing of 264 items. The five most frequent minor ailments were: upper respiratory tract infections (37%), headache (14%), musculo-skeletal pains (7%), allergy including hay fever (6%), indigestion (6%). The five most frequently dispensed items were: paracetamol (28%), sudafed (16%), ibuprofen (11%), aspirin (10%) and simple linctus (8%). Only two clients were referred directly to the GP and two advised to attend if symptoms persisted. CONCLUSIONS Minor ailment schemes elsewhere have demonstrated the potential to divert about one-third of patients with minor illnesses out of general practice and to care in the pharmacy. Such a scheme is being widely adopted in Scotland this year. Our results are the first to demonstrate the feasibility and acceptability of such a scheme in the refugee community.
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Procter NG. The mental health of moving asylum seekers from 'temporary' to 'permanent' protection visas: it's much more than a quick political fix. Contemp Nurse 2004; 17:179-82. [PMID: 15551668 DOI: 10.5172/conu.17.3.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Barnes DM, Harrison CL. Refugee Women's Reproductive Health in Early Resettlement. J Obstet Gynecol Neonatal Nurs 2004; 33:723-8. [PMID: 15561660 DOI: 10.1177/0884217504270668] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe reproductive health needs and screening rates for breast and cervical cancer for newly arrived (less than 90 days) refugee women in the United States. DESIGN A retrospective study of existing medical charts from 1996 to 2000. SETTING Refugee health screening clinic, central Texas. PATIENTS Refugee women (n = 283) newly arrived in the United States from Cuba (31.1%), Bosnia (26.1%), Vietnam (24.7%), and other countries (18.0%); age range = 18 to 74 years, mean age = 34.4 years. MAIN OUTCOME MEASURES Frequency of reproductive health problems and breast and cervical cancer screening rates. RESULTS Twenty-five percent of women in the sample were pregnant or had a reproductive health problem. A significant percentage older than 40 (86%) had never had a mammogram when compared to American women of the same age (33%). Only 24% reported having had a Pap test within the previous 3 years. CONCLUSIONS The risk of not receiving adequate reproductive health care is higher among newly arrived refugee women compared to nonrefugee women in the United States. For refugee women to enjoy optimum health, their individual needs and health care system issues must be addressed.
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Affiliation(s)
- Donelle M Barnes
- Harris School of Nursing, Texas Christian University, TCU Box 298620 Fort Worth, TX 76129, USA.
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Kralj L, Barriball L. Online information on primary care services for refugees and asylum-seekers. Br J Community Nurs 2004; 9:115-21. [PMID: 15028997 DOI: 10.12968/bjcn.2004.9.3.12435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Government initiatives concerning equitable services and information provision aim to provide for the whole community. This includes those recently arrived in England as refugees. This study evaluated the information provided online by 16 London primary care trusts (PCTs) on activities under way to meet the needs of the local refugee population and the extent to which government initiatives are being met. Information published on websites of PCTs with a refugee population estimated to be over 2.5% of the London total refugee population was surveyed using a 13-item framework based on guidelines for health professionals working in refugee health (Burnett and Fassil, 2002). The findings show a disparity between different types of information provided and variations in the overall standards achieved by individual PCTs, indicating a need for considerable work if the requirements of the public and government for access to high quality information about services are to be met. The majority of PCTs, however, provide good information regarding coordination of services and evidence of a thorough health needs assessment. The findings are relevant to health professionals working with refugees and to PCT employees involved in publishing information on the internet.
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Abstract
This paper is written on behalf of the West Australian Branch of the Australasian Faculty of Public Health Medicine. As public health physicians, we feel it is important that public health professionals should contribute constructively to address the needs of a socially deprived, marginalised group with high rates of physical and psychiatric morbidity. Depending on the definition, there are between 18 and 48 million asylum seekers and refugees in the world. Most seek protection in neighbouring countries, largely in Africa and Asia, rather than coming to North America, Europe and Australasia. Contrary to popular belief, numbers of successful applications to Australia's humanitarian program have actually fallen. This article attempts to correct misperceptions and misapprehensions about the effect of asylum seekers on the public health. Public health professionals should lobby for changes to Govemment policy that at present leave asylum seekers vulnerable to a cycle of poverty, ill-health and limited access to health services.
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Affiliation(s)
- Stephen Kisely
- Primary Care Mental Health Unit, University of Western Australia, Fremantle.
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Abstract
Asylum seekers living in the Australian community, and awaiting the outcome of applications for protection visas, may require medical treatment for a range of illnesses, and are likely to have psychological or musculoskeletal problems as a consequence of traumatic experiences in their own countries. Many require specialist treatment. Some asylum seekers living in the community are denied access to Medicare and can not afford basic medical treatment. This creates suffering in the short term and complications in the long term. Healthcare professionals have an ethical responsibility to provide basic medical care for asylum seekers in Australia.
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Affiliation(s)
- M F Harris
- School of Community Medicine, University of New South Wales, Sydney.
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Burnett A, Peel M. What brings asylum seekers to the United Kingdom? BMJ (CLINICAL RESEARCH ED.) 2001; 322:485-8. [PMID: 11222429 PMCID: PMC1119690 DOI: 10.1136/bmj.322.7284.485] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- A Burnett
- Medical Foundation for the Care of Victims of Torture, London NW5 3EJ.
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Montgomery S, Le Feuvre P. Health care for asylum seekers. Main obstacles are inflexibility of NHS and bureaucracy of support systems. BMJ (CLINICAL RESEARCH ED.) 2000; 321:893. [PMID: 11021875 PMCID: PMC1118687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Affiliation(s)
- D W Sellen
- Department of Anthropology and International Health, Emory University, Atlanta, GA 30322, USA.
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Johnstone P. Kosovo: the challenge to public health. J Epidemiol Community Health 1999; 53:450. [PMID: 10562860 PMCID: PMC1756935 DOI: 10.1136/jech.53.8.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hogan H. Meeting health needs of asylum seekers. White paper will make access to health care more difficult. BMJ (CLINICAL RESEARCH ED.) 1999; 318:671. [PMID: 10066224 PMCID: PMC1115107 DOI: 10.1136/bmj.318.7184.671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Nationally and internationally, there is a struggle to provide adequate health screening and assessment programs for refugees. The Department of Family Medicine at the University of Colorado Health Sciences Center in partnership with the Colorado Refugee Services Program has developed a comprehensive refugee health screening and assessment program. The program was designed to ensure access to screening and to provide better care for this vulnerable population. Key features of the program include a single point of access for all family members, full availability of appropriate interpreting services, comprehensive health assessments that include a thorough mental health screening, data collection and evaluation, and education of health care providers to deliver culturally responsive care. During the first 30 months of this program, comprehensive assessments were provided for more than 1600 refugees. Future directions include improving the efficiency of daily systems, seeking alternative sources of funding, improving follow-up and vaccination rates, expanding mental health services, and tracking health outcomes and refugees' utilization of health care services through longitudinal research.
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Affiliation(s)
- J Kennedy
- Department of Family Medicine, University of Colorado Health Sciences Center, Denver, USA.
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