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Kanengoni-Nyatara B, Watson K, Galindo C, Charania NA, Mpofu C, Holroyd E. Barriers to and Recommendations for Equitable Access to Healthcare for Migrants and Refugees in Aotearoa, New Zealand: An Integrative Review. J Immigr Minor Health 2024; 26:164-180. [PMID: 37665540 PMCID: PMC10771599 DOI: 10.1007/s10903-023-01528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/05/2023]
Abstract
The health system in Aotearoa New Zealand is predicated on equity in access to health services as a fundamental objective yet barriers to equitable access for migrant and refugees continue to exist. There is a paucity of studies that synthesise the experiences and realities of migrants, refugees and healthcare providers that hinder access to healthcare and provide recommendations to improve services. This review synthesised these barriers and recommendations, with an aim to improve equitable access to healthcare to migrants and refugees. An integrative review of 13 peer-reviewed research studies from EBSCOhost research databases published between January 2016 and September 2022. Studies included: (i) related to Aotearoa; (ii) had a focus on equitable delivery of healthcare to migrants and refugees; and (iii) had a full English text available. The PRISMA framework guided the reporting of the review. The findings were thematically analysed and presented using a narrative empirical synthesis. The findings were organised into three broad themes: attitudinal barriers, structural barriers, and recommendations. Attitudinal barriers included the lack of culturally competent healthcare providers, discrimination by healthcare providers, and personal, social, and cultural attributes. Structural barriers referred to policies and frameworks that regulated the accessibility of health services such as the cost of healthcare, accessibility and acceptability of interpreter services, length of allocated appointments and long waiting times for an appointment, difficulties navigating the health system, and logistical barriers. Recommendations focused on promoting a sense of belonging, enabling a whole-of-society approach that brings together all sectors involved in providing health care for collective impact, and advocating for government policies to create a system that addresses the core health service access needs. This review provides rich context-specific findings on the barriers to equitable access to healthcare and proposed interventions to enhance equitable health outcomes for migrants and refugees in Aotearoa. The review contributes to relevant policy decisions and has practical implications to build responsive health systems which are inclusive, equitable and best address the health needs of populations from diverse cultural backgrounds.
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Affiliation(s)
- Blessing Kanengoni-Nyatara
- AUT Migrant and Refugee Health Research Centre, Faculty of Health and Environmental Sciences, School of Public Health and Interdisciplinary Studies, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand
| | - Katie Watson
- Hato Hone St John, 600 Great South Road, Ellerslie, Auckland, 1051, New Zealand
| | - Carolina Galindo
- Hato Hone St John, 600 Great South Road, Ellerslie, Auckland, 1051, New Zealand
| | - Nadia A Charania
- AUT Migrant and Refugee Health Research Centre, Faculty of Health and Environmental Sciences, School of Public Health and Interdisciplinary Studies, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand
| | - Charles Mpofu
- AUT Migrant and Refugee Health Research Centre, Faculty of Health and Environmental Sciences, School of Public Health and Interdisciplinary Studies, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand
| | - Eleanor Holroyd
- AUT Migrant and Refugee Health Research Centre, Faculty of Health and Environmental Sciences, School of Public Health and Interdisciplinary Studies, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand.
- AUT Migrant and Refugee Health Research Centre, School of Public Health and Interdisciplinary Studies, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand.
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Cavit L, Charania NA. Exploring factors that influence vaccination uptake for children with refugee backgrounds: An interpretive description study of primary healthcare providers' perspectives. Vaccine 2023; 41:6690-6699. [PMID: 37802749 DOI: 10.1016/j.vaccine.2023.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Children with refugee backgrounds are at high risk of acquiring vaccine preventable diseases (VPDs) due to a complex set of factors, one being under-immunisation. In Aotearoa New Zealand (NZ), reported age-appropriate vaccination rates are suboptimal among children with refugee backgrounds. METHODS A qualitative interpretive description study was undertaken to explore factors associated with access and uptake of immunisations and develop strategies to improve age-appropriate vaccinations among refugee children post-resettlement in NZ. Semi-structured interviews were conducted with healthcare providers (nurses and doctors) (N = 14) across seven resettlement locations in NZ. Collected data was transcribed verbatim and thematically analysed. RESULTS Five themes were derived from the data that demonstrate the interrelated factors that influence vaccination uptake across the refugee caregiver, health provider and system levels. Providers discussed how caregivers' competing resettlement priorities and challenges early in the resettlement phase influenced their knowledge and access of vaccines and health services in NZ. Providers' knowledge of refugee caregivers' concerns was seen as a driver for positive change in forming therapeutic relationships with, and delivering health services to, former refugees. They discussed system level factors that influence access to and provision of immunisation services, such as resourcing, resettlement policies, system inefficiencies and missed opportunities. Emphasis was placed on communication between patients and providers to facilitate positive immunisation experiences. Overwhelming, providers displayed high motivation to improve immunisation services. Strategies were suggested to overcome identified barriers and included the provision of culturally and linguistically appropriate resources, education campaigns, reducing access barriers (e.g., after-hours clinics), and improving system efficiencies. CONCLUSIONS These findings highlight root factors that impact immunisation uptake and experiences among children with refugee backgrounds. To reduce the burden of VPDs, broad system level changes are required to address the barriers to vaccine uptake faced by both families of refugee backgrounds and health providers.
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Affiliation(s)
- Larisa Cavit
- Department of Public Health, Auckland University of Technology, 640 Great South Road, Manukau, Auckland 2025, New Zealand
| | - Nadia A Charania
- Department of Public Health, Auckland University of Technology, 640 Great South Road, Manukau, Auckland 2025, New Zealand; Migrant and Refugee Health Research Centre, Auckland University of Technology, Auckland, New Zealand.
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Petrović-van der Deen FS, Kennedy JD, Stanley J, Malihi A, Gibb S, Cunningham R. Health service utilisation by quota, family-sponsored and convention refugees in their first five years in New Zealand. Aust N Z J Public Health 2023; 47:100064. [PMID: 37301053 DOI: 10.1016/j.anzjph.2023.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/27/2022] [Accepted: 12/16/2022] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE This study examines and compares health service utilisation patterns between New Zealand's (NZ) three main refugee groups and the general NZ population. METHODS We used Statistics NZ's Integrated Data Infrastructure to identify quota, family-sponsored and convention refugees arriving in NZ (2007-2013). We analysed contact with primary care, emergency department (ED), and specialist mental health services for the first five years in NZ. Logistic regression models, adjusted for age, sex and deprivation, compared health service use between refugee groups and the general NZ population in years 1 and 5. RESULTS Quota refugees were more likely to be enrolled and in contact with primary care and specialist mental health services in year 1 than family-sponsored and convention refugees, but differences reduced over time. All refugee groups were more likely than the general NZ population to have presented to ED in year 1. CONCLUSIONS Quota refugees were better connected with health services in year 1 than the other two refugee groups. The types of frontline health services accessed by refugee groups differed from the general NZ population. IMPLICATIONS FOR PUBLIC HEALTH There should be systematic and equal support across all NZ regions to help refugees (regardless of visa type) navigate the NZ health system.
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Affiliation(s)
| | - Jonathan D Kennedy
- Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand; Newtown Union Health Service, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand; Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand
| | - Arezoo Malihi
- Centre for Asia Pacific Research Study (CAPRS), School of Counselling, Human Services and Social Work, Faculty of Education, University of Auckland, Auckland, New Zealand
| | - Sheree Gibb
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, New Zealand
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Yang B, Kelly C, Shamputa IC, Barker K, Thi Kim Nguyen D. Structural Origins of Poor Health Outcomes in Documented Temporary Foreign Workers and Refugees in High-Income Countries: A Review. Healthcare (Basel) 2023; 11:healthcare11091295. [PMID: 37174837 PMCID: PMC10177793 DOI: 10.3390/healthcare11091295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/25/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Despite growing evidence of racial and institutional discrimination on minoritized communities and its negative effect on health, there are still gaps in the current literature identifying health disparities among minoritized communities. This review aims to identify health barriers faced by relatively less studied migrant subgroups including documented temporary foreign workers and refugees residing in high-income Organisation for Economic Co-operation and Development (OECD) countries focusing on the structural origins of differential health outcomes. We searched Medline, CINAHL, and Embase databases for papers describing health barriers for these groups published in English between 1 January 2011 and 30 July 2021. Two independent reviewers conducted a title, abstract, and full text screening with any discrepancies resolved by consensus or a third reviewer. Extracted data were analyzed using an inductive thematic analysis. Of the 381 articles that underwent full-text review, 27 articles were included in this review. We identified housing conditions, immigration policies, structural discrimination, and exploitative labour practices as the four major emerging themes that impacted the health and the access to healthcare services of our study populations. Our findings highlight the multidimensional nature of health inequities among migrant populations and a need to examine how the broader context of these factors influence their daily experiences.
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Affiliation(s)
- Borum Yang
- Faculty of Medicine, Dalhousie University NB, Saint John, NB E2L 4L5, Canada
| | - Clara Kelly
- Department of Nursing & Health Sciences, University of NB, Saint John, NB E2L 4L5, Canada
| | - Isdore Chola Shamputa
- Department of Nursing & Health Sciences, University of NB, Saint John, NB E2L 4L5, Canada
| | - Kimberley Barker
- Department of Public Health, Government of NB, Saint John, NB E1A E9H, Canada
| | - Duyen Thi Kim Nguyen
- Department of Public Health, Government of NB, Saint John, NB E1A E9H, Canada
- Faculty of Business, University of NB, Saint John, NB E2L 4L5, Canada
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Davison R, Hobbs M, Quirk F, Guppy M. General practitioners' perspectives on the management of refugee health: a qualitative study. BMJ Open 2023; 13:e068986. [PMID: 36963788 PMCID: PMC10039989 DOI: 10.1136/bmjopen-2022-068986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE To explore general practitioners' (GPs) perceptions of the challenges and facilitators to managing refugee healthcare needs in regional Australia. SETTING A regional community in Australia involved in the resettlement of refugees. PARTICIPANTS Nine GPs from five practices in the region. DESIGN A qualitative study based on semistructured interviews conducted between September and November 2020. RESULTS The main challenges identified surrounded language and communication difficulties, cultural differences and health literacy and regional workforce shortages. The main facilitators were clinical and community supports, including refugee health nurses and trauma counselling services. Personal benefits experienced by GPs such as positive relationships, satisfaction and broadening scope of practice further facilitated ongoing healthcare provision. CONCLUSIONS Overall, GPs were generally positive about providing care to refugees. However, significant challenges were expressed, particularly surrounding language, culture and resources. These barriers were compounded by the regional location. This highlights the need for preplanning and consultation with healthcare providers in the community both prior to and during the settlement of refugees as well as ongoing support proportional to the increase in settlement numbers.
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Affiliation(s)
- Rachel Davison
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Megan Hobbs
- New England Institute of Healthcare and Research, University of New England, Armidale, New South Wales, Australia
| | - Frances Quirk
- New England Institute of Healthcare and Research, University of New England, Armidale, New South Wales, Australia
- Fife, University of St Andrews School of Medicine, St Andrews, Fife, UK
| | - Michelle Guppy
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
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Debela MS, Garrett APN, Charania NA. Vaccine hesitancy and its determinants among refugee parents resettled in Aotearoa New Zealand. Hum Vaccin Immunother 2022; 18:2131336. [PMID: 36315907 PMCID: PMC9746517 DOI: 10.1080/21645515.2022.2131336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vaccine hesitancy is an important factor underpinning suboptimal vaccine uptake and evidence on marginalized subgroups, such as refugees, is limited. This cross-sectional survey was conducted in 2020/21 with former refugee parents who resettled in Aotearoa New Zealand (NZ). The Parent Attitudes about Childhood Vaccines (PACV) was offered in Somali, Oromo, Arabic, and English languages, and the reliability of the four versions were evaluated. The prevalence of parental vaccine hesitancy was explored and the association between vaccine hesitancy and sociodemographic factors was examined using logistic regression. One hundred and seventy-eight responses were included in the analysis. The Cronbach's alpha scores for Somali, Oromo, Arabic, and English PACV were 0.89, 0.64, 0.53, and 0.77, respectively. The rate of parental vaccine hesitancy was 16.3%, 95% CI (10.7, 21.3). Most caregivers were concerned about vaccine side effects (47%), safety (43%), and efficacy (40%). Less than a quarter (21%) of parents had delayed their child receiving a vaccine and 12% had refused to vaccinate their child for reasons other than medical exemptions. After adjusting for covariate/s, parents' primary source of information and education status were significantly associated with vaccine hesitancy. Media as a primary source of vaccine information and low education status were associated with higher vaccine hesitancy. Vaccine hesitancy is relatively low among former refugees and is influenced by modifiable factors, including educational level and primary source of vaccine information. Vaccine information tailored to former refugee parents' concerns are required to reduce vaccine hesitancy and improve vaccine uptake.
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Affiliation(s)
- Mulisa Senbeta Debela
- Department of Public Health, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - A. P. Nick Garrett
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nadia A. Charania
- Department of Public Health, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand,Migrant and Refugee Health Research Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand,CONTACT Nadia A. Charania Department of Public Health, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
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Haider S, Maheen A, Ansari M, Stolley M. Health Beliefs and Barriers to Healthcare of Rohingya Refugees. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01342-2. [PMID: 35689155 DOI: 10.1007/s40615-022-01342-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/21/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
In recent years, over 1,000 Rohingya families have been resettled to Milwaukee, Wisconsin from areas where they faced trauma and health disparities. To better understand their health beliefs and barriers to healthcare, we conducted a qualitative study with ten community health workers and stakeholders serving the Milwaukee Rohingya community. Interviews were transcribed, coded, and analyzed. Themes included: 1) health is defined as being able to meet basic needs of the family/community; 2) prior and existing mistrust and fear of systems of authority impact healthcare seeking behavior; 3) past-trauma negatively impacts physical and mental health; 4) religion and spirituality influence beliefs about illness, recovery, and wellbeing; 5) linguistic, cultural, and educational barriers impact access, quality of care, and understanding of disease. These results begin to address the significant gap in our knowledge of the health beliefs and needs of the local Rohingya community and underscore the need for tailored interventions.
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Affiliation(s)
- Shabi Haider
- Department of Medicine and Cancer Center, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, US
| | - Aniya Maheen
- Department of Medicine and Cancer Center, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, US
| | - Moiz Ansari
- Department of Medicine and Cancer Center, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, US
| | - Melinda Stolley
- Department of Medicine and Cancer Center, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, US.
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Kennedy J, Kim H, Moran S, McKinlay E. Qualitative experiences of primary health care and social care professionals with refugee-like migrants and former quota refugees in New Zealand. Aust J Prim Health 2021; 27:391-396. [PMID: 34629146 DOI: 10.1071/py20285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/13/2021] [Indexed: 11/23/2022]
Abstract
Former quota refugees are known to have higher health and social care needs than the general population in resettlement countries. However, migrants with a refugee-like background (refugee-like migrants) in New Zealand are not currently offered systematic government-sponsored induction or health services. This study explored the experiences of New Zealand health and social care providers in general practice. Staff at two Wellington region general practices with known populations of refugee-like migrants and former quota refugees were approached to participate in an exploratory qualitative study. Semistructured audio-recorded interviews and focus groups were undertaken. Deductive and inductive analyses were used to identify key themes. Twelve interviews were undertaken with professionals with backgrounds in clinical pharmacy, cross-cultural work, general practice medicine, primary care nursing, reception and social work. Key themes from the interviews were communication challenges, organisational structure and teamwork, considerations to best meet core health and support needs, and the value of contextual knowledge. Healthcare workers perceived many similarities between working with refugee-like migrants and working with former quota refugees. Even though communication challenges were addressed, there were still barriers affecting the delivery of core health and support services. Primary care practices should focus on organisational structure to provide high-quality, contextually informed, interprofessional team-based health and social care.
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Affiliation(s)
- Jonathan Kennedy
- Department of Primary Health Care and General Practice, University of Otago, Wellington 6242, New Zealand; and Newtown Union Health Service, Wellington 6021, New Zealand; and Corresponding author.
| | - Helen Kim
- Department of Primary Health Care and General Practice, University of Otago, Wellington 6242, New Zealand
| | - Serena Moran
- Department of Primary Health Care and General Practice, University of Otago, Wellington 6242, New Zealand; and Newtown Union Health Service, Wellington 6021, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington 6242, New Zealand
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