1
|
Crawshaw AF, Vandrevala T, Knights F, Deal A, Lutumba LM, Nkembi S, Kitoko LM, Hickey C, Forster AS, Hargreaves S. Navigating vaccination choices: The intersecting dynamics of institutional trust, belonging and message perception among Congolese migrants in London, UK (a reflexive thematic analysis). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002620. [PMID: 38985733 PMCID: PMC11236099 DOI: 10.1371/journal.pgph.0002620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 06/03/2024] [Indexed: 07/12/2024]
Abstract
The COVID-19 pandemic disproportionately impacted intersectionally marginalised migrants, revealing systemic disparities in health outcomes and vaccine uptake. Understanding the underlying social and structural factors influencing health behaviours is necessary to develop tailored interventions for migrants, but these factors have been seldom explored. This qualitative study aimed to explore contextual factors shaping COVID-19 vaccination decision-making among Congolese migrants in the UK.A community-based participatory research study was designed and led by a community-academic partnership in London, UK (2021-2022). Peer-led, semi-structured interviews were conducted in Lingala with 32 adult Congolese migrants and explored beliefs, perceptions and lived experiences of migration, healthcare, vaccination and the COVID-19 pandemic. Reflexive thematic analysis generated two themes and a model conceptualising the vaccination decision-making process. Participants and community partners were financially compensated; ethics was granted by the University of London ethics committee (REC: 2021.0128).Participants highlighted the incompatibility of lockdown restrictions with their communal culture, which intensified feelings of exclusion and alienation. Concerns about COVID-19 vaccination were attributed to safety and effectiveness, partly informed by experiences and legacies of racial discrimination and exploitation. Inequality in the pandemic response and COVID-19 outcomes heightened participants' sense that their views and needs were being overlooked, and government sources and information were perceived as coercive. Our model depicts the interplay between institutional trust, belonging, and message perception, which shaped participants' vaccination decisions and led to (non-)engagement with COVID-19 vaccination. This research enhances understanding of how social and contextual factors may influence migrants' engagement with health interventions. It underscores the importance of partnering with migrant communities to understand their needs in context and co-design tailored interventions and inclusive messaging strategies that promote trust and belonging. Implementing systemic changes to address structural inequalities will be crucial to create an environment that supports engagement with health-protective behaviours and enhances health outcomes among migrant communities.
Collapse
Affiliation(s)
- Alison F. Crawshaw
- Institute for Infection and Immunity, The Migrant Health Research Group, St George’s, University of London, Cranmer Terrace, London, United Kingdom
| | - Tushna Vandrevala
- Faculty of Health, Science, Social Care and Education, Centre for Applied Health and Social Care Research, Kingston University London, London, United Kingdom
| | - Felicity Knights
- Institute for Infection and Immunity, The Migrant Health Research Group, St George’s, University of London, Cranmer Terrace, London, United Kingdom
| | - Anna Deal
- Institute for Infection and Immunity, The Migrant Health Research Group, St George’s, University of London, Cranmer Terrace, London, United Kingdom
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura Muzinga Lutumba
- Hackney Congolese Women Support Group, c/o Hackney CVS, The Adiaha Antigha Centre, London, United Kingdom
| | - Sarah Nkembi
- Hackney Congolese Women Support Group, c/o Hackney CVS, The Adiaha Antigha Centre, London, United Kingdom
| | - Lusau Mimi Kitoko
- Hackney Congolese Women Support Group, c/o Hackney CVS, The Adiaha Antigha Centre, London, United Kingdom
| | - Caroline Hickey
- Hackney Refugee and Migrant Forum and Hackney CVS, The Adiaha Antigha Centre, London, United Kingdom
| | | | - Sally Hargreaves
- Institute for Infection and Immunity, The Migrant Health Research Group, St George’s, University of London, Cranmer Terrace, London, United Kingdom
| |
Collapse
|
2
|
Knights F, Carter J, Deal A, Crawshaw A, Bouaddi O, Sanchez-Clemente N, Seedat F, Vanderslott S, Eagan R, Holt DE, Ciftci Y, Orcutt M, Seale H, Severoni S, Hargreaves S. Strengthening life-course immunisation in migrant populations: access, equity, and inclusion. THE LANCET REGIONAL HEALTH. EUROPE 2024; 41:100806. [PMID: 39119098 PMCID: PMC11306209 DOI: 10.1016/j.lanepe.2023.100806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 08/10/2024]
Abstract
Adult and adolescent migrants worldwide, and those arriving in Europe, are an under-immunised group for routine vaccinations due to missed childhood vaccines and doses in their countries of origin, and their subsequent marginalisation from health and vaccination systems. Declining population-level coverage for routine vaccines across Europe, which has accelerated post-pandemic, places these and other under-immunised populations at even greater risk of vaccine-preventable diseases. However, despite clear guidelines around the importance of delivering 'catch-up' vaccination throughout the life-course, migrants are rarely effectively incorporated into routine vaccination programmes on arrival to Europe. These populations have subsequently been involved in outbreaks, including measles and diphtheria, and are missing opportunities to receive more recently introduced vaccines such as HPV to align them with European vaccine schedules. WHO's new Immunization Agenda 2030 places a renewed emphasis on equitable access to vaccine systems and integrating catch-up vaccination for missed vaccines and doses throughout the life-course. In addition, lessons learned and innovations from the COVID-19 pandemic merit further consideration in the design and delivery of more inclusive vaccination programmes. We describe current gaps in policy and practice around life-course vaccination in migrant populations, key factors that drive low vaccine uptake and coverage, and explore the benefits of participatory approaches to designing and delivering interventions with impacted communities, to define new strategies to advance vaccine equity across the Region.
Collapse
Affiliation(s)
- Felicity Knights
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Alison Crawshaw
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Oumnia Bouaddi
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco
- The Lancet Migration European Regional Hub, UK
- Mohammed VI Center for Research and Innovation, Rabat, Morocco
| | - Nuria Sanchez-Clemente
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Farah Seedat
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Sam Vanderslott
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Rachel Eagan
- The Vaccine Confidence Project, LSHTM, London, UK
| | | | - Yusuf Ciftci
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Miriam Orcutt
- The Health and Migration Programme, World Health Organization, Geneva, Switzerland
| | - Holly Seale
- School of Population Health, University of New South Wales, Australia
| | - Santino Severoni
- The Health and Migration Programme, World Health Organization, Geneva, Switzerland
| | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| |
Collapse
|
3
|
MacFarlane A, Huschke S, Marques MJ, Gama A, Kinaan W, Hassan A, Papyan A, Phelan H, Severoni S, Kumar B, Dias S. Normalising participatory health research approaches in the WHO European region for refugee and migrant health: a paradigm shift. THE LANCET REGIONAL HEALTH. EUROPE 2024; 41:100837. [PMID: 39119099 PMCID: PMC11306213 DOI: 10.1016/j.lanepe.2024.100837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/01/2023] [Accepted: 01/04/2024] [Indexed: 08/10/2024]
Abstract
While people's involvement in health research is increasingly the encouraged norm in many countries, the involvement of refugees and migrants in research about their health is rare. Here, we call for a paradigm shift in the field of refugee and migrant health to make participatory health research routine, i.e. normalised. To disrupt 'business as usual', we synthesise evidence about meaningful research partnerships and features of inclusive participatory spaces. We present examples of decolonial, culturally attuned methods that can be used to reimagine and reinvigorate research practice because they encourage critical reflexivity and power-sharing: arts-based research using music and singing, participatory learning and action research, Photovoice and co-design (ideas generation) workshops. We consider the consequences of not making this paradigm shift. We conclude with recommendations for specific structural and policy changes and empirical research questions that are needed to inform the normalisation of participatory health research in this field.
Collapse
Affiliation(s)
- Anne MacFarlane
- WHO Collaborating Centre on Participatory Health Research with Refugees and Migrants, School of Medicine and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Susann Huschke
- WHO Collaborating Centre on Participatory Health Research with Refugees and Migrants, School of Medicine and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Maria J. Marques
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
| | - Walaa Kinaan
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
| | | | - Anna Papyan
- Shannon Family Resource Centre, Shannon, Co. Clare, Ireland
| | - Helen Phelan
- WHO Collaborating Centre on Participatory Health Research with Refugees and Migrants, School of Medicine and Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Bernadette Kumar
- Division of Health Services Research, Norwegian Institute of Public Health, Norway
- Co- Chair of The Regional Hub Europe Lancet Migration
| | - Sonia Dias
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
| |
Collapse
|
4
|
Nichini E, Asim S, Ansar A, Dong D. Beyond individual responsibility towards healthy food choices: A qualitative study among Pakistani women in Hong Kong. Appetite 2024; 197:107299. [PMID: 38493870 DOI: 10.1016/j.appet.2024.107299] [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: 10/18/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Abstract
While biomedical understandings of food and diet coupled with discourses on individual responsibility towards healthy food choices are nowadays prominent, other social and cultural meanings attached to food and diet are largely devalued. The limits of such a reductionist approach are more evident when related to the experiences of migrant and ethnic populations, whose alternative knowledge(s) and practices about food and health are especially neglected. A multicultural city with a public healthcare system inherited from the British colonial times and largely shaped by biomedical ideas of health, Hong Kong offers a lens into the limits of such a reductionist approach. Due to their vulnerability in the context of Hong Kong as shaped by intersecting social identities, 72 women from Pakistan were recruited to be our community partners in a community-based participatory action research project to investigate their health needs and concerns. 12 focus group discussions were conducted, exploring their experiences of "healthy" food and overweight especially related to their encounters with the Hong Kong public healthcare system, as these issues emerged as key health concerns within the community. Four major themes emerged: unmet expectations of care, health is beyond the individual, constraints to a healthy diet in the context of migration, and beyond health: food as care for diasporic women. This study highlights the limit of a reductionist approach to healthy food as merely based on nutrition and individual responsibility. It stresses the need of a counter-discourse in the field of public health, emphasizing not only alternative cultural ideas of health and food, but also enlarging the field of health in biomedical terms to embrace "care" and acknowledging the structural constraints shaping migrant and ethnic population's vulnerability in making "healthy" food choices.
Collapse
Affiliation(s)
- Elena Nichini
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, School of Public Health Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong.
| | - Saba Asim
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, School of Public Health Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong.
| | - Aneeta Ansar
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, School of Public Health Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong.
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, School of Public Health Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong.
| |
Collapse
|
5
|
Javadizadeh E, Oudshoorn A, Letts L, Barbic S, Shanoff C, Marshall CA. Participatory Research with Persons who Experience Mental Illness in Occupational Therapy: A Scoping Review. Can J Occup Ther 2024; 91:203-221. [PMID: 38240309 PMCID: PMC11088223 DOI: 10.1177/00084174231212760] [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] [Indexed: 05/12/2024]
Abstract
Background. Persons who experience mental illness also face stigma and discrimination that frequently lead to a loss of ability to exercise autonomy and agency in their lives. Purpose. The range and breadth of literature exploring participatory research with persons living with mental illness are unknown in occupational therapy and occupation science. We initiated this study to fill this gap in the existing occupational therapy and occupational science literature. Method. Using the method of Arksey and O'Malley, we have conducted a scoping review to identify the range and breadth of literature. A qualitative content analysis was performed. Findings. A total of 34 articles were included in the narrative synthesis. The content analysis led to three related themes from the included studies: (1) coming together; (2) unique potential of participatory research; and (3) challenges in conducting participatory research. Conclusions. This review highlights that participatory research is well suited to research conducted with persons living with mental illness to support meaningful engagement and minimize stigma throughout the research process. This review can guide future participatory research and practice in occupational therapy and occupational science with persons living with mental illness.
Collapse
Affiliation(s)
- Elham Javadizadeh
- Elham Javadizadeh, Health & Rehabilitation Sciences, Elborn College, University of Western Ontario, London, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
6
|
Mndala L, Kondoni C, Gadama L, Bamuya C, Kuyere A, Maseko B, Kachale F, Gondwe MJ, Lissauer D, Nyondo-Mipando AL. Developing comprehensive woman hand-held case notes to improve quality of antenatal care in low-income settings: participatory approach with maternal health stakeholders in Malawi. BMC Health Serv Res 2024; 24:628. [PMID: 38750447 PMCID: PMC11094996 DOI: 10.1186/s12913-024-10922-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/28/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In the quest for quality antenatal care (ANC) and positive pregnancy experience, the value of comprehensive woman hand-held case notes cannot be emphasised enough. However, the woman's health passport book in Malawi presents gaps which hinder provision of quality care, especially during pregnancy. We aimed to develop a compressive updated woman hand-held case notes tool (health passport book) which reflects WHO 2016 ANC guidelines in Malawi. METHODS From July 2022 to August 2022, we applied a co-creative participatory approach in 3 workshops with key stakeholders to compare the current ANC tool contents to the WHO 2016 ANC guidelines, decide on key elements to be changed to improve adherence and change in practice, and redesign the woman's health passport tool to reflect the changes. Within-group discussions led to whole-group discussions and consensus, guided by a modified nominal group technique. Facilitators guided the discussions while ensuring autonomy of the group members in their deliberations. Discussions were recorded and transcribed. Data was analysed through thematic analysis, and reduction and summaries in affinity diagrams. The developed tool was endorsed for implementation within Malawi's healthcare system by the national safe motherhood technical working group (TWG) in July 2023. RESULTS Five themes were identified in the analysis. These were (i) critical components in the current tool missed, (ii) reimagining the current ANC tool, (iii) opportunity for ultrasound scanning conduct and documentation, (iv) anticipated barriers related to implementation of the newly developed tool and (v) cultivating successful implementation. Participants further recommended strengthening of already existing policies and investments in health, strengthening public private partnerships, and continued capacity building of healthcare providers to ensure that their skill sets are up to date. CONCLUSION Achieving goals of quality ANC and universality of healthcare are possible if tools in practice reflect the guidelines set out. Our efforts reflect a pioneering attempt in Malawi to improve women's hand-held case notes, which we know help in enhancing quality of care and improve overall women's satisfaction with their healthcare system.
Collapse
Affiliation(s)
- Leonard Mndala
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.
- University of Liverpool, Liverpool, UK.
| | | | - Luis Gadama
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Catherine Bamuya
- Malawi Epidemiological and Intervention Research Unit, Karonga, Malawi
| | - Annie Kuyere
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Bertha Maseko
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | | | | | - David Lissauer
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- University of Liverpool, Liverpool, UK
| | - Alinane Linda Nyondo-Mipando
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- University of Liverpool, Liverpool, UK
- Kamuzu University of Health Sciences, Blantyre, Malawi
| |
Collapse
|
7
|
Crawshaw AF, Kitoko LM, Nkembi SL, Lutumba LM, Hickey C, Deal A, Carter J, Knights F, Vandrevala T, Forster AS, Hargreaves S. Co-designing a theory-informed, multicomponent intervention to increase vaccine uptake with Congolese migrants: A qualitative, community-based participatory research study (LISOLO MALAMU). Health Expect 2024; 27:e13884. [PMID: 37831054 PMCID: PMC10726157 DOI: 10.1111/hex.13884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/11/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Disparities in the uptake of routine and COVID-19 vaccinations have been observed in migrant populations, and attributed to issues of mistrust, access and low vaccine confidence. Participatory research approaches and behaviour change theory hold the potential for developing tailored vaccination interventions that address these complex barriers in partnership with communities and should be explored further. METHODS This study used a theory-informed, community-based participatory research approach to co-design a culturally tailored behaviour change intervention aimed at increasing COVID-19 vaccine uptake among Congolese migrants in London, United Kingdom (2021-2022). It was designed and led by a community-academic partnership in response to unmet needs in the Congolese community as the COVID-19 pandemic started. Barriers and facilitators to COVID-19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in-depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the capability, opportunity, motivation, behaviour model to identify target behaviours and strategies to include in interventions. Interventions were co-designed and tailored in workshops involving Congolese migrants. RESULTS Thirty-two Congolese adult migrants (24 (75%) women, mean 14.3 (SD: 7.5) years in the United Kingdom, mean age 52.6 (SD: 11.0) years) took part in in-depth interviews and 16 (same sample) took part in co-design workshops. Fourteen barriers and 10 facilitators to COVID-19 vaccination were identified; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences and environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivations and social opportunities. Strategies included culturally tailored behaviour change techniques based on education, persuasion, modelling, enablement and environmental restructuring, which resulted in a co-designed intervention comprising community-led workshops, plays and posters. Findings and interventions were disseminated through a community celebration event. CONCLUSIONS Our study demonstrates how behavioural theory can be applied to co-designing tailored interventions with underserved migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities' unique cultural needs and realities. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement (PPI) were embedded in the participatory study design and approach, with community members co-producing all stages of the study and co-authoring this paper. An independent PPI board (St George's Migrant Health Research Group Patient and Public Involvement Advisory Board) comprising five adult migrants with lived experience of accessing healthcare in the United Kingdom were also consulted at significant points over the course of the study.
Collapse
Affiliation(s)
- Alison F. Crawshaw
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | | | | | | | | | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineLondonUK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | - Felicity Knights
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | - Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Science, Social Care and EducationKingston University LondonLondonUK
| | | | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| |
Collapse
|
8
|
Bousmah MAQ, Gosselin A, Coulibaly K, Ravalihasy A, Taéron C, Senne JN, Gubert F, Desgrées du Loû A. Immigrants' health empowerment and access to health coverage in France: A stepped wedge randomised controlled trial. Soc Sci Med 2023; 339:116400. [PMID: 37988803 DOI: 10.1016/j.socscimed.2023.116400] [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: 04/27/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/23/2023]
Abstract
Throughout Europe, migration-related health inequalities are mirrored by large inequalities in health coverage. There is a need to develop novel strategies to secure access to health insurance for immigrants in Europe, in order to meet the shared Sustainable Development Goal of universal health coverage. We evaluated the impact of an original health-related empowerment intervention on access to health coverage among vulnerable, mostly undocumented immigrants in France. As part of the MAKASI study, we adopted an outreach approach and developed a community-based intervention with and for immigrants from sub-Saharan Africa living in precarious conditions in the Greater Paris area. This participatory intervention was grounded in the theory of individual empowerment. Using a stepped wedge randomised design, we first conducted a robust evaluation of the effect of the intervention on access to health coverage at three and six months post-intervention. We then investigated whether the intervention effect was mediated by a health empowerment process. Between 2018 and 2021, a total of 821 participants - 77% of whom were men - were recruited in public spaces and followed up for six months. Participants had been living in France for four years on average, 75% of them had no residence permit, and 44% had no health coverage at the time of inclusion. The probability of accessing health coverage increased by 29 percentage points at six months post-intervention (p < 0.01). This improvement was partially mediated by a health empowerment process, namely a reinforcement of participants' knowledge of and capacity to access available social and health resources. A health empowerment intervention largely improved access to health insurance among vulnerable immigrants in France. Our findings may be transferred to other settings where immigrants are entitled to health insurance. This study offers promising perspectives - beyond information provision and direct referral - to reduce migration-related inequalities in health coverage.
Collapse
Affiliation(s)
- Marwân-Al-Qays Bousmah
- Université Paris Cité, IRD, INSERM, Ceped, F-75006, Paris, France; French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.
| | - Anne Gosselin
- Université Paris Cité, IRD, INSERM, Ceped, F-75006, Paris, France; French Collaborative Institute on Migrations, CNRS, Aubervilliers, France; Institut National d'Études Démographiques, Aubervilliers, France
| | - Karna Coulibaly
- Université Paris Cité, IRD, INSERM, Ceped, F-75006, Paris, France; French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| | - Andrainolo Ravalihasy
- Université Paris Cité, IRD, INSERM, Ceped, F-75006, Paris, France; French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| | | | - Jean-Noël Senne
- RITM, Université Paris-Saclay, Sceaux, France; IRD, UMR LEDa-DIAL, PSL, Université Paris-Dauphine, CNRS, Paris, France
| | - Flore Gubert
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France; IRD, UMR LEDa-DIAL, PSL, Université Paris-Dauphine, CNRS, Paris, France
| | - Annabel Desgrées du Loû
- Université Paris Cité, IRD, INSERM, Ceped, F-75006, Paris, France; French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| |
Collapse
|
9
|
Servais L, Huberland V, Richelle L. Misuse of Pregabalin: a qualitative study from a patient's perspective. BMC Public Health 2023; 23:1339. [PMID: 37438829 DOI: 10.1186/s12889-023-16051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/05/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION The misuse of Pregabalin has been the subject of growing concern for several years. The effects sought are multiple and it is rarely taken as a single drug. It is most frequently used together with opioids, which may increase the risk of fatal overdose. In response to this emerging phenomenon, we seek to better understand the situation of misuse in Belgium and identify the people involved in it. METHODOLOGY A qualitative study using semi-structured interviews with 20 participants who misuse Pregabalin was conducted throughout the French-speaking region of Belgium between August 2021 and January 2022. Recruitment mostly took place in addictions centers, shelters for migrants and homeless persons and primary care centers. We then conducted a thematic analysis with the help of Nvivo software. RESULTS A profile emerged, of young male users, immigrants, mainly first generation immigrants coming from North Africa. They had in common a challenging or even traumatic migration pathway and precarious living conditions in Belgian territory. Most of them had no stable income. They saw Pregabalin as enabling them to cope with their daily situation. All had psychiatric and/or somatic comorbidities for which they had apparently not recieved adequate medical care. This seemed to lead many of them to use Pregabalin as self-medication, for anxiety-depressive disorders and chronic pain, and it was sometimes initiated in their home country. Pregabalin was never used alone. CONCLUSION This study has highlighted a rare and insufficient documented profile of Pregabalin misuse: self-medication among a group of first generation immigrants, most of whom have no previous history of opioid-related disorders. Measures should be taken to improve access to health and social care for this population, considering all their biopsychosocial vulnerabilities.
Collapse
Affiliation(s)
- Louise Servais
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, Route de Lennik 808, Brussels, CP 612 1070, Belgium.
- Département de Médecine Générale, Faculty of Medicine, Université Libre de Bruxelles, Route de Lennik 808, Brussels, CP 612 1070, Belgium.
| | - Vincent Huberland
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, Route de Lennik 808, Brussels, CP 612 1070, Belgium
- Département de Médecine Générale, Faculty of Medicine, Université Libre de Bruxelles, Route de Lennik 808, Brussels, CP 612 1070, Belgium
| | - Lou Richelle
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, Route de Lennik 808, Brussels, CP 612 1070, Belgium
- Département de Médecine Générale, Faculty of Medicine, Université Libre de Bruxelles, Route de Lennik 808, Brussels, CP 612 1070, Belgium
| |
Collapse
|
10
|
MacFarlane A, Puthoopparambil SJ, Waagensen E, Sisti LG, Costanzo G, Kayi I, Osseiran S, Sakarya S, Severoni S, Hannigan A. Framework for refugee and migrant health research in the WHO European Region. Trop Med Int Health 2023; 28:90-97. [PMID: 36576432 PMCID: PMC10107437 DOI: 10.1111/tmi.13845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Migration is a longstanding, growing global phenomenon. As a social determinant of health, migration can lead to health inequities between people on the move and host populations. Thus, it is imperative that there is a coordinated effort to advance migration- and health-related goals. WHO has a specific remit to support evidence-based decision-making in its Member States. As part of that remit, WHO Europe presents this Framework for Refugee and Migrant Health Research in the WHO European Region. It is designed as a starting point for debating and analysing a broad range of options and approaches to help inform a WHO global research agenda on health and migration. This is important because refugee and migrant health research is a complex interdisciplinary field that is expanding in a fast-changing socio-political environment. The Framework is intended for all stakeholders involved: academic, civil society organisations, refugees, migrants, policy-makers, healthcare providers, educators and funders. It is developed by academics in consultation with these stakeholder groups. It reflects on three specific interrelated dynamics in research practice. These are (i) research prioritisation; (ii) study samples and (iii) research design. The Framework offers recommendations to consider for each one of these. It elucidates the value of involving refugees and migrants in research and research agendas and the need to develop an ecosystem that will support and sustain participatory, interdisciplinary, transdisciplinary and inter-sectoral projects.
Collapse
Affiliation(s)
- Anne MacFarlane
- Public and Patient Involvement Research Unit, School of Medicine and Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Elisabeth Waagensen
- Division of Country Support, Emergency Preparedness and Response, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Leuconoe Grazia Sisti
- Health Directorate, National Institute for Health, Migration and Poverty, Rome, Italy
| | - Gianfranco Costanzo
- Health Directorate, National Institute for Health, Migration and Poverty, Rome, Italy
| | - Ilker Kayi
- Department of Public Health, Koç University School of Medicine, Istanbul, Turkey
| | - Souad Osseiran
- Migration Research Center, Koç University, Istanbul, Turkey
| | - Sibel Sakarya
- Department of Public Health, Koç University School of Medicine, Istanbul, Turkey
| | | | - Ailish Hannigan
- Public and Patient Involvement Research Unit, School of Medicine and Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
11
|
Crawshaw AF, Hickey C, Lutumba LM, Kitoko LM, Nkembi S, Knights F, Ciftci Y, Goldsmith LP, Vandrevala T, Forster AS, Hargreaves S. Codesigning an intervention to strengthen COVID-19 vaccine uptake in Congolese migrants in the UK (LISOLO MALAMU): a participatory qualitative study protocol. BMJ Open 2023; 13:e063462. [PMID: 36639215 PMCID: PMC9842599 DOI: 10.1136/bmjopen-2022-063462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Migrants positively contribute to host societies yet experience barriers to health and vaccination services and systems and are considered to be an underimmunised group in many European countries. The COVID-19 pandemic has highlighted stark inequities in vaccine uptake, with migrants facing access and informational barriers and lower vaccine confidence. A key challenge, therefore, is developing tailored vaccination interventions, services and systems which account for and respond to the unique drivers of vaccine uptake in different migrant populations. Participatory research approaches, which meaningfully involve communities in co-constructing knowledge and solutions, have generated considerable interest in recent years for those tasked with designing and delivering public health interventions. How such approaches can be used to strengthen initiatives for COVID-19 and routine vaccination merits greater consideration. METHODS AND ANALYSIS LISOLO MALAMU ('Good Talk') is a community-based participatory research study which uses qualitative and coproduction methodologies to involve adult Congolese migrants in developing a tailored intervention to increase COVID-19 vaccine uptake. Led by a community-academic coalition, the study will involve (1) semistructured in-depth interviews with adult Congolese migrants (born in Democratic Republic of Congo, >18 years), (2) interviews with professional stakeholders and (3) codesign workshops with adult Congolese migrants. Qualitative data will be analysed collaboratively using reflexive thematic analysis, and behaviour change theory will be used in parallel to support the coproduction of interventions and make recommendations across socioecological levels. The study will run from approximately November 2021 to November 2022. ETHICS AND DISSEMINATION Ethics approval was granted by the St George's University Research Ethics Committee (REC reference: 2021.0128). Study findings will be disseminated to a range of local, national and international audiences, and a community celebration event will be held to show impact and recognise contributions. Recommendations for implementation and evaluation of prototyped interventions will be made.
Collapse
Affiliation(s)
- Alison F Crawshaw
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Caroline Hickey
- Hackney Refugee and Migrant Forum, Hackney Council for Voluntary Service, London, UK
| | | | | | - Sarah Nkembi
- Hackney Congolese Women Support Group, London, UK
| | - Felicity Knights
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | | | - Lucy Pollyanna Goldsmith
- Institute for Infection and Immunity and Population Health Research Institute, St George's, University of London, London, UK
| | - Tushna Vandrevala
- Faculty of Health, Science, Social Care and Education, Centre for Applied Health and Social Care Research, Kingston University, Kingston, UK
| | | | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| |
Collapse
|
12
|
Gonçalves AQ, Sequeira-Aymar E, Aguilar Martín C, Dalmau RM, Cruz A, Evangelidou S, Hargreaves S, Requena-Mendez A, Jacques-Aviñó C. Usefulness and practicality of a multidisease screening programme targeting migrant patients in primary care in Spain: a qualitative study of general practitioners. BMJ Open 2022; 12:e065645. [PMID: 36385020 PMCID: PMC9670956 DOI: 10.1136/bmjopen-2022-065645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Some migrant groups are disproportionately affected by key infectious diseases in European countries. These pose a challenge for healthcare systems providing care to these groups. We aimed to explore the views of general practitioners (GPs) on the acceptability, adaptability and feasibility of a multidisease screening programme based on an innovative clinical decision-support system for migrants (the ISMiHealth tool), by examining the current gaps in healthcare provision and areas of good practice and the usefulness and limitations of training in the health needs of migrants. METHODS We undertook a qualitative descriptive study and carried out a series of focus groups (FGs) taking a pragmatic utilitarian approach. Participants were GPs from the four primary healthcare (PHC) centres in Catalonia, Spain, that piloted an intervention of the ISMiHealth tool. GPs were recruited using purposive and convenience sampling. FG discussions were transcribed and analysed using thematic content analysis. RESULTS A total of 29 GPs participated in four FGs. Key themes identified were: (1) GPs found the ISMiHealth tool to be very useful for helping to identify specific health problems in migrants, although there are several additional barriers to screening as part of PHC, (2) the importance of considering cultural perspectives when caring for migrants, and of the impact of migration on mental health, (3) the important role of PHC in healthcare provision for migrants and (4) key proposals to improve screening of migrant populations. GPs also highlighted the urgent need, to shift to a more holistic and adequately resourced approach to healthcare in PHC. CONCLUSIONS GPs supported a multidisease screening programme for migrant populations using the ISMiHealth tool, which aided clinical decision-making. However, intercultural participatory approaches will need to be adopted to address linguistic and cultural barriers to healthcare access that exist in migrant communities.
Collapse
Affiliation(s)
- Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Spain
- Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L'Ebre, Institut Català de la Salut, Tortosa, Spain
| | - Ethel Sequeira-Aymar
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Casanova, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Carina Aguilar Martín
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Spain
- Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Spain
| | - Rosa Maria Dalmau
- Equip d'Atenció Primària Tortosa Oest, Institut Català de la Salut, Tortosa, Spain
- Campus Terres de l'Ebre, Universitat Rovira i Virgili, Tortosa, Spain
| | - Angeline Cruz
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Stella Evangelidou
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
| | - Ana Requena-Mendez
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Disease, Karolinska University Hospital, Solna, Stockholm, Sweden
- CIBERINFEC, ISCIII - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Madrid, Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Barcelona, Spain
- Campus Bellaterra, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
| |
Collapse
|
13
|
Nellums LB, Latif A, Nkhoma K, Timmons S, Pareek M, Almidani S, Hussain B. COVID-19 boosters and building trust among UK minority ethnic communities. Lancet 2022; 400:643-644. [PMID: 35643093 PMCID: PMC9132542 DOI: 10.1016/s0140-6736(22)00945-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Laura B Nellums
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK.
| | - Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham NG5 1PB, UK
| | - Kennedy Nkhoma
- Cicely Saunders Institute, King's College London, London, UK
| | - Stephen Timmons
- Nottingham University Business School, University of Nottingham, Nottingham NG5 1PB, UK
| | - Manish Pareek
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Salma Almidani
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | | |
Collapse
|