Care preferences of older migrants and minority ethnic groups with various care needs: a protocol for a scoping review

INTRODUCTION

Worldwide, our societies are characterised by increasing diversity, which is greatly contributed to by people who have migrated from one country to another. To provide person-centred care, healthcare staff need to consider the personal background, biography and preferences of people with care needs. Little is known about the care preferences of older migrants and minority ethnic groups. The purpose of this planned scoping review is to explore and systematically investigate current research addressing the care preferences of older migrants and minority ethnic groups. In addition, gaps requiring further research will be identified. To the best of our knowledge, this scoping review will be the first to synthesise the literature regarding the preferences in nursing care of older migrants and minority ethnic groups.

METHODS

A scoping review will be conducted to identify and analyse the care preferences of older migrants and minority ethnic groups (population 60 years or older with various care needs). Based on the research aim, we will systematically search the electronic databases MEDLINE (via PubMed), CINAHL (via EBSCO) and PsycINFO (via EBSCO). We will include literature published in English and German with no restrictions regarding the publication date. The identified records will be independently screened (title/abstract and full text) by two reviewers. Data from the included studies will be extracted by one and verified by a second researcher. We will analyse the identified preferences with an inductive content analysis and will narratively present the review results in the form of tables.

ETHICS AND DISSEMINATION

There are no ethical concerns related to conducting this study. We will discuss our results with practitioners in the field of nursing care of older people with migration backgrounds. We will present our results and make them available to the public at (inter)national conferences and in the form of peer-reviewed and practice articles.

Improving health equity among the African ethnic minority through health system strengthening: a narrative review of the New Zealand healthcare system

Background

In New Zealand, health equity is a pressing concern and reaching disadvantaged populations has become the goal to close the inequity gap. Building and strengthening health systems is one way to secure better outcomes. However, the discourse to date has predominately focussed on inequities in health outcomes for Māori. This study has interest in the African ethnic minority community in New Zealand. It undertakes a narrative review of the New Zealand health system which aims to identify literature around the attainment of health equity of African minority by: (i) providing a critical overview of the healthcare delivery system using World Health Organization’s six inter-related building blocks of health system strengthening; (ii) developing a summary and discussions of the research results and; (iii) identifying priorities and recommendations for future research.

Method

A narrative review of 27 articles published between January 2010 and June 2019 were selected from CINAHL, PubMed, Scopus, Google Scholar. Grey literature also informed the review. Articles excluded studies: (i) non-related to New Zealand; (ii) with no focus on equity on ethnic minority in the delivering of healthcare; (iii) had no full text available.

Findings

Literature on Africans health outcomes were scarce regarding the six building blocks. However, findings show inequities in accessibility of health services, a non-ethnic inclusive health workforce, a leadership and governance which lack political will on migrant health and resultantly an under-performing health information system which influences resource allocation.

Recommendation and conclusion

An improvement and well-functioning health information system is pivotal to capture the unmet needs of the African population. There is a need for research and political will to invest in African minority health and diverse workforce that understands the background of the African population; and action to address structural and institutional racism and white privilege to address root causes of inadequate access and care processes for ethnic minorities.

Nutrition, the visceral immune system, and the evolutionary origins of pathogenic obesity

The global obesity epidemic is the subject of an immense, diversely specialized research effort. An evolutionary analysis reveals connections among disparate findings, starting with two well-documented facts: Obesity-associated illnesses (e.g., type-2 diabetes and cardiovascular disease), are especially common in: (i) adults with abdominal obesity, especially enlargement of visceral adipose tissue (VAT), a tissue with important immune functions; and (ii) individuals with poor fetal nutrition whose nutritional input increases later in life. I hypothesize that selection favored the evolution of increased lifelong investment in VAT in individuals likely to suffer lifelong malnutrition because of its importance in fighting intraabdominal infections. Then, when increased nutrition violates the adaptive fetal prediction of lifelong nutritional deficit, preferential VAT investment could contribute to abdominal obesity and chronic inflammatory disease. VAT prioritization may help explain several patterns of nutrition-related disease: the paradoxical increase of chronic disease with increased food availability in recently urbanized and migrant populations; correlations between poor fetal nutrition, improved childhood (catch-up) growth, and adult metabolic syndrome; and survival differences between children with marasmus and kwashiorkor malnutrition. Fats and sugars can aggravate chronic inflammation via effects on intestinal bacteria regulating gut permeability to visceral pathogens. The extremes in a nutrition-sensitive trade-off between visceral (immune-function) vs. subcutaneous (body shape) adiposity may have been favored by selection in highly stratified premedicine societies. Altered adipose allocation in populations with long histories of social stratification and malnutrition may be the result of genetic accommodation of developmental responses to poor maternal/fetal conditions, increasing their vulnerability to inflammatory disease.

Perspectives of UK Pakistani women on their behaviour change to prevent type 2 diabetes: qualitative study using the theory domain framework

BACKGROUND

Type 2 diabetes (T2D) is a debilitating disease, highly prevalent in UK South Asians, and preventable by lifestyle intervention. The 'New life, New you' (NLNY) physical activity (PA) and dietary intervention for T2D prevention was culturally adapted to better engage minority ethnic populations and tested for feasibility.

OBJECTIVES

To investigate Pakistani female participants' perspectives of their behaviour change and of salient intervention features.

SETTING

A community-based 8-week programme of group delivered PA sessions with behavioural counselling and dietary advice, culturally adapted for ethnic minority populations, in an area of socioeconomic deprivation. Participants to NLNY were recruited through screening events in community venues across the town.

PARTICIPANTS

Interviews were conducted with 20 Pakistani female NLNY participants, aged 26-45 (mean 33.5) years, from different parts of town.

RESULTS

Within the a priori Theoretical Domains Framework (intentions and goals, reinforcement, knowledge, nature of the activity, social role and identity, social influences, capabilities and skills, regulation and decision, emotion and environment), we identified the importance of social factors relating to participants' own PA and dietary behaviour change. We also identified cross-cutting themes as collateral benefits of the intervention including participants' 'psychological health'; 'responsibility' (for others' health, especially family members included in the new PA and diet regimes) and 'inclusion' (an ethos of accommodating differences).

CONCLUSIONS

Our findings suggest that culturally adapted interventions for Pakistani women at risk of T2D, delivered via group PA sessions with counselling and dietary advice, may encourage their PA and dietary behaviour change, and have collateral health and social benefits. The NLNY intervention appeared to be acceptable. We plan to evaluate recruitment, retention and likely effect of the intervention on participant behaviour prior to definitive evaluation.

Differences between 9-11 year old British Pakistani and White British girls in physical activity and behavior during school recess

Background

School recess provides an important opportunity for children to engage in physical activity. Previous studies indicate that children and adults of South Asian origin are less active than other ethnic groups in the United Kingdom, but have not investigated whether activity differs within the shared school environment. The aim of this study was to test the hypothesis that British Pakistani girls aged 9–11 years are less active during recess than White British girls.

Methods

In Study One, the proportion of recess spent by 137 White British (N = 70) and British Pakistani (N = 67) girls in sedentary behavior, moderate-to-vigorous activity (MVPA) and vigorous activity (VPA) was determined using accelerometry. In Study Two, 86 White British (N = 48) and British Pakistani (N = 38) girls were observed on the playground using the System for Observing Children’s Activity and Relationships during Play (SOCARP). Accelerometry data were collected during observations to allow identification of activities contributing to objectively measured physical activity.

Results

Accelerometry data indicated that British Pakistani girls spent 2.2% (95% CI: 0.2, 4.3) less of their total recess time in MVPA and 1.3% (95% CI: 0.2, 2.4) less in VPA than White British girls. Direct observation showed that British Pakistani girls spent 12.0% (95% CI: 2.9, 21.1) less playground time being very active, and 12.3% (95% CI: 1.7, 23.0) less time playing games. Time spent being very active according to direct observation data correlated significantly with accelerometer-assessed time spent in MVPA and VPA, and time spent playing games correlated significantly with accelerometer-assessed time spent in VPA, suggesting that differences in behavior observed in Study Two may have contributed to the differences in time spent in MVPA and VPA in Study One.

Conclusions

British Pakistani girls were less active than White British girls during school recess. Recess has been identified as a potentially important target for the delivery of physical activity interventions; such interventions should consider ways in which the activity levels of British Pakistani girls could be increased.