Health related quality of life among Iraqi immigrants settled in Malaysia

Health Related Quality of life Amongst Refugees: A meta Analysis of Studies Using the SF-36

The health of refugees has been widely documented, as has the impact of a range of factors throughout the migration journey from being exposed to violence to the impacts of immigration detention. This study adds to our understanding of health-related quality of life amongst refugees and asylum seekers by evaluating health-related quality of life as measured by the Short-Form 36 (SF-36) Health Survey using meta-analysis. The aims of this study were to (1) provide a summary and overview of health-related quality of life (as measured by the SF-36), including the extent to which this varies and (2) explore the factors that influence health-related quality of life (as measured by the SF-36) amongst refugees and asylum seekers. A search was undertaken of MEDLINE, CINAHL, PSYCINFO and SCOPUS, returning 3965 results. Papers were included if they sampled refugees (or asylum seeker or those with refugee-like experiences) and used the SF-36 (or its variants) as an outcome measure. Mean scores and standard deviations were pooled using a random effects model. The pooled sample size was 18,418. The pooled mean scores for the SF-36 physical summary measures was 54.99 (95% CI 46.01-63.99), while the mental health summary measure was 52.39 (95% CI 43.35-61.43). The pooled mean scores for each of the sub-scales ranged from 49.6 (vitality) to 65.54 (physical functioning). High heterogeneity was found between both summary measures and all sub-scales. In comparison to SF-36 results from general populations in high and middle income countries, these results suggest that refugee quality of life is generally poorer. However, this varied substantially between studies. One issue that is not well clarified by this review are the factors that contributed to health-related quality of life.

A Comparison Quality of Life of Children of Seasonal Agricultural Workers and Local Residents in Turkey

OBJECTIVES

Children of seasonal agricultural workers (SAW) live in the worst conditions of agricultural labor and, consequently, face many health risks. Therefore, it is essential to evaluate the quality of life (QoL) of these children. This study aimed to compare the QoL between children of SAW and local residents in semi-rural areas of Eskisehir, Turkey, and determine the factors affecting them.

METHODS

In this cross-sectional study, we included children of SAW living in temporary camp areas and those of local residents visiting the Family Health Center close to the camp areas. Basic sociodemographic data collection forms and the Pediatric Quality of Life (PedsQL) scale were employed for data collection. Univariate and multivariate analyses were used to determine factors that had a significant effect on the QoL.

RESULTS

We included 324 children of SAW and 256 local children. As per the multivariate analysis, QoL was lower in children aged between 8 and 12 years, with physician-diagnosed chronic diseases, and children of SAW. Also, there was no significant association between gender, parental education levels, family income, number of siblings, school attendance status, and QoL level.

CONCLUSION

The QoL of children of SAW families was significantly lower than their peer local children. Therefore, the appropriate authorities must prioritize the planning and implementation of health services for SAW families.

Health-Related Quality of Life and Life Satisfaction in a Greek Refugee Accommodation Center

Introduction In recent years, a large number of refugees have crossed the Greek borders. The aim of this study was to estimate the health-related quality of life (HRQoL) and life satisfaction (LS) of refugees and asylum seekers residing in the Vagiochori Accommodation Center. Methods The Short Form-36 (SF-36) survey tool and the Satisfaction With Life Scale (SWLS) were employed for the analysis. The sample consists of 144 individuals with an average age of 39.4 years, most of which are Afghans, married, and have a secondary education level. Non-parametric tests examined the association of respondents' demographics and health-related and residence-related characteristics with the physical component scale (PCS) and mental component scale (MCS) of SF-36 and SWLS. Regression analysis was used to examine the effect of these variables on dependent scales. Results HRQoL and LS of the participants were poor (median scores: PCS = 44.91, MCS = 42.05, and SWLS = 12.00). Age, gender, education, marital status, and specific health-related and residence-related characteristics were associated with HRQoL (p < 0.05). Marital status and specific health-related and residence-related characteristics were associated with SWLS. Conclusion In summary, social support, legal counseling, and a better understanding of refugees' concerns are required to improve refugees' and asylum seekers' HRQoL and LS.

Self-perceived mental health and factors associated with the mental health of Hong Kong's asylum-seekers and refugees - A mixed methods study

Rationale

The 21st century has seen vast flows of displaced people. In the year 2020 alone, an estimated 11.2 million were forcibly displaced as a result of persecution, conflict or generalized violence. The torment and fear of war, persecution and threat to life, whether in the home country, during the process of fleeing, or in the post-migration host country, can be extremely traumatic to these marginalized populations. Hong Kong is not a signatory to the 1951 UN Refugee Convention, but the territory has signed the 1967 UN(CAT) which requires the former colony to allow people who flee for their lives to have their cases processed in Hong Kong. Currently there are around 14,000 cases in Hong Kong, some of whom have been in Hong Kong for more than a decade, waiting for their claims to be processed, living on meagre government subsidies and with no right to work.

Objectives

The paper examines the mental health of asylum-seekers and refugees in Hong Kong and the factors associating with their mental health.

Method

A sequential mixed methods approach was conducted among asylum-seekers and refugees in Hong Kong between October 2019 and mid-2020. It comprised a pilot quantitative survey conducted with 47 participants, and follow-up qualitative interviews with 16 of the 47 participants. Survey results were analyzed using statistical measures while the qualitative in-depth interviews were thematically analyzed to identify emergent patterns and categories.

Results

Results from the quantitative data identify 52.2% of the asylum-seekers taking part as having symptomatic anxiety, 55.3% as having symptomatic depression and 54.3% as having overall problems. Qualitative results show that asylum-seekers and refugees cited lack of work and poverty as key factors affecting their mental health and well-being. Fear of being sent home was expressed by respondents who were married or having children for the fear of being separated from each other.

Acculturation, Adaptation, and Health among Croatian Migrants in Austria and Ireland: A Cross-Sectional Study

Since Croatia joined the European Union, majority of the studies on Croatian emigrants have predominantly addressed the reasons for migration and their future predictions. The primary purpose of this study was to investigate the relationship between the sense of coherence, health behavior, acculturation, adaptation, perceived health, and quality of life (QoL) in first-generation Croatian migrants living in Austria and Ireland. Our study is the first study that addresses the perceived health and QoL of Croatian migrants since the last emigration wave in 2013. An online survey was conducted in Austria (n = 112) and Ireland (n = 116) using standardized questionnaires. Multiple linear regression analyses were conducted for emigrated Croats to identify the predictors of perceived health and QoL. The analyses revealed that the sense of coherence and psychological adaptation were the strongest predictors of perceived health and QoL in Austria and Ireland. Furthermore, in the environmental domain of QoL, a higher education, higher net income, life in Austria rather than Ireland, better health behavior, higher sense of coherence, and better psychological and sociocultural adaptation explained 55.9% of the variance. Health policies and programs should use the salutogenic model to improve the health-related quality of life and psychological adaptation of Croatian migrants.

Factors influencing quality of life among syrian refugees pregnant women in Jordan: A cross-sectional study

Background

Pregnancy is a critical period of transition incorporating important normal physical, emotional, hormonal, and physiological status changes. These changes might affect the quality of life (QOL) of pregnant woman. This study aimed to examine the levels of quality of life and perceived social support of Syrian refugees' pregnant women in Al-Zaatari Refugee Camp in Jordan.

Methods

A cross-sectional survey design was used. A sample of 319 pregnant women was recruited from two maternal health clinics at Al-Zaatari Refugee Camp. Data were collected from June to August 2020 using the Arabic version of World Health Organization Quality of Life (WHOQOL-BREF), the Multidimensional Perceived Social Support (MSPSS) questionnaires, and two sheets were used to assess sociodemographic and obstetric variables.

Results

The study reveals that Syrian refugees' pregnant women had good satisfaction with their overall QOL and health status and social support. A significant relationship was found between the socioeconomic index and QOL. Also, age, being in the third trimester, and parity correlated negatively with QOL. In contrast, those who stayed in Jordan as a refugee for a longer period reported better QOL.

Conclusion

Syrian women in Jordan, in general, have a good QOL and high level of social support. However, women were least satisfied with their physical health domain. Several factors affected QOL including income, employment status, age, number of children, and pregnancy trimester. Social support is an important factor in improving the QOL among Syrian refugees' pregnant women.

The effects of oral health and social support on health-related quality of life of migrant older with children in Weifang, China

Background

With the accelerated urbanization and aging population in China, more and more migrant older with children (MOC) moved to new cities. Previous studies mainly explored the acculturation of MOC, yet few focused on the health conditions of this vulnerable group. This study aimed to investigate the effects of oral health and social support on health-related quality of life (HRQOL) of MOC in Weifang, China.

Method

This study was a cross-sectional study and participants were selected by multi-stage cluster random sampling in Weifang, China. The HRQOL was assessed via the 12-item Short-Form Health Survey (SF-12) which included the mental component summary (MCS) and the physical component summary (PCS). The oral health was evaluated by the Geriatric Oral Health Assessment Index (GOHAI). The social support was administered using the Social Support Rating Scale (SSRS). Descriptive analysis was used to describe participants’ sociodemographic variables, oral health and social support. Univariate analysis and binary logistic regression analysis was used to investigate the association between the social support, oral health and HRQOL.

Results and discussion

It was found that 25.0% of MOC were defined as MCS poor and PCS poor, respectively. Those participants with average and low monthly household income compared to those around them, average and poor oral health, and low levels of social support were more likely to have poor PCS. Those with temporary residence permits, fair and poor oral health, and medium and low levels of social support were more likely to report poor MCS.

Conclusion

Results indicated that better social support and oral health led to higher HRQOL of MOC. Implications for the government, communities and families of MOC were given to improve their HRQOL.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13843-0.

Quality of life among Syrian refugees in Germany: a cross-sectional pilot study

Background

More than 10 million Syrians have left their homes and sought refuge in neighboring countries, including Europe, since the beginning of the Syrian conflict in March 2011, and immigration continues to this day. This cross-sectional study included Syrian refugees residing in and around Hannover, Germany. We investigated whether general socioeconomic factors (e.g. age, sex, housing, asylum duration) were predictive factors for the quality of life (QOL) of Syrian refugees in Germany.

Methods

The QOL of Syrian refugees was assessed using the WHOQOL-BREF tool, a questionnaire assessing the QOL in four domains: Physical health, psychological, social relationships and environment. A total of 114 Syrian refugees, aged between 18 and 45 years, who obtained one of the following statuses, asylum, refugee protection or subsidiary protection, were included. The QOL domain and total scores of Syrian refugees in Germany were compared with a Western norm and Sub-Saharan population. Data were analyzed with the Spearman Rho correlation coefficient, Kruskal–Wallis and Mann–Whitney U test and multivariate linear regression.

Results

More than 65% of the participants (62.3% male, 37.7% female) were between 18 and 29 years old, and 45% had lived in Germany for less than four years. The lowest QOL score was reported in the social relationship’s domain (60.5%), while the psychological score was lowest in participants aged 40–45 years (P = 0.011). The age was significantly negatively associated with physical health (P = 0.010), psychological (P <  0.001) and the total QOL (P = 0.005). Asylum duration was associated with the environment domain (P = 0.040), the short-time refugees were less satisfied than the longtime refugees, and with aspects of the psychological domain in Enjoying life and Concentration ability (P <  0.001 and P = 0.033, respectively), yet was not associated with total QOL or total domain scores. There were significant associations between housing and the psychological domain (P = 0.032) and housing and the social relationship domain (P <  0.001). The refugees who living in camps registered a lower score in psychological than residents of apartments and houses, and the single refugees had a higher score than those married and divorced (P = 0.032 and P = 0.035, respectively).

Conclusions

The Syrian refugees participating in this study showed a low QOL score in the assessment of all domains compared to the normal population, especially regarding social relations and psychological; it was associated with socioeconomic factors, such as housing, asylum duration and marital status. This calls for urgent societal and political efforts to strengthen the social living conditions of Syrian refugees in Germany.

Health-Related Quality of Life among Rural-Urban Migrants Living in Dhaka Slums: A Cross-Sectional Survey in Bangladesh

BACKGROUND

The study aimed to assess the health-related quality of life (HRQoL) and its associated factors among urban slum dwellers who migrated from different rural parts of Bangladesh.

METHODS

The present study analyzed data from a Migration and Mobility Determinants on Health survey and was conducted in 2017 among 935 migrant slum dwellers of Dhaka city (North & South) and Gazipur City Corporations, as a part of the icddr,b's Urban Health and Demographic Surveillance System (UHDSS). The face-to-face interviews were conducted with the adult population by using a semi-structured questionnaire that included variables related to socio-demographics, migration, occupation, and HRQoL (SF-12). Bivariate and multiple linear regression analyses were performed to determine the factors associated with HRQoL.

RESULTS

The mean (±SD) scores of physical component summary (PCS), and mental component summary (MCS) were 57.40 ± 22.73 and 60.77 ± 22.51, respectively. As per multiple regression analysis, lower PCS scores were associated with having older age, being female, and not having any job. Mean MCS scores were significantly lower among participants who reported having older age, not having any job, not working/ less working hours (≤8 h/day), as well as increased work-related stress in the current urban slum.

CONCLUSIONS

The findings suggest that available urban social protection programs should include a comprehensive social safety net for the improvement of the slum infrastructure as well as proper health care and risk mitigation plans at workplaces.

Health-related quality of life among migrants and natives in Hamburg, Germany: An observational study

Purpose

The aim of this observational study was firstly, to assess the Health-related Quality of Life (HrQoL) among migrants and German natives in Hamburg, Germany, using the SF-12 mental and physical summary scores and secondly, to evaluate the contribution of selected sociodemographic and socioeconomic variables to explain the variance in mental and physical HrQoL separately for migrants and natives.

Methods

Face-to-face interviews were conducted with n=809 participants between May 2018 and July 2019 in six randomly selected statistical districts of Hamburg grouped into four levels of socioeconomic status (SES). The SF-12 questionnaire was used to measure the HrQoL. Socioeconomic (school education, income) and sociodemographic (age, gender, marital status, children) data was recorded, too.

Results

Migrants and natives scored higher in mental (migrants: M=45.77, SD=7.66; natives: M=47.60, SD=6.14) than in physical HrQoL (migrants: M=42.55, SD=5.55; natives: M=42.03, SD=4.71). Natives had a significantly higher (p<0.001) SF-12 mental summary score than migrants. There was a positive association between education and mental HrQoL (β=0.248, p=2.308) in the migrant but not in the native group. Due to limitations of the study the results of the impact of migration on the HrQoL require interpretation.

Conclusion

Differences between migrants and German natives in HrQoL were partially confirmed. Future research should differentiate more strongly between migration contexts as well as other determinants of health (e.g. early life, social support, unemployment) and their policy implications according to the WHO.

Health-Related Quality of Life Among Refugees and Asylum Seekers in Northern Greece

We aimed at assessing the health-related quality-of-life (HRQoL) of refugees and asylum seekers in Northern Greece. The SF-36 Health Survey was used to assess participants' HRQoL. Participants were contacted in person. Correlation and dependence tests were employed to examine the association of participants' demographic, residence-related and medical-related characteristics with the two SF-36 component (physical-PCS/mental-MCS) scales. Regressions were conducted to investigate the effect of these characteristics on component scales. Refugees and asylum seekers (n = 161) living in urban apartments and camps in Northern Greece participated in the study reporting poor HRQoL (PCS = 43.9, MCS = 39.5). Age, gender, duration of stay, benefits offered by Non-Governmental Organisations (NGOs), type of accommodation, suffering from a serious health problem and receipt of medication were associated with HRQoL. This study constitutes the first research assessing HRQoL of refugees and asylum seekers in Northern Greece.

Effects of Living Conditions, Subjective Integration, and Social Networks on Health-Related Quality of Life among the Migrant Elderly Following Children in Jinan, China

With accelerated urbanization in China, an increasing number of the migrant elderly following children (MEFC) have appeared. This study aims to explore the effects of living conditions, subjective integration, and social networks on the health-related quality of life (HRQOL) of MEFC in Jinan, China. HRQOL was assessed by the 12-item Short-Form Health Survey, which included the mental component summary (MCS) and the physical component summary (PCS). Univariate analyses and binary logistic regression were used to investigate the association between the above indicators and HRQOL. A total of 656 MEFC were selected by multi-stage cluster random sampling, 25.2% and 25.0% of whom were defined as poor MCS and poor PCS, respectively. Those who understood the local dialect, could trust others, and connected with friends were more likely to have good MCS; those with a nanny, faulty elevator, and no support from their spouse were the reverse. MEFC who were trans-city, had no elevator or a faulty elevator, and went to the hospital alone were more likely to have poor PCS; those who approved of living conditions in their hometowns were the reverse. Results indicated that better living conditions, stronger subjective integration, and wider social networks led to higher HRQOL of MEFC. Implications of the government, communities, and families of MEFC were given to improve their HRQOL.

Developing an evidence assessment framework and appraising the academic literature on migrant health in Malaysia: a scoping review

BACKGROUND

A large number of international migrants in Malaysia face challenges in obtaining good health, the extent of which is still relatively unknown. This study aims to map the existing academic literature on migrant health in Malaysia and to provide an overview of the topical coverage, quality and level of evidence of these scientific studies.

METHODS

A scoping review was conducted using six databases, including Econlit, Embase, Global Health, Medline, PsycINFO and Social Policy and Practice. Studies were eligible for inclusion if they were conducted in Malaysia, peer-reviewed, focused on a health dimension according to the Bay Area Regional Health Inequities Initiative (BARHII) framework, and targeted the vulnerable international migrant population. Data were extracted by using the BARHII framework and a newly developed decision tree to identify the type of study design and corresponding level of evidence. Modified Joanna Briggs Institute checklists were used to assess study quality, and a multiple-correspondence analysis (MCA) was conducted to identify associations between different variables.

RESULTS

67 publications met the selection criteria and were included in the study. The majority (n=41) of studies included foreign workers. Over two-thirds (n=46) focused on disease and injury, and a similar number (n=46) had descriptive designs. The average quality of the papers was low, yet quality differed significantly among them. The MCA showed that high-quality studies were mostly qualitative designs that included refugees and focused on living conditions, while prevalence and analytical cross-sectional studies were mostly of low quality.

CONCLUSION

This study provides an overview of the scientific literature on migrant health in Malaysia published between 1965 and 2019. In general, the quality of these studies is low, and various health dimensions have not been thoroughly researched. Therefore, researchers should address these issues to improve the evidence base to support policy-makers with high-quality evidence for decision-making.

The health-related quality of life of Syrian refugee women in their reproductive age

Background

Health-Related Quality of Life (HRQoL) for refugee women in reproductive age is highly affected by physical, political, psychosocial and environmental conditions in countries of asylum. HRQoL is enormously affected by the satisfaction of this vulnerable group with the physical, psychological, emotional and social care services provided in this critical time. Therefore, this study aimed toassess the HRQoL among Syrian refugee women of reproductive age living outside camps in Jordan.

Methods

A cross-sectional correlational study was conducted with a convenience sample of 523 Syrian refugee women in the host communities in Jordan.Health-related quality of life (HRQOL) was measured using the short-form 36 (SF-36) questionnaire.

Results

Significant negative correlations were found between SF-36 individual subscales score and the length of marriage, the number of children, parity and family income. The strongest correlations were between pain scale and length of marriage (r =  − .21), and between Energy/Fatigue and ‘number of children’ (r =  − .21). Conversely, antenatal care was positively correlated with physical, role emotional, pain, and general health. Physical functioning and general health were predicted significantly with less years of marriage, younger age at marriage, less violence and by higher family income.

Conclusion

This study suggests low HRQoL scores for women of reproductive age across all domains. Several factors such as years of marriage, age at marriage, the number of children, violence, antenatal care and family income affected the women’s general health. The provision of appropriate and accessible reproductive and maternal healthcare services in antenatal visits is critical for ensuring the immediate and long-term health and wellbeing of refugee women and their families.

Determinants of health-related quality of life among warfarin patients in Pakistan

INTRODUCTION

The effect of anticoagulation control on overall Health-Related Quality of Life (HRQoL) in patients taking warfarin in Pakistan has not been explored yet. Therefore, this study aimed to evaluate HRQoL among warfarin patients in Pakistan.

METHODS

This cross-sectional study was conducted among patients on warfarin in Pakistan. By purposive sampling, data were collected using demographic data collection form and the World Health Organization Quality of Life: Brief Version (WHOQOL-BREF). The WHOQOL-BREF is comprised of four domains; physical, psychological, social relationships, and environment. Descriptive and inferential statistical analysis was done using SPSS version 22.

RESULTS

Out of 295 warfarin patients, more females than males (<0.001) were observed (n = 184, 62.4%, and n = 111, 37.6% respectively). One hundred and eighteen (40.0%) patients were less than 30-years of age, whereas one hundred and seventy-seven (60.0%) patients were above 30-years of age. Mean scores for the physical (62.44±15.36), psychological (67.84±15.54), social (64.27±26.28) and environment domains (63.45±17.66) were observed.

CONCLUSION

Patients had overall lower to moderate but satisfactory HRQoL scores in all four domains. Age, gender, employment status, education level, the indication of use and duration of warfarin therapy was associated with one or more domains of HRQoL among warfarin patients. The findings of this study would serve as a primary database for future studies. This study highlights how non-clinical factors could impact HRQoL in studied patients.

Household Food Insecurity and Health-related Quality of Life in an Urban Adult Population in Iran

Background:

The relationship between food insecurity and mental and physical components of health-related quality of life (HRQOL) has been less addressed by healthcare professionals.

Objective:

We aimed to investigate the relationship between household food insecurity and mental and physical components of HRQOL in a large sample of urban people and to determine whether household food insecurity has a negative effect on mental and physical components of HRQOL.

Methods:

This cross-sectional study was conducted across twenty-two districts of Tehran (capital of Iran) during 2011. The participants were selected through multistage cluster random sampling. Two questionnaires were used to measure household food insecurity and HRQOL in the study population, while descriptive and inferential statistics were applied to test the relationships between these two parameters.

Results:

The mean age of the study population was 44.5 ± 15.5 years and most were female (64.8%). The results of this study indicated an independent relationship between household food insecurity and different subscales of HRQOL (P<0.001). Household food insecurity had a significant negative relationship with physical (β= -5.93; P<0.001) and mental (β= -6.54; P<0.001) summary scores of HRQOL. Likewise, average scores on all subscales of HRQOL according to household food security status were significantly different (P<0.001).

Conclusion:

Food insecurity was associated with mental and physical components of HRQOL among urban participants and can be considered as a part of comprehensive interventions that target to improve general health.

Health-related quality of life among Syrian refugees resettled in Sweden

PURPOSE

The main purpose of this study was to assess health-related quality of life (HRQoL) among Syrian refugees resettled in Sweden. Further, we wanted to investigate whether sex, age, education, area of residence, cohabitation and social support were associated with HRQoL in this population.

METHODS

This is a cross-sectional study including 1215 Syrian refugees from a randomly selected sample frame resettled in Sweden between the years 2011 and 2013. HRQoL was measured by the EQ-5D-5L descriptive system, and EQ-5D-5L index values were calculated. Associations between sex, age, education, area of residence, cohabitation, social support and EQ-5D-5L were investigated using multiple linear regression analysis.

RESULTS

Depression/anxiety was the most commonly (61.9%) reported EQ-5D-5L problem among the group of Syrian refugees. The mean EQ-5D-5L index value was found to be 0.754. Male sex, younger age, cohabitation and social support were found associated with a higher EQ-5D-5L index score.

CONCLUSIONS

Our results concerning long-lasting health problems among the study population indicate that there is a profound need for policies and interventions promoting refugees' health. Our results also show that social support, a modifiable factor, is relevant to refugees' overall health, pointing to the importance of public health interventions and policies targeting the facilitation, mobilization and enhancing of refugees' social support.

Health status of returning refugees, internally displaced persons, and the host community in a post-conflict district in northern Sri Lanka: a cross-sectional survey

Background

Although the adverse impacts of conflict-driven displacement on health are well-documented, less is known about how health status and associated risk factors differ according to displacement experience. This study quantifies health status and quality of life among returning refugees, internally displaced persons, and the host community in a post-conflict district in Northern Sri Lanka, and explores associated risk factors.

Methods

We analysed data collected through a household survey (n = 570) in Vavuniya district, Sri Lanka. The effect of displacement status and other risk factors on perceived quality of life as estimated from the 36-item Short Form Questionnaire, mental health status from 9-item Patient Health Questionnaire, and self-reported chronic disease status were examined using univariable analyses and multivariable regressions.

Results

We found strong evidence that perceived quality of life was significantly lower for internally displaced persons than for the host community and returning refugees, after adjusting for covariates. Both mental health status and chronic disease status did not vary remarkably among the groups, suggesting that other risk factors might be more important determinants of these outcomes.

Conclusions

Our study provides important insights into the overall health and well-being of the different displaced sub-populations in a post-conflict setting. Findings reinforce existing evidence on the relationship between displacement and health but also highlight gaps in research on the long-term health effects of prolonged displacement. Understanding the heterogeneity of conflict-affected populations has important implications for effective and equitable humanitarian service delivery in a post-conflict setting.

How are the undocumented migrants in Rome? Assessment of quality of life and its determinants among migrant population

Aim

The aim of this study is to evaluate the level of Health-Related Quality of Life (HRQoL) and its determinants among migrants in irregular situations in Italy.

Methods

This cross-sectional study was held in Rome in 2014. HRQoL was assessed through SF-12 questionnaire and physical (PCS) and mental component scores (MCS) were calculated; socio-demographic information and medical conditions were collected. Bivariate and multivariate analyses were performed to assess the impact of demographic and pathological variables on the HRQoL.

Results

The median PCS among the 200 migrants enrolled was 46.5 and the median MCS was 37.9, some points below the Italian average. The multivariate analysis revealed a negative association between PCS and age (P < 0.01), respiratory (P: 0.03) and Poverty-Related Diseases (PRDs) (P < 0.01). MCS, on the other hand, resulted negatively associated with neuropsychiatric diseases (P: < 0.01) and PRDs (P < 0.01).

Conclusion

Although multivariate analyses revealed that gender acts as an effect modifier the negative association between PRDs and the two dimensions of HRQoL is confirmed in both genders. This suggests a great impact of socio-economic status on the HRQoL. Public health could contribute to improve the HRQoL of migrants only taking into account social aspects of diseases and tailoring intervention on the specific needs of migrants.

Use of modern contraceptive methods and its association with QOL among Nepalese female migrants living in Japan

Introduction

Modern contraceptive use among migrants may be limited due to factors such as language barriers, socio-economic condition, and inadequate knowledge. Limited evidence is available on the factors associated with the use of modern contraceptive methods by migrants in Japan. Moreover, evidence remains scarce on the quality of life (QOL) of migrants in relation to contraceptive use. As the Nepalese migrant population in Japan is increasing, this study was conducted to address their sexual and reproductive health issues. Therefore, the objectives of this study were to examine the factors associated with the use of modern contraceptive methods and to explore the association between the use of modern contraceptive methods and QOL among married Nepalese female migrants in Japan.

Methods

This is a cross-sectional study conducted among 189 married Nepalese female migrants residing in five prefectures of Japan from August to October 2016. This study employed snowball sampling to recruit the migrants. Simple and multiple logistic analyses were used to examine the association between independent variables and the use of modern contraceptive methods. Similarly, multiple linear regression analysis was used to examine the association between the use of modern contraceptive methods and quality of life.

Results

Migrants who had higher knowledge of modern contraceptive methods were more likely to use them (Adjusted Odds Ratio [AOR] = 1.31; 95% Confidence Interval [CI]: 1.07, 1.60). The psychological domain scores were higher in those who used modern contraceptive methods (Coefficient [B] = 0.58; 95% CI: 0.05, 1.11).

Conclusion

This study highlights the importance of the knowledge of modern contraceptive methods to increase their use. Also, the use of modern contraceptive methods improves the psychological QOL domain scores of the migrants using them. These results suggest a need for sexual and reproductive health education for migrants, especially pertaining to modern contraceptive use.

Qualidade de vida de imigrantes brasileiras vivendo em Portugal

RESUMO O artigo teve como objetivo avaliar a Qualidade de Vida (QV) de brasileiras vivendo em Portugal. O 'Medical Outcomes Study: 36-Item Short Form Survey' (SF-36) e um questionário sociodemográfico foram aplicados à amostra de 682 brasileiras maiores de 18 anos. Verificou-se que a média dos preditores de QV foi superior para a dimensão 'capacidade funcional'; enquanto as dimensões 'aspectos emocionais', 'saúde mental' e 'vitalidade' apresentaram valores menores. Constatou-se que os processos da migração e da QV constituem pauta de investigação contínua para a promoção da saúde no país de acolhimento.

Quality of life in epileptic patients compared with healthy people

BACKGROUND

Epilepsy is a common chronic neurological disorder that has a great impact on people's lives. Patients with epilepsy are at increased risk for poor Quality of Life (QoL). The objective of this study was to evaluate the QoL of epileptic patients in comparison to healthy persons.

METHODS

This cross-sectional study was conducted on 52 epileptic patients from Golbu region in Neyshabur (a city in northeast of Iran). Using Short Form Health Survey (SF-36) scale, the data were collected between April and Jun 2012. Every patient were compared with two healthy persons. Epileptic and healthy persons were similar for age, sex and local residence. Pearson's correlation coefficient and t-independent test applied for data analysis through SPSS v. 16 software.

RESULTS

Of 52 epileptic patients, 24 were female (46.2%) and 28 were male (53.8%). The mean±SD age of epileptic patients was 40.92±20.33yr (Rang: 15-86yr). The total mean score of SF- 36 in patient group was 55.88 and in healthy group 68.52and this difference was statistically significant (p<0.001). Among the different subscales of SF-36 in epileptic patients, the highest and the lowest mean scores were found for social functioning and general health subscales, respectively. The mean scores in patient group in comparison to healthy group were lower in all subscales of SF-36 and these differences were statistically significant in all domains (except role limitations due to physical problems domain and role limitations due to emotional problems domain).

CONCLUSION

The study showed that epilepsy disease has an important role in QoL of patients, thus some interventional programs are necessary to improve their QOL.

Health-related quality of life of latin-american immigrants and spanish-born attended in spanish primary health care: socio-demographic and psychosocial factors

Background

This study compares the health-related quality of life of Spanish-born and Latin American-born individuals settled in Spain. Socio-demographic and psychosocial factors associated with health-related quality of life are analyzed.

Methods

A cross-sectional Primary Health Care multi center-based study of Latin American-born (n = 691) and Spanish-born (n = 903) outpatients from 15 Primary Health Care Centers (Madrid, Spain). The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) was used to assess health-related quality of life. Socio-demographic, psychosocial, and specific migration data were also collected.

Results

Compared to Spanish-born participants, Latin American-born participants reported higher health-related quality of life in the physical functioning and vitality dimensions. Across the entire sample, Latin American-born participants, younger participants, men and those with high social support reported significantly higher levels of physical health. Men with higher social support and a higher income reported significantly higher mental health. When stratified by gender, data show that for men physical health was only positively associated with younger age. For women, in addition to age, social support and marital status were significantly related. Both men and women with higher social support and income had significantly better mental health. Finally, for immigrants, the physical and mental health components of health-related quality of life were not found to be significantly associated with any of the pre-migration factors or conditions of migration. Only the variable “exposure to political violence” was significantly associated with the mental health component (p = 0.014).

Conclusions

The key factors to understanding HRQoL among Latin American-born immigrants settled in Spain are age, sex and social support. Therefore, strategies to maintain optimal health outcomes in these immigrant communities should include public policies on social inclusion in the host society and focus on improving social support networks in order to foster and maintain the health and HRQoL of this group.

"Coming to a Strange Land": The West African Migrant Women's Establishment of Home and Family in a New Culture Within Australia

PURPOSE

Migrating and establishing a new life in another culture can have diverse health effects especially for women. This article explores the struggles and social adjustment issues that might constitute negatively to the health of West African migrant women living in Australia.

DESIGN

Qualitative storytelling. Audiotaped voluntary stories from 20 West African migrant women living in Sydney, Australia were transcribed and analyzed.

FINDINGS

Three themes are presented for discussion: (1) But it is different here: life in a new country; (2) I have to do it all by myself: communal versus individual living; and (3) They don't listen to parents: perceived threats to the family unit.

CONCLUSION/IMPLICATION FOR PRACTICE

The demand for and the importance of nurses and midwives in supporting migrant families is demonstrated by findings suggesting that social adjustment into the Australian culture has a significant impact on both the nuclear and extended family unit of women.

The Social Determinants of Health in Association with Women's Health Status of Reproductive Age: A Population-Based Study

BACKGROUND

Prioritizing women's health helps achievement of the 4(th) and 5(th) goals of Millennium Development Program. This study aimed to investigate association between social determinants of health and women's health of reproductive age.

METHODS

This population-based cross-sectional study, using multi-stage sampling procedure was conducted on 770, 15 to 49-year-old women residing in any one of the 22 municipality zones across Tehran, Iran. Eligible women were interviewed at home with SF-36 (Short Form Health Survey) and socio-demographic questionnaires. Social determinants of health contains; ethnicity, education, job, income, and crowding index. Data were analyzed by ANOVA and Multiple Linear Regression using SPSS-16. The threshold of P.V was considered 0.05.

RESULTS

Overall, 770 women with mean age 33.9±9.3 years were interviewed. Majority of them were married (72.27%), housewives (62.2%), of Persian ethnicity (64.3%), and educated to high school level (43.8%). Age with dimensions of health except role emotional, mental health, and social functioning had significant association with B from -0.65 to -0.16.educational level with dimensions of health except role emotional andsocial functioning had significant association with B from 3.61 to 6.43 (P<0.05). Income with dimensions of health except role physical had significant association with B from -9.97 to -4.42.

CONCLUSION

Reflection of unfavorable economic conditions and low education level on negative women' health experiences are alarming. Interaction between social determinants of health and health status must be considered in policymaking, and there is a need for policies that would enhance health of women in the low education and income brackets.

Ethnicity does not account for differences in the health-related quality of life of Turkish, Moroccan, and Moluccan elderly in the Netherlands

BACKGROUND

Data on how different groups of elderly immigrants perceive health-related quality of life (HRQOL) is scarce and research on the influence of ethnicity on HRQOL across ethnic groups is missing. Measuring HRQOL may help to detect cross-cultural differences and to decide whether ethnic-specific health and prevention programmes are required to improve HRQOL. We investigated differences in HRQOL among three elderly immigrant populations with a special focus on the contribution of ethnicity, in addition to other well-known determinants, to HRQOL.

METHODS

Data were collected between October 2011 and July 2012 as part of the project entitled "Stem van de oudere migrant", a quasi-experimental study in the Netherlands focussing on health of immigrant elderly. A survey was conducted among 201 elderly (aged 55 years and older) Moroccans (98), Turks (69), and Moluccans (34). HRQOL was assessed using the SF-12, measuring physical and mental health composite scores (PCS resp. MCS). Chi-square tests and ANOVAs were performed for group comparison. Hierarchical multiple linear regressions were conducted to examine whether ethnicity uniquely contributed to the observed variance in HRQOL when multimorbidity, loneliness, socio-demographics, and acculturation were taken into account.

RESULTS

Moroccans had the lowest scores on PCS (34.3 ± 31.4) and MCS (42.1 ± 27.0), followed by Turks (45.7 ± 27.0 for PCS and 54.7 ± 22.2 for MCS), and Moluccans (71.7 ± 21.2 for PCS and 74.4 ± 22.1 for MCS). Ethnicity was not independently associated with PCS and MCS scores, in contrast to loneliness (PCS β -0.461, p < 0.001 and MCS β -0.435, p < 0.001) and multimorbidity (PCS β -0.380, p < 0.001 and MCS β -0.398, p < 0.001). Gender was independently associated with PCS (β 0.148, p = 0.026) and attachment to Dutch culture with MCS (β 0.144, p = 0.029).

CONCLUSIONS

The lower level of HRQOL reported by elderly immigrant populations was affected by multimorbidity and loneliness but not ethnicity. Similar to native elders, interventions aiming at improving HRQOL for immigrant elderly should focus on loneliness and (mental and physical) disease. Finally, health literacy deserves attention to maintain health.

TRIAL REGISTRATION

ISRCTN89447795.

Assessment measures of Health-Related Quality of Life (HRQoL) of migrants: a systematic review

Purpose

– Definition-problems concerning the terms “migrant” and “Health-Related Quality of Life” (HRQoL) have a negative impact on the operationalization and measurement of the multidimensional and subjective construct of HRQoL. The aims of this systematic literature review are to address the following questions: How can the instruments used within the research field “migration and HRQoL” be described or categorized? Which dimensions (psychological, physical and social) and associated sub-dimensions have been used concerning measuring HRQoL when measures are applied to migrants?

Design/methodology/approach

– A systematic review was conducted. Three databases (Medline, Embase and Cinahl) were systematically searched for the investigation on HRQoL of migrants. Articles written in English, German and Polish, published since 2003 and meeting other inclusion criteria, were included in the final analysis.

Findings

– In the first stage a total of 4,062 studies were identified. However, very few studies were found to focus on HRQoL among migrants. Finally, 28 studies were included in the analysis. The results confirm that the terms “migrant” and “Quality of Life” and “Health-Related Quality of Life” are neither congruently used nor defined, respectively, within these studies, which consequently impacts deleteriously on the application and measurement of the concept in these groups. The majority of the studies reported to measure HRQoL with a well-known and validated HRQoL instrument. The physical dimensions (symptoms/pain/vitality, energy/vitality/sleep and the objective/subjective health status) are predominantly represented in the reviewed literature. The psychological dimension mostly includes sub-dimensions such as psychological stress and depressive symptoms; the social dimension was predominantly considered as the sub-dimension social relationships/networking.

Originality/value

– This paper highlights profound issues in the accurate assessment of HRQoL in migrants. This may have a significant impact on delivery of appropriate evidenced-based care for migrants in need of healthcare intervention.

Use of different subjective health indicators to assess health inequalities in an urban immigrant population in north-western Italy: a cross-sectional study

Background

Despite the steady growth of the immigrant population in Italy, data on the health status of immigrants are scarce. Our main goals were to measure Health-Related Quality of Life (HRQoL), Self-Rated Health (SRH) and morbidity among immigrants in Genoa. We aimed to assess the relative contribution of some social, structural and behavioral determinants to “within-group” health disparities.

Methods

We enrolled 502 subjects by means of snowball sampling. The SF-12 questionnaire, integrated with socio-demographic and health-related items, was used. Multivariate logistic and Poisson regression models were applied in order to identify characteristics associated with poor SRH, lower SF-12 scores and prevalence of self-reported morbidities.

Results

Subjects showed relatively moderate levels of HRQoL (median physical and mental scores of 51.6 and 47.3, respectively) and about 15% of them rated their health as fair or poor. Lower scores in the physical dimension of HRQoL were associated with the presence of morbidities and immigration for work and religious reasons, while those who had migrated for religious and family reasons displayed a lower probability of lower scores in the mental dimension of HRQoL. Poor SRH was associated with female gender, overweight/obesity and presence of morbidities. Moreover, compared with immigrants from countries with a low human development index, immigrants from highly developed societies showed significantly lower odds of reporting poor SRH. About one-third of respondents reported at least one medical condition, while the prevalence of multi-morbidity was 10%. Females, over 45-year-olds, overweight and long-term immigrants had a higher prevalence of medical conditions.

Conclusions

Our study confirms the presence of health inequalities within a heterogeneous immigrant population. HRQoL, SRH and morbidity are valid, relatively rapid and cheap tools for measuring health inequalities, though they do so in different ways. These indicators should be used with caution and, if possible, simultaneously, as they could help to identify and to monitor more vulnerable subjects among immigrants.

Application of WHOQOL-BREF in Measuring Quality of Life in Health-Care Staff

BACKGROUND

The objective of this study was to evaluate the quality of life of Neyshabur health-care staff and some factors associated with it with use of WHOQOL-BREF scale.

METHODS

This cross-sectional study was conducted on 522 staff of Neyshabur health-care centers from May to July 2011. Cronbach's alpha coefficient was applied to examine the internal consistency of WHOQOL-BREF scale; Pearson's correlation coefficient was used to determine the level of agreement between different domains of WHOQOL-BREF. Paired t-test was used to compare difference between score means of different domains. T-independent test was performed for group analysis and Multiple Linear Regression was used to control confounding effects.

RESULTS

In this study, a good internal consistency (α = 0.925) for WHOQOL-BREF and its four domains was observed. The highest and the lowest mean scores of WHOQOL-BREF domains was found for physical health domain (Mean = 15.26) and environmental health domain (Mean = 13.09) respectively. Backward multiple linear regression revealed that existence chronic disease in staff was significantly associated with four domains of WHOQOL-BREF, education years was associated with two domains (Psychological and Environmental) and sex was associated with psychological domain (P < 0.05).

CONCLUSIONS

The findings from this study confirm that the WHOQOL-BREF questionnaire is a reliable instrument to measure quality of life in health-care staff. From the data, it appears that Neyshabur health-care staff has WHOQOL-BREF scores that might be considered to indicate a relatively moderate quality of life.

Health-related quality of life in migrant preschool children

BACKGROUND

Minority groups have a lower health-related quality of life (HRQOL), but there is little information if this finding also applies to children. In this study, we compared HRQOL between young children with and without migrant parents.

METHODS

Two cross-sectional studies of culturally diverse preschool populations in Switzerland: Ballabeina (40 preschools, 258 girls and 232 boys aged 4 to 6 years) and Youp'là Bouge (58 child care centers, 453 girls and 522 boys aged 2 to 4 years). Most children were born in Switzerland (Ballabeina: 92.3%; Youp'là Bouge: 93.7%). Number of migrant parents was considered as the main exposure. HRQOL was measured using the 23-item Pediatric Quality of Life Inventory.

RESULTS

Children of migrant parents had a significantly lower HRQOL total score (mean ± SD, Ballabeina: 84.2 ± 9.1; 82.7 ± 9.6 and 81.7 ± 11.7 for children with none, one or two migrant parents, respectively; Youp'là Bouge: 83.8 ± 8.6; 82.9 ± 9.5; 80.7 ± 11.7, all p < 0.05). Similar results were found in Ballabeina and Youp'là Bouge for social, school and physical functioning (all p < 0.05), but not for emotional functioning. The differences in HRQOL measures were partly mediated by children's place of birth, parental education, paternal occupational level, children's BMI, screen time and physical activity in one study (Ballabeina), but not in the other (Youp'là Bouge).

CONCLUSION

In preschoolers, children of migrant parents have lower HRQOL than children of non-migrant parents. These differences are only partly mediated by other sociocultural characteristics or lifestyle behavior. These families may need assistance to prevent further inequalities.

Posttraumatic growth, depressive symptoms, posttraumatic stress symptoms, post-migration stressors and quality of life in multi-traumatized psychiatric outpatients with a refugee background in Norway

Background

Psychiatric outpatients with a refugee background have often been exposed to a variety of potentially traumatizing events, with numerous negative consequences for their mental health and quality of life. However, some patients also report positive personal changes, posttraumatic growth, related to these potentially traumatic events. This study describes posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, post-migration stressors, and their association with quality of life in an outpatient psychiatric population with a refugee background in Norway.

Methods

Fifty five psychiatric outpatients with a refugee background participated in a cross-sectional study using clinical interviews to measure psychopathology (SCID-PTSD, MINI), and four self-report instruments measuring posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, and quality of life (PTGI-SF, IES-R, HSCL-25-depression scale, and WHOQOL-Bref) as well as measures of social integration, social network and employment status.

Results

All patients reported some degree of posttraumatic growth, while only 31% reported greater amounts of growth. Eighty percent of the patients had posttraumatic stress symptoms above the cut-off point, and 93% reported clinical levels of depressive symptoms. Quality of life in the four domains of the WHOQOL-Bref levels were low, well below the threshold for the’life satisfaction’ standard proposed by Cummins.

A hierarchic regression model including depressive symptoms, posttraumatic stress symptoms, posttraumatic growth, and unemployment explained 56% of the total variance found in the psychological health domain of the WHOQOL-Bref scale. Posttraumatic growth made the strongest contribution to the model, greater than posttraumatic stress symptoms or depressive symptoms. Post-migration stressors like unemployment, weak social network and poor social integration were moderately negatively correlated with posttraumatic growth and quality of life, and positively correlated with psychopathological symptoms. Sixty percent of the outpatients were unemployed.

Conclusions

Multi-traumatized refugees in outpatient clinics reported both symptoms of psychopathology and posttraumatic growth after exposure to multiple traumatic events. Symptoms of psychopathology were negatively related to the quality of life, and positively related to post-migration stressors such as unemployment, weak social network and poor social integration. Posttraumatic growth was positively associated with quality of life, and negatively associated with post-migration stressors. Hierarchical regression modeling showed that posttraumatic growth explained more of the variance in quality of life than did posttraumatic stress symptoms, depressive symptoms or unemployment. It may therefore be necessary to address both positive changes and psychopathological symptoms when assessing and treating multi-traumatized outpatients with a refugee background.