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Forray AI, Oltean O, Hanft-Robert S, Madzamba R, Liem A, Schouten B, Anthonissen C, Swartz L, Cherecheș RM, Higgen S, Hall BJ, Mösko M. Uncovering multi-level mental healthcare barriers for migrants: a qualitative analysis across China, Germany, Netherlands, Romania, and South Africa. BMC Public Health 2024; 24:1593. [PMID: 38877460 PMCID: PMC11177472 DOI: 10.1186/s12889-024-19046-z] [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: 11/06/2023] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Forced displacement is a significant issue globally, and it affected 112 million people in 2022. Many of these people have found refuge in low- and middle-income countries. Migrants and refugees face complex and specialized health challenges, particularly in the area of mental health. This study aims to provide an in-depth qualitative assessment of the multi-level barriers that migrants face in accessing mental health services in Germany, Macao (Special Administrative Region of China), the Netherlands, Romania, and South Africa. The ultimate objective is to inform tailored health policy and management practices for this vulnerable population. METHODS Adhering to a qualitative research paradigm, the study centers on stakeholders' perspectives spanning microsystems, mesosystems, and macrosystems of healthcare. Utilizing a purposive sampling methodology, key informants from the aforementioned geographical locations were engaged in semi-structured interviews. Data underwent thematic content analysis guided by a deductive-inductive approach. RESULTS The study unveiled three pivotal thematic barriers: language and communication obstacles, cultural impediments, and systemic constraints. The unavailability of professional interpreters universally exacerbated language barriers across all countries. Cultural barriers, stigmatization, and discrimination, specifically within the mental health sector, were found to limit access to healthcare further. Systemic barriers encompassed bureaucratic intricacies and a conspicuous lack of resources, including a failure to recognize the urgency of mental healthcare needs for migrants. CONCLUSIONS This research elucidates the multifaceted, systemic challenges hindering equitable mental healthcare provision for migrants. It posits that sweeping policy reforms are imperative, advocating for the implementation of strategies, such as increasing the availability of language services, enhancing healthcare providers' capacity, and legal framework and policy change to be more inclusive. The findings substantially contribute to scholarly discourse by providing an interdisciplinary and international lens on the barriers to mental healthcare access for displaced populations.
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Affiliation(s)
- Alina Ioana Forray
- Faculty of Political, Administrative and Communication Sciences, Center for Health Innovation, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Community Medicine, Discipline of Public Health and Management, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ovidiu Oltean
- Faculty of Political, Administrative and Communication Sciences, Center for Health Innovation, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Saskia Hanft-Robert
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Rowan Madzamba
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Andrian Liem
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Selangor, Malaysia
| | - Barbara Schouten
- Department of Communication Science, Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Center for Urban Mental Health, Amsterdam, The Netherlands
| | - Christine Anthonissen
- Department of General Linguistics, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Răzvan Mircea Cherecheș
- Faculty of Political, Administrative and Communication Sciences, Center for Health Innovation, Babeș-Bolyai University, Cluj-Napoca, Romania
- Postgraduate Program for Bio-Behavioral Integrative Medicine (UBBMed), Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Sanna Higgen
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Brian J Hall
- Center for Global Health Equity, NYU Shanghai, Shanghai, China
| | - Mike Mösko
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
- Department of Applied Human Sciences, University of Applied Sciences Magdeburg-Stendal, Stendal, Germany.
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Gartner K, Mösko M, Becker JC, Hanft-Robert S. Barriers to use of interpreters in outpatient mental health care: Exploring the attitudes of psychotherapists. Transcult Psychiatry 2024; 61:285-297. [PMID: 38298011 PMCID: PMC10943597 DOI: 10.1177/13634615241227337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
The support of professional interpreters is an essential component of adequate mental health care for migrants with limited language proficiency. Nevertheless, for varied reasons, only a small proportion of outpatient psychotherapists provide interpreter-mediated psychotherapy for migrants. This study explored the perspectives of psychotherapists who have not worked with professional interpreters in outpatient mental health care to identify factors that may prevent the use of interpreters in outpatient care and explore possible incentives to provide interpreter-mediated psychotherapy for migrants with limited language proficiency. Semi-structured interviews were conducted with 13 outpatient psychotherapists in Northern Germany who had not yet worked with professional interpreters in outpatient care. The interviews were audio recorded, transcribed and analysed using a structured content analysis approach. The psychotherapists named structural as well as subjective barriers and concerns. Findings suggest that improving structural factors, such as secure funding, minimal additional work, better preparation and training could facilitate the integration of professional interpreters into everyday treatment. Psychotherapists also mentioned concerns about their own confidence (e.g., insecurities regarding the triadic situation), the patient (e.g., reduced openness), the interpreter (e.g., doubts about suitability, motivation and empathy), as well as the therapeutic process (e.g., unclear allocation of roles). However, positive aspects and opportunities of interpreter-mediated psychotherapy were also described. These could be enhanced by the presence of conducive factors, such as existing trust between all parties and professional cooperation between interpreter and psychotherapist.
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Affiliation(s)
- Kim Gartner
- University of Osnabrück, Department of Psychology, Osnabrück, Germany
| | - Mike Mösko
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
- University of Applied Sciences Magdeburg-Stendal, Department of Applied Human Sciences, Stendal, Germany
| | - Julia C. Becker
- University of Osnabrück, Department of Psychology, Osnabrück, Germany
| | - Saskia Hanft-Robert
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
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Stylianopoulos P, Hertner L, Heinz A, Kluge U, Schäfer I, Penka S. Good practice in reaching and treating refugees in addiction care in Germany - a Delphi study. BMC Public Health 2024; 24:30. [PMID: 38166874 PMCID: PMC10763166 DOI: 10.1186/s12889-023-17446-1] [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: 06/23/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Health and adequate access to health care are human rights. Refugees are at risk for substance abuse. Despite the known structural and personal risk factors for abuse, refugees in Germany continue to face barriers to adequate addiction prevention and care, which is a violation of the fundamental human right to health care. The question arises as to how barriers for refugees in reaching addiction services and care can be overcome. In the presented study, strategies for good practices to deconstruct these barriers were identified. METHOD A total of 21 experts participated in a three-round, consensus-oriented Delphi-Process. The experts represented five different fields: addiction care services, including specialized programs for women, refugee aid services, academia, policy-making and immigrants' self-help services. RESULTS The Delphi-Process generated 39 strategies of good practice summarized in 9 major categories: Care System, Framework Conditions, Multilingualism, Information and Education, Access, Service-Level, Employee-Level, Employee-Attitudes and Networking. CONCLUSION In order to guarantee human rights regarding health and adequate access to health care for refugees, institutional barriers limiting access to prevention and treatment programs for addictive disorders must be abolished. The identified good practice strategies for Germany, if widely implemented, could contribute to this aim. By opening up prevention and treatment facilities for refugees, other marginalized groups could also benefit. While some of the strategies need to be implemented at the institutional level, political steps are also required at the system level including, e.g. financing of adequate translation services.
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Affiliation(s)
- Panagiotis Stylianopoulos
- Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Laura Hertner
- Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute for Empirical Integration and Migration Research at the Humboldt Universität zu Berlin, Berlin, Germany
| | - Ulrike Kluge
- Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute for Empirical Integration and Migration Research at the Humboldt Universität zu Berlin, Berlin, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| | - Simone Penka
- Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Namata C, Hatzidimitriadou E. Strategies for improving access to primary care services for homeless immigrants in England: a Delphi study. Prim Health Care Res Dev 2023; 24:e70. [PMID: 38093561 PMCID: PMC10790723 DOI: 10.1017/s1463423623000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/22/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023] Open
Abstract
AIM The aim of the study was to identify the most prioritized strategies in improving access to primary care services (PCS) for homeless immigrants. BACKGROUND The issue of improving access to PCS for homeless immigrants is a complex and multifaceted one, and yet there is limited research on the strategies aimed at improving these services. Hence, the need for more studies that directly engage homeless immigrants and service providers in understanding their barriers to accessing PCS and their preferences for improving access to these services. METHODS The study used a two round Delphi method to elicit the views of stakeholders. The Delphi process utilized a web-based questionnaire. The stakeholders included healthcare providers and voluntary sector providers. The first round had a total of 58 items belonging to 14 categories. The second round comprised a total of 25 items belonging to 12 categories which were preselected based on participants' ranking of their importance in the first round. Participants were required to rank the relative importance of all the items on a 5-point Likert scale. Data were analysed using the STATA-15 software package. FINDINGS A total of 12 stakeholders participated in both rounds of the Delphi survey. The top three strategies encompassed fighting against discrimination and prejudice, improving and promoting mental health services, and empowering homeless immigrants. These evidence-based strategies hold the potential to support the implementation of healthcare interventions aimed at improving access to PCS and healthcare outcomes for homeless immigrants. However, it is crucial to conduct further research that includes homeless immigrants in the Delphi study to gain insights into the strategies that are most important to them in enhancing access to PCS, as they are the primary target users. Such research will contribute to the development of comprehensive and effective interventions tailored to the specific needs of homeless.
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Affiliation(s)
- Carol Namata
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, England
| | - Eleni Hatzidimitriadou
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, England
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Schödwell S, Savin M, Lauke A, Abels I, Abdel-Fatah D, Penka S, Kluge U. [Structural discrimination and racism in hospital care: the role of the economic conditions in intercultural openness]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:1307-1315. [PMID: 36305898 PMCID: PMC9722881 DOI: 10.1007/s00103-022-03615-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/14/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Racism and structural discrimination in German healthcare have been little studied to date, although intercultural openness has been demanded for many years. At the same time, the processes of economization are progressing, especially in hospital care. This study examines current challenges of intercultural openness, including the influence of the economic framework. METHODS One hundred twelve guided interviews were conducted with hospital employees in Berlin from various professional groups and departments. They were asked about challenges, how they were coping, and ideas for solutions. RESULTS The consequences of economization are particularly visible in the care of patients with a history of flight or migration. A lack of resources combined with a lack of funding for language mediation leads to overburdening of healthcare workers and the tendency toward culturalization, in which the "culture" of the patients is used to explain their actions, and open racism. The breeding ground for this is the multiple insecurities experienced by staff due to the additional needs of these patients. Culturalization is described as an attempt to cope with their emotional distress in the face of lack of time and staff shortages. First and foremost, the wish for more time and additional staff was voiced. This being granted, further measures to reduce racism and structural discrimination were defined. DISCUSSION In order to counteract racism and culturalization, measures that focus on the economic framework conditions and institutional change processes are central.
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Affiliation(s)
- Steffen Schödwell
- Zentrum für Interkulturelle Psychiatrie und Psychotherapie (ZIPP)/AG Transkulturelle Psychiatrie, Klinik für Psychiatrie und Psychotherapie, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Mihaela Savin
- TransVer - Ressourcen-Netzwerk zur interkulturellen Öffnung, Klinik für Psychiatrie und Psychotherapie, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Anke Lauke
- TransVer - Ressourcen-Netzwerk zur interkulturellen Öffnung, Klinik für Psychiatrie und Psychotherapie, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ingar Abels
- Mentoring Competence Centers (MCC), Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Dana Abdel-Fatah
- Berliner Institut für empirische Integrations- & Migrationsforschung (BIM), Kultur‑, Sozial- und Bildungswissenschaftliche Fakultät, Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Simone Penka
- Zentrum für Interkulturelle Psychiatrie und Psychotherapie (ZIPP)/AG Transkulturelle Psychiatrie, Klinik für Psychiatrie und Psychotherapie, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- TransVer - Ressourcen-Netzwerk zur interkulturellen Öffnung, Klinik für Psychiatrie und Psychotherapie, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ulrike Kluge
- Zentrum für Interkulturelle Psychiatrie und Psychotherapie (ZIPP)/AG Transkulturelle Psychiatrie, Klinik für Psychiatrie und Psychotherapie, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Berliner Institut für empirische Integrations- & Migrationsforschung (BIM), Kultur‑, Sozial- und Bildungswissenschaftliche Fakultät, Humboldt Universität zu Berlin, Berlin, Deutschland
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Alkhaled T, Rohde G, Lie B, Johannessen B. Beyond challenges and enrichment: a qualitative account of cross-cultural experiences of nursing patients with an ethnic minority background in Norway. BMC Nurs 2022; 21:322. [PMID: 36419037 PMCID: PMC9685157 DOI: 10.1186/s12912-022-01102-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Substantial mass migrations to the Scandinavian countries have made them heterogeneous and multicultural societies. Migration has also influenced the workforce, especially the healthcare system that has had to accommodate a culturally diverse population. This qualitative study aimed to explore nurses' experiences in caring for patients with an ethnic minority background. METHODS Focus group interviews with a total of 21 nurses were conducted. Thematic analysis was performed on the transcribed and translated interviews. RESULTS The findings of this study revealed three major themes: various experiences concerning language barriers and the use of interpreters, the impact of religious and cultural values, and caring for patients with an ethnic minority background is professionally interesting but demanding. CONCLUSIONS Caring for culturally diverse patients offers both challenges and opportunities to enhance cultural competence and cultural sensitivity among nurses. Various culturally divergent needs of patients such as family visits, food preferences, expression of pain, and gender sensitivity are interlinked and depend on effective communication during encounters with nurses and the healthcare system at large.
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Affiliation(s)
- Tariq Alkhaled
- grid.23048.3d0000 0004 0417 6230Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Gudrun Rohde
- grid.23048.3d0000 0004 0417 6230Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway ,grid.417290.90000 0004 0627 3712Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Birgit Lie
- grid.417290.90000 0004 0627 3712Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Berit Johannessen
- grid.23048.3d0000 0004 0417 6230Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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De Schrijver L, Nobels A, Harb J, Nisen L, Roelens K, Vander Beken T, Vandeviver C, Keygnaert I. Victimization of Applicants for International Protection Residing in Belgium: Sexual Violence and Help-Seeking Behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12889. [PMID: 36232187 PMCID: PMC9566446 DOI: 10.3390/ijerph191912889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Sexual violence (SV) literature on applicants for international protection (AIPs) shows that they are at high risk of victimization. The study objectives are to provide an exploratory overview of the occurrence of SV in AIPs in Belgium and their help-seeking behavior (HSB). This overview is crucial to develop prevention strategies and care paths focusing on providing adequate care to AIP SV victims in Belgium. METHODS Quantitative data from structured interviews with AIPs (n = 62) triangulated with qualitative data from in-depth interviews with AIP SV victims (n = 11) served to explore the nature and impact of SV in AIPs in Belgium and their HSB. RESULTS A total of 83.9% of respondents have experienced SV. A total of 61.3% were victimized within the past year. Victimization seems more gender-balanced than in the general population. AIPs link SV to their legal status and their associated vulnerable situation. HSB upon SV was very limited in this sample. Help-seeking barriers interfering with the decision-making process to consult (in)formal resources were identified. CONCLUSIONS AIPs in Belgium are at high risk of SV. Despite the impact of SV on AIPs' lives, HSB upon SV is rare. The provision of age-appropriate sexual education and development of policies that will reduce help-seeking barriers is needed.
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Affiliation(s)
- Lotte De Schrijver
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Anne Nobels
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
- Department of Psychiatry, Ghent University Hospital, 9000 Ghent, Belgium
| | - Jonathan Harb
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Laurent Nisen
- CARE-ESPRIst, Études et Évaluations, University of Liège, 4000 Liège, Belgium
| | - Kristien Roelens
- Department of Obstetrics and Gynecology, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Tom Vander Beken
- Department of Criminology, Criminal Law and Social Law, Institute for International Research on Criminal Policy, Ghent University, 9000 Ghent, Belgium
| | - Christophe Vandeviver
- Department of Criminology, Criminal Law and Social Law, Institute for International Research on Criminal Policy, Ghent University, 9000 Ghent, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
| | - Ines Keygnaert
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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Di Napoli A, Ventura M, Spadea T, Giorgi Rossi P, Bartolini L, Battisti L, Cacciani L, Caranci N, Cernigliaro A, De Giorgi M, Fanolla A, Lazzeretti M, Mininni M, Mirisola C, Petrelli A. Barriers to Accessing Primary Care and Appropriateness of Healthcare Among Immigrants in Italy. Front Public Health 2022; 10:817696. [PMID: 35223739 PMCID: PMC8864157 DOI: 10.3389/fpubh.2022.817696] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The health status and health care needs of immigrant populations must be assessed. The aim of this study was to evaluate barriers to accessing primary care and the appropriateness of health care among resident immigrants in Italy, using indicators regarding maternal health, avoidable hospitalization, and emergency care. METHODS Cross-sectional study using some indicators of the National Monitoring System of Health Status and Healthcare of the Immigrant Population (MSHIP), coordinated by the National Institute for Health, Migration and Poverty (INMP), calculated on perinatal care, hospital discharge, and emergency department databases for the years 2016-2017 in nine Italian regions (Piedmont, Trento, Bolzano, Emilia-Romagna, Tuscany, Umbria, Latium, Basilicata, Sicily). The analyses were conducted comparing immigrant and Italian residents. RESULTS Compared to Italian women, immigrant women had fewer than five gynecological examinations (8.5 vs. 16.3%), fewer first examinations after the 12th week of gestational age (3.8 vs. 12.5%), and fewer than two ultrasounds (1.0 vs. 3.8%). Compared to Italians, immigrants had higher standardized rates (× 1,000 residents) of avoidable hospitalizations (males: 2.1 vs. 1.4; females: 0.9 vs. 0.7) and of access to emergency departments for non-urgent conditions (males: 62.0 vs. 32.7; females: 52.9 vs. 31.4). CONCLUSIONS In Italy, there appear to be major issues regarding accessing services and care for the immigrant population. Policies aimed at improving socioeconomic conditions and promoting integration can promote healthy lifestyles and appropriate access to health care, counteracting the emergence of health inequities in the immigrant population.
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Affiliation(s)
- Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Roma, Italy
| | - Martina Ventura
- National Institute for Health, Migration and Poverty (INMP), Roma, Italy
| | - Teresa Spadea
- Epidemiology Unit, Local Health Unit TO3 Piedmont Region, Grugliasco, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
| | - Letizia Bartolini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Battisti
- Epidemiological Observatory, Public Health Department - Local Health Unit, Trento, Italy
| | - Laura Cacciani
- Department of Epidemiology of the Lazio Regional Health Service, Roma, Italy
| | | | - Achille Cernigliaro
- Health Authority Sicily Region and Local Authority Trapani Province, Palermo, Italy
| | - Marcello De Giorgi
- Umbria Digitale - Health Information and Communication Technology Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Antonio Fanolla
- Provincial Government South Tyrol, Observatory for Health, Bolzano, Italy
| | | | | | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Roma, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Roma, Italy
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Communication in Health Care: Impact of Language and Accent on Health Care Safety, Quality, and Patient Experience. Am J Med Qual 2021; 36:355-364. [PMID: 34285178 DOI: 10.1097/01.jmq.0000735476.37189.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Permanent or temporary migration results in communication issues related to language barriers. The migrant's mother tongue is often different from that of the host country. Even when the same language is spoken, communication barriers arise because of differences in accent. These communication barriers have a significant negative impact on migrants accessing health care and their ability to understand instructions and seek follow-up care. A multidisciplinary team often has professionals from various countries. These migrant health care professionals find it difficult to communicate with patients of the host country and with their colleagues. Communication barriers, therefore, result in miscommunication or no communication between health care professionals and between health care professionals and patients. This increases the risk of medical errors and impacts quality of care and patient safety. This review looks at the impact of communication barriers in health care and endeavors to find effective solutions.
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Health Service Utilization of International Immigrants in Yiwu, China: Implication for Health Policy. J Immigr Minor Health 2021; 23:207-214. [PMID: 32740885 DOI: 10.1007/s10903-020-01066-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
International immigrants' health is receiving increasing attention, reflecting the need for health systems to adapt to diverse migrant populations. To better inform health policies suited for the needs of international immigrants living in China, empirical evidence on the health service utilization of these international immigrants living in China is urgently needed. Our study included 5459 international immigrants including inpatients and outpatients, who were treated over a 4-year period (2015-2018) in one of the most frequented hospitals by international immigrants in Yiwu, Zhejiang province. Data (e.g., demographic information, outpatient costs, inpatient costs, length of stay, and the average number of visits per patient) were extracted from the Health Information System at the hospital. Descriptive analysis was performed to analyze the basic characteristics of international immigrants living in China (e.g., medical costs, length of stay and the average number of visits per patient) during the study period. Multiple regression analysis was conducted to assess the factors that influence the health service utilization of international immigrants. International immigrants tended to use outpatient services (accounting for 97.22% of the whole sample) compared with inpatient services (only 2.78% of the whole sample). Most international immigrants visited the hospital because of orthopedics, otolaryngological diseases, pediatric-related diseases and skin-related diseases, followed by maternity and general surgery. The average number of visits to the outpatient department per patient was 2.1 in 2015 to 2.5 in 2018, and the length of stay increased from 3.45 days to 5.81 days during last four years. The outpatient costs increased from RMB 800.43(112.22 US$) to RMB 1756.98(246.33 US$), and inpatient costs rose from RMB 10,958.89(1536.44US$) to RMB 20,912.55(2931.94US$) during 2015-2018. The average number of visits and outpatient costs of international immigrants were both lower than those of local Chinese people (P < 0.05). However, there was no statistic difference in inpatient costs and LOS between international immigrants and Chinese. Having health insurance in China was significantly related with higher medical costs. Our results indicate that international immigrants living in China make greater use of outpatient services rather than hospitalization health services. Health services utilization is increasing in the last four years, but it was lower than that of local Chinese people especially outpatient service utilization. Moreover, more attention should be garnered toward specific health issues experienced by international immigrants, such as orthopedic health, maternal and child health, occupational diseases or accidents, and infectious diseases with skin-related symptoms. The policy implications from the results of this study are as follows. First, in order to improve international immigrants' health and access to health services in China, the government needs to pay more attention to incorporating international immigrants' health services to the current health system. Second, health policy is an important determining factor of access to health care, as policy can influence aspects of health services delivery such as the availability of resources, organization, and financing. Therefore, specific framework for the content of health policies focused on international immigrant populations should be developed.
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Identifying Consensus and Open Questions around Assessing or Predicting the Quality and Success of Cartilage Repair: A Delphi Study. SURGERIES 2021. [DOI: 10.3390/surgeries2030029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A range of surgical techniques have been developed for the repair or regeneration of lesioned cartilage in the human knee and a corresponding array of scoring systems have been created to assess their outcomes. The published literature displays a wide range of opinions regarding the factors that influence the success of surgical cartilage repair and which parameters are the most useful for measuring the quality of the repair at follow-up. Our objective was to provide some clarity to the field by collating items that were agreed upon by a panel of experts to be important in these areas. A modified, three-round Delphi consensus study was carried out consisting of one idea-generating focus-group and two subsequent, self-completed questionnaire rounds. In each round, items were assessed for their importance and level of consensus against pre-determined threshold levels. In total, 31 items reached consensus, including a hierarchy of tissues in the joint based on their importance in cartilage repair, markers of repair cartilage quality and the implications of environmental and patient-related factors. Items were stratified into those that can be employed for predicting the success of cartilage repair and those that could be used for assessing the structural quality of the resulting repair cartilage. Items that did not reach consensus represent areas where dissent remains and could, therefore, be used to guide future clinical and fundamental scientific research.
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Kikhia S, Gharib G, Sauter A, Vincens NCL, Loss J. Exploring how Syrian women manage their health after migration to Germany: results of a qualitative study. BMC Womens Health 2021; 21:50. [PMID: 33531000 PMCID: PMC7852358 DOI: 10.1186/s12905-021-01193-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/21/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the recent years, the number of Syrians living in Germany increased drastically due to the massive displacement caused by the Syrian conflict. Syrian migrant women in Germany are challenged by both the migration process and the changing of social roles. Seeking out healthcare may be hampered by linguistic and cultural barriers, but the new context may offer opportunities for health and well-being (free access to health care, civil/human rights). Little is known about how Syrian women manage their health after their resettlement in Germany. METHODS In depth interviews in Arabic were conducted with 9 Syrian women who were recruited through purposive sampling (18-55 years, migrated in 2011-2017, different education levels), focusing on capabilities to control one's health and to navigate the German healthcare system, and social/environmental barriers and facilitators to effectively manage their health. Interview transcripts were analysed using qualitative content analysis. RESULTS The women reported their health to be impaired by post-migration stressors, such as perceived discrimination, loss of social status and worrying about the future. Many interviewees felt disempowered and incompetent to successfully and actively navigate the German healthcare system, lacking information and not understanding their rights and options under the health insurance plan. The language barrier added to feeling vulnerable. Many women experienced doctors declining to treat them for capacity reasons; when treated, they often did not feel taken seriously or were dissatisfied with the emotional/cultural aspects of care. If possible, Arabic doctors were sought out. Some women, however, described improved resources for health, and appreciated better women's rights as a source of power. CONCLUSIONS The lack of information about the structure and offers of the German healthcare system, language and culture specific barriers as well as socio-cultural challenges are undermining the ability of Syrian women to manage their health effectively after their resettlement in Germany. Providing tailored information on the German healthcare system, creating a health-literacy supportive environment, and improving cultural sensitivity in healthcare provision could help Syrian women better utilize medical care offered in Germany.
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Affiliation(s)
- Salma Kikhia
- Medical Sociology, Regensburg University, Regensburg, Germany.
| | | | | | | | - Julika Loss
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Degrie L, Dierckx de Casterlé B, Gastmans C, Denier Y. 'Can you please hold my hand too, not only my breast?' The experiences of Muslim women from Turkish and Moroccan descent giving birth in maternity wards in Belgium. PLoS One 2020; 15:e0236008. [PMID: 32726359 PMCID: PMC7390407 DOI: 10.1371/journal.pone.0236008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 06/26/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives To reach nuanced understanding of the perinatal experiences of ethnic minority women from Turkish and Moroccan descent giving birth in maternity wards in Belgium thereby gaining insight into the underlying challenges of providing intercultural care for ethnic minority persons in a hospital setting. Methods A qualitative study design was used by conducting In-depth interviews with 24 women from Turkish and Moroccan descent who gave birth during the past three years in maternity wards in Flanders, Belgium. The interviews were analysed using a Grounded Theory Approach. Results This study shows that the women’s care experiences were shaped by the care interactions with their caregivers, more specifically on the attention that was given by the caregivers towards two essential dimensions of the care relationship, viz. Ereignis (attention to what happens) and Erlebnis (attention to how it happens). These two dimensions were interrelated in four different ways, which defined the women’s care experiences as being either ‘uncaring’, ‘protocolized’, ‘embraced’ or ‘ambiguous’. Moreover, these experiences were fundamentally embedded within the women’s cultural context, which has to be understood as a relational process in which an emotional and moral meaning was given to the women’s care expectations, interactions and interpretations of care. Conclusions The findings reveal that the quality of intercultural care depends on the nature and quality of care interactions between ethnic minority patients and caregivers much more than on the way in which cultural questions and tensions are being handled or dealt with in a practical way. As such, the importance of establishing a meaningful care relationship should be the priority when providing intercultural care. In this, a shift in perspective on ‘culture’ from being an ‘individual culture-in-isolation’ towards an understanding of culture as being inter-relational and emerging from within these care relationships is necessary.
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Affiliation(s)
- Liesbet Degrie
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Bernadette Dierckx de Casterlé
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, University of Leuven, Leuven, Belgium
| | - Chris Gastmans
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Yvonne Denier
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
- * E-mail:
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Riza E, Kalkman S, Coritsidis A, Koubardas S, Vassiliu S, Lazarou D, Karnaki P, Zota D, Kantzanou M, Psaltopoulou T, Linos A. Community-Based Healthcare for Migrants and Refugees: A Scoping Literature Review of Best Practices. Healthcare (Basel) 2020; 8:E115. [PMID: 32354069 PMCID: PMC7349376 DOI: 10.3390/healthcare8020115] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Strengthening community-based healthcare is a valuable strategy to reduce health inequalities and improve the integration of migrants and refugees into local communities in the European Union. However, little is known about how to effectively develop and run community-based healthcare models for migrants and refugees. Aiming at identifying the most-promising best practices, we performed a scoping review of the international academic literature into effective community-based healthcare models and interventions for migrants and refugees as part of the Mig-HealthCare project. METHODS A systematic search in PubMed, EMBASE, and Scopus databases was conducted in March 2018 following the PRISMA methodology. Data extraction from eligible publications included information on general study characteristics, a brief description of the intervention/model, and reported outcomes in terms of effectiveness and challenges. Subsequently, we critically assessed the available evidence per type of healthcare service according to specific criteria to establish a shortlist of the most promising best practices. RESULTS In total, 118 academic publications were critically reviewed and categorized in the thematic areas of mental health (n = 53), general health services (n = 36), noncommunicable diseases (n = 13), primary healthcare (n = 9), and women's maternal and child health (n = 7). CONCLUSION A set of 15 of the most-promising best practices and tools in community-based healthcare for migrants and refugees were identified that include several intervention approaches per thematic category. The elements of good communication, the linguistic barriers and the cultural differences, played crucial roles in the effective application of the interventions. The close collaboration of the various stakeholders, the local communities, the migrant/refugee communities, and the partnerships is a key element in the successful implementation of primary healthcare provision.
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Affiliation(s)
- Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Shona Kalkman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Alexandra Coritsidis
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8434, USA
| | - Sotirios Koubardas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Sofia Vassiliu
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Despoina Lazarou
- Institute of Human Sciences, Wadham College, University of Oxford, Oxford OX1 3PN, UK
| | - Panagiota Karnaki
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Dina Zota
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Athena Linos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
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European Psychiatric Association (EPA) guidance on quality assurance in mental healthcare. Eur Psychiatry 2020; 30:360-87. [DOI: 10.1016/j.eurpsy.2015.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 01/09/2023] Open
Abstract
AbstractPurpose:To advance the quality of mental healthcare in Europe by developing guidance on implementing quality assurance.Methods:We performed a systematic literature search on quality assurance in mental healthcare and the 522 retrieved documents were evaluated by two independent reviewers (B.J. and J.Z.). Based on these evaluations, evidence tables were generated. As it was found that these did not cover all areas of mental healthcare, supplementary hand searches were performed for selected additional areas. Based on these findings, fifteen graded recommendations were developed and consented by the authors. Review by the EPA Guidance Committee and EPA Board led to two additional recommendations (on immigrant mental healthcare and parity of mental and physical healthcare funding).Results:Although quality assurance (measures to keep a certain degree of quality), quality control and monitoring (applying quality indicators to the current degree of quality), and quality management (coordinated measures and activities with regard to quality) are conceptually distinct, in practice they are frequently used as if identical and hardly separable. There is a dearth of controlled trials addressing ways to optimize quality assurance in mental healthcare. Altogether, seventeen recommendations were developed addressing a range of aspects of quality assurance in mental healthcare, which appear usable across Europe. These were divided into recommendations about structures, processes and outcomes. Each recommendation was assigned to a hierarchical level of analysis (macro-, meso- and micro-level).Discussion:There was a lack of evidence retrievable by a systematic literature search about quality assurance of mental healthcare. Therefore, only after further topics and search had been added it was possible to develop recommendations with mostly medium evidence levels.Conclusion:Evidence-based graded recommendations for quality assurance in mental healthcare were developed which should next be implemented and evaluated for feasibility and validity in some European countries. Due to the small evidence base identified corresponding to the practical obscurity of the concept and methods, a European research initiative is called for by the stakeholders represented in this Guidance to improve the educational, methodological and empirical basis for a future broad implementation of measures for quality assurance in European mental healthcare.
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EPA guidance on cultural competence training. Eur Psychiatry 2020; 30:431-40. [DOI: 10.1016/j.eurpsy.2015.01.012] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 11/22/2022] Open
Abstract
AbstractThe stress of migration as well as social factors and changes related to the receiving society may lead to the manifestation of psychiatric disorders in vulnerable individuals after migration. The diversity of cultures, ethnicities, races and reasons for migration poses a challenge for those seeking to understand how illness is experienced by immigrants whose backgrounds differ significantly from their clinicians. Cultural competence represents good clinical practice and can be defined as such that a clinician regards each patient in the context of the patient's own culture as well as from the perspective of the clinician's cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. It points out that cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can improve the effectiveness of psychiatric treatment. To reach these aims, both individual and organizational competence are needed, as well as teaching competence in terms of educational leadership. The WPA Guidance on Mental Health and Mental Health Care for Migrants and the EPA Guidance on Mental Health Care for Migrants list a series of recommendations for policy makers, service providers and clinicians; these are aimed at improving mental health care for immigrants. The authors of this paper would like to underline these recommendations and, focusing on cultural competency and training, believe that they will be of positive value.
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Mohamed EA, Giama NH, Shaleh HM, Kerandi L, Oseini AM, Ahmed Mohammed H, Kerandi H, Allotey LK, Waaeys IA, Ali HA, Ali HM, Mohamed SA, Yang JD, Gaga WO, Tamire LL, Windissa A, Patten CA, Balls-Berry JE, Roberts LR. Knowledge, Attitudes, and Behaviors of Viral Hepatitis Among Recent African Immigrants in the United States: A Community Based Participatory Research Qualitative Study. Front Public Health 2020; 8:25. [PMID: 32211358 PMCID: PMC7067746 DOI: 10.3389/fpubh.2020.00025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 01/27/2020] [Indexed: 12/13/2022] Open
Abstract
Background: In the United States, hepatocellular carcinoma is the ninth leading cause of cancer mortality. Hepatocellular carcinoma disproportionately affects individuals of African ancestry with the rates being higher amongst individuals of foreign-born African ancestry. This study explored knowledge, attitudes, and behaviors toward viral hepatitis transmission, screening, and vaccination among recent African immigrants in Minnesota and identify ways to improve early detection and screening methods. Methods: A community based participatory research (CBPR) team with minority researchers and community members sought to gain insight on persons of African Ancestry knowledge, attitudes, and behaviors related to viral hepatitis by conducting a qualitative research study. The CBPR team developed a focus group moderator's guide with semi-structured questions related to transmission, screening, and vaccination of viral hepatitis. We conducted seven focus groups using bilingual, bicultural moderators with participants from local Ethiopian, Liberian and Kenyan communities from August 10th, 2014 to October 11th, 2014. Focus groups were audio recorded and transcribed. The CBPR team categorized the data into themes and subthemes with consensus using traditional content analysis. Results: Community partners recruited 63 participants with a majority identifying as male (51%). Participants lacked knowledge of viral hepatitis screening, vaccination, and treatment. Participants were aware of some behaviors that increased risk of acquisition of hepatitis. Participants endorsed a strategy of developing and delivering educational materials for African immigrants. Moreover, access to care and cultural awareness were mentioned as pivotal for prevention and treatment of viral hepatitis. Conclusions: Findings from this pilot study provide insight on areas of research focus. Having a research team consisting of members from the community helped to increase trust and foster an understanding of shared community values. Information from this study provides evidence to support the development culturally appropriate strategies to address disparities in viral hepatitis in these communities.
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Affiliation(s)
- Essa A Mohamed
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Nasra H Giama
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Hassan M Shaleh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Linda Kerandi
- Urgent Care and Clinic, Midpoint Medical Clinic, Brooklyn Park, MN, United States
| | - Abdul M Oseini
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA, United States
| | - Hager Ahmed Mohammed
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Henry Kerandi
- Urgent Care and Clinic, Midpoint Medical Clinic, Brooklyn Park, MN, United States
| | - Loretta K Allotey
- Medical School, University of Minnesota, Rochester, MN, United States
| | | | - Hamdi A Ali
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Hawa M Ali
- Medical School, University of Minnesota, Rochester, MN, United States
| | | | - Ju Dong Yang
- Transplant Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Wudneh O Gaga
- St. George Ethiopian Tewahido Orthodox Church, Rochester, MN, United States
| | - Lily L Tamire
- St. George Ethiopian Tewahido Orthodox Church, Rochester, MN, United States
| | - Awol Windissa
- Pillsbury United Communities, Minneapolis, MN, United States
| | - Christi A Patten
- Behavioral Health Research Program, Mayo Clinic, Rochester, MN, United States
| | | | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
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Van Keer RL, Fernandez SM, Bilsen J. Intercultural mediators in Belgian hospitals: Demographic and professional characteristics and work experiences. PATIENT EDUCATION AND COUNSELING 2020; 103:165-172. [PMID: 31349964 DOI: 10.1016/j.pec.2019.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the 1) socio-demographic characteristics, 2) working environment, 3) tasks and responsibilities and 4) work experiences of intercultural mediators (IMs) working in Belgian hospitals. METHODS Cross-sectional quantitative survey among all IMs working in Flemish and Brussels hospitals (n = 66). Data were descriptively analyzed. Meaningful associations between variables were also studied. RESULTS Most IMs are young women from first- and second-generation migrant groups with different levels of education. They work under different superiors and most IMs are not employed full-time. They work mainly with patients from their own ethnic group. Mostly they intervene directly in daily intercultural communication, as per their official task description, but they also perform other tasks, such as offering support to patients/families/staff/management. IMs would prefer more of the tasks they perform to be formalized. Furthermore, they want to have policy-making responsibilities. IMs have positive and negative work experiences, e.g. working overtime. CONCLUSIONS IMs' socio-demographic characteristics (ethnic origin - sex - education) and official task description is only adapted to needs in the workplace to a limited extent. Furthermore, intercultural mediation is poorly integrated into hospitals' organizational structure. PRACTICE IMPLICATIONS Different measures are needed, including tailored education and offering IMs enough organizational support and policy responsibilities.
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Affiliation(s)
- Rose-Lima Van Keer
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 1090 Brussel, Brussels, Belgium.
| | - Sarah Machado Fernandez
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 1090 Brussel, Brussels, Belgium.
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 1090 Brussel, Brussels, Belgium.
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Wamwayi MO, Cope V, Murray M. Service gaps related to culturally appropriate mental health care for African immigrants. Int J Ment Health Nurs 2019; 28:1110-1118. [PMID: 31207014 DOI: 10.1111/inm.12622] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2019] [Indexed: 11/29/2022]
Abstract
The population of overseas-born Australians continues to grow including the recent increase of immigrants and refugees from African countries. Due to this increase, healthcare services need to assess if current available services are culturally appropriate for African immigrant inpatients. This qualitative study, with a quality improvement focus, examined current services to identify key service gaps and consider recommendation to improve care of African immigrant mental health inpatients in the hospital from the point of view of staff working within the organisation. What was revealed is that services currently offered to African mental health inpatients were culturally inappropriate. Emerging themes included inadequate interpreter services, lack of cultural awareness staff training, lack of organisation link with other services, unmet spiritual needs, use of staff/families as interpreters, culturally inappropriate information, and lack of or inadequate culturally appropriate policies and framework. Changes to current practices are recommended to provide culturally appropriate mental health care to African inpatients.
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Affiliation(s)
- Michael O Wamwayi
- Discipline of Nursing, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Vicki Cope
- Discipline of Nursing, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Melanie Murray
- Discipline of Nursing, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
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Villadsen SF, Ims HJ, Nybo Andersen AM. Universal or Targeted Antenatal Care for Immigrant Women? Mapping and Qualitative Analysis of Practices in Denmark. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3396. [PMID: 31540218 PMCID: PMC6765944 DOI: 10.3390/ijerph16183396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 01/13/2023]
Abstract
Inequity in immigrants' health during pregnancy and childbirth has been shown. We studied the Danish regional organization of public midwifery-based antenatal care (ANC) for immigrant women to assess the strengths and weaknesses of organizing ANC as either universal or immigrant-targeted. A telephone survey in 2012 to all the Danish maternity wards (n = 20) was conducted. Semi-structured interviews with midwives providing targeted care (n = 6) were undertaken and characteristics of care were qualitatively analyzed, having the immigrant density of the facilities, the Danish ANC policy, and theories of cultural competence as the frame of reference. Six maternity wards were providing immigrant-targeted ANC. Targeted care implied longer consultations and increased attention to the individual needs of immigrant women. At these facilities, navigation in the health care system, body awareness, and use of interpreter services were key topics. The selection of women for targeted care was based on criteria (including names) that risk stigmatizing immigrant women. The arguments for not providing targeted care included that immigrant-targeted care was considered stigmatizing. Current universal care may overlook the needs of immigrant women and contribute to inequities. A strategy could be to improve dynamic cultural competencies of midwives, interpreter services, and flexibility of the care provision of the universal ANC system.
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Affiliation(s)
- Sarah Fredsted Villadsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark.
| | - Hodan Jama Ims
- Section of Social Medicine, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark.
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark.
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Barson S, Gauld R, Gray J, Henriks G, Krause C, Lachman P, Maher L, Massoud MR, Mathias L, Wagner M, Villa L. What initiatives do healthcare leaders agree are needed for healthcare system improvement? Results of a modified-Delphi study. J Health Organ Manag 2018; 32:1002-1012. [PMID: 30468416 DOI: 10.1108/jhom-08-2017-0216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to identify five quality improvement initiatives for healthcare system leaders, produced by such leaders themselves, and to provide some guidance on how these could be implemented. DESIGN/METHODOLOGY/APPROACH A multi-stage modified-Delphi process was used, blending the Delphi approach of iterative information collection, analysis and feedback, with the option for participants to revise their judgments. FINDINGS The process reached consensus on five initiatives: change information privacy laws; overhaul professional training and work in the workplace; use co-design methods; contract for value and outcomes across health and social care; and use data from across the public and private sectors to improve equity for vulnerable populations and the sickest people. RESEARCH LIMITATIONS/IMPLICATIONS Information could not be gathered from all participants at each stage of the modified-Delphi process, and the participants did not include patients and families, potentially limiting the scope and nature of input. PRACTICAL IMPLICATIONS The practical implications are a set of findings based on what leaders would bring to a decision-making table in an ideal world if given broad scope and capacity to make policy and organisational changes to improve healthcare systems. ORIGINALITY/VALUE This study adds to the literature a suite of recommendations for healthcare quality improvement, produced by a group of experienced healthcare system leaders from a range of contexts.
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Affiliation(s)
- Stuart Barson
- Otago Business School, University of Otago , Dunedin, New Zealand
| | - Robin Gauld
- Otago Business School, University of Otago , Dunedin, New Zealand
| | - Jonathon Gray
- Ko Awatea, Counties Manukau Health, Auckland, New Zealand
| | - Goran Henriks
- Qulturum, Jönköping County Council, Jönköping, Sweden
| | - Christina Krause
- British Columbia Patient Safety and Quality Council, Vancouver, Canada
| | - Peter Lachman
- International Society for Quality in Health Care, Dublin, Ireland
| | - Lynne Maher
- Ko Awatea, Counties Manukau Health, Auckland, New Zealand
| | | | - Lee Mathias
- Auckland District Health Board, Auckland, New Zealand
| | - Mike Wagner
- The Advisory Board Company, Washington, District of Columbia, USA
| | - Luis Villa
- Ko Awatea, Counties Manukau Health, Auckland, New Zealand
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22
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Silvestrini G, Federico B, Damiani G, Geraci S, Bruno S, Maisano B, Ricciardi W, Kunst AE. Healthcare utilization among urban homeless followed by an outpatient clinic: more intensive use by migrant groups. Eur J Public Health 2018; 27:96-101. [PMID: 28177446 DOI: 10.1093/eurpub/ckw108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giulia Silvestrini
- Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bruno Federico
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - Gianfranco Damiani
- Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stefania Bruno
- Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Walter Ricciardi
- Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anton Eduard Kunst
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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23
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Trost M, Wanke EM, Ohlendorf D, Klingelhöfer D, Braun M, Bauer J, Groneberg DA, Quarcoo D, Brüggmann D. Immigration: analysis, trends and outlook on the global research activity. J Glob Health 2018; 8:010414. [PMID: 29713462 PMCID: PMC5908396 DOI: 10.7189/jogh.08.010414] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Immigration has a strong impact on the development of health systems, medicine and science worldwide. Therefore, this article provides a descriptive study on the overall research output. Methods Utilizing the scientific database Web of Science, data research was performed. The gathered bibliometric data was analyzed using the established platform NewQIS, a benchmarking system to visualize research quantity and quality indices. Findings Between 1900 and 2016 a total of 6763 articles on immigration were retrieved and analyzed. 86 different countries participated in the publications. Quantitatively the United States followed by Canada and Spain were prominent regarding the article numbers. On comparing by additionally taking the population size into account, Israel followed by Sweden and Norway showed the highest performance. The main releasing journals are the Public Health Reports, the Journal of Immigrant and Minority Health and Social Science & Medicine. Over the decades, an increasing number of Public, Environmental & Occupational Health articles can be recognized which finally forms the mainly used subject area. Conclusion Considerably increasing scientific work on immigration cannot only be explained by the general increase of scientific work but is also owed to the latest development with increased mobility, worldwide crises and the need of flight and migration. Especially countries with a good economic situation are highly affected by immigrants and prominent in their publication output on immigration, since the countries' publication effort is connected with the appointed expenditures for research and development. Remarkable numbers of immigrants throughout Europe compel medical professionals to consider neglected diseases, requires the public health system to restructure itself and finally promotes science.
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Affiliation(s)
- Matthias Trost
- Goethe University Frankfurt, Department of Gynecology and Obstetrics, Frankfurt am Main, Germany.,Goethe University Frankfurt, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Frankfurt am Main, Germany
| | - Eileen M Wanke
- Goethe University Frankfurt, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Frankfurt am Main, Germany
| | - Daniela Ohlendorf
- Goethe University Frankfurt, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Frankfurt am Main, Germany
| | - Doris Klingelhöfer
- Goethe University Frankfurt, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Frankfurt am Main, Germany
| | - Markus Braun
- Goethe University Frankfurt, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Frankfurt am Main, Germany
| | - Jan Bauer
- Goethe University Frankfurt, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Frankfurt am Main, Germany
| | - David A Groneberg
- Goethe University Frankfurt, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Frankfurt am Main, Germany
| | - David Quarcoo
- Goethe University Frankfurt, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Frankfurt am Main, Germany.,Equal authors' contribution
| | - Dörthe Brüggmann
- Goethe University Frankfurt, Department of Gynecology and Obstetrics, Frankfurt am Main, Germany.,Goethe University Frankfurt, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Frankfurt am Main, Germany.,Equal authors' contribution
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24
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Giacco D, Priebe S. Mental health care for adult refugees in high-income countries. Epidemiol Psychiatr Sci 2018; 27:109-116. [PMID: 29067899 PMCID: PMC6998959 DOI: 10.1017/s2045796017000609] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/24/2017] [Indexed: 01/18/2023] Open
Abstract
Approximately one-third of people who have obtained refugee status live in high-income countries. Over recent years, the number of refugees has been increasing, and there are questions on how many of them need mental health care and which type of interventions are beneficial. Meta-analyses showed highly variable rates of mental disorders in adult refugees. This variability is likely to reflect both real differences between groups and contexts, and methodological inconsistencies across studies. Overall prevalence rates after resettlement are similar to those in host populations. Only post-traumatic stress disorder (PTSD) is more prevalent in refugees. In long-term resettled refugees, rates of anxiety and depressive disorders are higher and linked to poor social integration. Research on mental health care for refugees in high-income countries has been extensive, but often of limited methodological quality and with very context-specific findings. The existing evidence suggests several general principles of good practice: promoting social integration, overcoming barriers to care, facilitating engagement with treatment and, when required, providing specific psychological treatments to deal with traumatic memories. With respect to the treatment of defined disorders, only for the treatment of PTSD there has been substantial refugee-specific research. For other diagnostic categories, the same treatment guidelines apply as to other groups. More systematic research is required to explore how precisely the general principles can be specified and implemented for different groups of refugees and in different societal contexts in host countries, and which specific interventions are beneficial and cost-effective. Such interventions may utilise new communication technologies. Of particular importance are long-term studies to identify when mental health interventions are appropriate and to assess outcomes over several years. Such research would benefit from sufficient funding, wide international collaboration and continuous learning over time and across different refugee groups.
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Affiliation(s)
- D. Giacco
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - S. Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
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25
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Hjörleifsson S, Hammer E, Díaz E. General practitioners' strategies in consultations with immigrants in Norway-practice-based shared reflections among participants in focus groups. Fam Pract 2018; 35:216-221. [PMID: 29029132 DOI: 10.1093/fampra/cmx097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Immigrants comprise 16.8% of the population in Norway and meet General Practitioners (GPs) as their first point of contact with most health care services as do others in Norway. While Norwegian GPs are not trained in cultural competence, little is known about the extent to which they see good care for immigrants as relying on specific strategies. OBJECTIVES To explore the thoughts of GPs in Norway about strategies they might use with immigrant patients. METHODS We performed focus groups posing the question 'What strategies do you use when meeting immigrant patients?' to three groups of GPs working in Norway. Two groups comprised 10 trainee GPs each; the final group comprised eight certified GPs. Verbatim transcripts were analysed by systematic text condensation. RESULTS Strategies for consultations with immigrants emerged gradually throughout the focus groups, coalescing around (i) Respect and learn about immigrant culture. (ii) Particularize diagnosis and care, accommodating epidemiological and cultural knowledge for a given group, while keeping a keen eye on the individual. (iii) Inform about Norwegian health care. (iv) Organize resources such as time, translators and interdisciplinary teams. Other core elements of cultural competence, including reflections on the GP's own cultural background, were conspicuously absent, however. CONCLUSION Given the growing numbers of immigrants and the early transfer of refugees to general practice, our study points to the urgent need of supplementing teaching in patient-centred clinical method with cultural competence. Our study also highlights the potential of educational GP groups to develop strategies for cross-cultural consultations.
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Affiliation(s)
- Stefán Hjörleifsson
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Esperanza Díaz
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Centre for Minority Health Research, Oslo, Norway
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26
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Nellums LB, Rustage K, Hargreaves S, Friedland JS. Multidrug-resistant tuberculosis treatment adherence in migrants: a systematic review and meta-analysis. BMC Med 2018; 16:27. [PMID: 29466983 PMCID: PMC5822608 DOI: 10.1186/s12916-017-1001-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is a growing concern in meeting global targets for TB control. In high-income low-TB-incidence countries, a disproportionate number of MDR-TB cases occur in migrant (foreign-born) populations, with concerns about low adherence rates in these patients compared to the host non-migrant population. Tackling MDR-TB in this context may, therefore, require unique approaches. We conducted a systematic review and meta-analysis to identify and synthesise data on MDR-TB treatment adherence in migrant patients to inform evidence-based strategies to improve care pathways and health outcomes in this group. METHODS This systematic review and meta-analysis was conducted in line with PRISMA guidelines (PROSPERO 42017070756). The databases Embase, MEDLINE, Global Health and PubMed were searched to 24 May 2017 for primary research reporting MDR-TB treatment adherence and outcomes in migrant populations, with no restrictions on dates or language. A meta-analysis was conducted using random-effects models. RESULTS From 413 papers identified in the database search, 15 studies reporting on MDR-TB treatment outcomes for 258 migrants and 174 non-migrants were included in the systematic review and meta-analysis. The estimated rate of adherence to MDR-TB treatment across migrant patients was 71% [95% confidence interval (CI) = 58-84%], with non-adherence reported among 20% (95% CI = 4-37%) of migrant patients. A key finding was that there were no differences in estimated rates of adherence [risk ratio (RR) = 1.05; 95% CI = 0.82-1.34] or non-adherence (RR = 0.97; 95% CI = 0.79-1.36) between migrants and non-migrants. CONCLUSIONS MDR-TB treatment adherence rates among migrants in high-income low-TB-incidence countries are approaching global targets for treatment success (75%), and are comparable to rates in non-migrants. The findings highlight that only just over 70% of migrant and non-migrant patients adhere to MDR-TB treatment. The results point to the importance of increasing adherence in all patient groups, including migrants, with an emphasis on tailoring care based on social risk factors for poor adherence. We believe that MDR-TB treatment targets are not ambitious enough.
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Affiliation(s)
- Laura B. Nellums
- Infectious Diseases & Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 ONN UK
| | - Kieran Rustage
- Infectious Diseases & Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 ONN UK
| | - Sally Hargreaves
- Infectious Diseases & Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 ONN UK
| | - Jon S. Friedland
- Infectious Diseases & Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 ONN UK
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27
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Vignier N, Desgrées du Loû A, Pannetier J, Ravalihasy A, Gosselin A, Lert F, Lydié N, Bouchaud O, Dray Spira R. Access to health insurance coverage among sub-Saharan African migrants living in France: Results of the ANRS-PARCOURS study. PLoS One 2018; 13:e0192916. [PMID: 29447257 PMCID: PMC5814022 DOI: 10.1371/journal.pone.0192916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 01/20/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Migrants' access to care depends on their health insurance coverage in the host country. We aimed to evaluate in France the dynamic and the determinants of health insurance coverage acquisition among sub-Saharan migrants. METHODS In the PARCOURS life-event retrospective survey conducted in 2012-2013 in health-care facilities in the Paris region, data on health insurance coverage (HIC) each year since arrival in France has been collected among three groups of sub-Saharan migrants recruited in primary care centres (N = 763), centres for HIV care (N = 923) and for chronic hepatitis B care (N = 778). Year to year, the determinants of the acquisition and lapse of HIC were analysed with mixed-effects logistic regression models. RESULTS In the year of arrival, 63.4% of women and 55.3% of men obtained HIC. But three years after arrival, still 14% of women and 19% of men had not obtained HIC. HIC acquisition was accelerated in case of HIV or hepatitis B infection, for migrants arrived after 2000, and for women in case of pregnancy and when they were studying. Conversely, it was slowed down in case of lack of a residency permit and lack of financial resources for men. In addition, women and men without residency permits were more likely to have lost HIC when they had one. CONCLUSION In France, the health insurance system aiming at protecting all, including undocumented migrants, leads to a prompt access to HIC for migrants from sub-Saharan Africa. Nevertheless, this access may be impaired by administrative and social insecurities.
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Affiliation(s)
- Nicolas Vignier
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
- Groupe hospitalier Sud Ile-de-France, Department of Infectious and Tropical Diseases, Melun, France
| | | | - Julie Pannetier
- Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Paris, France
| | | | - Anne Gosselin
- Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Paris, France
| | - France Lert
- INSERM, Centre for Research in Epidemiology and Population Health (CESP-U 1018), Villejuif, France
| | - Nathalie Lydié
- Santé Publique France, French National Agency of Public Health, Saint-Maurice, France
| | - Olivier Bouchaud
- Paris 13 University, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Infectious and Tropical diseases, and Laboratoire Educations et Pratiques de Santé (LEPS EA 3412), Bobigny, France
| | - Rosemary Dray Spira
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
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28
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Chae D, Lee J, Asami K, Kim H. Experience of migrant care and needs for cultural competence training among public health workers in Korea. Public Health Nurs 2018; 35:211-219. [PMID: 29424104 DOI: 10.1111/phn.12390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study explored the experiences of public health workers (PHWs) providing health care for migrants living in Korea and clarified needs for cultural competence training. DESIGN AND SAMPLE Twenty-six PHWs from five public health centers in Gwangju city, South Korea, participated in this exploratory qualitative study. METHODS Five semi-structured focus group interviews of PHWs were conducted from September to December 2016. A directed content analysis approach was conducted using four categories: perceived characteristics of migrants, interaction between PHWs and migrants, interaction between PHWs and organizations/systems, and cultural competence training needs. RESULTS PHWs perceived that migrants lacked autonomy in health decisions and awareness of health behaviors. PHWs experienced difficulties in communicating and in establishing trusting relationships. They found clients hard to reach and easy to miss, a lack of continuity in health care programs, and inadequate human and material resources. They preferred passive teaching methods to activity-based simulation. PHWs believed essential training should be provided through e-learning to all PHWs, including management. CONCLUSION PHWs reported experiencing multiple challenges from a lack of preparedness for culturally competent care and their clients' vulnerability. Development of cultural competence training is suggested through e-learning that reflects the PHWs' experiences and provides systematic support.
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Affiliation(s)
- Duckhee Chae
- College of Nursing, Chonnam National University, Gwangju, South Korea
| | - Jina Lee
- Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea
| | - Keiko Asami
- College of Nursing, Chonnam National University, Gwangju, South Korea
| | - Hyunlye Kim
- Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea
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29
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30
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Gea-Sánchez M, Alconada-Romero Á, Briones-Vozmediano E, Pastells R, Gastaldo D, Molina F. Undocumented Immigrant Women in Spain: A Scoping Review on Access to and Utilization of Health and Social Services. J Immigr Minor Health 2017; 19:194-204. [PMID: 26880030 DOI: 10.1007/s10903-016-0356-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This scoping review summarizes and analyzes relevant studies related to the evidence published on undocumented immigrant women's access to and utilization of health and social services in Spain. Scientific literature was identified by entering search terms in seven electronic databases which combined retrieved health sciences peer-reviewed articles (Pubmed, Embase, CINAHL Plus and Scopus) and grey literature databases (Europa OpenGrey, DART-Europe and Google Scholar) published between 2004 and 2014 and written in Spanish or in English presenting data about Spain. Those that fulfill the inclusion criteria were selected after a blind peer reviewed process when pertinence and quality was debated. A total of 16 publications were included, the main topics being socio-cultural differences in the access and utilization of social and health services and barriers faced by immigrant women. None of the studies focused exclusively on undocumented women, hence further research is needed in this area.
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Affiliation(s)
- Montserrat Gea-Sánchez
- Department of Nursing, Faculty of Nursing and Physiotherapy, GESEC, University of Lleida, Street Rovira Roure 44, 25198, Lleida, Spain. .,Research Group in Health Care (GRECS), IRB Lleida, Lleida, Spain.
| | - Álvaro Alconada-Romero
- Department of Nursing, Faculty of Nursing and Physiotherapy, GESEC, University of Lleida, Street Rovira Roure 44, 25198, Lleida, Spain.,Council of Nurses of Lleida, Lleida, Spain
| | - Erica Briones-Vozmediano
- Department of Nursing, Faculty of Nursing and Physiotherapy, GESEC, University of Lleida, Street Rovira Roure 44, 25198, Lleida, Spain.,Public Health Research Group, University of Alicante, Alicante, Spain
| | - Roland Pastells
- Department of Nursing, Faculty of Nursing and Physiotherapy, GESEC, University of Lleida, Street Rovira Roure 44, 25198, Lleida, Spain.,Research Group in Health Care (GRECS), IRB Lleida, Lleida, Spain
| | - Denise Gastaldo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Fidel Molina
- Department of Geography and Sociology, GESEC, University of Lleida, Lleida, Spain
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31
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Diaz E, Mbanya VN, Gele AA, Kumar B. Differences in primary health care use among sub-Saharan African immigrants in Norway: a register-based study. BMC Health Serv Res 2017; 17:509. [PMID: 28754117 PMCID: PMC5534034 DOI: 10.1186/s12913-017-2404-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 06/21/2017] [Indexed: 12/26/2022] Open
Abstract
Background Immigrants’ utilization of primary health care (PHC) services differs from that of the host populations. However, immigrants are often classified in broad groups by continent of origin, and the heterogeneity within the same continent may hide variation in use among immigrant groups at a national level. Differences in utilization of PHC between sub-Saharan African immigrants have not received much attention. Methods Registry-based study using merged data from the National Population Register and the Norwegian Health Economics Administration. African immigrants and their descendants registered in Norway in 2008 (36,366 persons) where included in this study. Using χ2 test and logistic regression models, we assessed the differences in the use of PHC, including general practitioner (GP) and emergency room (ER) services, and the distribution of morbidity burden for immigrants from Somalia, Ethiopia, Eritrea, and Gambia. For the analyses, we used the number of visits and medical diagnoses from each consultation registered by the physician. Result Among the total studied population, 66.1% visited PHC within 1 year. The diagnoses registered were similar for all four immigrants groups, regardless of country of origin. Compared to immigrants from Somalia, the age and sex adjusted odds ratios (OR) for use of GP were significantly lower for Ethiopians (OR 0.91; 0.86–0.97), Eritreans (OR 0.85; 0.79–0.91), and Gambians (OR 0.88; 0.80–0.97). Similarly, we also observed lower use of ER among Ethiopians (OR 0.88; 0.81–0.95), Eritreans (OR 0.56; 0.51–0.62) and Gambians (OR 0.81; 0.71–0.92). However, immigrants from Somalia reduced their use of PHC with longer duration of stay in Norway. Differences between groups persisted after further adjustment for employment status. Conclusion Despite the similarities in diagnoses among the sub-Saharan African immigrant groups in Norway, their use of PHC services differs by country of origin and length of stay. It is important to assess the reasons for the differences in these groups to identify barriers and facilitators to access to healthcare for future interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2404-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Centre for Minority Health Research, Oslo, Norway
| | - Vivian N Mbanya
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O Box 1130, Blindern, 0318, Oslo, Norway.
| | - Abdi A Gele
- Norwegian Centre for Minority Health Research, Oslo, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Bernadette Kumar
- Norwegian Centre for Minority Health Research, Oslo, Norway.,Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O Box 1130, Blindern, 0318, Oslo, Norway
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32
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Falla AM, Veldhuijzen IK, Ahmad AA, Levi M, Richardus JH. Language support for linguistic minority chronic hepatitis B/C patients: an exploratory study of availability and clinicians' perceptions of language barriers in six European countries. BMC Health Serv Res 2017; 17:150. [PMID: 28219385 PMCID: PMC5319068 DOI: 10.1186/s12913-017-2095-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 02/11/2017] [Indexed: 12/23/2022] Open
Abstract
Background Language support for linguistic minorities can improve patient safety, clinical outcomes and the quality of health care. Most chronic hepatitis B/C infections in Europe are detected among people born in endemic countries mostly in Africa, Asia and Central/Eastern Europe, groups that may experience language barriers when accessing health care services in their host countries. We investigated availability of interpreters and translated materials for linguistic minority hepatitis B/C patients. We also investigated clinicians’ agreement that language barriers are explanations of three scenarios: the low screening uptake of hepatitis B/C screening, the lack of screening in primary care, and why cases do not reach specialist care. Methods An online survey was developed, translated and sent to experts in five health care services involved in screening or treating viral hepatitis in six European countries: Germany, Hungary, Italy, the Netherlands, Spain and the United Kingdom (UK). The five areas of health care were: general practice/family medicine, antenatal care, health care for asylum seekers, sexual health and specialist secondary care. We measured availability using a three-point ordinal scale (‘very common’, ‘variable or not routine’ and ‘rarely or never’). We measured agreement using a five-point Likert scale. Results We received 238 responses (23% response rate, N = 1026) from representatives in each health care field in each country. Interpreters are common in the UK, the Netherlands and Spain but variable or rare in Germany, Hungary and Italy. Translated materials are rarely/never available in Hungary, Italy and Spain but commonly or variably available in the Netherlands, Germany and the UK. Differing levels of agreement that language barriers explain the three scenarios are seen across the countries. Professionals in countries with most infrequent availability (Hungary and Italy) disagree strongest that language barriers are explanations. Conclusions Our findings show pronounced differences between countries in availability of interpreters, differences that mirror socio-cultural value systems of ‘difference-sensitive’ and ‘difference-blindness’. Improved language support is needed given the complex natural history of hepatitis B/C, the recognised barriers to screening and care, and the large undiagnosed burden among (potentially) linguistic minority migrant groups. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2095-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abby M Falla
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
| | - Irene K Veldhuijzen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - Amena A Ahmad
- Department of Health Sciences, Faculty Life Sciences / Public Health Research, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Miriam Levi
- Department of Health Sciences, Division of Hygiene, Preventive Medicine and Public Health, University of Florence, Florence, Italy
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
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33
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Degrie L, Gastmans C, Mahieu L, Dierckx de Casterlé B, Denier Y. "How do ethnic minority patients experience the intercultural care encounter in hospitals? a systematic review of qualitative research". BMC Med Ethics 2017; 18:2. [PMID: 28103849 PMCID: PMC5244561 DOI: 10.1186/s12910-016-0163-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/27/2016] [Indexed: 11/30/2022] Open
Abstract
Background In our globalizing world, caregivers are increasingly being confronted with the challenges of providing intercultural healthcare, trying to find a dignified answer to the vulnerable situation of ethnic minority patients. Until now, international literature lacks insight in the intercultural care process as experienced by the ethnic minority patients themselves. We aim to fill this gap by analysing qualitative literature on the intercultural care encounter in the hospital setting, as experienced by ethnic minority patients. Methods A systematic search was conducted for papers published between 2000 and 2015. Analysis and synthesis were guided by the critical interpretive synthesis approach. Results Fifty one articles were included. Four dimensions emerged, describing the intercultural care encounter as (1) a meeting of two different cultural contexts of care, (2) in a dynamic and circular process of (3) balancing between the two cultural contexts, which is (4) influenced by mediators as concepts of being human, communication, family members and the hospital’s organizational culture. Conclusions This review provides in-depth insight in the dynamic process of establishing intercultural care relationships in the hospital. We call for a broader perspective towards cultural sensitive care in which patients are cared for in a holistic and dignity-enhancing way. Electronic supplementary material The online version of this article (doi:10.1186/s12910-016-0163-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liesbet Degrie
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, blok D, box 7001, Leuven, 3000, Belgium.
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, blok D, box 7001, Leuven, 3000, Belgium
| | - Lieslot Mahieu
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, blok D, box 7001, Leuven, 3000, Belgium
| | - Bernadette Dierckx de Casterlé
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35 blok D, box 7001, Leuven, 3000, Belgium
| | - Yvonne Denier
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, blok D, box 7001, Leuven, 3000, Belgium
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Abstract
Background Immigration rates have increased recently in the UK. Migrant patients may have particular needs that are inadequately met by existing primary care provision. In the absence of national guidance, local adaptations are emerging in response to these new demands. Aim To formatively assess the primary care services offered to new migrants and the ways in which practitioners and practices are adapting to meet need. Design & setting Online survey and case studies of current practice across primary care in the UK. Case studies were selected from mainstream and specialist general practice as well as primary care provision in the third sector. Method Non-probability sample survey of primary care practitioners (n = 70) with descriptive statistical analysis. Qualitative case studies (n = 8) selected purposively; in-depth exploration of organisational and practitioner adaptations to services. Analysis is structured around the principles of equitable care. Results Survey results indicated that practitioners focused on working with communities and external agencies and adapting processes of, for example, screening, vaccination, and health checks. Lack of funding was cited most frequently as a barrier to service development (n = 51; 73%). Case studies highlighted the prominence partnership working and of an organisational and practitioner focus on equitable care. Adaptations centred on addressing wider social determinants, trauma, and violence, and additional individual needs; and on delivering culturally-competent care. Conclusion Despite significant resource constraints, some primary care services are adapting to the needs of new migrants. Many adapted approaches can be characterised as equity-oriented.
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Mygind A, Nørgaard LS, Traulsen JM, El-Souri M, Kristiansen M. Drawing on healthcare professionals’ ethnicity: lessons learned from a Danish community pharmacy intervention for ethnic minorities. Scand J Public Health 2016; 45:238-243. [DOI: 10.1177/1403494816683454] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: To present and discuss implementation experiences regarding the involvement of community pharmacists with ethnic minority backgrounds in a medication review intervention for ethnic minority poly-pharmacy patients in Denmark. Methods: Data sources include 1) reflection notes from an introductory seminar with pharmacists and the cross-disciplinary research team and 2) five individual interviews and one focus group interview with pharmacists. Data were thematically coded and synthesised to identify underlying rationales and challenges encountered when involving professionals with ethnic minority backgrounds in interventions for ethnic minorities. Results: Informants perceived the need for interventions targeted at ethnic minority poly-pharmacy patients, and highlighted the potential of involving professionals with diverse ethnic backgrounds in such interventions. However, implementation created challenges, because the professional identity of the pharmacists reduced their options for serving as peers with the same ethnic background. Furthermore, issues related to organisational difficulties and overcoming language barriers in the intervention impacted on the potential of involving professionals with ethnic minority backgrounds. Conclusions: Involving healthcare professionals with ethnic minority backgrounds in encounters with ethnic minorities holds potential for the adaptation of services to ethnically diverse populations, thus improving access to and quality of care. However, it is important to ensure sufficient personal and organisational support and to acknowledge the delicate balance between simultaneously serving as a peer and as a professional.
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Affiliation(s)
- Anna Mygind
- Section for Social and Clinical Pharmacy, Department of Pharmacy, School of Pharmacy, University of Copenhagen, Denmark
| | - Lotte Stig Nørgaard
- Section for Social and Clinical Pharmacy, Department of Pharmacy, School of Pharmacy, University of Copenhagen, Denmark
| | - Janine M. Traulsen
- Section for Social and Clinical Pharmacy, Department of Pharmacy, School of Pharmacy, University of Copenhagen, Denmark
| | - Mira El-Souri
- Section for Social and Clinical Pharmacy, Department of Pharmacy, School of Pharmacy, University of Copenhagen, Denmark
- Pharmakon, Danish College for Pharmacy Practice, Denmark
| | - Maria Kristiansen
- Center for Healthy Aging, Department of Public Health, University of Copenhagen, Denmark
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De Vito E, de Waure C, Specchia ML, Parente P, Azzolini E, Frisicale EM, Favale M, Teleman AA, Ricciardi W. Are undocumented migrants' entitlements and barriers to healthcare a public health challenge for the European Union? Public Health Rev 2016; 37:13. [PMID: 29450055 PMCID: PMC5810097 DOI: 10.1186/s40985-016-0026-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/21/2016] [Indexed: 11/10/2022] Open
Abstract
Undocumented migrants (UMs) are at higher risk for health problems because of their irregular status and the consequences of economic and social marginalization. Moreover, the emergent reality of undocumented migration in Europe calls for action in the field of management of UM's health demands as their access to health services has become a sensitive political and social issue. In this light, this paper aims to address UMs' entitlement and barriers to healthcare and related policies citing evidence from peer-reviewed and grey literature concerning people living in a country within the European Union without the legal right to be/remain in the destination country. A systematic review was performed using several databases and websites, and a total of 54 publications in English, with full text available, were taken into consideration. Between 2000 and 2015, Europe hosted the second largest number of international migrants (20 million, 1.3 million per year) after Asia. Even though there is limited evidence specifically focused on UMs' health, it is possible to state that infectious diseases, chronic illnesses, mental disorders, maternal-child conditions, dental issues, acute illnesses and injuries are the most common pathologies. In most cases across Europe, UMs have access only to emergency care. Even in countries where they are fully entitled to healthcare, formal and informal barriers hinder them from being or feeling entitled to this right. Socio-cultural barriers, such as language and communication problems, lack of formal and informal social and healthcare networks and lack of knowledge about the healthcare system and about informal networks of healthcare professionals are all common impediments. From the healthcare providers' perspective, there can be difficulties in providing appropriate care and in dealing with cultural and language barriers and false identification. Communication strategies play a central role in addressing the inequalities in access to healthcare services, and the definition and provision of specific training, focused on UMs' health needs, would be desirable. Improving access to healthcare for UMs is an urgent priority since the lack of access is proven to have serious consequences for UMs' health and wellbeing. Notwithstanding, few available examples of policies and best practices aimed at overcoming barriers in the delivery of healthcare to UMs are available.
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Affiliation(s)
- Elisabetta De Vito
- 1Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Campus Folcara, Via Sant'Angelo, 03043 Cassino, FR Italy.,2Centre for Global Health Research and Studies, Catholic University of Sacred Heart, Rome, Italy
| | - Chiara de Waure
- 2Centre for Global Health Research and Studies, Catholic University of Sacred Heart, Rome, Italy.,3Department of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Lucia Specchia
- 2Centre for Global Health Research and Studies, Catholic University of Sacred Heart, Rome, Italy.,3Department of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Paolo Parente
- 3Department of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Elena Azzolini
- 3Department of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | | | - Marcella Favale
- 3Department of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Adele Anna Teleman
- 2Centre for Global Health Research and Studies, Catholic University of Sacred Heart, Rome, Italy.,3Department of Public Health, Catholic University of Sacred Heart, Rome, Italy
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Bartolomei J, Baeriswyl-Cottin R, Framorando D, Kasina F, Premand N, Eytan A, Khazaal Y. What are the barriers to access to mental healthcare and the primary needs of asylum seekers? A survey of mental health caregivers and primary care workers. BMC Psychiatry 2016; 16:336. [PMID: 27686067 PMCID: PMC5041539 DOI: 10.1186/s12888-016-1048-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We aimed to assess the opinion of primary care workers, social workers, translators and mental health caregivers who work with asylum seekers about the latter's unmet needs and barriers to access to mental healthcare. METHODS We used a Likert scale to assess the opinion of 135 primary care workers (general practitioners, nurses, social workers and translators) and mental health caregivers about the proportion of asylum seekers with psychiatric disorders, their priority needs and their main barriers to mental health services. RESULTS Insufficient access to adequate financial resources, poor housing and security conditions, access to employment, professional training and legal aid were considered as priority needs, as were access to dental and mental healthcare. The main barriers to access to mental healthcare for asylum seekers included a negative representation of psychiatry, fear of being stigmatized by their own community and poor information about existing psychiatric services. CONCLUSIONS We found a good correlation between the needs reported by healthcare providers and those expressed by the asylum-seeking population in different studies. We discuss the need for greater mobility and accessibility to psychiatric services among this population.
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Affiliation(s)
- Javier Bartolomei
- CAPPI Servette, Department of Mental Health and Psychiatry, Geneva University Hospitals, 91 rue de Lyon, CH-1203, Genève, Switzerland.
| | - Rachel Baeriswyl-Cottin
- CAPPI Servette, Department of Mental Health and Psychiatry, Geneva University Hospitals, 91 rue de Lyon, CH-1203 Genève, Switzerland
| | - David Framorando
- CAPPI Servette, Department of Mental Health and Psychiatry, Geneva University Hospitals, 91 rue de Lyon, CH-1203 Genève, Switzerland
| | - Filip Kasina
- CAPPI Servette, Department of Mental Health and Psychiatry, Geneva University Hospitals, 91 rue de Lyon, CH-1203 Genève, Switzerland
| | - Natacha Premand
- CAPPI Servette, Department of Mental Health and Psychiatry, Geneva University Hospitals, 91 rue de Lyon, CH-1203 Genève, Switzerland
| | - Ariel Eytan
- Department of Mental Health and Psychiatry, Geneva University Hospitals, 2 Ch du Petit Bel-Air, CH-1225 Chêne-Bourg, Switzerland
| | - Yasser Khazaal
- Department of Mental Health and Psychiatry, Substance Abuse Unit, Geneva University Hospitals, Genève, Switzerland
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Lindenmeyer A, Redwood S, Griffith L, Teladia Z, Phillimore J. Experiences of primary care professionals providing healthcare to recently arrived migrants: a qualitative study. BMJ Open 2016; 6:e012561. [PMID: 27660320 PMCID: PMC5051449 DOI: 10.1136/bmjopen-2016-012561] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The main objectives of the study were to explore the experiences of primary care professionals providing care to recent migrants in a superdiverse city and to elicit barriers and facilitators to meeting migrants' care needs. This paper focuses on a strong emergent theme: participants' descriptions and understandings of creating a fit between patients and practices. DESIGN An exploratory, qualitative study based on the thematic analysis of semistructured interviews. SETTING AND PARTICIPANTS A purposive sample of 10 practices. We interviewed 6 general practitioners, 5 nurses and 6 administrative staff; those based at the same practice opted to be interviewed together. 10 interviewees were from an ethnic minority background; some discussed their own experiences of migration. RESULTS Creating a fit between patients and practice was complex and could be problematic. Some participants defined this in a positive way (reaching out, creating rapport) while others also focused on ways in which patients did not fit in, for example, different expectations or lack of medical records. A small but vocal minority put the responsibility to fit in on to migrant patients. Some participants believed that practice staff and patients sharing a language could contribute to achieving a fit but others outlined the disadvantages of over-reliance on language concordance. A clearly articulated, team-based strategy to create bridges between practice and patients was often seen as preferable. CONCLUSIONS Although participants agreed that a fit between patients and practice was desirable, some aimed to adapt to the needs of recently arrived migrants, while others thought that it was the responsibility of migrants to adapt to practice needs; a few viewed migrant patients as a burden to the system. Practices wishing to improve fit might consider developing strategies such as introducing link workers and other 'bridging' people; however, they could also aim to foster a general stance of openness to diversity.
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Affiliation(s)
- Antje Lindenmeyer
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sabi Redwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Laura Griffith
- Health Services Management Centre, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - Zaheera Teladia
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jenny Phillimore
- Institute of Research into Superdiversity, College of Social Sciences, University of Birmingham, Birmingham, UK
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Gimeno-Feliu LA, Calderón-Larrañaga A, Diaz E, Poblador-Plou B, Macipe-Costa R, Prados-Torres A. Global healthcare use by immigrants in Spain according to morbidity burden, area of origin, and length of stay. BMC Public Health 2016; 16:450. [PMID: 27230885 PMCID: PMC4882823 DOI: 10.1186/s12889-016-3127-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 05/10/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The healthcare of immigrants is an important aspect of equity of care provision. Understanding how immigrants use the healthcare services based on their needs is crucial to establish effective health policy. METHODS This retrospective, observational study included the total population of Aragon, Spain (1,251,540 individuals, of whom 11.9 % were immigrants). Patient-level data on the use of primary, specialised, hospital, and emergency care as well as prescription drug use in 2011 were extracted from the EpiChron Cohort and compared between immigrants and nationals. Multivariable standard or zero-inflated negative binomial regression models were generated, adjusting for age, sex, length of stay, and morbidity burden. RESULTS The annual visit rates of immigrants were lower than those of nationals for primary care (3.3 vs 6.4), specialised care (1.3 vs 2.7), planned hospital admissions/100 individuals (1.6 vs 3.8), unplanned hospital admissions/100 individuals (2.7 vs 4.7), and emergency room visits/10 individuals (2.3 vs 2.8). Annual prescription drug costs were also lower for immigrants (€47 vs €318). These differences were only partially attenuated after adjusting for age, sex and morbidity burden. CONCLUSION In a universal coverage health system offering broad legal access to immigrants, the global use of healthcare services was lower for immigrants than for nationals. These differences may be explained in part by the healthy migration effect, but also reveal possible inequalities in healthcare provision that warrant further investigation.
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Affiliation(s)
- Luis A Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain. .,San Pablo Health Centre, C/ Aguadores 7, 50003, Zaragoza, Spain. .,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.
| | - Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain
| | - Esperanza Diaz
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.,Norwegian Centre for Minority Health Research (NAKMI), Oslo University Hospital, Bergen, Norway
| | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain
| | | | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
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Was access to health care easy for immigrants in Spain? The perspectives of health personnel in Catalonia and Andalusia. Health Policy 2016; 120:396-405. [DOI: 10.1016/j.healthpol.2016.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 11/19/2022]
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41
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Villadsen SF, Mortensen LH, Andersen AMN. Care during pregnancy and childbirth for migrant women: How do we advance? Development of intervention studies – The case of the MAMAACT intervention in Denmark. Best Pract Res Clin Obstet Gynaecol 2016; 32:100-12. [DOI: 10.1016/j.bpobgyn.2015.08.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/13/2015] [Accepted: 08/15/2015] [Indexed: 11/17/2022]
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van Eechoud IJ, Grypdonck M, Beeckman D, Van Lancker A, Van Hecke A, Verhaeghe S. Oncology health workers' views and experiences on caring for ethnic minority patients: A mixed method systematic review. Int J Nurs Stud 2015; 53:379-98. [PMID: 26429358 DOI: 10.1016/j.ijnurstu.2015.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate what published research reveals about the views and experiences of oncology health workers when caring for ethnic minority patients. DESIGN Systematic review of qualitative and quantitative studies. DATA SOURCES The following databases were systematically screened: PubMed, CINAHL, Web of Science, and AnthroSource. Reference lists were checked for additional articles. REVIEW METHODS Empirical studies or systematic reviews (1/2000 to 12/2013) were included if they concerned the oncology setting and the views or experiences of healthcare workers and care users belonging to an ethnic or cultural minority group. The methodological quality of each individual study was assessed using the Critical Appraisal Skills Programme for Qualitative Studies and the Quality Assessment Tool for Quantitative Studies. RESULTS Eighteen publications met the inclusion criteria. Thirteen articles had a qualitative, four a quantitative, and one a mixed methods design. The results in the individual studies were heterogeneous. Most studies reported challenges or barriers when caring for ethnic minority patients, whereas fewer than half of the articles discussed facilitating factors and opportunities. Oncology health workers participating in the included studies sought to provide professional standards of care and tried to adapt care to the needs of ethnic minority patients. However, they experienced formidable communication barriers and they feared doing things that might be considered culturally insensitive. The organizational aspects of care for the oncology patient appeared to have a significant influence on how healthcare providers view and experience oncology care for ethnic minority patients. CONCLUSIONS Views and experiences of participating oncology health workers were characterized by a willingness to provide proper care for ethnic minority patients, but this was hampered by a tangle of interrelated issues such as linguistic barriers, fear and uncertainty, and assumptions about cultural matters. Organizational aspects were shown to be a strong influence on healthcare workers caring for ethnic minority patients. Due to methodological limitations of the included studies, conclusions should be viewed with caution.
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Affiliation(s)
- Ineke J van Eechoud
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Belgium.
| | - Mieke Grypdonck
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Dimitri Beeckman
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Aurélie Van Lancker
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Ann Van Hecke
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Sofie Verhaeghe
- Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Belgium
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Sun LY, Lee EW, Zahra A, Park JH. Should non-citizens have access to publicly funded health care? Public Health 2015; 129:1157-65. [DOI: 10.1016/j.puhe.2015.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 04/05/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
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Inequalities in healthcare access by type of visa in a context of restrictive health insurance policy: the case of Ukrainians in Czechia. Int J Public Health 2014; 59:715-9. [DOI: 10.1007/s00038-014-0592-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/23/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022] Open
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Suess A, Ruiz Perez I, Ruiz Azarola A, March Cerda JC. The right of access to health care for undocumented migrants: a revision of comparative analysis in the European context. Eur J Public Health 2014; 24:712-20. [DOI: 10.1093/eurpub/cku036] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cousien A, Obach D, Deuffic-Burban S, Mostafa A, Esmat G, Canva V, El Kassas M, El-Sayed M, Anwar WA, Fontanet A, Mohamed MK, Yazdanpanah Y. Is expert opinion reliable when estimating transition probabilities? The case of HCV-related cirrhosis in Egypt. BMC Med Res Methodol 2014; 14:39. [PMID: 24635942 PMCID: PMC4003824 DOI: 10.1186/1471-2288-14-39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 01/30/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Data on HCV-related cirrhosis progression are scarce in developing countries in general, and in Egypt in particular. The objective of this study was to estimate the probability of death and transition between different health stages of HCV (compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma) for an Egyptian population of patients with HCV-related cirrhosis. METHODS We used the "elicitation of expert opinions" method to obtain collective knowledge from a panel of 23 Egyptian experts (among whom 17 were hepatologists or gastroenterologists and 2 were infectiologists). The questionnaire was based on virtual medical cases and asked the experts to assess probability of death or probability of various cirrhosis complications. The design was a Delphi study: we attempted to obtain a consensus between experts via a series of questionnaires interspersed with group response feedback. RESULTS We found substantial disparity between experts' answers, and no consensus was reached at the end of the process. Moreover, we obtained high death probability and high risk of hepatocellular carcinoma. The annual transition probability to death was estimated at between 10.1% and 61.5% and the annual probability of occurrence of hepatocellular carcinoma was estimated at between 16.8% and 58.9% (depending on age, gender, time spent in cirrhosis and cirrhosis severity). CONCLUSIONS Our results show that eliciting expert opinions is not suited for determining the natural history of diseases due to practitioners' difficulties in evaluating quantities. Cognitive bias occurring during this type of study might explain our results.
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Affiliation(s)
- Anthony Cousien
- IAME, UMR 1137, INSERM, F-75018 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France
- EA2694, Université Lille Nord de France, Lille, France
| | - Dorothée Obach
- IAME, UMR 1137, INSERM, F-75018 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France
- EA2694, Université Lille Nord de France, Lille, France
| | - Sylvie Deuffic-Burban
- IAME, UMR 1137, INSERM, F-75018 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France
- Inserm U995, Université Lille 2 – Lille Nord de France, Lille, France
| | - Aya Mostafa
- Department of Community, Environmental and Occupational Medicine, Faculty of medicine, Ain Shams University, Cairo, Egypt
| | - Gamal Esmat
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Valérie Canva
- Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHRU Lille, France
| | - Mohamed El Kassas
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mohammad El-Sayed
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wagida A Anwar
- Department of Community, Environmental and Occupational Medicine, Faculty of medicine, Ain Shams University, Cairo, Egypt
| | - Arnaud Fontanet
- Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Mostafa K Mohamed
- Department of Community, Environmental and Occupational Medicine, Faculty of medicine, Ain Shams University, Cairo, Egypt
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, F-75018 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France
- Service de Maladies infectieuses et tropicales, Hôpital Bichat Claude Bernard, Paris, France
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Costa D, Matanov A, Canavan R, Gabor E, Greacen T, Vondráčková P, Kluge U, Nicaise P, Moskalewicz J, Díaz–Olalla JM, Straßmayr C, Kikkert M, Soares JJF, Gaddini A, Barros H, Priebe S. Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries. BMC Health Serv Res 2014; 14:49. [PMID: 24490720 PMCID: PMC3915221 DOI: 10.1186/1472-6963-14-49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 01/29/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Different service characteristics are known to influence mental health care delivery. Much less is known about the impact of contextual factors, such as the socioeconomic circumstances, on the provision of care to socially marginalized groups.The objectives of this work were to assess the organisational characteristics of services providing mental health care for marginalized groups in 14 European capital cities and to explore the associations between organisational quality, service features and country-level characteristics. METHODS 617 services were assessed in two highly deprived areas in 14 European capital cities. A Quality Index of Service Organisation (QISO) was developed and applied across all sites. Service characteristics and country level socioeconomic indicators were tested and related with the Index using linear regressions and random intercept linear models. RESULTS The mean (standard deviation) of the QISO score (minimum = 0; maximum = 15) varied from 8.63 (2.23) in Ireland to 12.40 (2.07) in Hungary. The number of different programmes provided was the only service characteristic significantly correlated with the QISO (p < 0.05). The national Gross Domestic Product (GDP) was inversely associated with the QISO. Nearly 15% of the variance of the QISO was attributed to country-level variables, with GDP explaining 12% of this variance. CONCLUSIONS Socioeconomic contextual factors, in particular the national GDP are likely to influence the organisational quality of services providing mental health care for marginalized groups. Such factors should be considered in international comparative studies. Their significance for different types of services should be explored in further research.
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Affiliation(s)
- Diogo Costa
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Alameda Prof Hernani Monteiro, 4200-319 Porto, Portugal
- Institute of Public Health, University of Porto, Porto, Portugal
| | - Aleksandra Matanov
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Reamonn Canavan
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - Edina Gabor
- National Institute for Health Development, Budapest, Hungary
| | - Tim Greacen
- Laboratoire de recherche, Etablissement public de santé Maison Blanche, Paris, France
| | - Petra Vondráčková
- Department of Addictology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Ulrike Kluge
- Clinic for Psychiatry and Psychotherapy, Charite, University Medicine Berlin, CCM, Berlin, Germany
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Bruxelles, Belgium
| | | | | | | | - Martijn Kikkert
- Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
| | - Joaquim JF Soares
- Department of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Andrea Gaddini
- Laziosanità ASP–Public Health Agency, Lazio Region, Rome, Italy
| | - Henrique Barros
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Alameda Prof Hernani Monteiro, 4200-319 Porto, Portugal
- Institute of Public Health, University of Porto, Porto, Portugal
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
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Are migrants health policies aimed at improving access to quality healthcare? An analysis of Spanish policies. Health Policy 2013; 113:236-46. [DOI: 10.1016/j.healthpol.2013.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 06/07/2013] [Accepted: 06/12/2013] [Indexed: 11/19/2022]
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Jaeger FN, Kiss L, Hossain M, Zimmerman C. Migrant-friendly hospitals: a paediatric perspective--improving hospital care for migrant children. BMC Health Serv Res 2013; 13:389. [PMID: 24093461 PMCID: PMC3852418 DOI: 10.1186/1472-6963-13-389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 09/27/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches. METHODS Semi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted. RESULTS Paediatric care can be complex, usually involving both the patient and the patient's family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking. CONCLUSIONS International research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care for PMs at both policy and service levels is an investment in the future that will benefit native and migrant families.
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Affiliation(s)
- Fabienne N Jaeger
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel street, London WC1E 7HT, UK
- Currently: Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- Currently: University of Basel, Basel, Switzerland
| | - Ligia Kiss
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel street, London WC1E 7HT, UK
| | - Mazeda Hossain
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel street, London WC1E 7HT, UK
| | - Cathy Zimmerman
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel street, London WC1E 7HT, UK
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Health services and the treatment of immigrants: data on service use, interpreting services and immigrant staff members in services across Europe. Eur Psychiatry 2013; 27 Suppl 2:S56-62. [PMID: 22863252 DOI: 10.1016/s0924-9338(12)75709-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The number of immigrants using health services has increased across Europe. For assessing and improving the quality of care provided for immigrants, information is required on how many immigrants use services, what interpreting services are provided and whether staff members are from immigrant groups. METHODS Structured interviews were conducted with 15 health services (9 primary care, 3 emergency departments, 3 mental health) located in areas with high immigrant populations in each of 16 European countries (n=240). Responses were collected on the availability of data on service use by immigrant patients, the provision of interpreting services and immigrant staff members. RESULTS Data on service use by immigrants were recorded by only 15% of services. More than 40% of services did not provide any form of interpreting service and 54% of the services reported having no immigrant staff. Mental health services were more likely to use direct interpreting services, and both mental health and emergency services were more likely to have immigrant staff members. DISCUSSION For assessing and improving the quality of care provided for immigrants, there is a need to improve the availability of data on service use by immigrants in health services throughout Europe and to provide more consistent access to interpreting services.
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