Health care for irregular migrants: pragmatism across Europe: a qualitative study

Strategies to Improve Care in the Emergency Department for Culturally and Linguistically Diverse Adults: a Systematic Review

BACKGROUND

The emergency department (ED) is an important gateway into the health system for people from culturally and linguistically diverse (CALD) backgrounds; their experience in the ED is likely to impact the way they access care in the future. Our review aimed to describe interventions used to improve ED health care delivery for adults from a CALD background.

METHODS

An electronic search of four databases was conducted to identify empirical studies that reported interventions with a primary focus of improving ED care for CALD adults (aged ≥ 18 years), with measures relating to ED system performance, patient outcomes, patient experience, or staff experience. Studies published from inception to November 2022 were included. We excluded non-empirical studies, studies where an intervention was not provided in ED, papers where the full text was unavailable, or papers published in a language other than English. The intervention strategies were categorised thematically, and measures were tabulated.

RESULTS

Following the screening of 3654 abstracts, 89 articles underwent full text review; 16 articles met the inclusion criteria. Four clear strategies for targeting action tailored to the CALD population of interest were identified: improving self-management of health issues, improving communication between patients and providers, adhering to good clinical practice, and building health workforce capacity.

CONCLUSIONS

The four strategies identified provide a useful framework for targeted action tailored to the population and outcome of interest. These detailed examples show how intervention design must consider intersecting socio-economic barriers, so as not to perpetuate existing disparity.

REGISTRATION

PROSPERO registration number: CRD42022379584.

"Border closure only increased precariousness": a qualitative analysis of the effects of restrictive measures during the COVID-19 pandemic on Venezuelan's health and human rights in South America

BACKGROUND

In 2010, a political and social crisis pushed thousands of Venezuelans out of their country; today, seven million Venezuelans live abroad. In addition, during the COVID-19 pandemic, border closure increased and affected specific vulnerable migration flows, such as Venezuelans trying to migrate to Chile through the Northern borders. In this context, there is little evidence of migrants' health status and needs, their access to health services, and other basic needs (e.g., housing) from a human rights perspective. Therefore, we qualitatively explored the effects of border closure due to the COVID-19 pandemic on Venezuelan migrants' health and human rights, focusing on access to healthcare in the Northern Chilean border that adjoins Peru and Bolivia.

METHODS

Following a case-study qualitative design, we conducted an ethnography that included participatory observation of relevant sites (e.g., hospitals, main squares, migrant shelters) in Antofagasta, Iquique, and Arica and 30 in-depth interviews with actors in the health sector (n = 7), experts from the non-governmental sector (n = 16), and governmental actors (n = 7) in three large cities close to the Northern border.

RESULTS

We found four main dimensions: (i) border and migration processes, (ii) specific groups and intersectionality, (iii) barriers to healthcare services, and (iv) regional and local responses to the crisis during the COVID-19 pandemic. Programs characterized by the presence of healthcare providers in the field were essential to attend to migrants' health needs at borders.

CONCLUSIONS

Coordination between actors is crucial to implement regional protocols that respond to current migration phenomena and migrants' health needs. Health policies using a human rights approach are urgently required to respond to migrants' healthcare needs at borders in South America.

The effect of equalization of public health services on the health China's migrant population: Evidence from 2018 China Migrants Dynamic Survey

Objectives

China has implemented an equalization of public health Services policy for migrants in 40 pilot cities since 2013. The main objective of this study is to explore the effect of this migrant-based reform policy on the health status of the migrant population in China.

Methods

Using the China Migrants Dynamic Survey (CMDS), we included 152,000 migrants aged 15 years or over in 2018. Standardized questionnaires were used to collect socio-economic information and self-reported health status. The Associations between the equalization of public health services and health status were estimated using Multiple regression estimation models and Propensity Score Matching (PSM) methods.

Results

Public health equalization reform in China has a significant and positive effect on the health status of the migrant population (β = 0.033, p < 0.001). Compared to males, higher income, under 60 years of age, inter-provincial mobility, and migrants those already living in urban areas, the equalization of public health Services had shown more significant positive effects on the groups who were inter-provincial migration (β = 0.055, p < 0.001), females (β = 0.055, p < 0.001), having low-income (β = 0.077, p < 0.001), aged over 60 years old (β = 0.191, p < 0.001), and living in rural areas (β = 0.038, p < 0.001). And multiple robustness tests prove that the above results are reliable.

Conclusions and implications

Our findings confirmed the positive health effect of the equalization of public health services reform on china's migrant population, especially among vulnerable groups such as those in low income groups, in rural areas and females. And we recommend that it is necessary to further promote the practices and experiences of the pilot cities. First, strengthen health education for the mobile population and improve their health literacy. Second, further increase the financial investment to improve the coverage of public health services and the equity in resource allocation among regions. Last, strengthen the information-based management of the migrant population and prevent and control infectious diseases.

Health Risks During Ukrainian Humanitarian Crisis

Background

The unprecedented exodus in the history of the European Union of more than 6 million Ukrainian refugees (May 13, 2022) is a cause for concern and could lead to a new difficult situation in terms of infectious disease control. Following the SARS-CoV-2 pandemic, Europe is facing a new challenge that could lead to a new wave of COVID-19 and an increase in the number of cases of tuberculosis or eradicated diseases, such as polio.

Aim

The purpose of this analysis was to provide an overview of lung diseases and health risks that could be encountered in refugees from Ukraine and translated to European Union`countries.

Methods

A systematic review was conducted in PubMed, World Health Organization, the UN Refugee Agency and the government's websites. Selected publications investigated the health problems arising from Ukrainian population migration from conflict areas and their impact on the public health system in the adoptive countries. The main potentially contagious diseases in Ukraine have also been reviewed.

Results

The population of Ukraine has serious public health problems such as SARS-CoV-2 infection, multidrug-resistant tuberculosis, high levels of drug resistance and difficulties with an effective vaccination program, so there are significant risks of developing epidemics in transit or host countries. The current crisis has major peculiarities because the migrants were not concentrated in the camps but there was a dispersion of them on large territories of European countries.

Conclusion

In order to meet the health needs of refugees, it is necessary to adapt health systems culturally and linguistically, to train health workers on the particularities of existing diseases in the countries of refugee origin, and to facilitate collection of medical data on migrants' health.

Health professionals' experiences of and attitudes towards mental healthcare for migrants and refugees in Europe: A qualitative systematic review

Migrants living in Europe constitute over half of the world's international migrants and are at higher risk of poor mental health than non-migrants, yet also face more barriers in accessing and engaging with services. Furthermore, the quality of care received is shaped by the experiences and attitudes of health professionals. The aim of this review was to identify professionals' attitudes towards migrants receiving mental healthcare and their perceptions of barriers and facilitators to service provision. Four electronic databases were searched, and 23 studies met the inclusion criteria. Using thematic synthesis, we identified three themes: 1) the management of multifaceted and complex challenges associated with the migrant status; 2) professionals' emotional responses to working with migrants; and 3) delivering care in the context of cultural difference. Professionals employed multiple strategies to overcome challenges in providing care yet attitudes towards this patient group were polarized. Professionals described mental health issues as being inseparable from material and social disadvantage, highlighting a need for effective collaboration between health services and voluntary organizations, and partnerships with migrant communities. Specialist supervision, reflective practice, increased training for professionals, and the adoption of a person-centered approach are also needed to overcome the current challenges in meeting migrants' needs. The challenges experienced by health professionals in attempting to meet migrant needs reflect frustrations in being part of a system with insufficient resources and without universal access to care that effectively stigmatizes the migrant status.

Perspectives on Spain's legislative experience providing access to healthcare to irregular migrants: a qualitative interview study

OBJECTIVES

In 2018, Spain adopted a national law that significantly expanded healthcare access to all residents, including undocumented migrants. This was a substantial shift from a more restrictive system of coverage in previous years. However, irregular migrants continue to experience challenges accessing healthcare in Spain. This study aimed to describe the legislative and administrative barriers to implementation of this law from the perspective of providers and administrators of the healthcare system.

DESIGN

We interviewed 12 individuals using a semistructured format.

SETTING

Spain.

PARTICIPANTS

12 participants were interviewed; 7 males, 5 females. Participants included Spanish healthcare workers, government officials, hospital administrators, individuals working with non-governmental organisations focused on the provision of healthcare, and experts studying healthcare for underserved populations.

PRIMARY AND SECONDARY OUTCOME MEASURES

Interviews delved into personal experiences and knowledge of the entitlements and barriers of providing or trying to access care for undocumented migrants.

RESULTS

The interviews yielded eight key themes: (1) context of universal healthcare in Spain pre-2012; (2) erosion of trust as rationale for more restrictive policies of 2012; (3) challenges of the 3-month residency requirement; (4) areas of ambiguity: exceptions in the 2012 Royal Decree Law not discussed in the 2018 Royal Decree Law; (5) jurisdictional authority and conflicts between national and AC government; (6) near impossibility of obtaining documentation for exportation of healthcare; (7) difficulties obtaining necessary paperwork to register residency; and (8) rise of NGOs to provide support to irregular migrants.

CONCLUSION

While there has been a general political movement to expand healthcare access for undocumented migrants in Spain, there remains a fundamental need to clarify the legal entitlements for undocumented migrants nationally and create administrative consistency across autonomous communities for providing health cards for undocumented migrants. Other countries may be able to draw lessons from the Spanish experience about the legislative frameworks surrounding access to healthcare for undocumented migrants.

Scoping the impact of COVID-19 on the nexus of statelessness and health in Council of Europe member states

Background

Stateless communities in Europe include ethnic Russians in the Baltic States, recent migrants, refugees, Roma, and other members of minority groups. Increases in COVID-19 infection have been observed in many European countries, including reported outbreaks in groups that include people and communities affected by statelessness, who often live in congested and sub-standard unhygienic conditions, work in informal sectors which hampers their adherence to public health measures (self-isolation/physical distancing/hand sanitation), or who are detained in immigration detention centres. The impact of COVID-19 on stateless people in Europe (estimated to be at least 600,000) is currently under researched, and there is an imperative to understand their experiences and situation, in order to generate evidence based measures, responses and actions to protect those most at risk.

Method

In order to better understand their unique position during the COVID-19 pandemic, we conducted a scoping review to explore and assess the nexus between statelessness and health during COVID-19 in Europe. Literature was found representing ten Council of Europe countries (Bulgaria, Denmark, Greece, Italy, Romania, Russia, Slovakia, Ireland, Ukraine and the United Kingdom), with 15 publications representing multiple countries. Four publications specifically focused on stateless people. The remainder focused on populations which include people disproportionately affected by statelessness both in the migratory context and those in situ (minority groups including Roma and ethnic Russians, and refugees and migrants).

Results

Three themes emerged from the analysis (Environmental determinants of health; access to healthcare services; and racism and vilification), with higher level abstraction centring on the nexus between existing adverse environmental determinants of health, compounded barriers to access healthcare during COVID-19; and the concerning rise in hate crime and scapegoating of minority populations during the COVID-19 emergency. Whilst the right to healthcare is a fundamental human right, with universal application and with access to healthcare services ensured to every human being without regards to race, religion or other criteria, including nationality status, this appears not to be the case for populations affected by statelessness during the COVID-19 health and state emergency. The right to a nationality (and realisation of the right to health and access to healthcare/public services) in the current pandemic times is crucial in a targeted effective and culturally sensitive public health response.

Conclusion

The hidden nature of statelessness, coupled with the marginalisation of stateless people, exacerbates the structural underpinning and interplay between statelessness, human rights, health rights and right to nationality during the COVID-19 pandemic. The review further highlights the need to protect stateless people. We further cannot underestimate the need for sensitive legal, health and social response measures to tackle disease transmission in vulnerable groups, continued statelessness of people in Europe, and hate crime, xenophobia and discrimination of those perceived to be at risk of contagion.

Health Service Utilization of International Immigrants in Yiwu, China: Implication for Health Policy

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.

Access to Healthcare for Migrant Patients in Europe: Healthcare Discrimination and Translation Services

Background: Discrimination based on ethnicity and the lack of translation services in healthcare have been identified as main barriers to healthcare access. However, the actual experiences of migrant patients in Europe are rarely present in the literature. Objectives: The aim of this study was to assess healthcare discrimination as perceived by migrants themselves and the availability of translation services in the healthcare systems of Europe. Methods: A total of 1407 migrants in 10 European Union countries (consortium members of the Mig-HealthCare project) were surveyed concerning healthcare discrimination, access to healthcare services, and need of translation services using an interviewer-administered questionnaire. Migrants in three countries were excluded from the analysis, due to small sample size, and the new sample consisted of N = 1294 migrants. Descriptive statistics and multivariable regression analyses were conducted to investigate the risk factors on perceived healthcare discrimination for migrants and refugees in the EU. Results: Mean age was 32 (±11) years and 816 (63.26%) participants were males. The majority came from Syria, Afghanistan, Iraq, Nigeria, and Iran. Older migrants reported better treatment experience. Migrants in Italy (0.191; 95% CI [0.029, 0.352]) and Austria (0.167; 95% CI [0.012, 0.323]) scored higher in the Discrimination Scale to Medical Settings (DMS) compared with Spain. Additionally, migrants with better mental health scored lower in the DMS scale (0.994; 95% CI [0.993, 0.996]), while those with no legal permission in Greece tended to perceive more healthcare discrimination compared with migrants with some kind of permission (1.384; 95% CI [1.189, 1.611]), as opposed to Austria (0.763; 95% CI [0.632, 0.922]). Female migrants had higher odds of needing healthcare assistance but not being able to access them compared with males (1.613; 95% CI [1.183, 2.199]). Finally, migrants with chronic problems had the highest odds of needing and not having access to healthcare services compared with migrants who had other health problems (3.292; 95% CI [1.585, 6.837]). Conclusions: Development of culturally sensitive and linguistically diverse healthcare services should be one of the main aims of relevant health policies and strategies at the European level in order to respond to the unmet needs of the migrant population.

Scientifically Informed Solidarity: Changing Anti-Immigrant Prejudice about Universal Access to Health

Currently, anti-immigrant sentiment has emerged again in European countries, as witnessed, for example, by the rise of xenophobic parties in many member states. This is a prejudice that is not new but that intensifies in certain circumstances, such as the economic crisis. This change in attitudes towards immigration has an impact on the preferences of citizens regarding the universal access to public resources and rights. The results of this article come from the analysis of certain variables of the Transnational European Solidarity Survey (TESS) conducted during 2016 in 13 member countries of the European Union. Specifically, two packages of variables are analysed regarding the degree of solidarity in relation to the access to public health services for immigrants before and after receiving scientific information about the collective benefits of the provision of health for the entire population, including undocumented immigrants. While there is much literature that analyses how scientific literacy in health and education issues improves the situation of vulnerable groups, few studies have analysed how scientific knowledge helps to modify the prejudices and discriminatory attitudes of the general population, thus contributing to the improvement of the health of the entire population.

Barriers to Accessing and Negotiating Mental Health Services in Asylum Seeking and Refugee Populations: The Application of the Candidacy Framework

This review brought together research investigating barriers asylum seekers and refugees (AS&R) face in accessing and negotiating mental health (MH) services. The candidacy framework (CF) was used as synthesizing argument to conceptualize barriers to services (Dixon-Woods et al. in BMC Med Res Methodol 6:35, 2006). Five databases were systematically searched. Twenty-three studies were included and analyzed using the CF. The seven stages of the framework were differentiated into two broader processes-access and negotiation of services. Comparatively more data was available on barriers to access than negotiation of services. The Identification of Candidacy (access) and Appearances at Services (negotiation) were the most widely discussed stages in terms of barriers to MH care. The stage that was least discussed was Adjudications (negotiation). The CF is useful to understand inter-related barriers to MH care experienced by AS&R. A holistic approach is needed to overcome these barriers together with further research investigating understudied areas of candidacy.

Factors associated with cervical cancer screening participation among migrant women in Europe: a scoping review

BACKGROUND

Cervical cancer screening has been effective in reducing incidence and mortality of cervical cancer, leading European countries to implement screening programs. However, migrant women show lower screening participation compared to nationals. This scoping review aims to provide a synthesis of the growing evidence on factors associated with participation in cervical cancer screening among migrant women in Europe.

METHODS

Electronic peer-reviewed databases were searched in November 2019 for studies on factors related to the participation of migrants in cervical cancer screening conducted in EU/EFTA countries, using comprehensive search expressions. Retrieved articles were screened and those eligible were selected for data extraction. Quantitative and qualitative studies were included. Factors were classified in barriers and facilitators and were divided into further categories.

RESULTS

Twenty out of 96 articles were selected and analyzed. Factors associated with participation in cervical cancer screening were classified in categories related to sociodemographic, healthcare-system, psychological, migration, knowledge, language, and cultural factors. Lack of information, lack of female healthcare providers, poor language skills, and emotional responses to the test (especially fear, embarrassment and discomfort) were the most reported barriers to cervical cancer screening. Encouragement from healthcare providers and information available in migrants' languages were frequently stated as facilitators. Results on the role of sociodemographic factors, such as age, education, employment and marital status, are the most conflicting, highlighting the complexity of the issue and the possibility of interactions between factors, resulting in different effects on cervical cancer screening participation among migrant women. Several identified barriers to screening are like those to access to healthcare services in general.

CONCLUSIONS

Efforts to increase migrant women's participation in CCS must target barriers to access to healthcare services in general but also specific barriers, including cultural differences about sexuality and gender, past traumatic personal experiences, and the gender and competences of healthcare professionals performing CCS. Healthcare services should strengthen resources to meet migrants' needs, including having CCS information translated and culturally adapted, as well as healthcare providers with skills to deal with cultural background. These findings can contribute to improve CCS programs among migrant women, reducing health disparities and enhancing their overall health and well-being.

Beliefs and challenges held by medical staff about providing emergency care to migrants: an international systematic review and translation of findings to the UK context

OBJECTIVE

Migration has increased globally. Emergency departments (EDs) may be the first and only contact some migrants have with healthcare. Emergency care providers' (ECPs) views concerning migrant patients were examined to identify potential health disparities and enable recommendations for ED policy and practice.

DESIGN

Systematic review and meta-synthesis of published findings from qualitative studies.

DATA SOURCES

Electronic databases (Ovid Medline, Embase (via Ovid), PsycINFO (via OVID), CINAHL, Web of Science and PubMed), specialist websites and journals were searched.

ELIGIBILITY CRITERIA

Studies employing qualitative methods published in English.

SETTINGS

EDs in high-income countries.

PARTICIPANTS

ECPs included doctors, nurses and paramedics.

TOPIC OF ENQUIRY

Staff views on migrant care in ED settings.

DATA EXTRACTION AND SYNTHESIS

Data that fit the overarching themes of 'beliefs' and 'challenges' were extracted and coded into an evolving framework. Lines of argument were drawn from the main themes identified in order to infer implications for UK policy and practice.

RESULTS

Eleven qualitative studies from Europe and the USA were included. Three analytical themes were found: challenges in cultural competence; weak system organisation that did not sufficiently support emergency care delivery; and ethical dilemmas over decisions on the rationing of healthcare and reporting of undocumented migrants.

CONCLUSION

ECPs made cultural and organisational adjustments for migrant patients, however, willingness was dependent on the individual's clinical autonomy. ECPs did not allow legal status to obstruct delivery of emergency care to migrant patients. Reported decisions to inform the authorities were mixed; potentially leading to uncertainty of outcome for undocumented migrants and deterring those in need of healthcare from seeking treatment. If a charging policy for emergency care in the UK was introduced, it is possible that ECPs would resist this through fears of widening healthcare disparities. Further recommendations for service delivery involve training and organisational support.

Impact of legal status change on undocumented migrants' health and well-being (Parchemins): protocol of a 4-year, prospective, mixed-methods study

INTRODUCTION

Migrants without residency permit, known as undocumented, tend to live in precarious conditions and be exposed to an accumulation of adverse determinants of health. Only scarce evidence exists on the social, economic and living conditions-related factors influencing their health status and well-being. No study has assessed the impact of legal status regularisation. The Parchemins study is the first prospective, mixed-methods study aiming at measuring the impact on health and well-being of a regularisation policy on undocumented migrants in Europe.

METHODS AND ANALYSIS

The Parchemins study will compare self-rated health and satisfaction with life in a group of adult undocumented migrants who qualify for applying for a residency permit (intervention group) with a group of undocumented migrants who lack one or more eligibility criteria for regularisation (control group) in Geneva Canton, Switzerland. Asylum seekers are not included in this study. The total sample will include 400 participants. Data collection will consist of standardised questionnaires complemented by semidirected interviews in a subsample (n=38) of migrants qualifying for regularisation. The baseline data will be collected just before or during the regularisation, and participants will subsequently be followed up yearly for 3 years. The quantitative part will explore variables about health (ie, health status, occupational health, health-seeking behaviours, access to care, healthcare utilisation), well-being (measured by satisfaction with different dimensions of life), living conditions (ie, employment, accommodation, social support) and economic situation (income, expenditures). Several confounders including sociodemographic characteristics and migration history will be collected. The qualitative part will explore longitudinally the experience of change in legal status at individual and family levels.

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee of Geneva, Switzerland. All participants provided informed consent. Results will be shared with undocumented migrants and disseminated in scientific journals and conferences. Fully anonymised data will be available to researchers.

The right to health: from citizen's right to human right (and back)

If health is a human right and if human rights are 'rights held by individuals simply because they are part of the human species', then all people, wherever they live, should be entitled to the same collective efforts that can protect or improve their health. In reality, not all people on the planet have access to the same set of health-related entitlements. There are huge disparities between the entitlements one can claim when living in a high-income country and the entitlements one can claim when living in a low-income country. Even within each country, there are disparities. The health-related entitlements people really have seem to be dependent on their belonging to a nation, family, or household. In this article, we explore and critically analyze two trends from a right-to-health perspective: the stagnation or even decrease of international assistance for health services in low- and middle-income countries and the increasing exclusion of undocumented migrants from health care in high-income countries. We argue that both trends constitute violations of the right to health; we posit an explanation for why they are occurring in countries that express support for human rights by expanding on the supposition that human rights are evolving from what were citizen's rights; and we discuss the role of individual human right supporters in an age of nationalism.

'Managing scarcity'- a qualitative study on volunteer-based healthcare for chronically ill, uninsured migrants in Berlin, Germany

OBJECTIVES

In Germany, healthcare for people lacking legal residency status and European Union citizens without health insurance is often provided by non-governmental organisations. Scientific studies assessing the situation of the patients with chronic diseases in this context are scarce. We aimed to characterise medical care for chronically ill migrants without health insurance and outline its possibilities and limitations from the treating physicians' perspective.

DESIGN

Qualitative semi-structured interviews; qualitative content analysis.

SETTING

Organisations and facilities providing healthcare for uninsured migrants: free clinics, medical practices and public health services.

PARTICIPANTS

14 physicians working regularly in healthcare for uninsured migrants.

RESULTS

Delayed contact to the healthcare system was frequently addressed in the interviews. Care was described as constrained by a scarcity of resources that often impedes adequate treatment for many conditions, most pronounced in the case of oncological diseases or chronic viral infections (HIV, hepatitis). For other chronic conditions such as cardiovascular diseases or diabetes, some diagnostics and basic medications were described as partially available, while management of complications or rehabilitative measures are frequently unfeasible. For the patients with mental health problems, attainability of psychotherapeutic treatment is reported as severely limited. Care is predominantly described as fragmented with limitations to information flow and continuity. Which level of care a patient receives appears to depend markedly on the respective non-governmental organisation and the individual commitment, subjective decisions and personal connections of the treating physician.

CONCLUSIONS

Restrictions in medical care for uninsured migrants have even more impact on chronically ill patients. Volunteer-based care often constitutes an inadequate compensation for regular access to the healthcare system, as it is strongly influenced by the limitation of its resources and its arbitrariness.

The Devil Is in the Detail-Understanding Divergence between Intention and Implementation of Health Policy for Undocumented Migrants in Thailand

Migrants’ access to healthcare has attracted attention from policy makers in Thailand for many years. The most relevant policies have been (i) the Health Insurance Card Scheme (HICS) and (ii) the One Stop Service (OSS) registration measure, targeting undocumented migrants from neighbouring countries. This study sought to examine gaps and dissonance between de jure policy intention and de facto implementation through qualitative methods. In-depth interviews with policy makers and local implementers and document reviews of migrant-related laws and regulations were undertaken. Framework analysis with inductive and deductive coding was undertaken. Ranong province was chosen as the study area as it had the largest proportion of migrants. Though the government required undocumented migrants to buy the insurance card and undertake nationality verification (NV) through the OSS, in reality a large number of migrants were left uninsured and the NV made limited progress. Unclear policy messages, bureaucratic hurdles, and inadequate inter-ministerial coordination were key challenges. Some frontline implementers adapted the policies to cope with their routine problems resulting in divergence from the initial policy objectives. The study highlighted that though Thailand has been recognized for its success in expanding insurance coverage to undocumented migrants, there were still unsolved operational challenges. To tackle these, in the short term the government should resolve policy ambiguities and promote inter-ministerial coordination. In the long-term the government should explore the feasibility of facilitating lawful cross-border travel and streamlining health system functions between Thailand and its neighbours.

Immigrants Psychopathology: Emerging Phenomena and Adaptation of Mental Health Care Setting by Native Language

Mental health of immigrants is an important social and clinical issue. Immigrants may report higher rates of mental disorders and lower levels of use of mental health service with respect to natives. The aim of the present work is to review recent findings of the psychopathology of immigrants and analyze how to adapt the mental care settings through the use of mother tongues. We searched the literature to individuate and review the most recent scientific articles focused on the psychopathology of immigrants realized in Europe. Moreover, we summarized the guidelines about immigrants mental health care and we focused on the barriers caused by language. We individuated 15 papers reporting data about mental disorders among immigrants and the related risk and protective factors. The articles reported information about psychosis, depression, anxiety, post-traumatic stress disorder, somatization and suicide rates. Risk and protective factors are individuated mainly among social factors (e.g. ethnic density effect, hosting countries' policies). Furthermore, immigrants encounter language barriers in the use of mental care services. The realization of cross-cultural training and the development of a working alliance between clinicians and interpreters resulted to be effective solutions even if these interventions are not frequently implemented. The extent of migratory flows and the related difficulties experienced by immigrants require attention and well-informed interventions. The high rates of incidence of mental disorder and the strict number of services who implement interventions taking into accounts fundamental aspect as language show that there is still a lot to do.

Immigration: analysis, trends and outlook on the global research activity

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.

Mental health care for adult refugees in high-income countries

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.

A systematic review on the use of healthcare services by undocumented migrants in Europe

Background

Undocumented migrants face particular challenges in accessing healthcare services in many European countries. The aim of this study was to systematically review the academic literature on the utilization of healthcare services by undocumented migrants in Europe.

Methods

The databases Embase, Medline, Global Health and Cinahl Plus were searched systematically to identify quantitative, qualitative and mixed methods studies published in 2007–2017.

Results

A total of 908 articles were retrieved. Deletion of duplicates left 531. After screening titles, abstracts and full texts according to pre-defined inclusion and exclusion criteria, 29 articles were included in the review. Overall, quantitative studies showed an underutilization of different types of healthcare services by undocumented migrants. Qualitative studies reported that, even when care was received, it was often inadequate or insufficient, and that many undocumented migrants were unfamiliar with their entitlements and faced barriers in utilizing healthcare services.

Conclusions

Although it is difficult to generalize findings from the included studies due to methodological differences, they provide further evidence that undocumented migrants in Europe face particular problems in utilizing healthcare services.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-2838-y) contains supplementary material, which is available to authorized users.

Undocumented Immigrant Women in Spain: A Scoping Review on Access to and Utilization of Health and Social Services

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.

Differences in the prevalence of hospitalizations and utilization of emergency outpatient services for ambulatory care sensitive conditions between asylum-seeking children and children of the general population: a cross-sectional medical records study (2015)

Background

Hospitalizations for ambulatory care sensitive (ACS) conditions are established indicators for the availability and quality of ambulatory care. We aimed to assess the differences between asylum-seeking children and children of the general population in a German city with respect to (i) the prevalence of ACS hospitalizations, and (ii) the utilization of emergency outpatient services for ACS conditions.

Methods

Using anonymous account data, all children admitted to the University Hospital Heidelberg in 2015 were included in our study. A unique cost unit distinguished asylum seekers residing in a nearby reception center (exposed) from the children of the general population. We adapted international lists of ACS conditions and calculated the prevalence of ACS hospitalizations and the utilization of emergency outpatient services for ACS conditions, attributable fractions among the exposed (Afe) and the population attributable fraction among total admissions (PAF) for each outcome. Differences in the prevalence of each outcome between exposed and controls were analyzed in logistic regression models adjusted for sex, age group and quarterly admission.

Results

Of the 32,015 admissions in 2015, 19.9% (6287) were from inpatient and 80.1% (25,638) from outpatient care. In inpatient care, 9.8% (622) of all admissions were hospitalizations for ACS conditions. The Afe of ACS hospitalizations was 46.57%, the PAF was 1.12%. Emergency service use for ACS conditions could be identified in 8.3% (3088) of all admissions (Afe: 79.57%, PAF: 5.08%). The odds ratio (OR) of asylum-seeking children being hospitalized for ACS conditions in comparison to the control group was 1.81 [95% confidence interval, CI: 1.02; 3.2]. The OR of the asylumseeking population compared to the general population for the utilization of emergency service use for ACS conditions was 4.93 [95% CI: 4.11; 5.91].

Conclusions

Asylum-seeking children had significantly higher odds of ACS hospitalization and of utilization of emergency outpatient services for ACS conditions. Using the concept of ACS conditions allowed measuring the strength of primary care provided to this local asylum-seeking population. This approach could help to compare the strength of primary care provision in different locations, and allow an objective.

Tuberculosis, human rights and ethics considerations along the route of a highly vulnerable migrant from sub-Saharan Africa to Europe

Migrant health is a critical public health issue, and in many countries attention to this topic has focused on the link between migration and communicable diseases, including tuberculosis (TB). When creating public health policies to address the complex challenges posed by TB and migration, countries should focus these policies on evidence, ethics, and human rights. This paper traces a commonly used migration route from sub-Saharan Africa to Europe, identifying situations at each stage in which human rights and ethical values might be affected in relation to TB care. This illustration provides the basis for discussing TB and migration from the perspective of human rights, with a focus on the right to health. We then highlight three strands of discussion in the ethics and justice literature in an effort to develop more comprehensive ethics of migrant health. These strands include theories of global justice and global health ethics, the creation of 'firewalls' to separate enforcement of immigration law from protection of human rights, and the importance of non-stigmatization to health justice. The paper closes by reflecting briefly on how TB programs can better incorporate human rights and ethical principles and values into public health practice.

Do attitudes and behavior of health care professionals exacerbate health care disparities among immigrant and ethnic minority groups? An integrative literature review

OBJECTIVES

Recent investigations of ethnicity related disparities in health care have focused on the contribution of providers' implicit biases. A significant effect on health care outcomes is suggested, but the results are mixed. The purpose of this integrative literature review is to provide an overview and synthesize the current empirical research on the potential influence of health care professionals' attitudes and behaviors towards ethnic minority patients on health care disparities.

DESIGN

Integrative literature review.

DATA SOURCES

Four internet-based literature indexes - MedLine, PsychInfo, Sociological Abstracts and Web of Science - were searched for articles published between 1982 and 2012 discussing health care professionals' attitudes or behaviors towards ethnic minority patients.

REVIEW METHODS

Thematic analysis was used to synthesize the relevant findings.

RESULTS

We found 47 studies from 12 countries. Six potential barriers to health care for ethnic minorities were identified that may be related to health care professionals' attitudes or behaviors: Biases, stereotypes and prejudices; Language and communication barriers; Cultural misunderstandings; Gate-keeping; Statistical discrimination; Specific challenges of delivering care to undocumented migrants.

CONCLUSIONS

Data on health care professionals' attitudes or behaviors are both limited and inconsistent. We thus provide reflections on methods, conceptualization, interpretation and the importance of the geographical or socio-political settings of potential studies. More empirical data is needed, especially on health care professionals' attitudes or behaviors towards (irregular) migrant patients.

Are undocumented migrants' entitlements and barriers to healthcare a public health challenge for the European Union?

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.

Political representation for social justice in nursing: lessons learned from participant research with destitute asylum seekers in the UK

The concept of social justice is making a revival in nursing scholarship, in part in response to widening health inequalities and inequities in high-income countries. In particular, critical nurse scholars have sought to develop participatory research methods using peer researchers to represent the 'voice' of people who are living in marginalized spaces in society. The aim of this paper is to report on the experiences of nurse and peer researchers as part of a project to explore the experiences of people who find themselves destitute following the asylum process in the UK. In seeking to explore social injustice, three challenges are identified: lack of a robust political theory, institutional/professional constraints and an absence of skills to engage with the politics of social (in)justice. Each challenge is presented, opposing voices outlined and some possible solutions are suggested. The work of political theorist Nancy Fraser is used as a conceptual framework, in particular her focus on mis/framing and political representation for social justice. In addition, it is suggested that social justice needs to be further embedded in nursing policy and curriculum. Finally, nurses are encouraged to develop practical political skills to engage with both politics and the media in a neoliberal globalizing world.

Paperless migrants and Norwegian general practitioners

BACKGROUND

In Norway, the rights of paperless migrants are restricted. We wished to investigate the extent to which Norwegian general practitioners give treatment to this group and their grounds for doing so, as well as to identify the health problems that were presented.

MATERIAL AND METHOD

In 2010, an online questionnaire was distributed to 3 994 general practitioners who were members of the Norwegian Medical Association.

RESULTS

Altogether 1 027 GPs responded. Of these, 237 (23 %) reported to have treated paperless migrants. Mental problems, pregnancy-related issues and respiratory ailments were the most frequently reported reasons for contact. Of the 237 GPs who reported to have treated paperless migrants, altogether 166 (70 %) stated that they would continue to receive these patients.

INTERPRETATION

The fact that most of the GPs who had treated paperless migrants would continue to receive this patient group and thus provide health services beyond this group’s entitlements, we regard as a wish to comply with the Code of Ethics for Norwegian doctors.

The influence of patients' immigration background and residence permit status on treatment decisions in health care. Results of a factorial survey among general practitioners in Switzerland

This study examines the influence of patients' immigration background and residence permit status on physicians' willingness to treat patients in due time. A factorial survey was conducted among 352 general practitioners with a background in internal medicine in a German-speaking region in Switzerland. Participants expressed their self-rating (SR) as well as the expected colleague-rating (CR) to provide immediate treatment to 12 fictive vignette patients. The effects of the vignette variables were analysed using random-effects models. The results show that SR as well as CR was not only influenced by the medical condition or the physicians' time pressure, but also by social factors such as the ethnicity and migration history, the residence permit status, and the economic condition of the patients. Our findings can be useful for the development of adequate, practically relevant teaching and training materials with the ultimate aim to reduce unjustified discrimination or social rationing in health care.

Reducing the health care burden for marginalised migrants: The potential role for primary care in Europe

There is a growing interest in the health of migrants worldwide. Migrants, particularly those in marginalised situations, face significant barriers and inequities in entitlement and access to high quality health care. This study aimed to explore the potential role of primary care in mitigating such barriers and identify ways in which health care policies and systems can influence the ability of primary care to meet the needs of vulnerable and marginalised migrants. The study compared routinely available country-level data on health system structure and financing, policy support for language and communication, and barriers and facilitators to health care access reported in the published literature. These were then mapped to a framework of primary care systems to identify where the key features mitigating or amplifying barriers to access lay. Reflecting on the data generated, we argue that culturally-sensitive primary care can play a key role in delivering accessible, high-quality care to migrants in vulnerable situations. Policymakers and practitioners need to appreciate that both individual patient capacity, and the way health care systems are configured and funded, can constrain access to care and have a negative impact on the quality of care that practitioners can provide to such populations. Strategies to address these issues, from the level of policy through to practice, are urgently needed.

Challenges in the provision of healthcare services for migrants: a systematic review through providers' lens

BACKGROUND

In recent years, cross-border migration has gained significant attention in high-level policy dialogues in numerous countries. While there exists some literature describing the health status of migrants, and exploring migrants' perceptions of service utilisation in receiving countries, there is still little evidence that examines the issue of health services for migrants through the lens of providers. This study therefore aims to systematically review the latest literature, which investigated perceptions and attitudes of healthcare providers in managing care for migrants, as well as examining the challenges and barriers faced in their practices.

METHODS

A systematic review was performed by gathering evidence from three main online databases: Medline, Embase and Scopus, plus a purposive search from the World Health Organization's website and grey literature sources. The articles, published in English since 2000, were reviewed according to the following topics: (1) how healthcare providers interacted with individual migrant patients, (2) how workplace factors shaped services for migrants, and (3) how the external environment, specifically laws and professional norms influenced their practices. Key message of the articles were analysed by thematic analysis.

RESULTS

Thirty seven articles were recruited for the final review. Key findings of the selected articles were synthesised and presented in the data extraction form. Quality of retrieved articles varied substantially. Almost all the selected articles had congruent findings regarding language andcultural challenges, and a lack of knowledge of a host country's health system amongst migrant patients. Most respondents expressed concerns over in-house constraints resulting from heavy workloads and the inadequacy of human resources. Professional norms strongly influenced the behaviours and attitudes of healthcare providers despite conflicting with laws that limited right to health services access for illegal migrants.

DISCUSSION

The perceptions, attitudes and practices of practitioners in the provision of healthcare services for migrants were mainly influenced by: (1) diverse cultural beliefs and language differences, (2) limited institutional capacity, in terms of time and/or resource constraints, (3) the contradiction between professional ethics and laws that limited migrants' right to health care. Nevertheless, healthcare providers addressedsuch problems by partially ignoring the immigrants'precarious legal status, and using numerous tactics, including seeking help from civil society groups, to support their clinical practice.

CONCLUSION

It was evident that healthcare providers faced several challenges in managing care for migrants, which included not only language and cultural barriers, but also resource constraints within their workplaces, and disharmony between the law and their professional norms. Further studies, which explore health care management for migrants in countries with different health insurance models, are recommended.

Challenges in the provision of healthcare services for migrants: a systematic review through providers' lens

BACKGROUND

In recent years, cross-border migration has gained significant attention in high-level policy dialogues in numerous countries. While there exists some literature describing the health status of migrants, and exploring migrants' perceptions of service utilisation in receiving countries, there is still little evidence that examines the issue of health services for migrants through the lens of providers. This study therefore aims to systematically review the latest literature, which investigated perceptions and attitudes of healthcare providers in managing care for migrants, as well as examining the challenges and barriers faced in their practices.

METHODS

A systematic review was performed by gathering evidence from three main online databases: Medline, Embase and Scopus, plus a purposive search from the World Health Organization's website and grey literature sources. The articles, published in English since 2000, were reviewed according to the following topics: (1) how healthcare providers interacted with individual migrant patients, (2) how workplace factors shaped services for migrants, and (3) how the external environment, specifically laws and professional norms influenced their practices. Key message of the articles were analysed by thematic analysis.

RESULTS

Thirty seven articles were recruited for the final review. Key findings of the selected articles were synthesised and presented in the data extraction form. Quality of retrieved articles varied substantially. Almost all the selected articles had congruent findings regarding language andcultural challenges, and a lack of knowledge of a host country's health system amongst migrant patients. Most respondents expressed concerns over in-house constraints resulting from heavy workloads and the inadequacy of human resources. Professional norms strongly influenced the behaviours and attitudes of healthcare providers despite conflicting with laws that limited right to health services access for illegal migrants.

DISCUSSION

The perceptions, attitudes and practices of practitioners in the provision of healthcare services for migrants were mainly influenced by: (1) diverse cultural beliefs and language differences, (2) limited institutional capacity, in terms of time and/or resource constraints, (3) the contradiction between professional ethics and laws that limited migrants' right to health care. Nevertheless, healthcare providers addressedsuch problems by partially ignoring the immigrants'precarious legal status, and using numerous tactics, including seeking help from civil society groups, to support their clinical practice.

CONCLUSION

It was evident that healthcare providers faced several challenges in managing care for migrants, which included not only language and cultural barriers, but also resource constraints within their workplaces, and disharmony between the law and their professional norms. Further studies, which explore health care management for migrants in countries with different health insurance models, are recommended.

Access to healthcare for undocumented migrants with communicable diseases in Germany: a quantitative study

BACKGROUND

Migrants without residence permits are de facto excluded from access to healthcare in Germany. There is one exception in relevant legislation: in the case of sexually transmitted infections and tuberculosis, the legislator has instructed the local Public Health Authorities to offer free and anonymous counseling, testing and, if necessary, treatment in case of apparent need. Furthermore, recommended vaccinations may be carried out free of charge. This study intends to comprehensively capture the services for undocumented migrants at Public Health Authorities in Germany.

METHODS

An e-mail survey of all Local Public Health Authorities (n = 384) in Germany was carried out between January and March 2011 using a standardized questionnaire.

RESULTS

One hundred thirty-nine of 384 targeted local Health Authorities completed the questionnaire (36.2%), of which approximately a quarter (n = 34) reported interaction with 'illegal' immigrants. Twenty-give authorities (18.4%) gave the indication to carry out treatment. This outpatient treatment option is mostly limited to patients afflicted with sexually transmitted infections with the distinct exception of human immunodeficiency virus/acquired immune deficiency syndrome.

CONCLUSIONS

The study highlights the gap between legislation and the reality of restricted access to medical services for undocumented migrants in Germany. It underlines the need of increased financial and human resources in Public Health Authorities and, overall, the simplification of national legislation to assure the right to healthcare.

Health and access to care for undocumented migrants living in the European Union: a scoping review

BACKGROUND

Literature on health and access to care of undocumented migrants in the European Union (EU) is limited and heterogeneous in focus and quality. Authors conducted a scoping review to identify the extent, nature and distribution of existing primary research (1990-2012), thus clarifying what is known, key gaps, and potential next steps.

METHODS

Authors used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to review identified sources. Findings were summarized thematically: (i) physical, mental and social health issues, (ii) access and barriers to care, (iii) vulnerable groups and (iv) policy and rights.

RESULTS

Fifty-four sources were included of 598 identified, with 93% (50/54) published during 2005-2012. EU member states from Eastern Europe were under-represented, particularly in single-country studies. Most study designs (52%) were qualitative. Sampling descriptions were generally poor, and sampling purposeful, with only four studies using any randomization. Demographic descriptions were far from uniform and only two studies focused on undocumented children and youth. Most (80%) included findings on health-care access, with obstacles reported at primary, secondary and tertiary levels. Major access barriers included fear, lack of awareness of rights, socioeconomics. Mental disorders appeared widespread, while obstetric needs and injuries were key reasons for seeking care. Pregnant women, children and detainees appeared most vulnerable. While EU policy supports health-care access for undocumented migrants, practices remain haphazard, with studies reporting differing interpretation and implementation of rights at regional, institutional and individual levels.

CONCLUSIONS

This scoping review is an initial attempt to describe available primary evidence on health and access to care for undocumented migrants in the European Union. It underlines the need for more and better-quality research, increased co-operation between gatekeepers, providers, researchers and policy makers, and reduced ambiguities in health-care rights and obligations for undocumented migrants.

Nurses’ experiences of encountering undocumented migrants in Swedish emergency healthcare

Purpose

– The purpose of this paper is to investigate how nurses’ working in emergency health care in Sweden experience their encounter with undocumented migrants.

Design/methodology/approach

– A total of 16 qualitative interviews were conducted and analyzed using a phenomenographic approach, aiming at describing various ways in which nurses experienced undocumentedness.

Findings

– The process of assessment involves formal regulations as well as interpersonal features, leading to uncertainty, conflicts and dilemmas when judging such situations. Nurses’ conceptions concerned the undocumented migrants’ migrant status and social existence; second, conflicts in encountering undocumentedness pertaining to an identification systems and judgments and emotional reactions; and thrid, shifts within and between arbitrary boundaries, with unclear conditions for interaction and creative maneuvering.

Research limitations/implications

– Further research is needed to develop guidelines or other structures to support nurses who deal with this kind of assessment in their daily work, to reduce ethical dilemmas and the risk of inequitable treatment.

Practical implications

– Guidelines to support nurses need to be further debated and discussed and implemented in health care education, as well as in clinical contexts.

Social implications

– Increased knowledge and awareness among nurses concerning migrants’ status and rights, might lead to better working conditions for nurses and thus more secure judgments.

Originality/value

– Research with a specific focus on emergency nurses’ conceptions of undocumentedness and their strategies for handling the ensuing practical and ethical dilemmas has not been conducted in Sweden before using a qualitative method.

Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries

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.

High attack rate for malaria through irregular migration routes to a country on verge of elimination

Irregular migration in the form of human smuggling and human trafficking is recognized as a global public health issue. Thirty-two cases of Plasmodium falciparum were detected in 534 irregular migrants returning to Sri Lanka via failed human smuggling routes from West Africa in 2012, contributing to the largest burden of imported cases in Sri Lanka as it entered elimination phase. Beyond the criminality and human rights abuse, irregular migration plays an important, but often forgotten, pathway for malaria re-introduction. Active surveillance of the growing numbers of irregular migrant flows becomes an important strategy as Sri Lanka advances towards goals of malaria elimination.

Health services and the treatment of immigrants: data on service use, interpreting services and immigrant staff members in services across Europe

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.

Mental health care for irregular migrants in Europe: barriers and how they are overcome

BACKGROUND

Irregular migrants (IMs) are exposed to a wide range of risk factors for developing mental health problems. However, little is known about whether and how they receive mental health care across European countries. The aims of this study were (1) to identify barriers to mental health care for IMs, and (2) to explore ways by which these barriers are overcome in practice.

METHODS

Data from semi-structured interviews with 25 experts in the field of mental health care for IMs in the capital cities of 14 European countries were analysed using thematic analysis.

RESULTS

Experts reported a range of barriers to mental health care for IMs. These include the absence of legal entitlements to health care in some countries or a lack of awareness of such entitlements, administrative obstacles, a shortage of culturally sensitive care, the complexity of the social needs of IMs, and their fear of being reported and deported. These barriers can be partly overcome by networks of committed professionals and supportive services. NGOs have become important initial points of contact for IMs, providing mental health care themselves or referring IMs to other suitable services. However, these services are often confronted with the ethical dilemma of either acting according to the legislation and institutional rules or providing care for humanitarian reasons, which involves the risk of acting illegally and providing care without authorisation.

CONCLUSIONS

Even in countries where access to health care is legally possible for IMs, various other barriers remain. Some of these are common to all migrants, whilst others are specific for IMs. Attempts at improving mental health care for IMs should consider barriers beyond legal entitlement, including communicating information about entitlement to mental health care professionals and patients, providing culturally sensitive care and ensuring sufficient resources.