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Baauw A, Brouwers CFS, Afshar SF, van Goudoever JB, Chinapaw MJM, Hoogsteder MHH. Perspectives of refugee parents and unaccompanied minors on initial health assessment and access to care. Eur J Pediatr 2024; 183:2871-2880. [PMID: 38589580 PMCID: PMC11192806 DOI: 10.1007/s00431-024-05523-5] [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] [Received: 01/05/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
To explore the needs, expectations, and experiences of asylum-seeking parents and unaccompanied minors under the age of 18 years on the initial health assessment for children and adolescents and access to care upon entry in the Netherlands, We conducted five semi-structured focus group discussions with asylum-seeking parents and unaccompanied minors, from Syria, Eritrea, Afghanistan, and other Middle-East and African countries, supported by professional interpreters. To triangulate findings, semi-structured interviews with health care professionals involved in care for refugee children were conducted. Transcripts of focus group discussions were inductively and deductively coded and content analyzed; transcripts of interviews were deductively coded and content analyzed. In total, 31 asylum-seeking participants: 23 parents of 101 children (between 0 and 18 years old), 8 unaccompanied minors (between 15 and 17 years), and 6 healthcare professionals participated. Parents and minors expressed that upon entry, their needs were met for vaccinations, but not for screening or care for physical and mental health problems. Parents, minors, and health professionals emphasized the necessity of appropriate information and education about health, diseases, and the health system. Cultural change was mentioned as stressful for the parent-child interaction and parental well-being. Conclusion: The perspectives of refugee parents and unaccompanied minors revealed opportunities to improve the experience of and access to health care of refugees entering the Netherlands, especially risk-specific screening and more adequate education about health, diseases, and the Dutch health care system. What is Known: • Refugees have specific health needs due to pre-flight, flight, and resettlement conditions. Health assessment upon entry was non-obligatory in the Netherlands, except for the tuberculosis screening. Health needs were not always met, and refugees experienced barriers in access to care. What is New: • The initial health assessment met the needs concerning vaccinations but mismatched the needs regarding physical and mental health assessment. Screening for specific risk-related diseases and mental health could enable refugee parents and minors to engage better with the health system.
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Affiliation(s)
- Albertine Baauw
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam UMC, Amsterdam Reproduction and Development Institute, University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands.
- Training Institute Global Health and Tropical Medicine, Dutch Society of Global Health and Tropical Medicine, Utrecht, The Netherlands.
| | - Chanine F S Brouwers
- Department Health and Society, Wageningen University and Research, Wageningen, The Netherlands
| | - Sogol Fathi Afshar
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Johannes B van Goudoever
- Amsterdam UMC, Amsterdam Reproduction and Development Institute, University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mai J M Chinapaw
- Training Institute Global Health and Tropical Medicine, Dutch Society of Global Health and Tropical Medicine, Utrecht, The Netherlands
| | - Mariëtte H H Hoogsteder
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
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Wahedi K, Zenner D, Flores S, Bozorgmehr K. Mandatory, voluntary, repetitive, or one-off post-migration follow-up for tuberculosis prevention and control: A systematic review. PLoS Med 2023; 20:e1004030. [PMID: 36719863 PMCID: PMC9888720 DOI: 10.1371/journal.pmed.1004030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/08/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Post-migration follow-up of migrants identified to be at-risk of developing tuberculosis during the initial screening is effective, but programmes vary across countries. We aimed to review main strategies applied to design follow-up programmes and analyse the effect of key programme characteristics on reported coverage (i.e., proportion of migrants screened among those eligible for screening) or yields (i.e., proportion of active tuberculosis among those identified as eligible for follow-up screening). METHODS AND FINDINGS We performed a systematic review and meta-analysis of studies reporting yields of follow-up screening programmes. Studies were included if they reported the rate of tuberculosis disease detected in international migrants through active case finding strategies and applied a post-migration follow-up (defined as one or more additional rounds of screening after finalising the initial round). For this, we retrieved all studies identified by Chan and colleagues for their systematic review (in their search until January 12, 2017) and included those reporting from active follow-up programmes. We then updated the search (from January 12, 2017 to September 30, 2022) using Medline and Embase via Ovid. Data were extracted on reported coverage, yields, and key programme characteristics, including eligible population, mode of screening, time intervals for screening, programme providers, and legal frameworks. Differences in follow-up programmes were tabulated and synthesised narratively. Meta-analyses in random effect models and exploratory analysis of subgroups showed high heterogeneity (I2 statistic > 95.0%). We hence refrained from pooling, and estimated yields and coverage with corresponding 95% confidence intervals (CIs), stratified by country, legal character (mandatory versus voluntary screening), and follow-up scheme (one-off versus repetitive screening) using forest plots for comparison and synthesis. Of 1,170 articles, 24 reports on screening programmes from 7 countries were included, with considerable variation in eligible populations, time intervals of screening, and diagnostic protocols. Coverage varied, but was higher than 60% in 15 studies, and tended to be lower in voluntary compared to compulsory programmes, and higher in studies from the United States of America, Israel, and Australia. Yield varied within and between countries and ranged between 53.05 (31.94 to 82.84) in a Dutch study and 5,927.05 (4,248.29 to 8,013.71) in a study from the United States. Of 15 estimates with narrow 95% CIs for yields, 12 were below 1,500 cases per 100,000 eligible migrants. Estimates of yields in one-off follow-up programmes tended to be higher and were surrounded by less uncertainty, compared to those in repetitive follow-up programmes. Yields in voluntary and mandatory programmes were comparable in magnitude and uncertainty. The study is limited by the heterogeneity in the design of the identified screening programmes as effectiveness, coverage and yields also depend on factors often underreported or not known, such as baseline incidence in the respective population, reactivation rate, educative and administrative processes, and consequences of not complying with obligatory measures. CONCLUSION Programme characteristics of post-migration follow-up screening for prevention and control of tuberculosis as well as coverage and yield vary considerably. Voluntary programmes appear to have similar yields compared with mandatory programmes and repetitive screening apparently did not lead to higher yields compared with one-off screening. Screening strategies should consider marginal costs for each additional round of screening.
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Affiliation(s)
- Katharina Wahedi
- Section for Health Equity Studies & Migration, Department of General Practice & Health Services Research, Heidelberg University Hospital, Marsilius-Arkaden, Heidelberg, Germany
| | - Dominik Zenner
- Clinical Reader in Infectious Disease Epidemiology, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Sergio Flores
- Department of Public Healthy and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden
| | - Kayvan Bozorgmehr
- Section for Health Equity Studies & Migration, Department of General Practice & Health Services Research, Heidelberg University Hospital, Marsilius-Arkaden, Heidelberg, Germany
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Germany, Bielefeld, Germany
- * E-mail:
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Kullamaa L, Reile R. Socio-demographic and regional differences in unmet healthcare needs among migrants in Europe. PLoS One 2023; 18:e0285886. [PMID: 37200280 DOI: 10.1371/journal.pone.0285886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/12/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Different barriers that hinder migrants' access to healthcare may have detrimental effect on health but also contribute to health inequalities. Given the lack of evidence on unmet healthcare needs among European migrant population, the study aimed to analyse the demographic, socio-economic and health-related patterning of unmet healthcare needs among migrants in Europe. METHODS European Health Interview Survey data from 2013-2015 covering 26 countries was used to analyse associations of individual-level factors and unmet healthcare needs among migrants (n = 12,817). Prevalences and 95% confidence intervals for unmet healthcare needs were presented for geographical regions and countries. Associations between unmet healthcare needs and demographic, socio-economic, and health indicators were analysed using Poisson regression models. RESULTS The overall prevalence of unmet healthcare needs among migrants was 27.8% (95% CI 27.1-28.6) but the estimate varied substantially across geographical regions in Europe. Unmet healthcare needs due to cost or access were patterned by various demographic, socio-economic, and health-related indicators but higher prevalence of UHN were universally found for women, those with the lowest income, and poor health. CONCLUSIONS While the high level of unmet healthcare needs illustrate migrants' vulnerability to health risks, the regional variations in the prevalence estimates and individual-level predictors highlight the variations in national policies regarding migration and healthcare legislations and differences in welfare-systems across Europe in general.
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Affiliation(s)
- Lembe Kullamaa
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Rainer Reile
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
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Moonen CPB, den Heijer CDJ, Dukers-Muijrers NHTM, van Dreumel R, Steins SCJ, Hoebe CJPA. A systematic review of barriers and facilitators for hepatitis B and C screening among migrants in the EU/EEA region. Front Public Health 2023; 11:1118227. [PMID: 36875381 PMCID: PMC9975596 DOI: 10.3389/fpubh.2023.1118227] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction Hepatitis B and C are a threat to public health. Screening of high-risk groups, such as migrants from high-endemic areas, enables early identification and treatment initiation. This systematic review identified barriers and facilitators for hepatitis B and C screening among migrants in the European Union/European Economic Area (EU/EEA). Methods Following PRISMA guidelines, databases PubMed, Embase via Ovid, and Cochrane were searched for English articles published between 1 July 2015 and 24 February 2022. Articles were included, not restricted to a specific study design, if they elaborated on HBV or HCV screening in migrant populations from countries outside Western Europe, North America, and Oceania, and residing in EU/EEA countries. Excluded were studies with solely an epidemiological or microbiological focus, including only general populations or non-migrant subgroups, or conducted outside the EU/EEA, without qualitative, quantitative, or mixed methods. Data appraisal, extraction, and quality assessment were conducted and assessed by two reviewers. Barriers and facilitators were categorized into seven levels based on multiple theoretical frameworks and included factors related to guidelines, the individual health professional, the migrant and community, interaction, the organization and economics, the political and legal level, and innovations. Results The search strategy yielded 2,115 unique articles of which 68 were included. Major identified barriers and facilitators to the success of screening related to the migrant (knowledge and awareness) and community level (culture, religion, support) and the organizational and economic level (capacity, resources, coordinated structures). Given possible language barriers, language support and migrant sensitivity are indispensable for facilitating interaction. Rapid point-of-care-testing is a promising strategy to lower screening barriers. Discussion The inclusion of multiple study designs provided extensive insight into barriers, strategies to lower these barriers, and facilitators to maximize the success of screening. A great variety of factors were revealed on multiple levels, therefore there is no one-size-fits-all approach for screening, and initiatives should be adopted for the targeted group(s), including tailoring to cultural and religious beliefs. We provide a checklist of facilitators and barriers to inform adapted interventions to allow for optimal screening impact.
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Affiliation(s)
- Chrissy P B Moonen
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Casper D J den Heijer
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Nicole H T M Dukers-Muijrers
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Ragni van Dreumel
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
| | - Sabine C J Steins
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
| | - Christian J P A Hoebe
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
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5
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Nkulu-Kalengayi FK, Ouma AA, Hurtig AK. 'HIV ended up in second place' - prioritizing social integration in the shadow of social exclusion: an interview study with migrants living with HIV in Sweden. Int J Equity Health 2022; 21:175. [PMID: 36471317 PMCID: PMC9724319 DOI: 10.1186/s12939-022-01783-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Migrants are overrepresented among people living with HIV in Sweden as they often face conditions that increased their risk and vulnerability for HIV/STI infections prior, during or after migration. Yet, there is limited research on their experiences and perceptions of living with HIV in the Swedish context. This study aims to explore migrants' experiences of living with HIV in Sweden. METHODS This is a qualitative study based on in-depth interviews with 13 migrants from 11 countries living with HIV in Sweden. Interviews were analysed with thematic analysis using an intersectional perspective to explore the interactions of multiple social identities such as ethnicity, socio-economic status, gender, age, and sexual orientation that shape an individual's or group's experiences. RESULTS The analysis resulted in a main theme: 'Prioritizing social integration-HIV ends up in second place', which is based on four subthemes: 'Better opportunities in the new country than what the home country could offer', 'Better conditions for LGBTQI people than in the home country', 'Navigating a new system: linguistic and bureaucratic challenges' and 'Feeling like a second-class resident: racism, xenophobia and multiple discrimination'. The results suggest that migrants living with HIV in Sweden experience social integration as a greater challenge than HIV infection. Although the new country offers opportunities for better living conditions, many participants described being challenged in their daily life by linguistic and structural barriers in their encounters with public services. They are facing multiple discrimination simultaneously as migrants due to their multiple and intersecting identities (e.g. being non-white, foreigners/foreign-born and non-Swedish speakers), which is compounded by HIV status and thus limit their opportunities in the new country and too often result in an existence of exclusion. CONCLUSION The study shows that most of the challenges that migrants living with HIV face are related to their status as migrants rather than HIV status, which is often not known by the public or authorities. These challenges are similar, but still differ depending on social position, previous experiences, time since arrival and since diagnosis. This emphasizes the importance of both intersectional, intersectoral and multisectoral approaches to address reported issues.
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Affiliation(s)
| | - Anne Adhiambo Ouma
- grid.12650.300000 0001 1034 3451Department of Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden
| | - Anna-Karin Hurtig
- grid.12650.300000 0001 1034 3451Department of Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden
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6
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Pfeil J, Bialek R, Heininger U, Liese J, Simon A, Stich A, Assaad K, von Both U, Janda A, Kitz C, Kobbe R, Kunze M, Lindert J, Ritz N, Trapp S, Fressle R, Hufnagel M. Aktualisierte Empfehlungen zur infektiologischen Versorgung von Flüchtlingen im Kindes- und Jugendalter in Deutschland (Stand 30. März 2022), angemeldet als S1-Leitlinie (AWMF-Register Nr. 048-017). Monatsschr Kinderheilkd 2022; 170:632-647. [PMID: 35645410 PMCID: PMC9130691 DOI: 10.1007/s00112-022-01499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/08/2022]
Abstract
Hintergrund Mit etwa 190.000 Asylanträgen im Jahr 2021 ist Deutschland das wichtigste Aufnahmeland von Asylsuchenden in Europa. Die vorliegenden Handlungsempfehlungen sollen eine Grundlage für eine evidenzbasierte und zielgerichtete infektiologische Versorgung minderjähriger Flüchtlinge schaffen. Ziele Die Handlungsempfehlungen sollen medizinisches Personal in der Versorgung minderjähriger Flüchtlinge unterstützen, um 1. einen unvollständigen Impfschutz frühzeitig zu erkennen und zu vervollständigen; 2. übliche Infektionskrankheiten zu diagnostizieren und zu behandeln; 3. in Deutschland seltene Infektionskrankheiten frühzeitig zu erkennen und zu therapieren. Material und Methoden Die Handlungsempfehlungen wurden als AWMF-Leitlinie Stufe 1 verfasst. Entsprechend wurden die Empfehlungen durch eine repräsentativ zusammengesetzte Expertengruppe der beteiligten Fachgesellschaften im informellen Konsens erarbeitet und final von den Vorständen der Fachgesellschaften offiziell verabschiedet. Ergebnisse Es werden Empfehlungen ausgesprochen, für den Umfang der Anamnese und der körperlichen Untersuchung minderjähriger Flüchtlinge. Für alle minderjährigen Flüchtlinge werden die Bestimmung eines Differenzialblutbildes sowie Untersuchungen auf Tuberkulose und Hepatitis B empfohlen. Je nach Herkunft und Alter werden weitere gezielte Untersuchungen z. B. auf Hepatitis C, HIV oder Schistosomiasis empfohlen. Zur raschen Vervollständigung des Impfstatus wird eine alters- und indikationsbezogene Priorisierung einzelner Impfungen vorgenommen. Diskussion Angesichts anhaltend hoher Flüchtlingszahlen ist eine weitere Professionalisierung der medizinischen Versorgung minderjähriger Flüchtlinge notwendig. Hierzu sollten die notwendigen strukturellen und personellen Rahmenbedingungen geschaffen werden.
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7
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Tirado V, Engberg S, Holmblad IS, Strömdahl S, Ekström AM, Hurtig AK. "One-time interventions, it doesn't lead to much" - healthcare provider views to improving sexual and reproductive health services for young migrants in Sweden. BMC Health Serv Res 2022; 22:668. [PMID: 35585585 PMCID: PMC9115984 DOI: 10.1186/s12913-022-07945-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Sexual and reproductive health and rights (SRHR) is an important aspect for young people. In Sweden, young migrants often encounter barriers to accessing and using sexual and reproductive health (SRH) services, despite that these services are free of charge for young people (ages 15–25). Healthcare providers’ views and best practices are of great importance for improving the utilisation of existing SRH services, particularly for young people. This study aims to understand healthcare providers’ experiences and perspectives on barriers to SRHR among young migrants and their suggestions for strategies to improve the provision of SRH services to this group. Methods Midwives, counsellors and nurses with at least five years of professional experience within SRHR were reached through a purposeful sample at primary care clinics, specialised clinics and youth-friendly clinics, which provide SRH services to migrant youths in Stockholm. Twelve interviews were conducted from May 2018 to February 2020. Qualitative content analysis was performed. Results The analysis identified one theme: Improving the fragmentation in the SRH services, and four sub-themes: 1. Being unaware of SRHR; 2. Creating trust and responsive interactions; 3. Communicating in the same language; and 4. Collaborating to build bridges. The barriers included distrust in the healthcare system, socio-cultural norms surrounding SRHR, incomplete translations, and a need for long-lasting collaboration with SRH services and other range of services for migrants. The strategies for improvement as suggested by participants included involving existing cultural groups and organisations to enable trust, consistent and dependable interpreters, a streamline of SRH services with other healthcare staff and health facilities, and collaborations with homes designated for young migrants and language schools for a direct linkage to service providers. Conclusions Findings indicate that there are fragmentations in SRH services, and these include lack of knowledge about SRHR among migrant youth, language and communication barriers, and a lack of structure needed to build dependable services that go beyond one-time interventions. While initiatives and strategies from healthcare providers for improvement of SRH services exist, the implementation of some strategies may also require involving the regional and national decision-makers and multi-stakeholders like communities, civil society and young migrants themselves.
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Affiliation(s)
- Veronika Tirado
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Siri Engberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Susanne Strömdahl
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Anna Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Titze L, Gros J, Büsselmann M, Lutz M, Streb J, Dudeck M. Immigrant Patients Adapt to the Culture of Admission and Experience Less Safety in Forensic Psychiatric Care. Front Psychol 2021; 12:701544. [PMID: 34381403 PMCID: PMC8350120 DOI: 10.3389/fpsyg.2021.701544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with an immigrant background are overrepresented in forensic psychiatric hospitals. As a result, daily work is impeded by language barriers and cultural differences. Furthermore, general therapy processes have not yet been adapted to this special patient population, and little reliable knowledge is available. All immigrants go through an acculturation process, which is related to their mental well-being. Four acculturation strategies exist: integration, separation, assimilation, and marginalization. The strategy chosen depends on the extent of someone's orientation toward their country of origin and the country of admission. The current study aimed to expand knowledge of forensic patients with a migration background in Germany by evaluating their self-reported acculturation processes and associated individual and social factors, e.g., the ward climate. Therefore, we studied forensic patients with a migration background from 11 forensic hospitals in Bavaria, Germany. Besides completing the Frankfurter Acculturation Scale (FRACC) and Essen Climate Evaluation Schema (EssenCES), the participants provided information on their clinical and biographical history. We recruited 235 patients with a migration background and found that the participants oriented themselves more toward the culture of admission and less toward the country of origin than the reference sample did. Moreover, the patients experienced significantly less safety on the ward than the forensic reference sample did. A possible explanation for the patients' orientation is the lack of possibilities to adhere to their cultural traditions. Patients may feel less safe because of their limited knowledge of German and cultural misunderstandings.
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Affiliation(s)
- Larissa Titze
- Department of Forensic Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Julia Gros
- Department of Forensic Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Michael Büsselmann
- Department of Forensic Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Maximilian Lutz
- Department of Forensic Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Judith Streb
- Department of Forensic Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
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Barra M, Broqvist M, Gustavsson E, Henriksson M, Juth N, Sandman L, Solberg CT. Severity as a Priority Setting Criterion: Setting a Challenging Research Agenda. HEALTH CARE ANALYSIS 2020; 28:25-44. [PMID: 31119609 PMCID: PMC7045747 DOI: 10.1007/s10728-019-00371-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda.
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Affiliation(s)
- Mathias Barra
- The Health Services Research Unit - HØKH, Akershus University Hospital, Sykehusveien 25, Postboks 1000, 1473, Lørenskog, Norway.
| | - Mari Broqvist
- Department of Medical and Health Sciences, The National Centre for Priorities in Health, Linköping University, Linköping, Sweden
| | - Erik Gustavsson
- Department of Culture and Communication, Centre for Applied Ethics, Linköping University, Linköping, Sweden.,Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Martin Henriksson
- Department of Medical and Health Sciences, Center for Medical Technology Assessment, Linköping University, Linköping, Sweden
| | - Niklas Juth
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Solna, Sweden
| | - Lars Sandman
- Department of Medical and Health Sciences, The National Centre for Priorities in Health, Linköping University, Linköping, Sweden
| | - Carl Tollef Solberg
- The Health Services Research Unit - HØKH, Akershus University Hospital, Sykehusveien 25, Postboks 1000, 1473, Lørenskog, Norway.,Global Health Priorities, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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10
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Duracinsky M, Thonon F, Bun S, Ben Nasr I, Dara AF, Lakhdari S, Coblentz-Baumann L, Lert F, Dimi S, Chassany O. Good acceptability of HIV, HBV, and HCV screening during immigration medical check-up amongst migrants in France in the STRADA study. PLoS One 2020; 15:e0235260. [PMID: 32589652 PMCID: PMC7319329 DOI: 10.1371/journal.pone.0235260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/11/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction The prevalence of HIV, hepatitis B, and hepatitis C amongst migrants in France is high. Thus, effective screening and follow-up is needed. The mandatory medical check-up for residency application is an opportunity to offer rapid HIV and hepatitis testing. The main objective of the STRADA study is to create a feasible and acceptable screening strategy for migrants. Within the STRADA study, this qualitative research examined the acceptability of conducting screening tests in the context of residency application. Methods We conducted a qualitative study amongst legal migrants over 18 years of age with sufficient knowledge of the French, English, or Arabic language. Interviews were performed following a semi-structured interview guide of open-ended questions. Interviews were transcribed verbatim and subsequently analyzed through thematic analysis. Results We interviewed 34 migrants. Mean age was 32.6 (min-max: 19, 59) years. The participants’ region of origin was mostly Sub-Saharan Africa and the main reason for migrating to France was family reunification. Migrants' acceptability of HIV and hepatitis testing was high. Participants who accepted testing indicated a benefit for individual health and to avoid transmission. Most preferred rapid tests; reluctance was related to anxiety about the immediate results and the perceived reliability of rapid tests. Migrants' knowledge about HIV was satisfactory, but inadequate for hepatitis. Screening in the context of a compulsory medical visit did not present an obstacle for acceptability. Some expressed concern in the case of HIV but when explained, the independence between obtaining the residence permit along with screening and access to medical care was well understood. Discussion Medical check-ups at immigration centers is an opportunity to screen for HIV and hepatitis which is considered acceptable by migrants. Informing migrants that test results do not affect residency applications, and incorporating their preferences, are all important to optimize the acceptability of screening.
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Affiliation(s)
- Martin Duracinsky
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
- Hôpital Bicêtre, Service d’infectiologie, Le Kremlin Bicêtre, France
- AP-HP, hôpital Hôtel-Dieu, Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Paris, France
- * E-mail:
| | - Frédérique Thonon
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Sonia Bun
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Imène Ben Nasr
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Aïchata Fofana Dara
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Sabrina Lakhdari
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | | | - France Lert
- Agence nationale de recherche sur le sida et les hépatites virales (ANRS), Paris, France
| | - Svetlane Dimi
- Hôpital Foch, Service d’Hépatologie, Suresnes, France
| | - Olivier Chassany
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
- AP-HP, hôpital Hôtel-Dieu, Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Paris, France
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11
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Berbyuk Lindström N, Rodríguez Pozo R. Perspectives of Nurses and Doulas on the Use of Information and Communication Technology in Intercultural Pediatric Care: Qualitative Pilot Study. JMIR Pediatr Parent 2020; 3:e16545. [PMID: 32181748 PMCID: PMC7109617 DOI: 10.2196/16545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/09/2020] [Accepted: 01/27/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sweden is rapidly becoming an increasingly multicultural and digitalized society. Encounters between pediatric nurses and migrant mothers, who are often primary caregivers, are impeded by language problems and cultural differences. To support mothers, doulas, who are women having the same linguistic and cultural backgrounds, serve as cultural bridges in interactions with health care professionals. In addition, information and communication technology (ICT) can potentially be used to manage interactions owing to its accessibility. OBJECTIVE The objective of this study was to investigate the role of ICT in managing communicative challenges related to language problems and cultural differences in encounters with migrant mothers from the perspectives of Swedish pediatric nurses and doulas. METHODS Deep semistructured interviews with five pediatric nurses and four doulas from a migrant-dense urban area in western Sweden were audio recorded, transcribed, and analyzed using thematic content analysis. RESULTS The results showed that ICT contributes to mitigating communicative challenges in interactions by providing opportunities for nurses and migrant mothers to receive distance interpreting via telephones and to themselves interpret using language translation apps. Using images and films from the internet is especially beneficial while discussing complex and culturally sensitive issues to complement or substitute verbal messages. These findings suggest that ICT helps enable migrant mothers to play a more active role in interactions with health care professionals. This has important implications for their involvement in other areas, such as child care, language learning, and integration in Sweden. CONCLUSIONS The findings of this study suggest that ICT can be a bridging tool between health care professionals and migrants. The advantages and disadvantages of translation tools should be discussed to ensure that quality communication occurs in health care interactions and that health information is accessible. This study also suggests the development of targeted multimodal digital support, including pictorial and video resources, for pediatric care services.
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12
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Louka C, Chandler E, Ranchor AV, Broer H, Pournaras S, Ravensbergen SJ, Stienstra Y. Asylum seekers' perspectives on vaccination and screening policies after their arrival in Greece and The Netherlands. PLoS One 2019; 14:e0226948. [PMID: 31877563 PMCID: PMC6932865 DOI: 10.1371/journal.pone.0226948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 12/10/2019] [Indexed: 01/07/2023] Open
Abstract
Introduction Europe has been dealing with an increasing number of refugees during the past 5 years. The timing of screening and vaccination of refugees is debated by many professionals, however refugees’ perspectives on health issues are infrequently taken into account. In this study, we aimed to investigate asylum seekers’ perspectives on infectious diseases screening and vaccination policies. Materials and methods Interviews were conducted in Greece and the Netherlands. Asylum seekers and recently arrived refugees were approached and informed with the help of interpreters; consent forms were acquired. The survey focused on demographic data, vaccination status, screening policies and prevention of infectious diseases. Results A total of 61 (43 male, 70.5%) refugees (30 Afghanis, 16 Syrian, 7 Erithrean) were interviewed. Mean age was 35.2 years (SD 13.5) and 50% had received primary or secondary education, while 24.6% received none. Median time after arrival in Greece and the Netherlands was 24 months (IQR 8.5–28). 44 out of 61 (72.1) participants were willing to be vaccinated after arrival in Europe, 26 preferred vaccination and screening to be performed at the point of entry. The need for screening and vaccination was perceived higher amongst participants in Greece (100% vs 43.3%) due to living conditions leading to increased risk of outbreaks. Conclusion Participants were willing to communicate their perspectives and concerns. Screening and vaccination programs could be more effective when implemented shortly after arrival and by involving asylum seekers and refugees when developing screening and vaccination interventions.
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Affiliation(s)
- Christina Louka
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- ESCMID study group for infections in travelers and migrants, Basel, Switzerland
- * E-mail:
| | - Elizabeth Chandler
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Adelita V. Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Spyros Pournaras
- Laboratory of Clinical Microbiology, ‘ATTIKON’ University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofanne J. Ravensbergen
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- ESCMID study group for infections in travelers and migrants, Basel, Switzerland
| | - Ymkje Stienstra
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- ESCMID study group for infections in travelers and migrants, Basel, Switzerland
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13
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Barghadouch A, Skovdal M, Norredam M. Do health reception policies in the Nordic region recognize the rights of asylum-seeking and resettled refugee children? Health Policy 2019; 123:1173-1184. [PMID: 31629550 DOI: 10.1016/j.healthpol.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
According to the United Nations Committee on the Rights of the Child, it is critical that refugee children's rights are upheld in all national policies covering vulnerable children. This article examines how health policies in the Nordic region recognize the health needs of newly arrived refugee children, and whether these policies respect their individual rights. The article maps out, compares and contrasts health reception policies in Denmark, Finland, Norway and Sweden, paying particular attention to how each addresses the rights and needs of refugee children. The policy documents were obtained through desk-research conducted from January 2017-January 2018. We analysed 34 national laws and guidelines that support the health reception of refugee children. We find that only a few health reception policies across the Nordic region have been written specifically for refugee children. The policies identified predominantly recognize refugee children's right of access to somatic healthcare services, and to emergency services. Their rights to mental health services or broader health-enabling contexts were addressed to a lesser extent. We conclude that there is a need for further recognition of refugee children as rights-holders, and for the intentions of health reception policies to be expanded to include mental health services and health-promoting initiatives. Further research is needed on whether and how the current policies play out in actual health reception practices.
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Affiliation(s)
- Amina Barghadouch
- Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark.
| | - Morten Skovdal
- Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark
| | - Marie Norredam
- Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark
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14
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Wångdahl J, Westerling R, Lytsy P, Mårtensson L. Perspectives on health examination for asylum seekers in relation to health literacy - focus group discussions with Arabic and Somali speaking participants. BMC Health Serv Res 2019; 19:676. [PMID: 31533817 PMCID: PMC6751618 DOI: 10.1186/s12913-019-4484-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 08/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asylum seekers coming to most countries are offered a specific health examination. A previous study concluded that a considerable proportion of those taking part of it in Sweden had poor experiences of the communication in and the usefulness of this examination and had poor health literacy. The aim of this study was to explore in greater depth the experiences of the health examination for asylum seekers among Arabic- and Somali-speaking participants in Sweden. A secondary aim was to examine experiences and discuss findings using a health literacy framework. METHODS Seven focus group discussions were conducted with 28 Arabic and Somali speaking men and women that participated in a health examination for asylum seekers. Data were analyzed by latent content analysis. RESULTS One overarching theme - beneficial and detrimental - was found to represent the participants' experiences of the health examination for asylum seekers. Three categories were identified that deal with those experiences. The category of "gives some good" describes the examination as something that "gives support and relief" and "cares on a personal level." The category of "causes feelings of insecurity" describes the examination as something that "lacks clarity" and that "does not give protection." The category "causes feelings of disappointment" views the examination as something that "does not fulfil the image of a health examination" and "does not focus on the individual level." CONCLUSION The health examination for asylum seekers was experienced as beneficial and detrimental at the same time. The feelings were influenced by the experiences of information and communication before, during and after the examination and on how health literate the organizations providing the HEA are. To achieve more satisfied participants, it is crucial that all organizations providing the HEA become health literate and person-centered.
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Affiliation(s)
- Josefin Wångdahl
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala Science Park, Box 564, 751 22, Uppsala, Sweden.
| | - Ragnar Westerling
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala Science Park, Box 564, 751 22, Uppsala, Sweden
| | - Per Lytsy
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala Science Park, Box 564, 751 22, Uppsala, Sweden
| | - Lena Mårtensson
- Institution of Department of Neuroscience and Physiology/Occupational Therapy, University of Gothenburg, Box 455, 405 30, Göteborg, SE, Sweden
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15
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Gürbüz B, Großkreutz C, Vortel M, Borde T, Rancourt RC, Stepan H, Sauzet O, Henrich W, David M, Seidel V. The influence of migration on women's satisfaction during pregnancy and birth: results of a comparative prospective study with the Migrant Friendly Maternity Care Questionnaire (MFMCQ). Arch Gynecol Obstet 2019; 300:555-567. [PMID: 31267197 DOI: 10.1007/s00404-019-05227-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/19/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Approximately 21% of Germany's inhabitants have been born abroad or are of direct descent of immigrants. A positive birth experience has an effect on a woman's mental health and her future family planning choices. While international studies showed that immigrant women are less satisfied with their birth experience, no such study has been conducted in Germany until now. METHODS At our center of tertiary care in Berlin, with approximately 50% immigrants among patients, pregnant women of at least 18 years of age were offered participation in this study. A modified version of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) designed by Gagnon et al. in German, English, French, Spanish, Arabic and Turkish was used. We compared non-immigrant women to immigrant women and women with direct descent of immigrants. For certain analysis, the latter two groups were included together under the category "migration background". RESULTS During the study period, 184 non-immigrant, 214 immigrant women and 62 direct descendants of immigrants were included. The most frequent countries of origin were Syria (19%), Turkey (17%), and Lebanon (9%). We found a slight difference between groups regarding age (non-immigrants: mean 33 years versus women with any migration background: mean 31) as well as parity with more non-immigrants delivering their first child. No difference in the satisfaction with care was observed between immigrant and any migration background groups (p ≥ 0.093 in the two-sided Fisher's exact test). At least 75.8% of all participating women reported complete satisfaction with care during labor, birth and after birth. Interestingly, the level of German language proficiency did not influence the immigrant patient's satisfaction with care. CONCLUSION The study results show no difference regarding overall satisfaction with care during labor and birth despite a relevant language barrier. We are for the first time providing the MFMCQ in German and Turkish. Further future analyses on the impact of patient expectations on satisfaction with care will be conducted.
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Affiliation(s)
- B Gürbüz
- Clinic of Obstetrics, Universitätsklinikum Leipzig, Leipzig, Germany
| | - C Großkreutz
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin,, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Vortel
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin,, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - T Borde
- Alice Salomon Hochschule, Berlin, Germany
| | - R C Rancourt
- Division of 'Experimental Obstetrics', Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Berlin, Germany
| | - H Stepan
- Clinic of Obstetrics, Universitätsklinikum Leipzig, Leipzig, Germany
| | - O Sauzet
- Bielefeld School of Public Health and Centre for Statistics, Bielefeld University, Bielefeld, Germany
| | - W Henrich
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin,, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M David
- Clinic of Gynecology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - V Seidel
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin,, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany.
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16
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Aldin A, Chakraverty D, Baumeister A, Monsef I, Noyes J, Jakob T, Seven ÜS, Anapa G, Woopen C, Kalbe E, Skoetz N. Gender differences in health literacy of migrants: a synthesis of qualitative evidence. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2019. [DOI: 10.1002/14651858.cd013302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Angela Aldin
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological Malignancies; University of Cologne; Kerpener Str. 62 Cologne Germany
| | - Digo Chakraverty
- University of Cologne, Faculty of Medicine and University Hospital Cologne; Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI); Kerpenerstr. 62 Cologne NRW Germany 50937
| | - Annika Baumeister
- University of Cologne, Faculty of Medicine and University Hospital Cologne; Research Unit Ethics, Institute for the History of Medicine and Medical Ethics; Kerpener Str. 62 Cologne NRW Germany 50937
- University of Cologne; Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES); Cologne Germany
| | - Ina Monsef
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological Malignancies; University of Cologne; Kerpener Str. 62 Cologne Germany
| | - Jane Noyes
- Bangor University; Centre for Health-Related Research, Fron Heulog; Bangor Wales UK LL57 2EF
| | - Tina Jakob
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological Malignancies; University of Cologne; Kerpener Str. 62 Cologne Germany
| | - Ümran Sema Seven
- University of Cologne, Faculty of Medicine and University Hospital Cologne; Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI); Kerpenerstr. 62 Cologne NRW Germany 50937
| | - Görkem Anapa
- University of Cologne, Faculty of Medicine and University Hospital Cologne; Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI); Kerpenerstr. 62 Cologne NRW Germany 50937
| | - Christiane Woopen
- University of Cologne, Faculty of Medicine and University Hospital Cologne; Research Unit Ethics, Institute for the History of Medicine and Medical Ethics; Kerpener Str. 62 Cologne NRW Germany 50937
- University of Cologne; Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES); Cologne Germany
| | - Elke Kalbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne; Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI); Kerpenerstr. 62 Cologne NRW Germany 50937
| | - Nicole Skoetz
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Cancer; University of Cologne; Kerpener Str. 62 Cologne Germany 50937
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17
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Shedrawy J, Lönnroth K, Kulane A. 'Valuable but incomplete!' A qualitative study about migrants' perspective on health examinations in Stockholm. Int Health 2019; 10:191-196. [PMID: 29474639 DOI: 10.1093/inthealth/ihy007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/19/2018] [Indexed: 11/14/2022] Open
Abstract
Background A voluntary health examination is offered to asylum seekers in Sweden with the purpose of detecting infectious diseases and identifying other health needs. This study aimed to explore the organization, content and perceived value of the health examination from the perspective of asylum seekers. Methods Semi-structured interviews were conducted with 18 migrants recruited from different settings in Stockholm. Data were transcribed verbatim and analysed using thematic analysis in relation to the availability, accessibility, acceptability and quality framework. Results Participants reported positive aspects of the health examination while raising important concerns, categorized into the following themes: availability-despite being available, the service was considered to be delayed with perceived implication for infection control; accessibility-migrants experienced no physical or economic barrier to access the health examination, especially when it was performed through a mobile clinic, however, they had limited access to information; acceptability and quality-migrants trusted the health staff, however, the examination lacked important aspects related to mental health and dental care needs, among other health needs. Conclusion Health examinations are valued by participants but failed to identify and address many perceived health needs. Mobile clinics seem a practical strategy to improve accessibility.
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Affiliation(s)
- Jad Shedrawy
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
| | - Knut Lönnroth
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Asli Kulane
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
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18
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Delilovic S, Kulane A, Åsbring N, Marttila A, Lönnroth K. What value for whom? - provider perspectives on health examinations for asylum seekers in Stockholm, Sweden. BMC Health Serv Res 2018; 18:601. [PMID: 30075782 PMCID: PMC6091028 DOI: 10.1186/s12913-018-3422-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 07/26/2018] [Indexed: 11/29/2022] Open
Abstract
Background In Sweden asylum seekers are offered a voluntary health examination, free-of-charge (HE). The HE coverage is low. The organization and implementation of the HE involves collaboration between different agencies with different roles within the provision of health information and service. This study aimed to assess their perspectives on the barriers and facilitators regarding implementation of the HE, as well as on the purpose, content and value of the HE. Method Thematic analysis of focus groups, individual and group interviews conducted between 2016 and 17 with 41 participants from various authorities and healthcare professionals involved in the delivery of HE in Stockholm. Results Suggestions were taken from interviewees of how to facilitate the uptake and delivery of HE through improved outreach to the target group with better collaboration, coordination and continuity between authorities. Apart from control of specific communicable diseases, the perceived ultimate goal of HE varied and was often vaguely formulated. Respondents desired better monitoring to assess the effects of HE and predict needs among asylum seekers. This included standardized procedures to promote equitable health care access and more explicit inclusion of mental health and other health dimensions in the HE. Conclusion There are several possible avenues for improving HE coverage and uptake. However, ambiguity exists concerning the benefits of such efforts given the uncertainty of the value of HE. Lack of available data on health status, determinants of health and impact of HE among asylum seekers emerged as barriers preventing optimal approaches for the assessment of health needs. Implementation of standardized guidelines, procedures and documentation would aid the understanding. A more holistic approach beyond infectious diseases is necessary. This would only be useful if there is value in screening for such conditions. More research is required to assess the effectiveness and cost-effectiveness of HE and related screening policies in Sweden. Electronic supplementary material The online version of this article (10.1186/s12913-018-3422-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sara Delilovic
- Department of Public Health Sciences (PHS), Social medicine, Infectious Diseases and Migration Research Group, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Stockholm County Council Health Service, Box 6909, 102 39, Stockholm, Sweden.
| | - Asli Kulane
- Department of Public Health Sciences (PHS), Social medicine, Infectious Diseases and Migration Research Group, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Nina Åsbring
- Stockholm County Council Health Service, Box 6909, 102 39, Stockholm, Sweden
| | - Anneli Marttila
- Department of Public Health Sciences (PHS), Social medicine, Infectious Diseases and Migration Research Group, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Knut Lönnroth
- Department of Public Health Sciences (PHS), Social medicine, Infectious Diseases and Migration Research Group, Karolinska Institutet, 171 77, Stockholm, Sweden.,Stockholm County Council Health Service, Box 6909, 102 39, Stockholm, Sweden
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19
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Barkensjö M, Greenbrook JTV, Rosenlundh J, Ascher H, Elden H. The need for trust and safety inducing encounters: a qualitative exploration of women's experiences of seeking perinatal care when living as undocumented migrants in Sweden. BMC Pregnancy Childbirth 2018; 18:217. [PMID: 29879940 PMCID: PMC5992748 DOI: 10.1186/s12884-018-1851-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 05/25/2018] [Indexed: 12/03/2022] Open
Abstract
Background Studies from around the world have shown that women living as undocumented migrants have limited and deficient access to perinatal care, increasing their risks of both physical and psychological complications during pregnancy and childbirth. Failures to provide equal access to healthcare have been criticized extensively by the United Nations. In 2013, undocumented migrants’ rights to healthcare in Sweden were expanded to include full access to perinatal care. Research surrounding clinical encounters involving women living as undocumented migrants remains largely lacking. The present study aimed to provide a composite description of women’s experiences of clinical encounters throughout pregnancy and childbirth, when living as undocumented migrants in Sweden. Methods Taking an inductive approach, qualitative content analysis was implemented. Thirteen women from ten different countries were interviewed. Meaning-units were extracted from the data collected in order to identify emergent overarching themes. Results In clinical encounters where healthcare professionals displayed empathic concern and listening behaviours, women felt empowered, acknowledged, and encouraged, leading them to trust clinicians, diminishing fears relating to seeking healthcare services. Conversely, when neglectful behaviour on part of healthcare professionals was perceived in encounters, anxiousness and fear intensified. Vulnerability and distress induced by the women’s uncertain living circumstances were apparent across themes, and appeared exacerbated by traumatic memories, difficulties in coping with motherhood, and fears of deportation. Conclusion The present study contributes unique and important knowledge surrounding women’s experience of being pregnant and giving birth when living as undocumented migrants. The overarching findings indicated that the needs of undocumented migrant women were largely similar to those of all expectant mothers, but that due to vulnerabilities relating to their circumstances, flexible and informed care provision is essential. Being knowledgeable on undocumented migrants’ rights to healthcare is vital, as clinical encounters appeared highly consequential to the women’s well-being and help-seeking behaviours. Negative encounters inflicted emotional distress and fear. Contrastingly, positive encounters promoted trust in clinicians, personal empowerment, and relief. Positive clinical encounters could provide rare opportunities to assist an otherwise elusive population at increased risk for both physical and psychological complications, highlighting the crucial need for adherence to ethical principles in clinical practice.
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Affiliation(s)
- My Barkensjö
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30, Gothenburg, Sweden.
| | - Josephine T V Greenbrook
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30, Gothenburg, Sweden.,School of Psychology, Institute of Psychology, Health, and Society, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.,School of Law, University of Edinburgh, Old College, South Bridge, Edinburgh, Scotland, EH8 9YL, UK
| | - Josefine Rosenlundh
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30, Gothenburg, Sweden
| | - Henry Ascher
- Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 16A, Box 414, 405 30 Gothenburg, Sweden.,Department of Research and Development, Angered Hospital, Gothenburg, Sweden
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30, Gothenburg, Sweden
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Beeres DT, Cornish D, Vonk M, Ravensbergen SJ, Maeckelberghe ELM, Boele Van Hensbroek P, Stienstra Y. Screening for infectious diseases of asylum seekers upon arrival: the necessity of the moral principle of reciprocity. BMC Med Ethics 2018; 19:16. [PMID: 29499693 PMCID: PMC5834863 DOI: 10.1186/s12910-018-0256-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 02/21/2018] [Indexed: 11/26/2022] Open
Abstract
Background With a large number of forcibly displaced people seeking safety, the EU is facing a challenge in maintaining solidarity. Europe has seen millions of asylum seekers crossing European borders, the largest number of asylum seekers since the second world war. Endemic diseases and often failing health systems in their countries of origin, and arduous conditions during transit, raise questions around how to meet the health needs of this vulnerable population on arrival in terms of screening, vaccination, and access to timely and appropriate statutory health services. This paper explores the potential role of the principle of reciprocity, defined as the disposition ‘to return good in proportion to the good we receive, and to make reparations for the harm we have done’, as a mid-level principle in infectious disease screening policies. Main text More than half of the European countries implemented screening programmes for newly arrived asylum seekers. Screening may serve to avoid potential infectious disease risks in the receiving countries as well as help identify health needs of asylum seekers. But screening may infringe upon basic rights of those screened, thus creating an ethical dilemma. The use of the principle of reciprocity can contribute to the identification of potential improvements for current screening programmes and emphasizes the importance of certain rights into guidelines for screening. It may create a two way moral obligation, upon asylum seekers to actively participate in the programme, and upon authorities to reciprocate the asylum seekers’ participation and the benefits for the control of public health. Conclusion The authors argue that the reciprocity principle leads to a stronger ethical justification of screening programmes and help achieve a balance between justifiable rights claims of the host population and the asylum seekers. The principle deserves a further and more thorough exploration of its potential use in the field of screening, migration and infectious diseases.
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Affiliation(s)
- Dorien T Beeres
- Infectious Disease Unit, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Darren Cornish
- Babylon Primary Health Care Services, Elst, Groningen, The Netherlands
| | - Machiel Vonk
- Department of Infectious Diseases, Regional Public Health Service Groningen, Groningen, The Netherlands
| | - Sofanne J Ravensbergen
- Infectious Disease Unit, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Els L M Maeckelberghe
- Institute for Medical Education, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter Boele Van Hensbroek
- Faculty of Philosophy, Department of Ethics, Social and Political Philosophy, University of Groningen, Groningen, The Netherlands
| | - Ymkje Stienstra
- Infectious Disease Unit, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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