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Yeshitila YG, Gold L, Abimanyi-Ochom J, Riggs E, Daba TT, Le HND. Effectiveness and cost-effectiveness of models of maternity care for women from migrant and refugee backgrounds in high-income countries: A systematic review. Soc Sci Med 2024; 358:117250. [PMID: 39186841 DOI: 10.1016/j.socscimed.2024.117250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/27/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Different models of care may be appropriate for various groups of women during their perinatal period, depending on their risk level, location, and accessibility of healthcare practitioners and facilities. Evaluating these models' effectiveness and cost-effectiveness is critical to allocating resources and offering sustained care to women from refugee backgrounds. This systematic review aimed to synthesize evidence on the effectiveness and cost-effectiveness of maternity care models among women from migrant and refugee backgrounds living in high-income countries. METHODS A comprehensive search of major databases for studies published in English between 2000 and 2023 was developed to identify literature using defined keywords and inclusion criteria. Two authors independently screened the search findings and the full texts of eligible studies. The quality of the included studies was appraised, and qualitative and quantitative results were synthesised narratively and presented in tabular form. The review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Forty-seven research papers from six countries were included in the review. The review highlighted the positive impact of community and stakeholders' involvement in the implementation of models of maternity care for women from migrant and refugee backgrounds. The review summarised the models of care in terms of their effectiveness in improving perinatal health outcomes and minimising medical interventions, continuum of care in maternity services, enhancing health literacy, maternity service use and navigating the healthcare system, social support, and sense of belongingness, and addressing cultural and linguistic barriers. Notably, only one study conducted a partial economic evaluation to determine the cost-effectiveness of the model. CONCLUSION AND IMPLICATIONS FOR PRACTICE AND RESEARCH While the reviewed models demonstrated effectiveness in improving perinatal health outcomes, there was considerable variation in outcome measures and assessment tools across the models. Thus, reaching a consensus on prioritised perinatal outcomes and measurement tools is crucial. Researchers and policymakers should collaborate to enhance the quality and quantity of economic evaluations to support evidence-based decision-making. This includes thoroughly comparing costs and outcomes across various health models to determine the most efficient interventions. By emphasizing the importance of comprehensive economic evaluations, healthcare systems can better allocate resources, ultimately leading to more effective and efficient healthcare delivery.
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Affiliation(s)
- Yordanos Gizachew Yeshitila
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Victoria, Australia; School of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia.
| | - Lisa Gold
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Victoria, Australia
| | - Julie Abimanyi-Ochom
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Victoria, Australia
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children Research Institute, Parkville, Victoria, Australia; Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tadesse Tollossa Daba
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Victoria, Australia; Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ha N D Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Victoria, Australia
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Tang K, Hill E, Pellicano E, Thompson C, Myers B. Barriers to and enablers of the transition from child and adolescent to adult mental health services for autistic young people and/or those with attention deficit hyperactivity disorder: protocol for a scoping review. BMJ Open 2024; 14:e083373. [PMID: 39153772 PMCID: PMC11331835 DOI: 10.1136/bmjopen-2023-083373] [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: 12/18/2023] [Accepted: 08/01/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION Autistic young people and/or those with attention deficit hyperactivity disorder (ADHD) who have co-occurring mental health conditions experience significant challenges when transitioning from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). However, barriers and facilitators to this service transition are poorly understood for this population. This scoping review aims to synthesise the available evidence on barriers and enablers to the transition from CAMHS to AMHS for autistic young people and/or those with ADHD. METHODS AND ANALYSIS Arksey and O'Malley's six-step framework for scoping reviews will be used. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist will guide the reporting of this review. Electronic databases of Medline, PsycINFO, CINAHL, Scopus, ProQuest Central and Google Scholar will be searched for relevant articles published in English with no date limitations. Title, abstract and full-text screening will be completed by two independent reviewers. Studies will be eligible for inclusion if the article focuses on (1) adolescents and/or young people (aged 18-24) with a primary diagnosis of autism spectrum disorder and/or ADHD (population) and (2) describes factors associated with service or care transitions (concept) (3) from CAMHS to AMHS (context). Study quality will be evaluated using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. Data describing the factors that enable or inhibit the transition from CAMHS to AMHS will be extracted and synthesised using the Bronfenbrenner's social ecological model as a framework for organising and reporting results. ETHICS AND DISSEMINATION Ethics approval is not required. Findings will be disseminated via peer-reviewed publications and presented at conferences. TRIAL REGISTRATION NUMBER https://doi.org/10.17605/OSF.IO/BZPQF.
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Affiliation(s)
- Kim Tang
- Curtin University, Perth, Western Australia, Australia
| | | | | | | | - Bronwyn Myers
- Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
- Alcohol, Tobacco and Other Drug Research Institute, South African Medical Research Council, Tygerberg, South Africa
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Hughes M, Whitaker L. Listening deeply to refugee background women to understand experiences of domestic and family violence in their communities to foster engagement with global support systems. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2024; 33:175-191. [PMID: 38875352 DOI: 10.1080/14461242.2024.2357193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 05/15/2024] [Indexed: 06/16/2024]
Abstract
As trauma survivors, women and girls from refugee backgrounds face significant challenges when settling in host countries; the risk of domestic and family violence (DFV) accentuates these difficulties. Reflecting on findings from a seven-year university and industry research partnership, this article explores the etiology of DFV in women from refugee backgrounds living in non-metropolitan Australia. Drawing on action research principles and intersectional and social ecological theoretical frameworks, this study captured diverse women's views about experiences and strategies for addressing DFV in refugee communities. Having developed trusting relationships with participants over the different study phases, the first author conducted in-depth interviews with women of refugee backgrounds, listening deeply and confirming findings with participants as they emerged. Interviews were also conducted with staff from settlement, health and specialist domestic violence services to offer a broad perspective on how best to support refugee women experiencing DFV. Key findings revealed stressors and support that impact violence, such as employment status and acculturation, and identification of who the women would trust if experiencing violence. By understanding the interweaving factors influencing women's risk of DFV and strategies to address it, global healthcare providers will be better positioned to collaborate with refugee communities and specialist services.
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Affiliation(s)
- Mandy Hughes
- Faculty of Business, Law and Arts, Southern Cross University, Gold Coast, Australia
| | - Louise Whitaker
- Faculty of Health, Southern Cross University, Gold Coast, Australia
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4
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Gettler LT, Jankovic-Rankovic J, Gengo RG, Eick GN, Nash MP, Arumah EN, Boru AM, Ali SA, Urlacher SS, Meyer JS, Snodgrass JJ, Oka RC. Refugee health and physiological profiles in transitional settlements in Serbia and Kenya: Comparative evidence for effects of gender and social support. Psychoneuroendocrinology 2024; 165:107024. [PMID: 38569397 DOI: 10.1016/j.psyneuen.2024.107024] [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: 10/13/2023] [Revised: 01/30/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024]
Abstract
When armed conflict compels people to flee from their homelands, they embark on protracted journeys during which they experience wide ranging physical, social, and psychological challenges. Few studies have focused on refugee psychosocial and physiological profiles during the transitional phase of forced migration that often involves temporary sheltering. Transient refugees' experiences can vary substantially based on local socio-ecological conditions in temporary settlements, including the length of stay, living conditions, as well as the availability and accessibility of physical and social resources. In this study, we compared physiological and psychosocial data from refugees (N=365; 406 observations) in Serbia and Kenya, respectively, with divergent temporal (length of stay) and socio-ecological conditions. In Serbia, refugees resided in asylum centers (mean stay: 0.9 y); in Kenya they were living in Kakuma Refugee Camp (mean stay: 8.8 y), one of the world's largest camps at the time. We had limited ability to directly compare psychosocial measures and used meta-analytic techniques to evaluate predictors of refugee mental and physical health at the two sites, including based on perceived social support. Refugees in Serbia had higher fingernail cortisol (p < 0.001) and were less likely to have elevated C-reactive protein (CRP) levels (p < 0.01) than refugees in Kakuma. We found common gender differences in both settings; women had lower cortisol but higher EBV antibody titers and higher likelihood of having elevated CRP compared to men (all p < 0.01). Woman also reported poorer mental and physical health (p < 0.001). These physiological and health differences may reflect variation between men and women in their psychosocial and physical experiences of factors such as stress, violence, and trauma during their journeys and as transitional refugees. Finally, we also found that refugees with lower levels of perceived social support reported poorer physical and mental health (p < 0.001). Although our results are cross-sectional, they suggest that this intermittent phase of the refugee experience is a key window for helping enhance refugee well-being through an emphasis on interpersonal and community support systems.
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Affiliation(s)
- Lee T Gettler
- Department of Anthropology, Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA.
| | | | - Rieti G Gengo
- Department of Anthropology, Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Geeta N Eick
- Department of Anthropology, University of Oregon, OR, USA
| | | | | | | | | | | | - Jerrold S Meyer
- Psychological and Brain Sciences, University of Massachusetts- Amherst, MA, USA
| | | | - Rahul C Oka
- Keough School of Global Affairs, Department of Anthropology, University of Notre Dame, Notre Dame, IN, USA
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Kim NR, Lee JY, Park J, Lau ST. Ecological predictors of cultural competence among nurses in the neonatal intensive care unit: A cross-sectional descriptive study. Nurs Health Sci 2024; 26:e13115. [PMID: 38605597 DOI: 10.1111/nhs.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/26/2024] [Accepted: 03/16/2024] [Indexed: 04/13/2024]
Abstract
Active migration and globalization have led to increased opportunities for critical care nurses to care for patients from diverse racial and cultural backgrounds. This study thus aimed to identify the individual, interpersonal, and organizational factors affecting cultural competence levels among neonatal intensive care unit (NICU) nurses based on an ecological model. This was a cross-sectional descriptive study that included 135 NICU nurses in South Korea. A hierarchical multiple linear regression analysis was conducted using the proposed ecological model, and a regression model for each of the four subdomains of cultural competence was constructed and compared. NICU nurses' cultural competencies were influenced not only by the "necessity of multicultural education" and "ethnocultural empathy" at the individual level but by the "hospital's readiness and support for cultural competencies" at the organizational level. To promote the cultural competence of nurses in critical care settings, environmental and organizational support should be improved, along with developing strategies that focus on nurses' individual characteristics. It is also necessary to investigate the "intersectionality" of the effects of individual and environmental factors on cultural competence.
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Affiliation(s)
| | - Ja-Yin Lee
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Jiyoung Park
- College of Nursing, Institute for Health Science Research, Inje University, Busan, South Korea
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Naal H, Alaeddine R, Brome D, Daou T, Hudroj L, el Sayed I, Soubra R, Hokayem J, Ghalayini M, Slim W, Saleh S. Capacity building and community of practice for women community health workers in low-resource settings: long-term evaluation of the Mobile University For Health (MUH). Front Glob Womens Health 2024; 5:1304954. [PMID: 38832109 PMCID: PMC11144904 DOI: 10.3389/fgwh.2024.1304954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 05/01/2024] [Indexed: 06/05/2024] Open
Abstract
Background Lebanon has been facing a series of crises, significantly increasing health challenges, and straining its healthcare infrastructure. This caused deficiencies in the system's ability to attend to population health needs, and it profoundly impacted vulnerable and refugee communities who face additional challenges accessing healthcare services. In response, the Global Health Institute at the American University of Beirut designed and implemented the Mobile University for Health (MUH), which promotes task-shifting through capacity building complemented by communities of practice (CoP). The program aimed to prepare vulnerable women to assume the role of community health workers (CHW) within their communities, and to promote positive health knowledge and behaviours. Methods A mixed-methods approach was used to evaluate MUHs' three certificates (women's health, mental health and psychosocial support, and non-communicable diseases). Implementation took place between 2019 and 2022, with 83 CHWs graduating from the program. Short-term data including knowledge assessments, course evaluations, and community member feedback surveys were collected. 93 semi-structured interviews with CHWs and 14 focus group discussions with community members were conducted to evaluate the long-term impact of the capacity building and CoP components. Results Data revealed multiple strengths of the initiative, including increased access to education for the community, effectiveness of blended learning modality, successful planning and delivery of CoP sessions, and improved knowledge, skills, and health behaviours over time. The supplementary CoP sessions fostered trust in CHWs, increased community empowerment, and increased leadership skills among CHWs. However, some challenges persisted, including limited access to healthcare services, implementation logistical issues, difficulties with some aspects of the learning modality, and some resistance within the communities. Conclusion MUH promoted and improved positive health knowledge and behaviours within targeted vulnerable populations in Lebanon. The supplementary CoP component proved instrumental in empowering CHWs and enhancing their impact within their communities. The study highlights the need for ongoing training and support for CHWs and underscores the importance of continued investment and adaptation of such initiatives through a gendered lens. This evaluation provides evidence on the successes of a capacity building model that has strong potential for scale and replication across health topics in conflict-affected contexts.
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Affiliation(s)
- Hady Naal
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Reem Alaeddine
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Dayana Brome
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Tracy Daou
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Laura Hudroj
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Israa el Sayed
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Racha Soubra
- Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, QC, Canada
| | - Joanne Hokayem
- School of Public Health, Harvard University, Cambridge, MA, United States
| | - Mohamad Ghalayini
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Waed Slim
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Adebayo CT, Olukotun OV, Olukotun M, Kirungi J, Gondwe KW, Crooks NK, Singer RB, Adams S, Alfaifi FY, Dressel A, Fahmy L, Kako P, Snethen J, Valhmu LM. Experiences of gender-based violence among Somali refugee women: a socio-ecological model approach. CULTURE, HEALTH & SEXUALITY 2024; 26:654-670. [PMID: 37516928 PMCID: PMC10825063 DOI: 10.1080/13691058.2023.2236163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
Gender-based violence (GBV) is an all-encompassing term that speaks to acts or threats that may lead to physical, sexual or emotional harm to an individual based on their gender. This paper provides a scoping review of research on gender-based violence among Somali refugee women in different parts of the world. Using the socio-ecological model as a framework, we reviewed 30 empirical studies focusing on some form of GBV among Somali refugee women. We identified societal, community and individual factors contributing to the experience of GBV. We also discuss how these factors influence women's willingness to access care, especially healthcare and social services. The review reveals that oftentimes, institutions that work closely with this population have a limited understanding of how closely culture affects the willingness and ability to seek help about GBV. Based on our analysis, we suggest ways in which social institutions and healthcare providers can provide culturally-safe support to Somali refugee women who have experienced some form of GBV.
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Affiliation(s)
| | | | - Mary Olukotun
- Faculty of Nursing, University of Alberta-Edmonton, Edmonton, AB, Canada
| | - Jackline Kirungi
- Department of African & African Diaspora Studies, University of Wisconsin, Milwaukee, WI, USA
| | | | - Natasha K. Crooks
- Human Development Nursing Science, University of Illinois, Chicago, IL, USA
| | - Randi B. Singer
- Human Development Nursing Science, University of Illinois, Chicago, IL, USA
| | - Shukri Adams
- Ras Al Khaimah School of Nursing, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | | | - Anne Dressel
- College of Nursing, University of Wisconsin, Milwaukee, WI, USA
| | - Laila Fahmy
- Department of Psychology, Towson University, Towson, MD, USA
| | - Peninah Kako
- College of Nursing, University of Jazan, Gizan, Saudi Arabia
| | - Julia Snethen
- College of Nursing, University of Jazan, Gizan, Saudi Arabia
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Jolof L, Rocca P, Carlsson T. Women's experiences of trauma-informed care for forced migrants: A qualitative interview study. Heliyon 2024; 10:e28866. [PMID: 38596047 PMCID: PMC11002685 DOI: 10.1016/j.heliyon.2024.e28866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/11/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Forced migration affect the health and wellbeing of millions of women. The aim was to explore experiences of trauma-informed care among women who are forced migrants. Methods This was an exploratory qualitative study. Eleven women who had concluded treatment at multidisciplinary trauma centers in Sweden were interviewed, recruited through consecutive sampling. Audio-recorded interviews were transcribed and analyzed with systematic text condensation. Results Women dealt with mental and physical manifestations in a challenging psychosocial situation. Various structural and individual barriers were addressed that hindered access to adequate health services. Women appreciated various benefits of the treatment and recalled the care as supportive and compassionate. However, undergoing treatment was considered demanding, requiring significant determination and energy. Participants suggested that peer support could enhance the support. Conclusions Migrant women experience a range of health-related burdens and encounter barriers to trauma-informed care. While demanding, treatment has the potential to alleviate symptoms. Health professionals and stakeholders providing trauma-informed care need to ensure that their services are accessible and culturally sensitive towards the unique needs of women. Peer support has the potential to enhance support further, which need further evaluation.
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Affiliation(s)
- Linda Jolof
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Patricia Rocca
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Muir KJ, Merchant RM, Lasater KB, Brooks Carthon JM. Emergency Nurses' Reasons for Not Recommending Their Hospital to Clinicians as a Good Place to Work. JAMA Netw Open 2024; 7:e244087. [PMID: 38592724 PMCID: PMC11004828 DOI: 10.1001/jamanetworkopen.2024.4087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/01/2024] [Indexed: 04/10/2024] Open
Abstract
Importance Half of emergency nurses report high burnout and intend to leave their job in the next year. Whether emergency nurses would recommend their workplace to other clinicians may be an important indicator of a hospital's ability to recruit clinicians. Objective To examine why emergency nurses do not recommend their hospital to other clinicians as a good place to work. Design, Setting, and Participants This qualitative study used directed content analysis of open-text responses (n = 142) from the RN4CAST-NY/IL survey of registered nurses licensed in New York and Illinois between April 13 and June 22, 2021. Inductive and deductive analytic approaches guided study theme development informed by the Social Ecological Model. The collected data were analyzed from April to June 2023. Main Outcomes and Measures Nurses who answered "probably not" or "definitely not" to the survey question, "Would you recommend your place of employment as a good place to work?" were prompted to provide a rationale in an open-text response. Results In this qualitative study of 142 emergency nurses (mean [SD] age, 43.5 [12.5] years; 113 [79.6%] female; mean [SD] experience, 14.0 [12.2] years), 94 (66.2%) were licensed to work in New York and the other 48 (33.8%) in Illinois. Five themes and associated subthemes emerged from the data. Themes conveyed understaffing of nurses and ancillary support (theme 1: unlimited patients with limited support); inadequate responsiveness from unit management to work environment safety concerns (theme 2: unanswered calls for help); perceptions that nurses' licenses were in jeopardy given unsafe working conditions and compromised care quality (theme 3: license always on the line); workplace violence on a patient-to-nurse, clinician-to-nurse, and systems level (theme 4: multidimensional workplace violence); and nurse reports of being undervalued by hospital management and unfulfilled at work in delivering suboptimal care to patients in unsafe working conditions (theme 5: undervalued and unfulfilled). Conclusions and Relevance This study found that emergency department nurses did not recommend their workplace to other clinicians as a good place to work because of poor nurse and ancillary staffing, nonresponsive hospital leadership, unsafe working conditions, workplace violence, and a lack of feeling valued. These findings inform aspects of the work environment that employers can address to improve nurse recruitment and retention.
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Affiliation(s)
- K. Jane Muir
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia
| | - Raina M. Merchant
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
| | - Karen B. Lasater
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - J. Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Kaur M, Bridi L, Kaki D, Albahsahli B, Bencheikh N, Saadi A, Bandoli G, Anderson CA, Sideman AB, Al-Rousan T. Funding for Refugee Health Research From the National Institutes of Health Between 2000 and 2020. JAMA Netw Open 2024; 7:e2350837. [PMID: 38198139 PMCID: PMC10782235 DOI: 10.1001/jamanetworkopen.2023.50837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/20/2023] [Indexed: 01/11/2024] Open
Abstract
Importance The US has historically resettled more refugees than any other country, with over 3.5 million refugees since 1980. The National Institutes of Health (NIH) is the largest public funder of biomedical research and development, but its role in mitigating many health disparities refugees experience through its funded research remains unknown. Objective To examine the NIH's research funding patterns on refugee health research over the last 2 decades. Design, Setting, and Participants Secondary analysis of NIH-funded grants between 2000 and 2020 using a cross-sectional study design. The NIH Research Portfolio Online Reporting Tools database was used to find relevant grants. Data were analyzed from November 2021 to September 2022. Main Outcomes and Measures NIH grants awarded by year, state, grant type, research area, funding institute, grant duration, and amount funded. Results Of 1.7 million NIH grants funded over the 20-year study period, only 78 addressed refugee health. Funded grants were mostly training grants (23 grants [29%]), followed by hypothesis-driven research (R01 grants; 22 grants [28%]), pilot or preliminary investigation proposals (13 grants [17%]), and other types of grants (20 grants [26%]). The most studied research domain was mental health (36 grants [46%]), followed by refugee family dynamics and women's and children's health (14 grants [18%]). A total of 26 grants (33%) were funded by the National Institute of Mental Health and 15 (19%) were funded by the National Institute of Child Health and Human Development. Most grants were US-based (60 grants [76%]) and the state of Massachusetts received the greatest amount of funding ($14 825 852 [18%]). In 2020, the NIH allocated about $2.3 million to refugee health research, or less than 0.01% of its $42 billion budget that year. The number of grants funded in each time period did not always reflect changes in the number of refugees resettled in the US over the years. Conclusions and Relevance This cross-sectional study found that there remain significant gaps in the understanding of and interventions in the health research needs of refugees locally and along the migratory route. To close these gaps, the NIH should increase its investments in comprehensive studies assessing the physical, mental, and social well-being of this expanding population. This can be achieved by ensuring that all NIH institutes allocate budgets specifically for refugee health research and extend support for the training of refugee researchers.
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Affiliation(s)
- Mehak Kaur
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Lana Bridi
- School of Medicine, University of California, San Diego, La Jolla
| | - Dahlia Kaki
- School of Medicine, University of California, San Francisco
| | - Behnan Albahsahli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Nissma Bencheikh
- School of Medicine, University of California, San Diego, La Jolla
| | - Altaf Saadi
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Gretchen Bandoli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Cheryl A.M. Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | | | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
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DiClemente-Bosco K, Binyungu A, Shabani C, Pellowski JA, Operario D, Nugent N, Harrison A. 'I am because you are': Community support as a bridge to mental wellbeing for resettled African refugee women living in Rhode Island. Glob Public Health 2024; 19:2314106. [PMID: 38334139 PMCID: PMC10966713 DOI: 10.1080/17441692.2024.2314106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
African refugee women resettled in the United States are exposed to multiple risk factors for poor mental health. Currently, no comprehensive framework exists on which to guide mental health interventions specific to this population. Through a community-based participatory research partnership, we interviewed N = 15 resettled African refugees living in Rhode Island. Here we (1) describe how meanings of mental health within the African refugee community vary from US understandings of PTSD, depression, and anxiety and (2) generate a framework revealing how mental health among participants results from interactions between social support, African sociocultural norms, and US norms and systems. Multiple barriers and facilitators of mental wellbeing lie at the intersections of these three primary concepts. We recommend that public health and medicine leverage the strength of existing community networks and organisations to address the heavy burden of poor mental health among resettled African refugee women.
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Affiliation(s)
- Kira DiClemente-Bosco
- Center for Dissemination and Implementation Science, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI
| | | | | | - Jennifer A. Pellowski
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Nicole Nugent
- Departments of Psychiatry and Human Behavior, Pediatrics, and Emergency Medicine at the Warren Alpert Medical School of Brown University, Providence, RI
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI
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Azugbene EA, Cornelius LJ, Johnson-Agbakwu CE. African Immigrant Women's Maternal Health Experiences in Clarkston, Georgia: A Qualitative Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:603-616. [PMID: 38155870 PMCID: PMC10754423 DOI: 10.1089/whr.2023.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 12/30/2023]
Abstract
Introduction The maternal health experiences of African immigrant women, their utilization of health care services, and the effects on maternal health have received limited attention in research. This research explored the maternal health experiences of African immigrant women residing in Clarkston, Georgia, and their use of health services. Methods Fourteen African immigrant women responded to semistructured interviews. An adapted version of the Andersen health care utilization model explained the predisposing factors, enabling factors, and need factors, which influence the use of maternal health care for African immigrant women. Results Findings were presented according to the Andersen health care utilization model. Analysis of the interviews resulted in 11 themes. The themes were as follows: (1) Community social structure, (2) community health beliefs, (3) health organization concerning the use of women, infants, and children, (4) social support at the individual level, (5) limited English proficiency, (6) need for better health education, (7) perception of care, (8) health financing, (9) long wait times and lack of transportation, (10) fear of medication and obstetrical interventions, and (11) impact of Female Genital Mutilation/Cutting. Discussion Maternal health practices of African immigrant women are impacted by environmental and cultural factors. Public health interventions should be implemented to advance African immigrant women's health care utilization practices through required health education and tailored care, which will translate to positive maternal health experiences.
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Affiliation(s)
- Ehiremen Adesua Azugbene
- Maternal and Child Health Translational Research Team (MCHTRT), College of Public Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | | | - Crista E. Johnson-Agbakwu
- Division of Preventive and Behavioral Medicine, UMass Chan Medical School, UMass Memorial Health, Worcester, Massachusetts, USA
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Wu YM, Kreitewolf J, Kronick R. The Relationship between Wellbeing, Self-Determination, and Resettlement Stress for Asylum-Seeking Mothers Attending an Ecosocial Community-Based Intervention: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7076. [PMID: 37998307 PMCID: PMC10671536 DOI: 10.3390/ijerph20227076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/25/2023]
Abstract
Psychosocial support programs have been increasingly implemented to protect asylum seekers' wellbeing, though how and why these interventions work is not yet fully understood. This study first uses questionnaires to examine how self-efficacy, satisfaction of basic psychological needs, and adaptive stress may influence wellbeing for a group of asylum-seeking mothers attending a community-based psychosocial program called Welcome Haven. Second, we explore mothers' experiences attending the Welcome Haven program through qualitative interviews. Analysis reveals the importance of relatedness as a predictor of wellbeing as well as the mediating role of adaptive stress between need satisfaction and wellbeing. Further, attending Welcome Haven is associated with reduced adaptive stress and increased wellbeing, which correspond with the thematic analysis showing that attendance at the workshops fostered a sense of belonging through connection with other asylum seekers and service providers as well as empowerment through access to information and self-expression. The results point to the importance of community-based support that addresses adaptive stress and the promotion of social connection as key determinants of wellbeing. Nonetheless, the centrality of pervasive structural stressors asylum seekers experience during resettlement also cautions that relief offered by interventions may be insufficient in the face of ongoing systemic inequality and marginalization.
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Affiliation(s)
- Yufei Mandy Wu
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 1A2, Canada;
- Department of Psychology, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Jens Kreitewolf
- Department of Psychology, McGill University, Montreal, QC H3A 1G1, Canada
- Department of Mathematics and Statistics, McGill University, Montreal, QC H3A 1G1, Canada
| | - Rachel Kronick
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 1A2, Canada;
- Lady Davis Research Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Institut Universitaire SHERPA, Montreal, QC H3N 1Y9, Canada
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Donnelly A, Haintz GL, McKenzie H, Graham M. Influences on reproductive decision-making among forcibly displaced women resettling in high-income countries: a scoping review and thematic analysis. Int J Equity Health 2023; 22:179. [PMID: 37670302 PMCID: PMC10478383 DOI: 10.1186/s12939-023-01993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/20/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Forced displacement impacts the health, rights and safety of women, which is further compounded by gender inequality. In particular, this has consequences for forcibly displaced women's reproductive health once resettled in a new country. To ensure the reproductive health and rights of forcibly displaced women during and after resettlement, there must be careful consideration of their reproductive decision-making taking into account the context and environment of the host country. AIM This scoping review aimed to explore the influences on reproductive decision-making among forcibly displaced women resettling in high-income countries. METHOD A scoping review was conducted following the PRISMA-ScR for reporting. EBSCO was used to search databases covering global health, health policy, psychology, sociology, and philosophy for articles published from 1 January 2012 to 27 April 2022. Data extracted from each article included author(s), year of publication, publication type, aims/objectives, study design, sampling method, data collection or eligibility criteria, study population (i.e., sample size and characteristics), migration status, country(ies) of origin, host country(ies), key findings and limitations. Two independent reviewers screened all articles against eligibility criteria using Covidence. Data charting and thematic analysis were performed independently by one reviewer. FINDINGS Nineteen articles published between 2013 and 2022 mostly conducted in the United States (36.8%) and Australia (21.1%), with the majority reporting on qualitative findings (68.4%), and women from a wide array of countries and cultures (most commonly African countries) were included. Influences on women's reproductive decision-making related to the contexts before displacement, during displacement, and after arrival, with influences on women's reproductive decision-making identified specific to the context. The influences before displacement included conflict; religious beliefs; socio-cultural gendered expectations; and external control over reproductive autonomy. During displacement influences included paternalism and access to education. Influences after arrival included pressure, restriction, coercion; knowledge and misconceptions; patriarchal power dynamics; and seeking empowerment. An adapted socio-ecological model was developed to interpret the findings. CONCLUSION This review highlights the complexity and nuances within forcibly displaced women's experiences which influence their reproductive decision-making. Further research may review the evidence base to provide guidance for healthcare professionals and health policies aimed at empowering women to make autonomous reproductive decisions; develop training for healthcare professionals to prevent pressure, restriction and coercion of women's reproductive autonomy; and inform development of policy that takes an intersectional approach to women's health rights and gender equality.
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Affiliation(s)
- Arielle Donnelly
- School of Health and Social Development, Deakin University, Burwood, VIC, 3125, Australia.
| | - Greer Lamaro Haintz
- School of Health and Social Development, Deakin University, Geelong, VIC, 3220, Australia
| | - Hayley McKenzie
- School of Health and Social Development, Deakin University, Burwood, VIC, 3125, Australia
| | - Melissa Graham
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
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Lluch C, O'Mahony J, D'Souza M, Hawa R. Health Literacy of Healthcare Providers and Mental Health Needs of Immigrant Perinatal Women in British Columbia: A Critical Ethnography. Issues Ment Health Nurs 2023; 44:746-757. [PMID: 37437242 DOI: 10.1080/01612840.2023.2227267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
AIMS This research explores how health care providers determine the mental health needs of immigrant women in the perinatal phase of childbirth. The contextual factors that affect the mental health of these women and influence their engagement with the British Columbian communities in which they reside are investigated. METHOD Using a critical ethnographic approach, eight health care providers were interviewed to gain insight into health care provider's health literacy and immigrant perinatal women's mental health. Each participant was interviewed for 45-60 min in the period from January to February 2021 to obtain relevant data. RESULTS Three themes emerged from the data analysis: the health care provider's role and his/her health literacy, the health literacy of the participant, and the impact of the ongoing COVID-19 pandemic on the participant's situation. CONCLUSIONS The findings indicate that a healthy working relationship between the health care provider and an immigrant woman in the perinatal phase of childbirth is essential to facilitate an effective interchange of health information.
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Affiliation(s)
- Conchitina Lluch
- School of Nursing, Thompson Rivers University, Kamloops, BC, Canada
| | - Joyce O'Mahony
- School of Nursing, Thompson Rivers University, Kamloops, BC, Canada
| | - Melba D'Souza
- School of Nursing, Thompson Rivers University, Kamloops, BC, Canada
| | - Roula Hawa
- Family Studies & Human Development, School of Behavioural and Social Sciences, Brescia University College at Western, London, ON, Canada
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Williams KDA, Dougherty SE, Utsey SO, LaRose JG, Carlyle KE. "Could Be Even Worse in College": Social Factors, Anxiety, and Depressive Symptoms Among Black Men on a College Campus. J Racial Ethn Health Disparities 2023; 10:1165-1177. [PMID: 35428951 DOI: 10.1007/s40615-022-01302-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
Understanding mental health risks among Black men is a step forward in reducing health and educational disparities that are persistent in today's society. Semi-structured focus groups were conducted with 20 Black male undergraduate students from a college campus in the Southeast. The aim was to identify and understand the social and contextual factors impacting their risk of experiencing anxiety and depressive symptoms. A thematic analysis, theoretically grounded in the social-ecological model (SEM), was conducted, revealing three overarching themes: 1) what is known or felt about mental health 2) causes of stressors and 3) signs as symptoms. Discussions with men offered insight into their perspectives and personal experiences related to mental health issues and perceived risk factors. Themes suggest that the college transition, academic workload, perceived financial distress, and their desire and need to conform to ideals of masculinity were significant risk factors and stressors. Men offered descriptions of specific symptoms and health behaviors associated with such stress, including social isolation, anger, irritability, and changes in their own personal behaviors. Key findings paint a picture of college mental health experiences for some Black male college students. Moving forward, more research is needed to expand on this study's findings and improve mental health risk among this underserved population. Future directions are discussed alongside the results presented in this paper.
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Affiliation(s)
- Kofoworola D A Williams
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, USA.
| | - Sharyn E Dougherty
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Shawn O Utsey
- Department of African American Studies, Virginia Commonwealth University College of Humanities & Sciences, Richmond, VA, USA
| | - Jessica G LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kellie E Carlyle
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Altun A, Brown H, Sturgiss E, Russell G. Experiences of Assyrian refugee women seeking care for chronic pain: a qualitative study. Int J Equity Health 2023; 22:83. [PMID: 37158876 PMCID: PMC10169379 DOI: 10.1186/s12939-023-01891-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/11/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Refugee women exhibit some of the highest rates of chronic pain yet the diversity and challenges of health care systems across countries pose numerous challenges for refugee women trying to access quality health care. OBJECTIVE We sought to explore the experiences of Assyrian refugee women seeking care for chronic pain. METHODS Semi-structured interviews (face-to-face and virtual) were undertaken with 10 Assyrian women of refugee background living in Melbourne, Australia. Audio recordings and field notes of interviews were collected and themes were identified using a phenomenological approach. Women were required to be conversant in English or Arabic and willing to use a translator if necessary. RESULTS We identified five major themes of women's experiences accessing care for chronic pain: (1) the story of pain; (2) the experience of help seeking in Australia and home country; (3) factors shaping the ability to access appropriate care; (4) support seeking systems; and (5) influence of culture and gender roles. CONCLUSION Exploring refugee women's experience of seeking care for chronic pain reinforces the need to explore hard to reach population's perspectives in research and helps to understand how vectors of disadvantage may intersect. For successful integration into health care systems of host countries, particularly for complex conditions such as chronic pain, there is a need to work with women community members to develop programs that are culturally aligned to enhance access pathways to care.
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Affiliation(s)
- Areni Altun
- Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | | | - Elizabeth Sturgiss
- Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Academic Unit of General Practice, Australian National University, Canberra, Australia
| | - Grant Russell
- Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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MacDonnell JA, Dastjerdi FM, Bokore N, Tharao W. Activism and immigrant women's mental health and wellbeing: Building Canadian service provider capacity in the settlement and mental health sectors. Health Care Women Int 2023; 45:579-599. [PMID: 37010454 DOI: 10.1080/07399332.2023.2190981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/10/2023] [Indexed: 04/04/2023]
Abstract
In this qualitative community-based research, we explore service providers' use of activism-based resources and the supports they need to use activism as a tool to promote the mental health and wellbeing of racialized immigrant women. 19 service providers working in settlement and mental health services in the Greater Toronto Area, Canada, participated in one of three focus groups. We analyzed the data using a postcolonial feminist lens. Service providers' understandings of activism, strategies for promoting client mental health and wellbeing, and organizational barriers shaping their practice emerged as relevant. We offer recommendations for building activism-based resources, programs and services that include collaborations with racialized immigrant women communities and action at the organizational level to support service provider practice.
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Affiliation(s)
| | | | - Nimo Bokore
- School of Social Work, Carleton University, Ottawa, Ontario, Canada
| | - Wangari Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto, Ontario, Canada
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Bletscher C, Spiers S. "Step by Step We Were Okay Now": An Exploration of the Impact of Social Connectedness on the Well-Being of Congolese and Iraqi Refugee Women Resettled in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5324. [PMID: 37047940 PMCID: PMC10094254 DOI: 10.3390/ijerph20075324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
Little is known about the gendered impacts of the displacement and resettlement process. Women are known to struggle more with feelings of belonging and the creation of social networks to access essential information, resources, and social and emotional support to enhance their overall health and well-being. The purpose of the present study was to qualitatively explore female refugee perceptions of belongingness and social connectedness post-resettlement into their U.S. host community. Conducted between January and June of 2016, through the partnership of multiple governmental, nonprofit, and community-based organizations, two female focus groups were conducted among Congolese (n = 6) and Iraqi (n = 6) U.S. resettled refugees. Descriptive surveys were distributed to participants, providing valuable insights into participant demographics and indicators that could impact the integration process (i.e., age, language, country of origin, ethnicity, education, length of time spent in the U.S., housing). Participants discussed the social connections (individuals, communities, organizations) that acted as facilitators or inhibitors of developing social capital. The importance of building strong transformational bonding (family members, other refugees) and bridging (host community) relationships, alongside transactional ties with linking agencies (resettlement social services), was critical for a positive resettlement experience. The strength of their network ties among these social connections contributed to their perceptions of belongingness and well-being post-resettlement into their host community.
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Plusch J, Jane Muir K. "Doc in the Box": The impact of an emergency department move on interprofessional collaboration, patient care, and clinician job satisfaction. Int Emerg Nurs 2023; 67:101267. [PMID: 36863070 DOI: 10.1016/j.ienj.2023.101267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Health care organizations undergo unit space reconfiguration (e.g., expansion) projects in order to accommodate rising patient volumes with limited health care space. The purpose of this study was to describe the impact of an emergency department physical space move on clinician-perceived interprofessional collaboration, patient care delivery, and clinician job satisfaction. METHOD A secondary qualitative, descriptive data analysis of 39 in-depth interviews from an ethnography was conducted from August 2019 to February 2021 at an academic medical center emergency department with nurses, physicians, and patient care technicians in the Southeastern United States. The Social Ecological Model was a conceptual guide for the analysis. RESULTS Three study themes, "It's like an old dive bar", "spatial blind spot", and "privacy and aesthetic work environment" emerged from the 39 interviews. Clinicians perceived that the move from a centralized to decentralized work space impacted interprofessional collaboration through divided clinician work spaces. Increased square footage in the new emergency department was beneficial for patient satisfaction but contributed to difficulty monitoring patients for care escalation. However, increased space and individualized patient rooms increased perceived clinician job satisfaction. CONCLUSION Space reconfiguration projects inhealth carecan have positive implications for patient care, but may result in inefficiencies to the health care team and patient care that must be considered. Study findings inform health care work environment renovation projects on an international level.
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Affiliation(s)
- Jamie Plusch
- Medstar Georgetown University Hospital, Washington, DC 20007, USA.
| | - K Jane Muir
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA 19140, USA.
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21
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Griffin G, Ali M, Nau SZ, Riggs E, Dantas JAR. Accessing and navigating healthcare: A scoping review of the experiences of women of refugee background from Myanmar. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3459-e3476. [PMID: 35915878 PMCID: PMC10087957 DOI: 10.1111/hsc.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/20/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
Despite well-documented health problems, healthcare access by women of refugee background in resettlement countries is typically poor. Suggested reasons include inadequate health literacy and resettlement challenges. A scoping review to explore the experiences of women of refugee background from Myanmar accessing and navigating healthcare was conducted following Arksey and O'Malley's framework, with an intersectional lens. Studies were analysed thematically following Braun and Clark's approach; four themes (eight subthemes) were constructed: Culture (Constructions of health; Navigating cultural tensions); Gender (Shifting gender roles; Sexual and reproductive health); Survivorship (Past health experiences; Strength in collectivism); and Language (The language barrier; Masked communication barriers). Intersectional factors of culture, gender, survivorship and language influenced women's experiences, shaping barriers and facilitators to healthcare. Community networks and bicultural peers are resources which may be enhanced. Research into trauma-informed cultural competency programs, community education and bicultural health navigators is recommended to support women of refugee background from Myanmar.
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Affiliation(s)
- Georgia Griffin
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia
| | - Mohammed Ali
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia
| | - S. Zaung Nau
- School of Management and MarketingCurtin UniversityBentleyWestern AustraliaAustralia
| | - Elisha Riggs
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia
| | - Jaya A. R. Dantas
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia
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22
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Chrzan-Dętkoś M, Rodríguez-Muñoz MF, Krupelnytska L, Morozova-Larina O, Vavilova A, López HG, Murawaska N, Radoš SN. Good Practices in Perinatal Mental Health for Women during Wars and Migrations: A Narrative Synthesis from the COST Action Riseup-PPD in the Context of the War in Ukraine. CLÍNICA Y SALUD 2022. [DOI: 10.5093/clysa2022a14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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Rosenthal T, Touyz RM, Oparil S. Migrating Populations and Health: Risk Factors for Cardiovascular Disease and Metabolic Syndrome. Curr Hypertens Rep 2022; 24:325-340. [PMID: 35704140 PMCID: PMC9198623 DOI: 10.1007/s11906-022-01194-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW To summarize results of recent studies of migrants in Europe and North America and ongoing efforts to adapt strategies to provide them with inclusive sensitive health care. RECENT FINDINGS Major predisposing factors for developing hypertension, obesity, diabetes, and the metabolic syndrome in migrating populations and refugees were identified. Susceptibility to the metabolic syndrome is predominantly due to environmental factors and psychological stress. Acculturation also contributes to the emergence of cardiovascular (CV) risk factors in first-generation adult immigrants. Increased risk for later development of hypertension and dyslipidemia has also been detected in adolescent immigrants. Targets for public health efforts were based on data that show important differences in CV risk factors and prevalence of the metabolic syndrome among ethnic immigrant groups. Studies in young adults focused on lifestyle and dietary behaviors and perceptions about weight and body image, while the focus for older adults was end-of-life issues. Two important themes have emerged: barriers to health care, with a focus on cultural and language barriers, and violence and its impact on immigrants' mental health.
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Affiliation(s)
- Talma Rosenthal
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rhian M Touyz
- Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Suzanne Oparil
- Vascular Biology & Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294-0007, USA.
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Haider S, Maheen A, Ansari M, Stolley M. Health Beliefs and Barriers to Healthcare of Rohingya Refugees. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01342-2. [PMID: 35689155 DOI: 10.1007/s40615-022-01342-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/21/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
In recent years, over 1,000 Rohingya families have been resettled to Milwaukee, Wisconsin from areas where they faced trauma and health disparities. To better understand their health beliefs and barriers to healthcare, we conducted a qualitative study with ten community health workers and stakeholders serving the Milwaukee Rohingya community. Interviews were transcribed, coded, and analyzed. Themes included: 1) health is defined as being able to meet basic needs of the family/community; 2) prior and existing mistrust and fear of systems of authority impact healthcare seeking behavior; 3) past-trauma negatively impacts physical and mental health; 4) religion and spirituality influence beliefs about illness, recovery, and wellbeing; 5) linguistic, cultural, and educational barriers impact access, quality of care, and understanding of disease. These results begin to address the significant gap in our knowledge of the health beliefs and needs of the local Rohingya community and underscore the need for tailored interventions.
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Affiliation(s)
- Shabi Haider
- Department of Medicine and Cancer Center, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, US
| | - Aniya Maheen
- Department of Medicine and Cancer Center, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, US
| | - Moiz Ansari
- Department of Medicine and Cancer Center, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, US
| | - Melinda Stolley
- Department of Medicine and Cancer Center, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, US.
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Hermaszewska S, Sweeney A, Camminga B, Botelle R, Elliott K, Sin J. Lived experiences of transgender forced migrants and their mental health outcomes: systematic review and meta-ethnography. BJPsych Open 2022; 8:e91. [PMID: 35535515 PMCID: PMC9169499 DOI: 10.1192/bjo.2022.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Owing to multiple, complex and intersecting health inequities, systemic oppression and violence and discrimination in their home countries, some transgender people are forced to migrate to countries that offer them better legal protection and wider social acceptance. AIMS This review sought to explore and understand the multiple factors that shape the mental health outcomes of transgender forced migrants (TFMs). METHOD We systematically searched nine electronic databases for multidisciplinary literature (PROSPERO ID: CRD42020183062). We used a meta-ethnographic approach to synthesise data. We completed a quality appraisal and developed a socio-ecological model to draw together our findings. RESULTS We retrieved 3399 records and screened titles, abstracts and full text to include 24 qualitative studies in this review. The synthesis identified individual survival strategies and factors in interpersonal, organisational and societal environments that contributed to profound deprivation and mental distress in TFMs. Pervasive and persistent violence and discrimination, economic exclusion, barriers to healthcare and a dependency on legal documentation were identified as key factors leading to poor mental health outcomes. Sources of resilience included community acceptance and support, being granted asylum, societal affirmation of gender, fulfilment of basic rights and healthcare access. Individual strategies for survival, such as hope and having purpose in life, were important in bringing relief from distress. CONCLUSIONS Improved communication and knowledge about the unique needs and concerns of TFMs through interventions at the individual, interpersonal, organisational and societal levels are necessary to improve mental health outcomes.
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Affiliation(s)
| | - Angela Sweeney
- Department of Health Service and Population Research, King's College London, UK
| | - B Camminga
- African Centre for Migration & Society, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Jacqueline Sin
- School of Health Sciences, City University of London, UK
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Hawkins MM, Holliday DD, Weinhardt LS, Florsheim P, Ngui E, AbuZahra T. Barriers and facilitators of health among older adult immigrants in the United States: an integrative review of 20 years of literature. BMC Public Health 2022; 22:755. [PMID: 35421979 PMCID: PMC9008931 DOI: 10.1186/s12889-022-13042-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There are over seven million older adult immigrants in the United States, and that number is expected to increase. Older adult immigrants in the United States have unique factors that influence their health.
Methods
In this integrative review, we systematically review 20 years of peer-reviewed literature on the barriers (i.e. isolation, lack of English Language Proficiency, low health literacy, lack of SES resources, discrimination) and facilitators (i.e. English Language Proficiency and maintaining ones native language, social support, culturally sensitive providers, healthcare access) of health among older adult immigrants in the United States.
Results
We found differing uses of the term ‘older adult’, emphasis on the lack of homogeneity among older adult immigrants, social support and isolation as significant barriers and facilitators of older adult immigrant health, and inconsistencies in uses and definitions of acculturation. We also examined relevant theories in the literature. Based on the literature review, focusing on Acculturation Theory, Social Cognitive Theory, and Successful Aging Theory, combining these three theories with findings from the literature to create the Older Adult Immigrant Adapted Model for Health Promotion.
Conclusions
Public health strives to promote health and prevent adverse health outcomes. Our integrative review not only systematically and thoroughly explicates 20 years of literature, but the Older Adult Immigrant Adapted Model for Health Promotion, provides guidance for future research and interventions.
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Brooks MA, Meinhart M, Samawi L, Mukherjee T, Jaber R, Alhomsh H, Kaushal N, Al Qutob R, Khadra M, El-Bassel N, Dasgupta A. Mental health of clinic-attending Syrian refugee women in Jordan: associations between social ecological risks factors and mental health symptoms. BMC Womens Health 2022; 22:4. [PMID: 34996436 PMCID: PMC8742365 DOI: 10.1186/s12905-021-01584-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background The mental health of refugee women is often affected by multiple risk factors in their social ecology. Assessing these risk factors is foundational in determining potential areas for intervention. We used the social ecological model to examine risk factors associated with self-reported mental health symptoms among clinic-attending Syrian refugee women in Jordan. We hypothesize that individual (older age, unmarried, have more children under 18, difficulty reading/writing with ease), interpersonal (intimate partner violence [IPV]), community and societal level risk factors (greater number of postmigration stressors), will be associated with depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms. Methods We surveyed 507 women using a cross-sectional clinic-based systematic sampling approach between April and November 2018. We used multivariable regressions to examine associations between different risk factors in the social ecology on depression, anxiety, and PTSD. Additional multivariable regressions explored associations between specific postmigration stressors and mental health conditions. Results We found rates of depression among our sample to be 62.92%; anxiety 57.46%; and PTSD 66.21%. Our hypothesis was partially supported. At the individual level, age was directly associated with anxiety (aOR 1.04, 95% CI [1.02, 1.06]) and PTSD (aOR 1.03, 95% CI [1.01, 1.06]), while marriage decreased odds for depression (aOR 0.41, 95% CI [0.19, 0.92]) and PTSD (aOR 0.36, 95% CI [0.15, 0.87]). IPV was associated with depression (aOR 2.78, 95% CI [1.72, 4.47]); anxiety (aOR 3.30, 95% CI [2.06, 5.27]); and PTSD (aOR 5.49, 95% CI [3.09, 9.76]). Each additional community and societal risk factor (postmigration stressor) increased the odds for depression (aOR 1.32, 95% CI [1.22, 1.42]), anxiety (aOR 1.28, 95% CI [1.19, 1.39]), and PTSD (aOR 1.46, 95% CI [1.33, 1.60]). Conclusion Understanding social ecological risk factors associated with mental health conditions of Syrian refugee women is vital to addressing their mental health needs. IPV and postmigration stressors are consistently impactful with all mental health conditions. IPV resulted in the largest odds increase for all mental health conditions. Multilevel interventions are needed to address mental health risk factors at multiple levels of the social ecology.
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Affiliation(s)
- Mohamad Adam Brooks
- School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA.
| | - Melissa Meinhart
- School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Luma Samawi
- School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Trena Mukherjee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Ruba Jaber
- University of Jordan School of Medicine, Amman, Jordan
| | - Hani Alhomsh
- School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Neeraj Kaushal
- School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | | | - Maysa' Khadra
- University of Jordan School of Medicine, Amman, Jordan
| | - Nabila El-Bassel
- School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Anindita Dasgupta
- School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA
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Saleem GT, Champagne M, Haider MN, Leddy JJ, Willer B, Asante I, Kent A, Joseph T, Fitzpatrick JM. Prevalence and Risk Factors for Intimate Partner Physical Violence-Related Acquired Brain Injury Among Visitors to Justice Center in New York. J Head Trauma Rehabil 2022; 37:E10-E19. [PMID: 34985036 DOI: 10.1097/htr.0000000000000750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The recent United States Government Accountability Office report highlights the need for improved data on the prevalence of intimate partner violence (IPV)-related acquired brain injury (ABI) to help direct Health & Human Services public efforts. This article identifies the prevalence and risk factors for IPV-related ABI among survivors of IPV at a Justice Center in New York. SETTING Community Justice Center. PARTICIPANTS Forty survivors of IPV, aged 17 to 73 years (median 32, interquartile range: 25.25, 42) were assessed within 60 days of sustaining physical violence. DESIGN Retrospective chart review. MAIN MEASURES The HELPS and the Danger Assessment-Revised were used at the initial Center visit. RESULTS Of the 40 physical IPV survivors screened, all (100%) reported a prior history of partner-induced ABI within the past 60 days. Thirty-seven (92.5%) survivors also reported sustaining at least 1 potential hypoxic brain injury from strangulation. However, only 16 (40%) survivors screened positive on the HELPS for a history of IPV-related mild traumatic brain injury. Females (95%) and individuals with low income (67.5%) largely comprised our sample. Compared with the County's average, the proportion of African Americans/Blacks and refugees was 227% higher (42.5% vs 13%) and 650% higher (7.5% vs 1.09%), respectively. Refugee status (P = .017) also correlated with number of previous ABIs. On an exploratory binary logistic regression with stepwise selection, only balance difficulties (P = .023) and difficulty concentrating/remembering (P = .009) predicted a positive screen for mild traumatic brain injury. CONCLUSIONS Consistent with previous findings, our data indicate a high prevalence of IPV-related ABI among visitors to a New York Justice Center. An overrepresentation of African Americans/Blacks and refugees in our sample relative to the region signified a higher prevalence of IPV in these populations and warrants a provision of more trauma-informed ABI resources to these groups/communities. Intimate partner violence survivors visiting Justice Centers should be screened for motor/neurocognitive symptoms suggestive of mild traumatic brain injury. Further research to identify the prevalence and risk factors of IPV-related ABI statewide and nationwide is urgently needed to improve resource allocation and clinical management.
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Affiliation(s)
- Ghazala T Saleem
- Department of Rehabilitation Sciences, University at Buffalo, The State University of New York (Dr Saleem); Jacobs School of Medicine and Biomedical Sciences, The State University of New York, Buffalo (Mss Champagne, Kent, and Joseph); UBMD Department of Orthopaedics and Sports Medicine (Drs Haider and Leddy) and Department of Psychiatry (Willer), Jacobs School of Medicine and Biomedical Sciences, The State University of New York, Buffalo; Department of Public Health, School of Public Health and Health Professions, The State University of New York, Buffalo (Mr Asante); and Department of Social Work, The State University of New York, Buffalo State College (Dr Fitzpatrick)
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Lindsjö C, Sjögren Forss K, Kumlien C, Rämgård M. Health promotion focusing on migrant women through a community based participatory research approach. BMC WOMENS HEALTH 2021; 21:365. [PMID: 34656089 PMCID: PMC8520311 DOI: 10.1186/s12905-021-01506-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022]
Abstract
Background Migrants are often more vulnerable to health issues compared to host populations, and particularly the women. Therefore, migrant women’s health is important in promoting health equity in society. Participation and empowerment are central concepts in health promotion and in community-based participatory research aimed at enhancing health. The aim of this study was to identify conditions for health promotion together with women migrants through a community-based participatory research approach. Methods A community-based participatory research approach was applied in the programme Collaborative Innovations for Health Promotion in a socially disadvantaged area in Malmö, Sweden, where this study was conducted.
Residents in the area were invited to participate in the research process on health promotion. Health promoters were recruited to the programme to encourage participation and a group of 21 migrant women participating in the programme were included in this study. A qualitative method was used for the data collection, namely, the story-dialogue method, where a process involving issue, reflections and actions guided the dialogues. The material was partly analysed together with the women, inspired by the second-level synthesis. Results Two main health issues, mental health and long-term pain, were reflected upon during the dialogues, and two main themes were elaborated in the process of analysis: Prioritising spare time to promote mental health and Collaboration to address healthcare dissatisfaction related to long-term pain. The women shared that they wanted to learn more about the healthcare system, and how to complain about it, and they also saw the togetherness as a strategy along the way. A decision was made to start a health circle in the community to continue collaboration on health promotion. Conclusions The community-based participatory research approach and the story dialogues constituted an essential foundation for the empowerment process. The health circle provides a forum for further work on conditions for health promotion, as a tool to support migrant women’s health.
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Affiliation(s)
- Cecilia Lindsjö
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, 20506, Malmö, Sweden.
| | - Katarina Sjögren Forss
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, 20506, Malmö, Sweden
| | - Christine Kumlien
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, 20506, Malmö, Sweden
| | - Margareta Rämgård
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, 20506, Malmö, Sweden
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Alexander N, Mathilde S, Øivind S. Post-migration Stressors and Subjective Well-Being in Adult Syrian Refugees Resettled in Sweden: A Gender Perspective. Front Public Health 2021; 9:717353. [PMID: 34568258 PMCID: PMC8458654 DOI: 10.3389/fpubh.2021.717353] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
A number of post-migration stressors have been shown to adversely affect mental health in refugees resettled in high-income countries, including poor social integration, financial difficulties and discrimination, and recent evidence suggests that these effects are gender specific. Social support has been found to buffer against post-migration stress in some studies on refugee populations, though the evidence on this is mixed. The present study used cross-sectional survey data from a nationwide, randomly sampled group of adult refugees from Syria resettled in Sweden between 2008 and 2013 (N sample = 4,000, n respondents = 1,215, response rate 30.4%) to investigate gender-specific associations between post-migration stressors and subjective well-being (SWB) and whether these associations were modified by social support. SWB was measured with the WHO-5 Well-being Index (scaled 0-100), dichotomized into high (≥50) and low (<50) SWB. Main analyses were stratified by gender, and regressed SWB on four domains of post-migration stress (financial strain, social strain, competency strain and discrimination) using logistic regression, adjusting for sociodemographic variables and traumatic experiences. Social support was tested as an effect modifier. In fully adjusted models, main risk factors for low SWB were high financial strain, especially in males (ORhigh vs. low strain, males = 10.30 [4.91-21.6], p < 0.001 vs. ORhigh vs. low strain, females= 3.84 [1.68-8.79], p = 0.002), and high social strain, only in males (ORhigh vs. low strain, males = 9.21 [3.96-21.4], p < 0.001 vs. ORhigh vs. low strain, females = 1.03 [0.40-2.64], p = ns). There was some evidence that social support buffered the adverse association of financial strain with SWB. In conclusion, the present study found clear support of gender-specific effects of post-migration stressors on SWB. Mitigation strategies and interventions should be aware of and sensitive to these potential gendered effects, and future research exploring mental health in the context of resettlement stress should have a heightened focus on the important role of gender.
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Affiliation(s)
- Nissen Alexander
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden.,Division for Forced Migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Sengoelge Mathilde
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Solberg Øivind
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden
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