Migrants’ and refugees’ health: towards an agenda of solutions

Resilience Informatics: Role of Informatics in Enabling and Promoting Public Health Resilience to Pandemics, Climate Change, and Other Stressors

Climate change, local epidemics, future pandemics, and forced displacements pose significant public health threats worldwide. To cope successfully, people and communities are faced with the challenging task of developing resilience to these stressors. Our viewpoint is that the powerful capabilities of modern informatics technologies including artificial intelligence, biomedical and environmental sensors, augmented or virtual reality, data science, and other digital hardware or software, have great potential to promote, sustain, and support resilience in people and communities. However, there is no "one size fits all" solution for resilience. Solutions must match the specific effects of the stressor, cultural dimensions, social determinants of health, technology infrastructure, and many other factors.

Understanding Refugees Health Experiences in Host Countries: Three Theoretical Perspectives

Healthcare providers working with forcefully displaced populations often have limited knowledge and skills regarding the care of this population. The reasons are twofold. First, most of the research on refugee health does not consider refugees' adaptive skills, diversity of experiences, and daily life context. Second, healthcare providers' knowledge of how the sociopolitical environment shapes health research and practice in the context of refugee care is often limited. This work aims to specify gaps in refugee healthcare and research by applying a relational approach to three theoretical frameworks. The relational approach supports a pragmatic, in-depth understanding of healthcare practices by shifting the focus of the inquiry from description of social structures toward exploration of processes and relations that propagate and sustain such structures. The focus is on the threefold interaction between refugees, healthcare providers, and healthcare institutions. The three theoretical frameworks are as follows: First, using concepts from the Theory of Practice by Bourdieu, we examine how gaps in care can result from a mismatch between the dispositions and skills that refugees develop through life experience and the cultural-professional practices of healthcare providers in host countries. Second, the Cultural Determinants of Help Seeking by Saint Arnault is applied to posit that gaps in care can result from differences in the meanings that healthcare providers and refugees assign to their interactions. Finally, we use the concept of Othering as described in nursing by Canales to explain how power dynamics inherent in the interaction between refugees and healthcare systems can affect refugee healthcare and research. This relational approach helps to elucidate some of the culture-bound mechanisms of health maintenance and help-seeking and brings attention to the sociopolitical context that shapes the way we care to refugees.

Contribution of diversity of social participation on the mental health of humanitarian migrants during resettlement

AIMS

By the end of 2022, an estimated 108.4 million individuals worldwide experienced forced displacement. Identifying modifiable factors associated with the mental illness of refugees is crucial for promoting successful integration and developing effective health policies. This study aims to examine the associations between the changes in the diversity of social participation and psychological distress among refugees throughout the resettlement process, specifically focusing on gender differences.

METHODS

Utilizing data from three waves of a longitudinal, nationally representative cohort study conducted in Australia, this study involved 2399 refugees interviewed during Wave 1, 1894 individuals interviewed during Wave 3 and 1881 respondents during Wave 5. At each wave, we assessed psychological distress and 10 types of social participation across 3 distinct dimensions, including social activities, employment and education. The primary analysis employed mixed linear models and time-varying Cox models. Gender-stratified analyses and sensitivity analyses were performed.

RESULTS

Refugees engaging in one type or two or more types of social participation, compared with those not engaging in any, consistently had lower psychological distress scores (β = -0.62 [95% confidence interval (CI), -1.07 to -0.17] for one type of social participation; β = -0.57 [95% CI, -1.04 to -0.10] for two or more types of social participation) and a reduced risk of experiencing psychological distress (hazard ratio [HR] = 0.81 [95% CI, 0.65-0.99] for one type of social participation; HR = 0.77 [95% CI, 0.61-0.97] for two or more types of social participation) during the resettlement period. When stratifying the results by gender, these associations in the adjusted models only remained significant in male refugees. Moreover, three specific types of social participation, namely sporting activities, leisure activities and current employment status, were most prominently associated with a reduced risk of psychological distress.

CONCLUSIONS

The findings of this cohort study suggest that social participation was consistently associated with reduced risks of psychological distress among male refugees during resettlement. These findings highlight the significance of promoting meaningful social participation and interaction may be an effective strategy to improve the mental health of refugees and facilitate their successful integration into society, especially among male refugees.

Effects of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals living in a refugee camp in Greece: A randomized controlled trial

Background

The metabolic syndrome epidemic, including in forcibly displaced individuals, requires cost-effective prevention and treatment strategies. Yet, the health needs of forcibly displaced individuals often remain underserved. Our study evaluated the effect of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals in a refugee camp in Greece and examined the indirect effect through cardiorespiratory fitness on metabolic syndrome components.

Methods

We conducted a randomized controlled trial involving an intervention and a wait-list control group with n = 142 (52.8 % women) forcibly displaced Southwest Asians and Sub-Saharan Africans. The intervention group participated for 10 weeks in exercise and sport activities. Outcomes were cardiorespiratory fitness and single metabolic syndrome components. Effects were analyzed with structural equation modeling.

Results

In total, 62.7 % of participants presented with low cardiorespiratory fitness levels (<40th percentile), and 24.6 % met the criteria for metabolic syndrome. In the intervention group, 73.5 % attended the exercise and sport sessions at least once a week. There was evidence for a direct intervention effect on cardiorespiratory fitness, ßdirect = 0.12, p = 0.022, but not for any of the metabolic syndrome components (p ≥ 0.192). Cardiorespiratory fitness significantly facilitated the intervention's indirect effect on abdominal obesity, ßindirect = -0.03, p = 0.012, high diastolic blood pressure, ßindirect = -0.04, p = 0.011, and elevated triglycerides, ßindirect = -0.03, p = 0.025.

Conclusion

Implementing exercise and sport activities in a refugee camp in Greece effectively reaches a wider target population and improves cardiorespiratory fitness among forcibly displaced individuals. The intervention contributes to a decrease in abdominal obesity, high diastolic blood pressure and elevated triglycerides indirectly via improved cardiorespiratory fitness.

Barriers and enabling factors for utilizing physical rehabilitation services by Afghan immigrants and refugees with disabilities in Iran: a qualitative study

INTRODUCTION

Individuals with a migrant background often underutilize physical rehabilitation services (PRS) compared to the host population. This disparity is attributed to various barriers, including limited access to information, language barriers, illiteracy, and cultural factors. To improve PRS utilization by Afghan immigrants and refugees in Iran, it is crucial to identify these barriers and enabling factors. In response, this study explored the barriers and enabling factors for utilizing PRS among Afghan immigrants and refugees with disabilities in Iran.

METHODS

This qualitative study was conducted in Iran between January and March 2023. Participants were selected through convenient and snowball sampling. Individual, semi-structured interviews were carried out both in face-to-face and online formats. Data analysis occurred concurrently with data collection, using the directed content analysis approach.

RESULTS

Findings from our research indicate that common barriers to PRS utilization among Afghan immigrants and refugees include insufficient insurance coverage, high service costs, expensive transportation and accommodation, limited knowledge about Iran's health system, inadequate awareness of available supports, restricted access to PRS in remote areas, impatience among PRS providers, fear of arrest and deportation, a lack of trust in modern treatments, stringent immigration rules, high inflation rates limiting the ability to pay for PRS, and limited social support. On the other hand, several enabling factors were identified, such as strengthening insurance coverage, utilizing the capacities of charities and NGOs, providing information about available services, promoting respectful behavior by healthcare providers towards patients, facilitating cultural integration, and increasing immigrants' awareness of available services and eligibility criteria.

CONCLUSION

The barriers and enabling factors uncovered in this study offer valuable insights into the complexities surrounding PRS utilization by Afghan immigrants and refugees with disabilities in Iran. Understanding and addressing these factors is essential for developing targeted interventions and policies that can improve access and utilization, ultimately leading to enhanced health outcomes for this vulnerable population.

Exploring refugees' experience of accessing dental health services in host countries: a scoping review

Introduction

Refugees often face worse oral health outcomes, such as periodontal diseases and dental caries in host countries due to barriers including language and cultural differences, institutional discrimination, and restricted use of dental health services. This scoping review aims to map and summarise the available studies on refugees' experience of accessing dental health services in the host countries, to identify the main characteristics of the dental health services that refugees access and to explore the barriers and enablers to navigate the dental health service system in their host countries.

Methods

The Joanna Briggs Institute (JBI) framework was adopted. PubMed, Scopus, Assia, CINAHL and Social Services Abstract were searched. A search strategy was developed using Medical Subject Headings (MeSH) terms and a combination of search operators and syntax used in MEDLINE were adopted for the remaining databases. Data were synthesised using thematic analysis.

Results

Fourteen articles were included. Most studies used qualitative methods and Australia seemed to be the country with the highest number of publications surrounding this topic. The included studies showed that refugees frequently encountered substantial obstacles when attempting to access dental services in host countries. Numerous barriers such as language barriers, cultural differences, and lack of health insurance or financial support hindered refugees' ability to access these services. Additionally, many refugees possessed limited knowledge of the dental care system in their new country. As a result of untreated dental problems, refugees suffered from pain and other health complications.

Discussion

This scoping review explored the challenges refugees have experienced in accessing dental health services in host countries, which included the key barriers such as affordability, accessibility, accommodation, availability, awareness, and acceptability. The scarcity of relevant research highlighted the need for a more comprehensive understanding of refugees' experiences accessing dental health services in host countries. Limited data were identified regarding evidence focusing on the characteristics of dental services accessed by refugees in host countries.

Refugees' Care Experiences, Self-Reported Health Outcomes and Transition to Mainstream Health Care After One Year at the Refugee Engagement and Community Health (REACH) Clinic

This study reports how refugees experienced care at an integrated clinic during their first year in Canada and how they transitioned to a community physician. A survey was completed by 75 Government Assisted Refugees followed at the REACH clinic between 2018 and 2020; 16 agreed to an additional interview. Regression modelling explored the relationship between "perceived health status at one year" and several independent variables. Qualitative thematic analysis provided context. Tailored access to care and enhanced communication through interpretation contributed to satisfaction with clinic services. A significant positive relationship was found between their perceived health status and frequency of visits (p < 0.042), and "doctors' advice about how to stay healthy" (p < 0.039). Interview findings highlighted the important role of settlement agencies, timing for a successful transition and physicians' support resources. While refugees benefit from attending integrated clinics, these should also prepare the care transition to community physicians. Targeted government funding and continued medical education could enhance refugees' transition experience.

Knowledge, Beliefs, and Cultural Practices of Sexual and Reproductive Health Among Afghan Refugee Women in Türkiye

INTRODUCTION

Limited research on experiences of women, who constitute a double vulnerable group in both women and refugee status, regarding sexual and reproductive health. The purpose of this study is to examine the knowledge, beliefs, and cultural practices of Afghan women living in Türkiye regarding sexual and reproductive health.

METHOD

This descriptive phenomenological study was conducted with 18 Afghan refugee women. In-depth, semi-structured interviews were conducted to collect data.

RESULTS

Four themes emerged from interviews: cultural practices and beliefs related to pregnancy and postpartum, use of contraceptive methods, gender-based violence, and access to health services.

CONCLUSIONS

Afghan women have different cultural practices regarding prenatal, pregnancy, and postpartum and lack of knowledge about sexual and reproductive health. Considering individual differences in sexual and reproductive health, providing sensitive, supportive, and informative services is recommended.

Beyond supply and demand: a new ecological framework for understanding the access of young migrants to sexual and reproductive health services in Sweden

BACKGROUND

Although the sexual and reproductive health and rights (SRHR) of young people and migrants should be prioritised, young migrants' sexual and reproductive health (SRH) is rarely studied in Sweden.

OBJECTIVES

To explore young migrants' understanding and experiences of sexual rights and examine their perceptions and experiences in accessing SRH services.

METHODS

This is a mixed method study including a national survey that recruited 1773 newly arrived young migrants; a youth clinic survey that recruited 1089 youths after visiting youth clinics; and a qualitative study that included 13 interviews with newly arrived Arabic-speaking migrant men. The results are synthesised using a new ecological framework of access to understand the factors influencing young migrant access to health care based on the levels of the ecological model and the five steps of access: approachability, acceptability, adequacy, affordability, and quality.

RESULTS

Young migrants understood SRH as both 'essential' and 'a right.' Their sexual rights were less fulfiled compared to other young people in Sweden, particularly for men, non-binary, LGBTQ+, those born in South Asia, without a residence permit, and those of low economic conditions. SRH services were largely unapproachable as almost half of those who needed them did not utilise them. Services were generally acceptable due to the 'open environment,' however, some young migrants faced cultural insensitivity, fear of exposure, low parental support, and long waiting times. SRH services' quality was perceived as good, however, negative experiences were reported, particularly in the domains of respect, equity, privacy, non-prejudice, and consultation quality.

CONCLUSION

The access of young migrants to SRH services is facilitated by an 'open environment' and available and good quality services; however, they faced serious barriers such as limited access to information about the health system, comprehensive sexual education, lack of cultural sensitivity, and cultural racism.

Future directions for One Health research: Regional and sectoral gaps

Implementation of a One Health approach varies considerably between different geographical regions and remains challenging to implement without greater inclusivity of different disciplinary capacity and expertise. We performed comparative analyses of abstracts presented at the 1st World One Health Congress (WOHC 2011) and 6th WOHC (2020) to explore and describe the evolving demographics and disciplinary scope of One Health research. We classified abstracts into six One Health research categories and twenty-three subcategories. We also recorded corresponding authors' country and regional affiliation as well as study country (i.e., the country in which the research was conducted) to explore potential asymmetries between funding recipients and study subjects. The WOHC has seen a significant expansion in participation over the last 10 years. The numbers of abstracts accepted to the Congress increased threefold over the last decade (i.e., 302 abstracts in 2010, and 932 abstracts in 2020). At both Congresses, "Disease Surveillance" accounted for the largest proportion (105/302 (35%) and 335/932 (36%) in 2010 and 2020, respectively) of all abstracts accepted. However, "Environmental and Ecological Issues" (33/302 (10%) and 94/932 (11%)), and "Sustainable Food Systems" (19/302 (6%) and 44/932 (4%)) were less well-represented categories of One Health research in both 1st and 6th WOHC respectively. In contrast, "Antimicrobial Resistance" related research increased substantially over time (4/302 (1%) in 2011) and (119/932 (13%) in 2020). There were also differences in the type of research by authors based in "Very High Human Development" index countries compared to "Medium and Low Human Development. "Public Policy" dominated the former, whereas "Disease Surveillance" dominated the latter, suggesting potential regional differences regarding One Health research priorities. The results of the study highlight potential regional gaps and differences in One Health research priorities, with respect to emphasis on operational (surveillance) versus strategic (policy) One Health activities.

Enhancing healthcare access during disasters and emergencies: Recommendations from Nepali migrants in Japan

Migrants in Japan often face difficulties accessing healthcare due to language barriers, lack of information, shortage of interpreters, amongst other barriers. With an increase in the number of foreigners in Japan, it is also expected that health and safety concerns for migrants will rise during times of crisis or disaster. The purpose of this article is to present recommendations from Nepali migrants themselves about various actions that stakeholders or policymakers could take to improve healthcare access during future disasters, emergencies, or crises in Japan. Recommendations from Nepali migrants in this study include mobilization of Nepali healthcare professionals, self-preparedness, a disaster information centre by the embassy, Nepali hotline services, telehealth services, and mutual help. By working together and leveraging available resources, it is possible to ensure that migrants are not left behind in the face of disasters and emergencies. Further research is required to determine the most effective ways to improve healthcare access for migrants in Japan during disasters, crises, or emergencies.

Bridging the gap: Using CHNRI to align migration health research priorities in India with local expertise and global perspectives

Background

Migration and health are increasingly recognised as a global public health priority, but concerns have been raised on the skewed nature of current research and the potential disconnect between health needs and policy and governance responses. The Migration Health South Asia (MiHSA) network led the first systematic research priority-setting exercise for India, aligned with the global call to develop a clearly defined migration health research agenda that will inform research investments and guide migrant-responsive policies by the year 2030.

Methods

We adapted the Child Health and Nutrition Research Initiative (CHNRI) method for this priority setting exercise for migration health. Guided by advisory groups established at international and country levels, we sought research topics from 51 experts from diverse disciplines and sectors across India. We consolidated 223 responses into 59 research topics across five themes and scored them against five predefined criteria: answerability, effectiveness, feasibility, impact, and effect on equity. We then calculated research priority scores (RPS) and average expert agreement (AEA) each research topic and theme.

Results

A third of the 59 research topics were on migrants' health and health care access, 12 on social determinants of migrants' health, 10 on policies, law and migration health governance, eight on health systems' responsiveness, and five on migration health discourse. Three of the top five priority topics pertained to migrants' health care access. The policies, law, and governance theme had the highest overall RPS score.

Conclusions

There is a noticeable gap between research priorities identified by experts at the country-level and the current research focus and priorities set globally. This disconnect between the global and local perspectives in migration health scholarship hinders the development of context-specific and suitable policy agendas for improving migrants' health. Our co-developed agenda emphasises the need to prioritise research on the capacity of existing systems and policies so as to make them more migration-aware and responsive to migrants' health needs.

Effectiveness of Interventions to Improve Digital Health Literacy in Forced Migrant Populations: Protocol for a Mixed Methods Systematic Review

BACKGROUND

Digital health literacy is considered a health determinant that can influence improved health and well-being, health equity, and the reduction of social health inequalities. Therefore, it serves as an asset for individuals to promote their health. However, low digital health literacy is a major problem among forced migrant populations. They do not always have the capacity and skills to access digital health resources and use them appropriately. To our knowledge, no studies are currently available to examine effective interventions for improving digital health literacy among forced migrant populations.

OBJECTIVE

This paper presents the protocol for a systematic review that aims to assess the effectiveness of digital health literacy interventions among forced migrant populations. With this review, our objectives are as follows: (1) identify interventions designed to improve digital health literacy among forced migrant populations, including interventions aimed at creating enabling conditions or environments that cater to the needs and expectations of forced migrants limited by low levels of digital health literacy, with the goal of facilitating their access to and use of eHealth resources; (2) define the categories and describe the characteristics of these interventions, which are designed to enhance the abilities of forced migrants or adapt digital health services to meet the needs and expectations of forced migrant populations.

METHODS

A mixed methods systematic review will be conducted according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) checklist. The research will be conducted in an iterative process among the different authors. With the help of a medical information specialist, a specific search strategy will be formulated for the 6 most relevant databases (ie, MEDLINE, Embase, CINAHL, Web of Science, Academic Search Premier, PsycINFO, and the Google Scholar search engine). A literature search covering studies published between 2000 and 2022 has already been conducted. Two reviewers then proceeded, individually and independently, to conduct a double selection of titles, abstracts, and then full texts. Data extraction will be conducted by a reviewer and validated by a senior researcher. We will use the narrative synthesis method (ie, structured narrative summaries of key themes) to present a comprehensive picture of effective digital health literacy interventions among forced migrant populations and the success factors of these interventions.

RESULTS

The search strategy and literature search were completed in December 2022. A total of 1232 articles were identified. The first selection was completed in July 2023. The second selection is still in progress. The publication of the systematic review is scheduled for December 2023.

CONCLUSIONS

This mixed methods systematic review will provide comprehensive knowledge on effective interventions for digital literacy among forced migrant populations. The evidence generated will further inform stakeholders and aid decision makers in promoting equitable access to and use of digital health resources for forced migrant populations and the general population in host countries.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50798.

Migrants and Healthcare during COVID-19, the Case of Kanchanaburi Province in Thailand

Since the outbreak of COVID-19, as reported by the WHO in December 2019 and subsequently declared a public health emergency of international concern, a distinct set of risk factors and vulnerabilities faced by migrants are affecting their exposure to the pandemic and its associated outcomes. This study aims to analyze the social determinants of health among migrants and their associated factors and compare the socio-demographic characteristics, patterns of COVID-19, and healthcare attendance and utilization among migrant workers and non-migrants. A descriptive study design was used to analyze COVID-19 morbidity among migrant workers. There were a total of 73,762 migrants living in the province by December 2021, with varied statuses and nationalities. Most of the migrants were from Myanmar, constituting about 80.1%. A total of 24,837 COVID-19 cases in Kanchanaburi province were recorded in 2020-2021. COVID-19 cases among migrant workers accounted for 22.3% during the period under review. Half, 2914 (52.7%) of the migrant female workers were victims of COVID-19 infections. Persons under the age of 18 accounted for about one-fifth of all the COVID-19 cases. Older, over 60 years old, Thais had about twice (10.1%) the COVID-19 cases compared with the older migrants (5.5%). There was a significant increase in healthcare attendance and utilization by non-migrants and migrants during the year under review. Migrants are at high risk of COVID-19 infection. Therefore, public health guidance for the prevention of COVID-19 should prioritize safeguarding the health of migrants by considering their individual characteristics and actions. Enhancing health insurance schemes for migrants, particularly vulnerable migrant groups, is critical for inclusive and expanded healthcare access. Physical, social, and economic environments that impact the health and well-being of migrants should be integral to pandemic prevention, preparedness, response, and recovery.

Double burden of vulnerability for refugees: conceptualization and policy solutions for financial protection in Iran using systems thinking approach

INTRODUCTION

Iran is host to one of the world's largest and longest-standing refugee populations. Although Iran has initiated a basic health insurance scheme for refugees throughout the country since September 2015, the population coverage of this scheme is very low, and various factors have caused a significant percentage of refugees to still lack insurance coverage and often face financial hardships when receiving health services. In response, this study aimed to understand barriers to insurance coverage among refugees in Iran and propose effective policies that can address persistent gaps in financial protection.

METHODS

This qualitative study was conducted in two phases. First, a review of policy documents and interviews with participants were conducted to investigate the common barriers and facilitators of effective insurance coverage for refugees in Iran. Then, a systems thinking approach was applied to visualize the common variables and interactions on the path to achieving financial protection for refugees.

RESULTS

Findings showed that various factors, such as (1) household-based premium for refugees, (2) considering a waiting time to be eligible for insurance benefits, (3) determining high premiums for non-vulnerable groups and (4) a deep difference between the health services tariffs of the public and private service delivery sectors in Iran, have caused the coverage of health insurance for non-vulnerable refugees to be challenging. Furthermore, some policy solutions were found to improve the health insurance coverage of refugees in Iran. These included removing household size from premium calculations, lowering current premium rates and getting monthly premiums from non-vulnerable refugees.

CONCLUSIONS

A number of factors have caused health insurance coverage to be inaccessible for refugees, especially non-vulnerable refugees in Iran. Therefore, it is necessary to adopt effective policies to improve the health financing for the refugee with the aim of ensuring financial protection, taking into account the different actors and the interactions between them.

A Mixed Methods Protocol for Developing Strategies to Improve Access to Health Care Services for Refugees and Asylum Seekers in Gauteng Province, South Africa

Access to healthcare is a fundamental human right for all people, including refugees and asylum seekers. Despite the provision in the Refugee Act of South Africa, which allows refugees to enjoy the same access to health services as the citizens of the Republic, refugees still encounter challenges in accessing such services in Gauteng province. This protocol aims to develop strategies to improve access to health care services for refugees and asylum seekers in Gauteng province, South Africa. The study will be conducted in three phases. An exploratory sequential mixed methods design will be employed in phase 1 of the study; the initial study will be based on a qualitative approach followed by a quantitative approach. Phase 1 (a) of this study will employ a qualitative approach in Gauteng province among conveniently sampled health practitioners as well as purposively sampled refugees and asylum seekers. Interviews will be used to collect data that will be analyzed thematically. Phase 1 (b) will adopt a quantitative approach based on the findings from the initial qualitative study. The ethical principles of informed consent, anonymity, privacy, confidentiality, and avoidance of harm will be adhered to throughout the research process. Phase 1 (c) will be meta-inference and conceptualization. Phase 2 will focus on the development of strategies using strength, weakness, opportunities, and threats analysis and a build, overcome, explore, and minimize model to guide the process. In Phase 3, the Delphi technique will be used to validate the developed strategies. The conclusion and recommendations will be based on the findings of the study.

Prevalence of COVID-19 vaccine acceptance among migrant and refugee groups: A systematic review and meta-analysis

Objectives

Understanding COVID-19 vaccine hesitancy among migrant and refugee groups is critical for achieving vaccine equity. Therefore, we aimed to estimate the prevalence of COVID-19 vaccine acceptance among migrant and refugee populations.

Methods

A systematic review (PROSPERO: CRD42022333337) was conducted (December 2019-July 2022) using PubMed, Scopus, Web of Science, ProQuest and Google Scholar.

Results

Nineteen studies from 12 countries were included. The pooled estimated prevalence of COVID-19 vaccine willingness among migrant and refugee groups was 70% (19 studies, 95% CI: 62.3-77.4%, I2: 99.19%, τ2: 0.03). Female and male participants did not differ significantly with each other (p = 0.64). Although no individual variable contributed statistically significantly in multivariable meta-regression analysis, the multivariable model that considered methodological quality, mean age of participants, participant group and country of origin explained 67% of variance.

Discussion

Proportions of migrant/refugee groups receiving COVID-19 vaccinations approximated those observed among general populations. Additional studies are needed to examine factors relating to vaccine willingness to identify the most significant factors that may be targeted in interventions.

Taking a "Care Pathway/Whole Systems" Approach to Equality Diversity Inclusion (EDI) in Organ Donation and Transplantation in Relation to the Needs of "Ethnic/Racial/Migrant" Minority Communities: A Statement and a Call for Action

International evidence shows variation in organ donation and transplantation (ODT) based upon a range of patient characteristics. What is less well understood is the impact of patient "ethnicity/race/immigration background," as these terms are defined and intended differently across countries. We also know that these characteristics do not operate in isolation but intersect with a range of factors. In this paper, we propose a framework that seeks to clarify the definition of the key terms "ethnicity/race/migrant" and to review how these communities are operationalized across European studies about inequities in ODT. Further, patients and the public wish to see Equality Diversity Inclusion (EDI) approaches in their everyday lives, not just in relation to ODT. We propose a 'care pathway/whole-systems' approach to ODT encompassing culturally competent public health interventions for a) the prevention and management of chronic diseases, b) improvements in public engagement for the promotion of the culture of ODT and enhancements in end-of-life care, through to c) enhanced likelihood of successful transplant among migrant/ethnic minority communities. Our framework recognizes that if we truly wish to take an EDI approach to ODT, we need to adopt a more social, human and holistic approach to examining questions around patient ethnicity.

Psychological well-being, mental distress, metabolic syndrome, and associated factors among people living in a refugee camp in Greece: a cross-sectional study

Background

Forcibly displaced people face various challenges and are therefore at higher risk of being affected by mental and physiological distress. The present study aimed to determine levels of psychological well-being, PTSD symptom severity, metabolic syndrome, and associated factors among forcibly displaced people in Greece in response to WHO's call for evidence-based public health policies and programs for forcibly displaced people.

Methods

We conducted a cross-sectional study among n = 150 (50% women) forcibly displaced people originating from Sub-Sahara Africa and Southwest Asia living in a Greek refugee camp. Self-report questionnaires were used to assess psychological well-being, symptoms of PTSD, depression, generalized anxiety disorder and insomnia, perceived stress, headache, and perceived fitness. Cardiovascular risk markers were assessed to determine metabolic syndrome, and cardiorespiratory fitness was measured with the Åstrand-Rhyming Test of Maximal Oxygen Uptake.

Results

The prevalence of mental distress and physiological disorders was overall elevated. Only 53.0% of participants rated their psychological well-being as high. Altogether, 35.3% scored above the clinical cut-off for PTSD, 33.3% for depression, 27.9% for generalized anxiety disorder, and 33.8% for insomnia. One in four (28.8%) participants met criteria for metabolic syndrome. While the prevalence of moderate or severe insomnia symptoms and metabolic syndrome differed little from the global population, the risk of being affected by mental distress was markedly increased. In multivariable analysis, higher perceived fitness was associated with higher psychological well-being (OR = 1.35, p = 0.003) and a decreased likelihood for metabolic syndrome (OR = 0.80, p = 0.031). Participants with elevated psychiatric symptoms were less likely to report high psychological well-being (OR = 0.22, p = 0.003) and had increased odds for higher PTSD severity (OR = 3.27, p = 0.034). Increased stress perception was associated with higher PTSD symptoms (OR = 1.13, p = 0.002).

Conclusion

There is an elevated risk for mental distress compared to the global population and an overall high mental and physiological burden among people living in a Greek refugee camp. The findings underpin the call for urgent action. Policies should aim to reduce post-migration stressors and address mental health and non-communicable diseases by various programs. Sport and exercise interventions may be a favorable add-on, given that perceived fitness is associated with both mental and physiological health benefits.

Migration status, physical limitations and associated self-rated health: a study of older Indian adults

BACKGROUND

Migrant status with mobility impairment becomes a double burden for health and wellbeing of older adults. This study examined the independent relationships and multitude effects between migrant status, functional and mobility impairments and poor self-rated health (SRH) among older Indian adults.

METHODS

This study utilised nationally representative Longitudinal Ageing Study in India wave-1 (LASI) data, including a sample of 30,736 individuals aged 60 years and above. The main explanatory variables were migrant status, difficulty in activities of daily living (ADL), difficulty in instrumental activities of daily living (IADL) and mobility impairments; and the outcome variable was poor-SRH. Multivariable logistic regression and stratified analyses were used to fulfil the study objectives.

RESULTS

Overall, about 23% of older adults reported poor-SRH. Reporting poor-SRH was more prevalent (28.03%) among recent migrants (less than ten years). The prevalence of reporting poor-SRH was significantly higher among older adults who had mobility impairment (28.65%), difficulty in ADL or IADL (40.82% & 32.57%). Migrant older adults (regardless of duration) who had mobility impairment had significantly greater odds of reporting poor-SRH compared with non-migrant older adults who did not have mobility impairment. Similarly, older respondents who had problems in ADL and IADL with migration status had higher odds of reporting poor-SRH than their non-migrant counterparts with no such problems.

CONCLUSIONS

The study revealed the vulnerability of migrant older adults with functional and mobility disability, as well as those with limited socioeconomic resources and suffering from multimorbidity on rating their perceived health. The findings can be utilised to target outreach programmes and provision of services for migrating older individuals with mobility impairments and enhance their perceived health and ensure active ageing.

Determinants of attitudes towards refugees and intercultural sensitivity of nursing students: A descriptive and correlational study

BACKGROUND

The number of refugees, asylum seekers, and migrants is increasing worldwide. It is crucial to determine attitudes and intercultural sensitivities of nursing students towards refugees and individuals from different cultures. These nursing students will be providing healthcare in the future to these diverse communities.

OBJECTIVES

To determine the attitudes towards refugees and intercultural sensitivity of nursing students and to identify the determinants of these parameters.

DESIGN

The study was conducted with a descriptive and correlational design.

SETTINGS

Nursing departments of two universities in Ankara, Turkey.

PARTICIPANTS

The population of the study consisted of nursing students at two universities (N = 1530). A total of 905 students were included in the study.

METHODS

Data were obtained by a personal information form, the Attitudes Towards Refugees Scale, and the Intercultural Sensitivity Scale. Linear regression analysis was used to analyze the data obtained from the scales.

RESULTS

The participants' mean Attitudes Towards Refugees Scale score was 82.49 ± 16.66 and the Intercultural Sensitivity Scale score was 91.31 ± 11.15. Caring for refugees, intercultural sensitivity, interaction engagement, and respect for cultural differences were associated with attitudes towards refugees. Academic level, income, place of residence, and attitude towards refugees were associated with intercultural sensitivity.

CONCLUSIONS

Most of the nursing students displayed a negative attitude towards refugees, although they presented a high level of intercultural sensitivity. Integration of refugee-related topics into the nursing education curriculum and designing education programs are recommended to increase awareness and positive attitudes, and to improve cultural competence of nursing students.

Negative and protective experiences influencing the well-being of refugee children resettling in Germany: a qualitative study

OBJECTIVE

Conflict, forced migration and searching for safety in a foreign land are all experiences common to refugee children. They experience potentially traumatic events that are distinct from the general population, yet current adverse childhood experience (ACE) studies do not cover these events. Studies that do examine refugee children's experiences typically focus on a single stage of migration or adversities from the community, offering insight into only a fraction of their realities. This study aimed to identify potentially traumatising and protective experiences subjectively perceived as influencing refugee children's well-being from all stages of migration and all socio-ecological levels.

DESIGN

Qualitative study with thematic analysis of semi-structured individual and group interviews. Themes were organised within a socio-ecological model.

SETTING

Non-profit organisations, youth welfare facilities and societies that organise civic engagement for refugee families in the Rhine-Neckar region in Germany provided rooms where interviews could be conducted.

PARTICIPANTS

Refugee parents and children who spoke one of the four most common languages of those seeking asylum in Germany in 2018 were included. This study excluded refugees who were not fleeing a conflict area. Forty-seven refugee parents and 11 children (aged 8-17 years) from Syria, Iraq, Palestine, Afghanistan and Eritrea participated.

RESULTS

Eight major themes emerged from interviews including six reflecting potentially negative experiences and two potentially protective themes. These themes evolved from experiences such as family dispersion, displacement, rigorous immigration and national policies, as well as constructive parenting and community support.

CONCLUSION

It is increasingly important to identify these diverse experiences as the refugee population continues to grow, and the increased prevalence of poor health outcomes in refugee children continues to be widely documented. Identifying ACEs specifically relevant to refugee children could contribute to understanding potential pathways and could further serve as a starting point for tailored interventions.

Financing of health services for undocumented immigrants in Iran: common challenges and potential solutions

INTRODUCTION

Iran is host to one of the largest urban refugee populations worldwide, about two million of whom are undocumented immigrants (UIs). UIs are not eligible to enroll in the Iranian health insurance scheme and have to pay out-of-pocket to access most health services. This increases the likelihood that they will delay or defer seeking care, or incur substantial costs if they do seek care, resulting in worse health outcomes. This study aims to improve understanding of the financial barriers that UIs face in utilizing health services and provide policy options to ensure financial protection to enhance progress towards UHC in Iran.

METHODS

This qualitative study was conducted in 2022. A triangulation approach, including interviews with key informants and comparing them with other informative sources to find out the complementary findings, was applied to increase data confirmability. Both purposive and snowball sampling approaches were used to select seventeen participants. The data analysis process was done based on the thematic content analysis approach.

RESULTS

The findings were explained under two main themes: the financial challenges in accessing health services and the policy solutions to remove these financial barriers, with 12 subthemes. High out-of-pocket payments, high service prices for UIs, fragmented financial support, limited funding capacity, not freeing all PHC services, fear of deportation, and delayed referral are some of the barriers that UIs face in accessing health care. UIs can get insurance coverage by using innovative ways to get money, like peer financing and regional health insurance, and by using tools that make it easier, like monthly premiums without policies that cover the whole family.

CONCLUSION

The formation of a health insurance program for UIs in the current Iranian health insurance mechanism can significantly reduce management costs and, at the same time, facilitate risk pooling. Strengthening the governance of health care financing for UIs in the form of network governance may accelerate the inclusion of UIs in the UHC agenda in Iran. Specifically, it is necessary to enhance the role of developed and rich regional and international countries in financing health services for UIs.

Differential Probability in Unmet Healthcare Needs Among Migrants in Four European Countries

Migrants and refugees try to reach Europe to seek protection and a better life. The responsiveness and stewardship of the European countries health system have an impact on the ability to access healthcare. This study aims to investigate the differential probability of healthcare unmet needs among migrants living in four European countries. We used a 2019 cross-sectional data from the European Union Income and Living Conditions survey. We performed a two-stage probit model with sample selection, first to identify the respondents with need for care, then those who need it but have not received it. We analysed reasons for unmet needs through accessibility, availability and acceptability. We then performed country studies assessing the national health systems, financing mechanisms and migration policies. Bringing together data on financial hardship and unmet needs reveals that migrants living in Europe have a higher risk of facing unmet healthcare needs compared to native citizens, and affordability of care remains a substantial barrier. Our results showed the country heterogeneity in the differential migrants’ unmet needs according to the place where they live, and this disparity seems attributed to the health system and policies applied. Given the diversity of socioeconomic conditions throughout the European countries, the health of migrants depends to a large degree on the integration and health policies in place. We believe that EU policies should apply further efforts to respect core health and protection ethics and to acknowledge, among others, principles of ‘do-no-harm’, equity and the right to health.

A Qualitative Inquiry of Older Afghan Refugee Women's Individual and Sociocultural Factors of Health and Health Care Experiences in the United States

INTRODUCTION

Approximately 132,000 Afghans have resettled in the United States since the 1980s and are now aging. As older adults, sociocultural factors influence health and health-related behaviors. This study aimed to explore older Afghan refugee women's perceptions of individual and sociocultural factors of health and health care experiences.

METHODS

A focused ethnography methodology was conducted with 27 semi-structured interviews with older Afghan refugee women, family members, and community key informants in Southern California. Recorded interviews were transcribed and analyzed using inductive thematic analysis.

RESULTS

Five themes were identified as key to health promotion in the post-migration setting: (a) health promotion through Islam, (b) the centrality of family, (c) ongoing stressors that impact health, (d) needing support in navigating health services, and (e) miscommunication leading to mistrust of health care providers.

DISCUSSION

Health interventions should consider social and cultural contexts and faith-based and family-centered approaches when addressing older Afghan refugee women's long-term health and well-being.

The effect of peer-to-peer education on health literacy, knowledge, and adherence to COVID-19 protocols in vulnerable adolescents

BACKGROUND

The study was done to examine the effectiveness of peer-to-peer education on increasing health literacy, knowledge s, and observance of coronavirus disease (COVID-19) health prevention protocols in vulnerable adolescents.

METHOD

The study was a one-group intervention (before and after the intervention) that was performed on 1200 vulnerable adolescents living in varamin. The educational intervention was presented to adolescents in a face-to-face session. In the next step, the adolescents were taught the information received by three members of their families. Data were evaluated using a self-designed questionnaire before, and three months after the intervention. The paired t-test was used to compare scores of health literacy, compliance, and knowledge before and after the intervention at a 0.05 confidence level. The Multiple linear regression model was used to determine the predictive factors of observance of COVID-19 preventive behaviors.

RESULTS

The most of adolescents were in the age group of 14 to 18 years (60%) and most of them were girls (61.5%). The most important source of information about COVID-19 disease was radio and television (59.6%). The results showed that the effectiveness of the intervention in increasing the adolescents' health literacy, knowledge, and adherence to preventive behaviors were 40%, 30%, and 23%, respectively. The effectiveness of the intervention in increasing their families' health literacy and adherence to the protocols were 11% and 20%, respectively (p = 0.001).

DISCUSSION

Involving volunteer adolescents as health ambassadors and transmitting messages and methods of promoting personal protection against COVID-19 epidemics to family members had a significant effect on increasing the knowledge and adherence to the health procedures.

Application of the optimizing health literacy and access (Ophelia) process in partnership with a refugee community in Australia: Study protocol

Refugees experience health inequities resulting from multiple barriers and difficulties in accessing and engaging with services. A health literacy development approach can be used to understand health literacy strengths, needs, and preferences to build equitable access to services and information. This protocol details an adaptation of the Ophelia (Optimizing Health Literacy and Access) process to ensure authentic engagement of all stakeholders to generate culturally appropriate, needed, wanted and implementable multisectoral solutions among a former refugee community in Melbourne, Australia. The Health Literacy Questionnaire (HLQ), widely applied around the world in different population groups, including refugees, is usually the quantitative needs assessment tool of the Ophelia process. This protocol outlines an approach tailored to the context, literacy, and health literacy needs of former refugees. This project will engage a refugee settlement agency and a former refugee community (Karen people origin from Myanmar also formerly knowns as Burma) in codesign from inception. A needs assessment will identify health literacy strengths, needs, and preferences, basic demographic data and service engagement of the Karen community. This community will be engaged and interviewed using a semi-structured interview based on the Conversational Health Literacy and Assessment Tool (CHAT) will cover supportive professional and personal relationships, health behaviors, access to health information, use of health services, and health promotion barriers and support. Using the needs assessment data, vignettes portraying typical individuals from this community will be developed. Stakeholders will be invited to participate in ideas generation and prioritization workshops for in-depth discussion on what works well and not well for the community. Contextually and culturally appropriate and meaningful action ideas will be co-designed to respond to identified health literacy strengths, needs, and preferences of the community. This protocol will develop and test new and improved methods that are likely to be useful for community-based organizations and health services to systematically understand and improve communication, services and outcomes among disadvantaged groups, particularly migrants and refugees.

Understanding the impact of digital technology on the well-being of older immigrants and refugees: A scoping review

Background

The fast-paced development of digital technologies in the areas of social media, pet robots, smart homes, and artificial intelligence, among others, profoundly influence the daily lives of older adults. Digital technology can improve the well-being and quality of life of older adults, older immigrants and refugees who suffer migration-associated stress, loneliness, health and psychosocial challenges.

Aims

The aim of this scoping review is to map out extant empirical literature that has examined the implication of digital technology among older refugees and immigrants.

Methods

Using a1 five-stage framework, we conducted a scoping review of peer-reviewed empirical studies published in English with no time restrictions. We searched nine databases for the reviews, and abstracts were reviewed using Rayyan QCRi(c) before the full-text review. The comprehensive database search yielded 4134 articles, of which 15 met the inclusion criteria.

Results

The results of the review suggest that digital technology is essential to the well-being, quality of life of older immigrants and refugees, especially for maintaining and building new social support networks, navigating opportunities, coping with migration-induced stress through e-leisure, and staying connected to their culture. The literature also revealed poor utilisation of digital technologies amongst older immigrants and refugees, suggesting barriers to access.

Conclusion

The study concluded by highlighting the need for more research and interventions that focus on multiple strategies, including education for increased access to and utilisation of digital technology to ensure that more older migrants can benefit from the advantages of digital technology in a safe way.

Barriers adult refugees face to community health and patient engagement: a systematic review

Meeting the health needs of refugee populations and increasing access to healthcare remains a challenge for healthcare systems globally. As such, community health and patient engagement are increasingly recommended strategies to address health-related issues among refugees. This systematic review aims to identify the reported barriers that adult refugees encounter with community health and patient engagement. Data sources included MEDLINE, Embase, APA PsycINFO, CINAHL, and Core Collection (Web of Science), yielding 1156 records. After removing duplicates and two levels of screening, 18 studies were selected for qualitative analysis. The barriers were conceptualised as cultural norms, pre-departure history, education, language proficiency, stigma, racism, social support, and multi-factorial barriers. These barriers can be addressed to improve rapport with refugees and the quality of community health and patient engagement initiatives.

Left behind on the path to 90-90-90: understanding and responding to HIV among displaced people

INTRODUCTION

In 2021, the number of people affected by displacement worldwide reached the highest on record, with an estimated 30.5 million refugees and 4.6 million asylum seekers seeking safety across international borders and further 53.2 million people displaced within their countries of origin. Most forcibly displaced persons come from or relocate to lower- and middle-income countries (LMICs) and many of those countries have large HIV epidemics. In this commentary, we describe some of the challenges at the intersection of HIV and displacement vulnerabilities that cannot be easily addressed in resource-limited environments.

DISCUSSION

HIV transmission and prevention and treatment efforts in the context of displacement are affected by myriad behavioural, social and structural factors across different stages of the displacement journey. For example, structural barriers faced by people experiencing displacement in relation to HIV prevention and care include funding constraints and legal framework deficiencies. Such barriers prevent all forced migrants, and particularly those whose sexual identities or practices are stigmatized against, access to prevention and care equal to local residents. Xenophobia, racism and other social factors, as well as individual risky behaviours facilitated by experiences of forced migration, also affect the progress towards 90-90-90 targets in displaced populations. Current evidence suggests increased HIV vulnerability in the period before displacement due to the effect of displacement drivers on medical supplies and infrastructure. During and after displacement, substantial barriers to HIV testing exist, though following resettlement in stable displacement context, HIV incidence and viral suppression are reported to be similar to those of local populations.

CONCLUSIONS

Experiences of often-marginalized displaced populations are diverse and depend on the context of displacement, countries of origin and resettlement, and the nature of the crises that forced these populations to move. To address current gaps in responses to HIV in displacement contexts, research in LMIC, particularly in less stable resettlement settings, needs to be scaled up. Furthermore, displaced populations need to be specifically addressed in national AIDS strategies and HIV surveillance systems. Finally, innovative technologies, such as point-of-care viral load and CD4 testing, need to be developed and introduced in settings facing displacement.

Experiences and Perceived Barriers of Asylum Seekers and People with Refugee Backgrounds in Accessing Healthcare Services in Romania

Traditionally a country of emigration, Romania recently experienced an increased migration influx, although it is more a country of transit than a destination for refugees and irregular migrants. Refugees often face difficulties when trying to meet their needs and access essential services. This study aims to explore the experiences and barriers of asylum seekers and people with refugee backgrounds in accessing healthcare services in Romania. It is an exploratory study with a qualitative research design, which uses an inductive and deductive approach, with thematic analysis being applied in order to grasp the difficulties and barriers that asylum seekers and people with refugee backgrounds experience in accessing essential social services. The research was based on seven in-depth interviews with representatives of significant national or international non-governmental organisations assisting refugees and asylum seekers in Romania and 129 semi-structured interviews with different categories of people with refugee backgrounds from Southwest Asia, Eastern Africa and Ukraine. One of the most salient themes we identified relates to accessing the healthcare system. Participants talked about what information they needed to access medical services, where they looked for this information, and what barriers they faced in the process. Cultural, linguistic, structural, and financial barriers were perceived as the most significant. Improved public awareness, a better understanding of asylum issues, and stronger community support are essential to addressing inequalities experienced by this vulnerable population.

Health and health-related behaviours in refugees and migrants who self-identify as sexual or gender minority - A National population-based study in Sweden

BACKGROUND

To examine health and health-related behaviors in migrant and refugee individuals who identify as sexual or gender minority, and in comparison to their heterosexual peers.

METHODS

The study included 168,952 individuals (aged 16-84 years, males: 45·9%, sexual or gender minorities: 3·1%) who answered the Swedish National Public Health Survey in 2018 and 2020. Participants were grouped into Swedish-and Western-born (White) heterosexual, White sexual- or gender minority, migrant heterosexual, migrant sexual- or gender minority, refugee heterosexual, and refugee sexual- or gender minority. Outcomes included mental health (for example suicidal ideation, wellbeing), general health, risky behaviors (risk alcohol use, risk gambling, and substance use), and experiences of violence. Associations between 1) sexual- or gender -ethnic identities and 2) gender-ethnic identities and all outcomes were analyzed using logistic and linear regression adjusting for sex, age, and educational level.

FINDINGS

Being a sexual- or gender minority, regardless of ethnic minority status, was associated with worse general health and mental ill-health compared to heterosexual peers including suicidal ideation in refugee sexual- or gender minority individuals (OR 2·42, 95 % CI 1·44-4·08). Ethnic minorities (heterosexual and sexual- or gender minority migrants and refugees) had lower odds of drug and risk alcohol use compared to White heterosexual peers but higher odds of risk gambling (1·88, 1·49-2·37 for refugee heterosexuals). Transgender refugees had high odds for risk gambling (8·62, 1·94-38·40) and exposure to physical violence (7·46, 2·97-18·70).

INTERPRETATION

In this national population-based study, sexual and gender minority individuals have worse mental and general health regardless of ethnic minority status. We did not find evidence for worse health in sexual- or gender minority refugees in comparison to migrant, and White sexual- or gender minorities and their heterosexual peers. Transgender individuals (White and ethnic minority) experienced significantly higher levels of physical violence. Public health policy should emphasize preventive measures to reduce exposure to violence and discrimination in sexual- and gender minority individuals, increase access and use of mental healthcare services and sensitise healthcare professionals about higher rates of health and related issues faced by sexual- and gender minority individuals including those with multiple minority identities.

FUNDING

We received no external funding for this study and hence the funder had no role in the study design, data collection, data analysis, data interpretation, writing of the manuscript and the decision to submit.

Sharing country experiences: The WHO Global School on Refugee and Migrant Health in Jordan

In 2021, Jordan was the first country to host the Global School for Refugee and Migrant Health, to improve the knowledge of the public health implications of migration. These perspective articles aim to retrieve salient reflections during the School as a baseline for further enhancement of migrant and health programs. During the School, a compilation of achievements, challenges, and opportunities was discussed around specific interrelated subjects, such as health system management and mental health. Successful examples were provided in the integration of refugees and migrants into health policies. On the other hand, the national health information systems are often not migrant-sensitive and evidence is still poor around mental health problems of refugees and migrants. Health financing remains a critical subject to address in a tailored way. The School highlighted the need to continue the exchange of experiences to promote a common approach to tackle similar needs.

Systematic review of electronic health records to manage chronic conditions among displaced populations

OBJECTIVES

The objective of this study was to assess the impact of electronic health records (EHRs) on health outcomes and care of displaced people with chronic health conditions and determine barriers and facilitators to EHR implementation in displaced populations.

DESIGN

A systematic review protocol was developed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Systematic Reviews.

DATA SOURCES

MEDLINE, Embase, PsycINFO, CINAHL, Health Technology Assessment, Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was searched from inception to 12 April 2021.

ELIGIBILITY CRITERIA FOR SELECTED STUDIES

Inclusion criteria were original research articles, case reports and descriptions of EHR implementation in populations of displaced people, refugees or asylum seekers with related chronic diseases. Grey literature, reviews and research articles unrelated to chronic diseases or the care of refugees or asylum populations were excluded. Studies were assessed for risk of bias using a modified Cochrane, Newcastle-Ottawa and Joanna Briggs Institute tools.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data from each study using Covidence. Due to heterogeneity across study design and specific outcomes, a meta-analysis was not possible. An inductive thematic analysis was conducted using NVivo V.12 (QSR International, Melbourne, Australia). An inductive analysis was used in order to uncover patterns and themes in the experiences, general outcomes and perceptions of EHR implementation.

RESULTS

A total of 32 studies across nine countries were included: 14 in refugee camps/settlements and 18 in asylum countries. Our analysis suggested that EHRs improve health outcomes for chronic diseases by increasing provider adherence to guidelines or treatment algorithms, monitoring of disease indicators, patient counselling and patient adherence. In asylum countries, EHRs resource allocation to direct clinical care and public health services, as well as screening efforts. EHR implementation was facilitated by their adaptability and ability to integrate into management systems. However, barriers to EHR development, deployment and data analysis were identified in refugee settings.

CONCLUSION

Our results suggest that well-designed and integrated EHRs can be a powerful tool to improve healthcare systems and chronic disease outcomes in refugee settings. However, attention should be paid to the common barriers and facilitating actions that we have identified such as utilising a user-centred design. By implementing adaptable EHR solutions, health systems can be strengthened, providers better supported and the health of refugees improved.

The effects of the global health crisis on U. S. immigration policies: shifting political agenda-setting and the mobility crisis of immigrants

The continuing health crisis (COVID-19) reinforces a historical pattern in which partisan-elected officials engage as legislative policy entrepreneurs (LPE) and use the health crisis time as a policy window to advance specifically restricted agendas by (re)introducing immigration bills on the House and Senate. The current exploratory qualitative study utilizes the theoretical underpinning of Kingdon's Multiple Streams Framework (MSF) to analyze the US House immigration bills from 2013 to 2021. The qualitative method of content relational analysis was applied in this research to capture the shifts and changes in (re)introduced immigration bills (n = 904) in the US House of Representatives for the 113th, 114th, 115th, and 116th sessions. Capturing and examining the underlying tone, word choices, and proposed measures in these immigration bills during health and non-health crisis periods received special attention. The qualitative relational content analysis revealed three major themes: (1) During public health crises (Ebola, Zika, and the first two years of COVID-19), restrictive House immigration bills tend to rise sharply; (2) Elected representatives from the Southern States are more likely to introduce restrictive immigration bills during health crises; and (3) Restrictive immigration bills are more likely to receive partisan support (bill co-sponsors) during health crises. The findings emphasize the need for inclusive agenda-setting during health crises and provide light on adaptive measures for supporting underprivileged immigrant communities with increased access to healthcare and public support.

The Challenge of Reaching Undocumented Migrants with COVID-19 Vaccination

Access to vaccination against a health threat such as that presented by the COVID-19 pandemic is an imperative driven, in principle, by at least three compelling factors: (1) the right to health of all people, irrespective of their status; (2) humanitarian need of undocumented migrants, as well as of others including documented migrants, refugees and displaced people who are sometimes vulnerable and living in precarious situations; and (3) the need to ensure heath security globally and nationally, which in the case of a global pandemic requires operating on the basis that, for vaccination strategies to succeed in fighting a pandemic, the highest possible levels of vaccine uptake are required. Yet some population segments have had limited access to mainstream health systems, both prior to as well as during the COVID-19 pandemic. People with irregular resident status are among those who face extremely high barriers in accessing both preventative and curative health care. This is due to a range of factors that drive exclusion, both on the supply side (e.g., systemic and practical restrictions in service delivery) and the demand side (e.g., in uptake, including due to fears that personal data would be transmitted to immigration authorities). Moreover, undocumented people have often been at increased risk of infection due to their role as "essential workers", including those experiencing higher exposure to the SARS-CoV-2 virus due to frontline occupations while lacking protective equipment. Often, they have also been largely left out of social protection measures granted by governments to their populations during successive lockdowns. This article reviews the factors that serve as supply-side and demand-side barriers to vaccination for undocumented migrants and considers what steps need to be taken to ensure that inclusive approaches operate in practice.

Palliative Care Utilisation Among Non-Western Migrants in Denmark: A Qualitative Study Of the Experiences of Patients, Family Caregivers and Healthcare Professionals

This study explores care experiences while utilising palliative care services of non-western migrant families from the perspectives of patients, family caregivers, and healthcare professionals in Denmark. Twenty-three semi-structured individual and group interviews were conducted among eight patients with a life-threatening disease, 11 family caregivers, and ten healthcare professionals. Thematic analysis revealed three themes: 1) Communication between families and healthcare professionals; 2) Building and lack of trusting relations, and feeling safe, and 3) Access to information and navigating in the healthcare system. Moreover, ''language and culture'' emerged as transaction themes that are not mutually exclusive, however, interconnect across the mentioned three themes. Non-western migrant families can be supported by healthcare professionals' cultural competency training, negotiating on providing services concerning information, patient preferences, family involvement, and palliative care setting. This study findings urge inter-sectoral collaboration to ensure needs-oriented and linguistically and culturally appropriate palliative care services for non-western migrant families in Denmark.

An undergraduate medical education framework for refugee and migrant health: Curriculum development and conceptual approaches

BACKGROUND

International migration, especially forced migration, highlights important medical training needs including cross-cultural communication, human rights, as well as global health competencies for physical and mental healthcare. This paper responds to the call for a 'trauma informed' refugee health curriculum framework from medical students and global health faculty.

METHODS

We used a mixed-methods approach to develop a guiding medical undergraduate refugee and migrant health curriculum framework. We conducted a scoping review, key informant interviews with global health faculty with follow-up e-surveys, and then, integrated our results into a competency-based curriculum framework with values and principles, learning objectives and curriculum delivery methods and evaluation.

RESULTS

The majority of our Canadian medical faculty respondents reported some refugee health learning objectives within their undergraduate medical curriculum. The most prevalent learning objective topics included access to care barriers, social determinants of health for refugees, cross-cultural communication skills, global health epidemiology, challenges and pitfalls of providing care and mental health. We proposed a curriculum framework that incorporates values and principles, competency-based learning objectives, curriculum delivery (i.e., community service learning), and evaluation methods.

CONCLUSIONS

The results of this study informed the development of a curriculum framework that integrates cross-cultural communication skills, exploration of barriers towards accessing care for newcomers, and system approaches to improve refugee and migrant healthcare. Programs should also consider social determinants of health, community service learning and the development of links to community resettlement and refugee organizations.

Blockchain technology in migrant and refugee health: A scoping review

Background

The increase of forcibly displaced people worldwide is a challenge for health systems and their ability to provide access and equity in Health as a universal right. In the case of migrants and refugees, their journey exacerbates this challenge, as they go through diverse countries, camps, and humanitarian teams. Hence, the collection and analysis of health data are essential in providing quality care. The scientific community has been studying health digital technologies to answer health data consolidation, transparency, and global surveillance efficiency issues. Observing some empirical experiments with Blockchain in migrants and refugee health, we assessed the state-of-the-art by conducting a literature review.

Methods

Blockchain applications are still emerging, which means that peer-reviewed literature may still be scarce in life science databases. Therefore, to gather the most appropriate available evidence, we used a diverse and balanced set of databases that compile articles and journals from different fields. We used a multi-step scoping review to refine search keywords and analyse the literature. We included studies between 2008 and 2021 that reported value, utility, or use cases of Blockchain in support of migrant and refugee health.

Results

We identified a total of 69 articles, with 22 retained for full-text analysis and 8 of those being relevant. We employed Rayyan application to manage and evaluate the references by two researchers working independently. We identified two main uses of Blockchain technology to support migrant and refugee health: mitigate the lack of personal identification and make health records available. Blockchain also promotes data reliability in humanitarian aid, academic certificates, legal contracts, and financial transactions.

Conclusions

The availability of reliable information about individuals facilitates universal health coverage, improves cooperation between diaspora-related countries, and supports global health efficiency in line with the third goal of the Sustainable Development Goals 2030 agenda. Given its characteristics of decentralization, resilience, transparency, and auditability, Blockchain remains a promising avenue for future research in migrant and refugee health.

Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach

Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology. Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method. Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person's country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests. Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people.

States and Refugee Integration: a Comparative Analysis of France, Germany, and Switzerland

The Syrian civil war led to mass migration and Europe becoming a potential site of refuge. How have Syrians experienced refuge in Europe? Drawing on 58 interviews with Syrian refugees in Germany, France, and Switzerland, we find that refugees continue to experience exclusion in all integration domains including those found as markers and means, social connections, facilitators, and foundations of integration . While our cases demonstrate that Syrian refugees in Europe experience discrimination across all domains, not all conditions are equal. Using narrative analysis, differences were observed within three integration domains. Accessing language programs was more challenging in France, finding housing was more challenging in Germany, and F type residence permits limited refugees’ rights in Switzerland more than in other countries. Discrimination across domains is deepening the socio-cultural-economic divide between autochthonous communities and Syrian refugees, but not all domains are equally divisive across countries. The findings outline that where these states outsourced refugee services, refugees experienced increased barriers to integration.

Implementation, effectiveness and monitoring of telemedicine program in Bhutanese refugees camp in Eastern Nepal

Background:

Methods:

Results:

Conclusions:

Climate change impacts on infectious diseases in the Eastern Mediterranean and the Middle East (EMME)-risks and recommendations

The Eastern Mediterranean and Middle East (EMME) region has rapid population growth, large differences in socio-economic levels between developed and developing countries, migration, increased water demand, and ecosystems degradation. The region is experiencing a significant warming trend with longer and warmer summers, increased frequency and severity of heat waves, and a drier climate. While climate change plays an important role in contributing to political instability in the region through displacement of people, food insecurity, and increased violence, it also increases the risks of vector-, water-, and food-borne diseases. Poorer and less educated people, young children and the elderly, migrants, and those with long-term health problems are at highest risk. A result of the inequalities among EMME countries is an inconsistency in the availability of reliable evidence about the impacts on infectious diseases. To help address this gap, a search of the literature was conducted as a basis for related recommended responses and suggested actions for preparedness and prevention. Since climate change already impacts the health of vulnerable populations in the EMME and will have a greater impact in future years, risk assessment and timely design and implementation of health preparedness and adaptation strategies are essential. Joint national and cross-border infectious diseases management systems for more effective preparedness and prevention are needed, supported by interventions that improve the environment. Without such cooperation and effective interventions, climate change will lead to an increasing morbidity and mortality in the EMME from infectious diseases, with a higher risk for the most vulnerable populations.