Social and economic influences on disparities in the health of racial and ethnic group Canadian immigrants

Care-seeking strategies of migrants during the transition from a specific primary healthcare facility for uncovered individuals to common ambulatory general practice: A French qualitative study

BACKGROUND

Migrants have complex health needs but face multiple barriers to accessing health care. In France, permanent healthcare access offices (PASSs), as specific primary health care facilities (SPHCs), provide care to people without health insurance coverage. Once these patients obtain health insurance, they are referred to common ambulatory general practice. The aim of this study was to explore migrants' experiences and strategies for seeking common primary care after having been treated by an SPHC.

METHODS

We conducted a qualitative study based on grounded theory between January and April 2022. We held semi-structured interviews with migrants who had consulted a PASS. Two researchers performed an inductive analysis.

RESULTS

We interviewed 12 migrants aged 22 to 65 to confirm data saturation. The interviewees relied on "referents": professional referents (to be properly treated for specific health problems), guides (to find their way through the healthcare system), or practical referents (to address practical issues such as translation, travel needs, or medical matters). Those who considered the PASS to be a referent expressed disappointment and incomprehension at the time of discharge. Referral procedures and the first encounter with common ambulatory general practice were decisive in whether the interviewees accessed and stayed in a coordinated primary care pathway. The perceived quality of care depended on a feeling of being considered and listened to. For interviewees who received first-time services from an ambulatory general practice, the way in which they were referred to and their first experience with an ambulatory GP could influence their adherence to care.

CONCLUSIONS

The conditions of transition from SPHCs to common ambulatory general practice can impact migrants' adherence to a coordinated primary care pathway. Referral can improve these patients' care pathways and ease the transition from a PASS to ambulatory care. Healthcare professionals at SPHCs should pay special attention to vulnerable migrants without previous experience in ambulatory general practice and who depend on referents in their care pathways. For these patients, adapted referral protocols with further individual support and empowerment should be considered.

Dominican Adolescents' Preferences for Content, Design, and Functionality of a Mobile Application for Type 1 Diabetes Mellitus Self-management

OBJECTIVE

The purpose of this interdisciplinary study was to determine Dominican adolescents' preferences for the content, functionality (i.e. food's glycemic index list, and amount of insulin based on foods' carbohydrate count), and design of a culturally and linguistically relevant mobile application (app) for type 1 diabetes mellitus (T1DM) self-management. The app would facilitate T1DM self-management education and support by addressing providers' challenges in monitoring patients' disease progression and promoting patient adherence to recommended lifestyle changes. Findings inform an app development process that considers the linguistic and cultural values, norms, and structures of people with T1DM and their providers in the Dominican Republic.

METHODS

Phone interviews were conducted with 23 adolescents (14 to 18 years of age), using a semistructured questionnaire. The research team conducted the data analysis using NVivo through a deductive and inductive approach.

RESULTS

The findings suggest that, regardless of the context, adolescents with T1DM desire similar features and functionalities in a self-management app. Overall, participants preferred an app with a graphic format that has accessible information, a straightforward design, and instructional videos. Participants also desired that an app provide information and reminders about proper eating and insulin administration timing and be a vehicle to access a social network to foster mutual support and encouragement.

CONCLUSIONS

Our study highlights adolescents' perspectives on components for inclusion in an app for T1DM self-management. Participants' recommendations for the app's potential usability, contents, and design features will be used to guide the development of a new app to promote engagement and foster better health outcomes.

Role of country of origin and state of residence for dietary change among foreign-born adults in the US

Place of origin and place of current residence may shape migrants' health-related behaviors. Using the nationally-representative US New Immigrant Survey (n = 7930), we examined associations between country of origin, state of residence, and dietary changes among foreign-born adults. 65% of migrants reported dietary change since immigration (mean score = 7.3; range = 1-10); 6% of the variance was explained by country of origin characteristics; 1.6% by US state of residence; 1.4% by their interaction. Country of origin factors, specifically availability of animal source foods and sweets, were associated with dietary change, availability of sweets also including greater abandonment of specific foods and adoption of others.

The Use of Digital Health Interventions for Cardiometabolic Diseases Among South Asian and Black Minority Ethnic Groups: Realist Review

BACKGROUND

Digital health interventions (DHIs) for the prevention and management of cardiometabolic diseases have become increasingly common. However, there is limited evidence for the suitability of these approaches in minority ethnic populations, who are at an increased risk of these diseases.

OBJECTIVE

This study aimed to investigate the use of DHIs for cardiovascular disease and type 2 diabetes among minority ethnic populations in countries with a majority of White, English-speaking populations, focusing on people who identified as South Asian, Black, or African American.

METHODS

A realist methodology framework was followed. A literature search was conducted to develop context-mechanism-outcome configurations, including the contexts in which DHIs work for the target minority ethnic groups, mechanisms that these contexts trigger, and resulting health outcomes. After systematic searches, a qualitative analysis of the included studies was conducted using deductive and inductive coding.

RESULTS

A total of 15 studies on the uptake of DHIs for cardiovascular disease or diabetes were identified, of which 13 (87%) focused on people with an African-American background. The review found evidence supporting the use of DHIs in minority ethnic populations when specific factors are considered in implementation and design, including patients' beliefs, health needs, education and literacy levels, material circumstances, culture, social networks, and wider community and the supporting health care systems.

CONCLUSIONS

Our context-mechanism-outcome configurations provide a useful guide for the future development of DHIs targeted at South Asian and Black minority ethnic populations, with specific recommendations for improving cultural competency and promoting accessibility and inclusivity of design.

Physical Health of Older Canadians: Do Intersections Between Immigrant and Refugee Status, Racialized Status, and Socioeconomic Position Matter?

It is unclear whether racial or nativity health disparities exist among older Canadians and what social and economic disadvantages may contribute to these differences. Secondary analysis of data collected from respondents aged 55 and older in the Canadian General Social Survey 27 was performed. The outcome variable was self-reported physical health. Compared to racialized immigrants, white immigrant and Canadian-born respondents had approximately 35% higher odds of good health. Among racialized older adults, the odds of good health were better if they were younger than 75, more affluent, better educated, had a confidant, had not experienced discrimination in the past five years, and were more acculturated. Racialized immigrants are at a health disadvantage compared to white groups in Canada; however, greater acculturation, social support, and lower experiences of discrimination contribute to better health among racialized older adults.