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Petrie G, Angus K, O'Donnell R. A scoping review of academic and grey literature on migrant health research conducted in Scotland. BMC Public Health 2024; 24:1156. [PMID: 38658855 PMCID: PMC11044410 DOI: 10.1186/s12889-024-18628-1] [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: 09/04/2023] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Migration to Scotland has increased since 2002 with an increase in European residents and participation in the Asylum dispersal scheme. Scotland has become more ethnically diverse, and 10% of the current population were born abroad. Migration and ethnicity are determinants of health, and information on the health status of migrants to Scotland and their access to and barriers to care facilitates the planning and delivery of equitable health services. This study aimed to scope existing peer-reviewed research and grey literature to identify gaps in evidence regarding the health of migrants in Scotland. METHODS A scoping review on the health of migrants in Scotland was carried out for dates January 2002 to March 2023, inclusive of peer-reviewed journals and grey literature. CINAHL/ Web of Science/SocIndex and Medline databases were systematically searched along with government and third-sector websites. The searches identified 2166 journal articles and 170 grey literature documents for screening. Included articles were categorised according to the World Health Organisation's 2016 Strategy and Action Plan for Refugee and Migrant Health in the European region. This approach builds on a previously published literature review on Migrant Health in the Republic of Ireland. RESULTS Seventy-one peer reviewed journal articles and 29 grey literature documents were included in the review. 66% were carried out from 2013 onwards and the majority focused on asylum seekers or unspecified migrant groups. Most research identified was on the World Health Organisation's strategic areas of right to health of refugees, social determinants of health and public health planning and strengthening health systems. There were fewer studies on the strategic areas of frameworks for collaborative action, preventing communicable disease, preventing non-communicable disease, health screening and assessment and improving health information and communication. CONCLUSION While research on migrant health in Scotland has increased in recent years significant gaps remain. Future priorities should include studies of undocumented migrants, migrant workers, and additional research is required on the issue of improving health information and communication.
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Affiliation(s)
- G Petrie
- Caledonia House, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - K Angus
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - R O'Donnell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
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Stransky ML, Bremer-Kamens M, Bair-Merritt M, Howard C, Brooks C, Meill A, Morris A, Sheldrick RC. Conceptualizations of health, ability to act upon those definitions and desire for supports among families from historically marginalized communities. Child Care Health Dev 2024; 50:e13214. [PMID: 38062906 DOI: 10.1111/cch.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/25/2024]
Abstract
Respect for parents' values and clinician-parent collaboration is less common among families from historically marginalized communities. We investigated how parents from marginalized communities operationalize health and their preferences for paediatric primary care. We recruited families who spoke English, Haitian Creole or Spanish with at least one child younger than 6 years old. Staff queried families' values and life experiences, perspectives on health and healthcare, social supports and resources. Fourteen interviews with the parents of 26 children were thematically analysed. Interviews revealed the following four themes: (1) parents' definitions of 'health' extend beyond physical health; (2) families' ability to actuate health definitions is complicated by poverty's impact on agency; (3) parents engage in ongoing problem recognition and identify solutions, but enacting solutions can be derailed by barriers and (4) parents want support from professionals and peers who acknowledged the hard work of parenting. Eliciting parents' multidimensional conceptualizations of health can support families' goal achievement and concern identification in the context of isolation, limited agency and few resources. Efforts to improve family centred care and reduce disparities in paediatric primary care must be responsive to the strengths, challenges, resources and priorities of marginalized families.
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Affiliation(s)
- Michelle L Stransky
- Center for the Urban Child and Healthy Family, Boston Medical Center, Boston, MA, USA
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Miriam Bremer-Kamens
- Center for the Urban Child and Healthy Family, Boston Medical Center, Boston, MA, USA
| | - Megan Bair-Merritt
- Center for the Urban Child and Healthy Family, Boston Medical Center, Boston, MA, USA
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | | | | | - Anita Morris
- Center for the Urban Child and Healthy Family, Boston Medical Center, Boston, MA, USA
| | - R Christopher Sheldrick
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
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3
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Hsu C, Williamson BD, Becker M, Berry B, Cook AJ, Derus A, Estrada C, Gacuiri M, Kone A, McCracken C, McDonald B, Piccorelli AV, Senturia K, Volney J, Wilson KB, Green BB. Engaging staff to improve COVID-19 vaccination response at long-term care facilities (ENSPIRE): A cluster randomized trial of co-designed, tailored vaccine promotion materials. Contemp Clin Trials 2024; 136:107403. [PMID: 38052297 DOI: 10.1016/j.cct.2023.107403] [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: 07/11/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND COVID-19 vaccination rates among long-term care center (LTCC) workers are among the lowest of all frontline health care workers. Current efforts to increase COVID-19 vaccine uptake generally focus on strategies that have proven effective for increasing influenza vaccine uptake among health care workers including educational and communication strategies. Experimental evidence is lacking on the comparative advantage of educational strategies to improve vaccine acceptance and uptake, especially in the context of COVID-19. Despite the lack of evidence, education and communication strategies are recommended to improve COVID-19 vaccination rates and decrease vaccine hesitancy (VH), especially strategies using tailored messaging for disproportionately affected populations. METHODS We describe a cluster-randomized comparative effectiveness trial with 40 LTCCs and approximately 4000 LTCC workers in 2 geographically, culturally, and ethnically distinct states. We compare the effectiveness of two strategies for increasing COVID-19 booster vaccination rates and willingness to promote COVID-19 booster vaccination: co-design processes for tailoring educational messages vs. an enhanced usual care comparator. Our study focuses on the language and/or cultural groups that are most disproportionately affected by VH and low COVID-19 vaccine uptake in these LTCCs. CONCLUSION Finding effective methods to increase COVID-19 vaccine uptake and decrease VH among LTCC staff is critical. Beyond COVID-19, better approaches are needed to improve vaccine uptake and decrease VH for a variety of existing vaccines as well as vaccines created to address novel viruses as they emerge.
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Affiliation(s)
- Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, United States of America; Global Alliance to Prevent Prematurity and Stillbirth, United States of America; University of Washington School of Public Health, United States of America.
| | - Brian D Williamson
- Kaiser Permanente Washington Health Research Institute, United States of America; Department of Biostatistics, University of Washington, United States of America
| | - Marla Becker
- Kaiser Permanente Washington Health Research Institute, United States of America; Era Living, United States of America
| | - Breana Berry
- Center for Research and Evaluation, Kaiser Permanente Georgia, United States of America
| | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, United States of America; Department of Biostatistics, University of Washington, United States of America
| | - Alphonse Derus
- Kaiser Permanente Washington Health Research Institute, United States of America
| | - Camilo Estrada
- Kaiser Permanente Washington Health Research Institute, United States of America
| | - Margaret Gacuiri
- Kaiser Permanente Washington Health Research Institute, United States of America
| | - Ahoua Kone
- University of Washington School of Public Health, United States of America; Kaiser Permanente Bernard J Tyson School of Medicine, Department of Health Systems Science, United States of America
| | - Courtney McCracken
- Center for Research and Evaluation, Kaiser Permanente Georgia, United States of America
| | - Bennett McDonald
- Center for Research and Evaluation, Kaiser Permanente Georgia, United States of America
| | | | - Kirsten Senturia
- Global Alliance to Prevent Prematurity and Stillbirth, United States of America; University of Washington School of Public Health, United States of America
| | - Jaclyn Volney
- Center for Research and Evaluation, Kaiser Permanente Georgia, United States of America
| | - Kanetha B Wilson
- Center for Research and Evaluation, Kaiser Permanente Georgia, United States of America
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, United States of America; Kaiser Permanente Bernard J Tyson School of Medicine, Department of Health Systems Science, United States of America
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Ward A, Andrews L, Black A, Williamson AE. Communicating effectively with inclusion health populations: 2022 ICCH symposium. PATIENT EDUCATION AND COUNSELING 2023; 117:107977. [PMID: 37708698 DOI: 10.1016/j.pec.2023.107977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To describe communication strategies for clinical practice that allow practitioners to work more effectively with marginalised population groups and to discuss how to incorporate these into medical practice. METHODS Active practitioners working in inclusion health and people with lived experience of homelessness and the asylum-seeking process shared their perspectives in the symposium at the 2022 International Conference on Communication in Healthcare (ICCH) and a subsequent conference on empathy in healthcare. The views of attendees were sought. SYMPOSIUM DISCUSSION We describe the perspectives shared at the symposia under two main themes: communication needs in people experiencing homelessness and migrant populations, and trauma-informed practice. CONCLUSIONS People experiencing homelessness have more communication challenges compared to the general adult population. Migrant, refugee, and asylum-seeking populations also face the complexity of negotiating unfamiliar healthcare, legal and social systems with the added burden of language barriers. Trauma-informed practice provides a useful framework that can improve communication with these groups.
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Affiliation(s)
- Andy Ward
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK.
| | | | - Anna Black
- Department of General Practice and Primary Care, University of Glasgow, UK
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Herzig van Wees S, Stålgren M, Viberg N, Puranen B, Ekström AM, Larsson EC. "Who is Anders Tegnell?" Unanswered questions hamper COVID-19 vaccine uptake: A qualitative study among ethnic minorities in Sweden. Vaccine 2023; 41:7476-7481. [PMID: 37953100 DOI: 10.1016/j.vaccine.2023.11.016] [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: 04/25/2022] [Revised: 10/27/2023] [Accepted: 11/05/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Despite high COVID-19 vaccination coverage in many European countries, vaccination uptake has been lower among ethnic minorities, including in Sweden. This is in spite of the increased risk of contracting the virus and targeted efforts to vaccinate among first and second generation migrants. The aim of this study was to understand this dilemma by investigating ethnic minorities' perceptions and their experience of accessing the COVID-19 vaccine. METHODS This is a qualitative study drawing on 18 semi-structured interviews with health volunteers working in ethnic minority communities and with participants from the two largest ethnic minorities in Sweden (Syria and Somalia). Deductive qualitative analysis was completed using the 3C model by WHO (Complacency, Confidence and Convenience). RESULTS Complacency does not appear to be a barrier to intention to vaccinate. Participants are well aware of COVID-19 risk and the benefits of the vaccine. However, confidence in vaccine poses a barrier to uptake and there are a lot of questions and concerns about vaccine side effects, efficacy and related rumors. Confidence in health providers, particularly doctors is high but there was a sense of conflicting information. Accessing individually tailored health information and health providers is not convenient and a major reason for delaying vaccination or not vaccinating at all. Trust in peers, schools and faith-leaders is high and constitute pathways for effective health information sharing. CONCLUSION Ethnic minorities in Sweden are willing to get vaccinated against COVID-19. However, to increase vaccination uptake, access to individually tailored and face to face health information to answer questions about vaccine safety, efficacy, conflicting information and rumors is urgently required.
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Affiliation(s)
| | - Maria Stålgren
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nina Viberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Center of Excellence for Sustainable Health (CESH), Karolinska Institutet, Stockholm, Sweden
| | - Bi Puranen
- World Values Survey Association, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, South Central Hospital, Stockholm, Sweden
| | - Elin C Larsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Women and Childrens' Health, Karolinska Institutet, Stockholm, Sweden
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Jones L, Danks E, Costello B, Jolly K, Cross-Sudworth F, Latthe P, Fassam-Wright M, Clarke J, Byrne A, Taylor J. Views of female genital mutilation survivors, men and health-care professionals on timing of deinfibulation surgery and NHS service provision: qualitative FGM Sister Study. Health Technol Assess 2023; 27:1-113. [PMID: 36946235 PMCID: PMC10041342 DOI: 10.3310/jhwe4771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Background Female genital mutilation is an important UK health-care challenge. There are no health benefits of female genital mutilation, and it is associated with lifelong physical, psychological and sexual impacts. The annual cost to the NHS to care for survivors is £100M. Deinfibulation may improve the health and well-being of some women, but there is no consensus on the optimal timing of surgery for type 3 survivors. UK care provision is reportedly suboptimal. Objectives We aimed to explore the views of survivors, men and health-care professionals on the timing of deinfibulation surgery and NHS service provision. Methods This was a qualitative study informed by the Sound of Silence framework. This framework is useful for researching sensitive issues and the health-care needs of marginalised populations. A total of 101 interviews with 44 survivors, 13 men and 44 health-care professionals were conducted, supplemented by two workshops with affected communities (participants, n = 10) and one workshop with stakeholders (participants, n = 30). Data were analysed using a hybrid framework method. Results There was no clear consensus between groups on the optimal timing of deinfibulation. However, within groups, survivors expressed a preference for deinfibulation pre pregnancy; health-care professionals preferred antenatal deinfibulation, with the caveat that it should be the survivor's choice. There was no consensus among men. There was agreement that deinfibulation should take place in a hospital setting and be undertaken by a suitable health-care professional. Decision-making around deinfibulation was complex. Deficiencies in professionals' awareness, knowledge and understanding resulted in impacts on the provision of appropriate care. Although there were examples of good practice and positive care interactions, in general, service provision was opaque and remains suboptimal, with deficiencies most notable in mental health. Deinfibulation reportedly helps to mitigate some of the impacts of female genital mutilation. Interactions between survivors and health-care professionals were disproportionately framed around the law. The way in which services are planned and provided often silences the perspectives and preferences of survivors and their families. Limitations Only a minority of the interviews were conducted in a language other than English, and the recruitment of survivors was predominantly through maternity settings, which meant that some voices may not have been heard. The sample of men was relatively small, limiting interpretation. Conclusions In general, service provision remains suboptimal and can silence the perspectives and preferences of survivors. Deinfibulation services need to be widely advertised and information should highlight that the procedure will be carried out in hospital by suitable health-care professionals and that a range of time points will be offered to facilitate choice. Future services should be developed with survivors to ensure that they are clinically and culturally appropriate. Guidelines should be updated to better reflect the needs of survivors and to ensure consistency in service provision. Future work Research is needed to (1) map female genital mutilation service provision; (2) develop and test effective education to address deficits in awareness and knowledge for affected communities and health-care professionals; and (3) develop, monitor and evaluate clinically and culturally competent female genital mutilation services. Trial registration Current Controlled Trials ISRCTN14710507. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment Programme and will be published in full in Health Technology Assessment; Vol. 27, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Laura Jones
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Emma Danks
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Benjamin Costello
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Fiona Cross-Sudworth
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Pallavi Latthe
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Joanne Clarke
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alison Byrne
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, UK
| | - Julie Taylor
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Moayerian N, Stephenson M, Abu Karaki M, Abbadi R. Exploring Syrian Refugees' Access to Medical and Social Support Services Using a Trauma-Informed Analytic Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2031. [PMID: 36767397 PMCID: PMC9914972 DOI: 10.3390/ijerph20032031] [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: 10/28/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Even after arrival in new countries, refugees may be exposed to traumatic events. This state is exacerbated by contextual stressors, including the resettlement process, asylum proceedings and threats of deportation. This paper is rooted in a trauma-informed framework. We interviewed 16 male Syrian refugee migrant workers employed on a Jordanian farm during crop harvesting season to explore the quality and level of medical care and mental health services they received in light of the framework's principal dimensions (e.g., safety, trust, intersectionality). We found that this vulnerable group of individuals is living a marginal and marginalized existence and depends on the goodwill of the growers for whom they work to treat them with a modicum of dignity and respect. Second, their itinerancy makes it difficult for this population to take advantage of available medical and mental health services at the nation's major refugee camps. Finally, our interlocutors preferred their current lives, as isolating and limiting as they are, as superior to full-time residence in the camps, because they perceive their present way of life as according a measure of dignity, self-direction and autonomy they could not enjoy in the camps.
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Affiliation(s)
- Neda Moayerian
- School of Urban Planning, University of Tehran, Tehran 14155-6619, Iran
| | - Max Stephenson
- Institute for Policy and Governance, School of Public and International Affairs Virginia Tech, Blacksburg, VA 24061, USA
| | - Muddather Abu Karaki
- Department of Media and Strategic Studies, Al-Hussein Bin Talal University, Ma’an 71111, Jordan
| | - Renad Abbadi
- Department of English Language and Literature, Al-Hussein Bin Talal University, Ma’an 71111, Jordan
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Tirado V, Engberg S, Holmblad IS, Strömdahl S, Ekström AM, Hurtig AK. "One-time interventions, it doesn't lead to much" - healthcare provider views to improving sexual and reproductive health services for young migrants in Sweden. BMC Health Serv Res 2022; 22:668. [PMID: 35585585 PMCID: PMC9115984 DOI: 10.1186/s12913-022-07945-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Sexual and reproductive health and rights (SRHR) is an important aspect for young people. In Sweden, young migrants often encounter barriers to accessing and using sexual and reproductive health (SRH) services, despite that these services are free of charge for young people (ages 15–25). Healthcare providers’ views and best practices are of great importance for improving the utilisation of existing SRH services, particularly for young people. This study aims to understand healthcare providers’ experiences and perspectives on barriers to SRHR among young migrants and their suggestions for strategies to improve the provision of SRH services to this group. Methods Midwives, counsellors and nurses with at least five years of professional experience within SRHR were reached through a purposeful sample at primary care clinics, specialised clinics and youth-friendly clinics, which provide SRH services to migrant youths in Stockholm. Twelve interviews were conducted from May 2018 to February 2020. Qualitative content analysis was performed. Results The analysis identified one theme: Improving the fragmentation in the SRH services, and four sub-themes: 1. Being unaware of SRHR; 2. Creating trust and responsive interactions; 3. Communicating in the same language; and 4. Collaborating to build bridges. The barriers included distrust in the healthcare system, socio-cultural norms surrounding SRHR, incomplete translations, and a need for long-lasting collaboration with SRH services and other range of services for migrants. The strategies for improvement as suggested by participants included involving existing cultural groups and organisations to enable trust, consistent and dependable interpreters, a streamline of SRH services with other healthcare staff and health facilities, and collaborations with homes designated for young migrants and language schools for a direct linkage to service providers. Conclusions Findings indicate that there are fragmentations in SRH services, and these include lack of knowledge about SRHR among migrant youth, language and communication barriers, and a lack of structure needed to build dependable services that go beyond one-time interventions. While initiatives and strategies from healthcare providers for improvement of SRH services exist, the implementation of some strategies may also require involving the regional and national decision-makers and multi-stakeholders like communities, civil society and young migrants themselves.
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Affiliation(s)
- Veronika Tirado
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Siri Engberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Susanne Strömdahl
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Anna Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Nowak AC, Namer Y, Hornberg C. Health Care for Refugees in Europe: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031278. [PMID: 35162300 PMCID: PMC8834962 DOI: 10.3390/ijerph19031278] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/08/2022] [Accepted: 01/19/2022] [Indexed: 12/31/2022]
Abstract
Background: Accessing and using health care in European countries pose major challenges for asylum seekers and refugees due to legal, linguistic, administrative, and knowledge barriers. This scoping review will systematically describe the literature regarding health care for asylum seekers and refugees in high-income European countries, and the experiences that they have in accessing and using health care. Methods: Three databases in the field of public health were systematically searched, from which 1665 studies were selected for title and abstract screening, and 69 full texts were screened for eligibility by the main author. Of these studies, 44 were included in this systematic review. A narrative synthesis was undertaken. Results: Barriers in access to health care are highly prevalent in refugee populations, and can lead to underusage, misuse of health care, and higher costs. The qualitative results suggest that too little attention is paid to the living situations of refugees. This is especially true in access to care, and in the doctor-patient interaction. This can lead to a gap between needs and care. Conclusions: Although the problems refugees and asylum seekers face in accessing health care in high-income European countries have long been documented, little has changed over time. Living conditions are a key determinant for accessing health care.
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Affiliation(s)
- Anna Christina Nowak
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
- Correspondence:
| | - Yudit Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany;
| | - Claudia Hornberg
- Department of Sustainable Environmental Health Sciences, Faculty of Medicine, Bielefeld University, 33615 Bielefeld, Germany;
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Poppleton A, Howells K, Adeyemi I, Chew‐Graham C, Dikomitis L, Sanders C. The perceptions of general practice among Central and Eastern Europeans in the United Kingdom: A systematic scoping review. Health Expect 2022; 25:2107-2123. [DOI: 10.1111/hex.13433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Aaron Poppleton
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
- School of Medicine Keele University Keele UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM‐PSTRC) Manchester UK
| | - Kelly Howells
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
| | - Isabel Adeyemi
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
| | | | - Lisa Dikomitis
- Kent and Medway Medical School University of Kent and Canterbury Christ Church University Canterbury UK
| | - Caroline Sanders
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM‐PSTRC) Manchester UK
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Au M, Preston R, Ray RA, Davis M. Refugee healthcare perceptions in regional northern Australia: transition through engagement, access, trust, privacy, the old, and the new. Aust J Prim Health 2021; 27:382-390. [PMID: 34162466 DOI: 10.1071/py20265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/22/2021] [Indexed: 11/23/2022]
Abstract
Current Australian Government policy aims to resettle refugees in regional Australia, but little is known about their primary and hospital healthcare experiences in these settings. By taking an interpretive approach to a narrative inquiry methodology, a qualitative study was performed to examine refugee perceptions of health care in a regional centre of northern Queensland, Australia. Purposive sampling and an interview guide were developed in partnership with the local refugee resettlement agency. Semi-structured interviews were performed with 14 refugees and involved interpreters. Transcripts were thematically organised into a story, validated by participants. Using QSR NVivo 12, all researchers analysed the transcripts. Themes were validated at a community event. Six themes were described: service issues, self-advocacy, knowledge and understanding that changes with time, interpreter issues, regional-metropolitan differentials, and the influence of the past on present behaviour. A conceptual framework involving engagement, access, trust and privacy, and the old versus the new, can be used to describe refugees' experiences. Discrimination, transport, and reliance on family and peers may be experiences that are more prominent in regional Australia. Refugees require high-quality information-sharing practices, formal support systems, and better models of service delivery for interpreting support. Clinicians need to be culturally respectful with their interactions.
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Affiliation(s)
- Michael Au
- Western Sydney Local Health District, NSW, Australia; and College of Medicine and Dentistry, James Cook University, Qld, Australia; and Corresponding author.
| | - Robyn Preston
- College of Medicine and Dentistry, James Cook University, Qld, Australia; and School of Health, Medical and Applied Sciences, Central Queensland University, Qld, Australia
| | - Robin A Ray
- College of Medicine and Dentistry, James Cook University, Qld, Australia
| | - Meg Davis
- Townsville Multicultural Support Group, Townsville, Qld, Australia
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Views and experiences of family physicians about Syrian refugee patients in Turkey: a qualitative research. Prim Health Care Res Dev 2021; 22:e19. [PMID: 34034844 PMCID: PMC8165330 DOI: 10.1017/s1463423621000190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM The aim of this study was to describe the attitudes, views and solution proposals of family physicians (FPs) about primary healthcare problems of Syrian refugee patients. This study would be the very first study for Turkey that evaluates the attitudes, views and solution proposals of FPs about primary healthcare problems of Syrian refugee patients. BACKGROUND Following the anti-regime demonstrations that started in March 2011, the developments in Syria created one of the biggest humanitarian crises in the world and the largest number of asylum seekers continue to be hosted in Turkey. There are some studies evaluating asylum seekers' access to healthcare services in Europe, and the common result is that refugees have free access to primary healthcare services in most countries; however, they face many obstacles when accessing primary healthcare services. While there are studies in the literature evaluating the situation of access to primary healthcare services from the perspective of asylum seekers; there are few studies evaluating the opinions/views of FPs. METHODS A qualitative methodology informed by the grounded theory was used to guide the research. A total of 20 FPs were interviewed face to face through semi-structured interviews, using 12 questions about their lived experience and views caring of refugee population. Interviews were analysed thematically. FINDING The following themes were revealed: Benefiting from Primary Health Care Services, Benefiting from Rights, Differences Between the Approach/Attitudes of Turkish Citizens and Refugees, Barriers to Healthcare Delivery, Training Needs of Physicians, Solution proposals. FPs reported that there is a need for support in primary care and a need for training them and refugees in this regard and they specified refugee healthcare centres are the best healthcare centres for refugees; however, the number of these and provided services should be increased.
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Tengilimoğlu D, Zekioğlu A, Budak F, Eriş H, Younis M. Refugees' Opinions about Healthcare Services: A Case of Turkey. Healthcare (Basel) 2021; 9:healthcare9050490. [PMID: 33919316 PMCID: PMC8143307 DOI: 10.3390/healthcare9050490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Migration is one of the most important social events in human history. In recent years, Turkey hosted a high number of asylum seekers and refugees, primarily because of continuing wars and radical social changes in the Middle East. Methods: Using a random sampling method, Syrian refugees aged 18 and over, who can communicate in Turkish, were reached via personal contact and a total of 714 refugees participated in the study voluntarily. Results: Turkey has mounted with some success and to point out that even though participating refugees in both provinces are young and healthy, almost 50% have bad or worse health status, 61% have chronic diseases, and 55% need regular medication. Participating refugees living in Şanlıurfa stated that ‘Hospitals are very clean and tidy.’ (3.80 ± 0.80). The answers given to the following statements had the highest mean for the participating refugees living in Kilis; ‘Hospitals are clean and tidy.’ (3.22 ± 1.25). Conclusion: Due to financial and human resource deficiencies, there are problems in providing preventive and therapeutic health services, especially to refugees living outside the refugee camps in bad conditions. It is important that refugees are encouraged to apply to family health and community health centers in this context.
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Affiliation(s)
- Dilaver Tengilimoğlu
- Management Department, Faculty of Management, Atilim University, 06530 Ankara, Turkey;
| | - Aysu Zekioğlu
- Health Management Department, Faculty of Health Sciences, Trakya University, 22100 Edirne, Turkey
- Correspondence:
| | - Fatih Budak
- Health Management Department, Faculty of Health Sciences, Kilis 7 Aralık University, 79000 Kilis, Turkey;
| | - Hüseyin Eriş
- Medical Documentation, Vocational School of Health, Harran University, 63000 Şanlıurfa, Turkey;
| | - Mustafa Younis
- College of Health Sciences, Jackson State University, Jackson, MS 39217, USA;
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Communication Experiences in Primary Healthcare with Refugees and Asylum Seekers: A Literature Review and Narrative Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041469. [PMID: 33557234 PMCID: PMC7913992 DOI: 10.3390/ijerph18041469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/03/2022]
Abstract
Refugee and asylum seeker population numbers are rising in Western countries. Understanding the communication experiences, within healthcare encounters, for this population is important for providing better care and health outcomes. This review summarizes the literature on health consultation communication experiences of refugees and asylum seekers living in Western countries. Seven electronic databases were searched from inception to 31 March 2019. Studies were included if they aimed to improve, assess or report on communication/interaction in the primary health care consultation setting with refugees or asylum seekers, and were conducted in Western countries. A narrative synthesis of the literature was undertaken. Thematic analysis of the 21 included articles, showed that refugees and asylum seekers experience a range of communication challenges and obstacles in primary care consultations. This included practical and relational challenges of organizing and using informal and formal interpreters and cultural understanding of illness and healthcare. Non-verbal and compassionate care aspects of communication emerged as an important factor in helping improve comfort and trust between healthcare providers (HCP) and refugees and asylum seekers during a healthcare encounter. Improvements at the systems level are needed to provide better access to professional interpreters, but also support compassionate and humanistic care by creating time for HCPs to build relationships and trust with patients.
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15
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Asfaw BB, Beiersmann C, Keck V, Nikendei C, Benson-Martin J, Schütt I, Lohmann J. Experiences of psychotherapists working with refugees in Germany: a qualitative study. BMC Psychiatry 2020; 20:588. [PMID: 33308187 PMCID: PMC7733283 DOI: 10.1186/s12888-020-02996-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 12/03/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite a high burden of mental health problems among refugees, there is limited knowledge about effective mental health care provision for this group. Although substantial efforts in understanding the complexity of cross-cultural psychotherapy - which in the context of this study we use to refer to therapy with client and therapist of different cultural backgrounds - have been made, there remains a dearth of research exploring barriers for effective cross-cultural psychotherapy. This study aimed at narrowing this gap in knowledge by exploring major challenges encountered by psychotherapists in cross-cultural psychotherapy and strategies which have proven useful in overcoming such challenges. METHODS We employed a qualitative study design, conducting semi-structured in-depth interviews with 10 purposely selected psychotherapists working with refugees in Germany. Respondents were from varying theoretical background and had varying levels of experience. Data were analyzed using a thematic approach, following a mix of deductive and inductive coding. RESULTS Respondents reported three main challenges in their cross-cultural practice: different or unrealistic expectations of clients towards what psychotherapy would offer them; challenges grounded in different illness explanatory models; and communication challenges. In dealing with these challenges, respondents recommended psychoeducation to overcome issues related to problematic expectations towards psychotherapy; "imagining the real", identifying "counter magic" and other client-appropriate resources to deal with issues related to clients' foreign illness attributions; and translators in dealing with communication barriers, though the latter not univocally. CONCLUSIONS Results show that psychotherapy with refugees can be very successful, at least from the psychotherapist perspective, but also poses significant challenges. Our findings underline the importance of developing, testing, and institutionalizing structured and structural approaches to training psychotherapists in cross-cultural therapy at scale, to accommodate the rising mental health care need of refugees as a client group.
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Affiliation(s)
- Baye Berihun Asfaw
- Department of Psychology, College of Social Sciences and Humanities, University of Gonder, P.O. Box: 196, Gonder, Ethiopia.
| | - Claudia Beiersmann
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Verena Keck
- Department of Social and Cultural Anthropology, Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Janine Benson-Martin
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Gesundheitsamt Enzkreis, Pforzheim, Germany
| | | | - Julia Lohmann
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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16
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Hoare T, Vidgen A, Roberts NP. How do people seeking asylum in the United Kingdom conceptualize and cope with the asylum journey? Med Confl Surviv 2020; 36:333-358. [PMID: 33280427 DOI: 10.1080/13623699.2020.1849960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
People seeking asylum experience traumatic events and psychological difficulties in country-of-origin, in 'flight', and during re-settlement. Research with this population has focussed on using quantitative methods to examine psychopathology from exposure to traumatic events, and there is a paucity of qualitative research exploring subjective experiences of this population throughout their asylum journey. Few studies have examined ways asylum seekers might cope with such events. This study aimed to address this gap by employing Constructivist Grounded Theory to understand the ways people seeking asylum conceptualize and cope with their experiences across the asylum process. Semi-structured interviews were conducted with eleven people seeking asylum accessing a third sector mental health project and/or primary-care health service. Four main themes emerged from the data: 'Before Asylum', 'Displacement', 'Identity in the UK' and 'Reflections on the Future'. The stress of the asylum system and adaptation to new environments are core aspects of the theory, along with an exploration of how people cope with these circumstances, via internal psychological strategies and external support sources. Prior experiences (including the development of 'inner strength') impacted upon how participants conceptualized their everyday experiences, and this shaped their considerations for the future. Service implications are discussed.
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Affiliation(s)
- Thomas Hoare
- Child & Family Psychology Department, Aneurin Bevan University Health Board , Newport, UK
| | - Andrew Vidgen
- Rehabilitation and Recovery Service, Adult Mental Health Services, Cardiff and Vale UHB , Cardiff, UK
| | - Neil P Roberts
- Traumatic Stress Service, Cardiff and Vale UHB , Cardiff, UK.,Division of Psychological Medicine and Clinical Neurosciences, Cardiff University , Cardiff, UK
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17
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Cho H, Jeong S, Kang C, Kang HJ, Jang S, Jang S. Risk Factors and the Usual Source of Care on Non-Adherence to Antihypertensive Drugs in Immigrants with Hypertension. Patient Prefer Adherence 2020; 14:2123-2133. [PMID: 33173281 PMCID: PMC7648264 DOI: 10.2147/ppa.s269008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Immigrants are vulnerable to suboptimal health care utilization including non-adherence of medication use. Thus, we aimed to identify the potential risk factors of non-adherence and evaluate whether utilizing a usual source of care was associated with medication adherence in immigrants. METHODS We utilized the Korea National Health Insurance Claims Database between 2012 and 2015. Cases were immigrants who had antihypertensive prescriptions at the time of hypertension diagnosis in 2012. Controls were native-born Koreans with hypertension who were 1:1 matched to immigrants by age, sex, and Charlson comorbidity index. We used the medication possession ratio for three years to assess the adherence to antihypertensive drugs. The likelihood of non-adherence was evaluated between cases and controls by multivariate linear regression models stratified by age, sex, and number of clinic visits. We assessed the potential risk factors of non-adherence in immigrants by multivariate linear regression and logistic regression models, respectively. RESULTS In total, 4114 immigrants and 4114 matched native-born Koreans with hypertension were included. The mean MPR was significantly lower in immigrants (56% vs 70%, p<0.0001). Immigrants showed almost two times the level of non-adherence as native-born Koreans (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.83-2.21). Stratified analyses on non-adherence presented the highest non-adherence (2.28 times) in immigrants in the younger group (30-49 years old) and the lowest non-adherence in immigrants in 65 and old group where the risk was 1.69 times higher than native Korean with the same age. The absence of a usual source of care significantly increased medication non-adherence by 1.31 to 1.58 times among immigrants. CONCLUSION When the number of visited clinics increased, the degree of non-adherence increased consistently. Therefore, the systematization of registering with primary care (a usual source of care) might be a modifiable health care strategy to improve health care outcomes in immigrants.
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Affiliation(s)
- Hyemin Cho
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Sohyun Jeong
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Cinoo Kang
- Department of Biostatics and Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Hee-Jin Kang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Suhyun Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
- Correspondence: Sunmee Jang College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoero, Yeonsu-Gu, Incheon21936, South KoreaTel +82-32-820-4941Fax +82-32-820-4829 Email
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Phillimore J, Brand T, Bradby H, Padilla B. Healthcare bricolage in Europe's superdiverse neighbourhoods: a mixed methods study. BMC Public Health 2019; 19:1325. [PMID: 31640648 PMCID: PMC6805362 DOI: 10.1186/s12889-019-7709-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies of the relationship between diverse populations, healthcare access and health outcomes have been dominated by approaches focusing on ethno-national groups or specific healthcare sectors. Healthcare bricolage conceptualises the processes by which individuals use multiple resources to address health concerns. It is relevant in superdiverse neighbourhoods with complex populations. This paper is original in its application of mixed methods to examine the extent to which, and the reasons why, individuals engage in healthcare bricolage. METHODS The study utilized a parallel sequential methodology. Eight superdiverse neighbourhoods were selected, two in each of Bremen, Birmingham, Lisbon and Uppsala. Ethnographic research scoping the nature of each healthcare ecosystem was followed by 160 interviews (20 each neighbourhood) with a maximum variation sample of residents undertaken October 2015 to December 2016. Interviewees were asked to recall a health concern and describe actions taken to attempt resolution. Data was coded with a MAXQDA codebook checked for inter-coder reliability. Interview findings enabled identification of five types of bricolage, the nature of healthcare resources utilised and the factors which influenced residents' tactics. Results were used to design a household survey using new questions and validated epidemiological instruments implemented January to October 2017. Respondents were identified using random address files and interviewed in person or by telephone. Multinomal logistic regressions were used to estimate the effect of changing the values of determinants on the probability of observing an outcome. RESULTS Age, gender, level of education, migration background and extent of functional limitation were associated with bricolage tactics. Individuals demonstrating high levels of agency were more likely than those with low levels to engage in bricolage. Residents with high levels of trust in physicians were less likely to bricolage than those with lower levels of trust. Levels of health literacy showed no significant effects. CONCLUSIONS The nature and severity of health concern, trust in physicians and agency shaped residents' bricolage tactics. The concept of bricolage enabled us to make visible the actions and resources utilised around public healthcare systems that would otherwise remain outwith healthcare access research. Actions were frequently undertaken via networks offering insights into healthcare-seeking behaviour.
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Affiliation(s)
- Jenny Phillimore
- Institute for Research into Superdiversity (IRiS), School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany
| | - Hannah Bradby
- Sociology Department, Uppsala University, Box 624, Se-751 26, Uppsala, Sweden
| | - Beatriz Padilla
- University of South Florida, Fowler Avenue, Tampa, FL, 33620, USA.,Instituto Universitario de Lisboa (ISCTE-IUL), Lisbon, Portugal
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Evans C, Tweheyo R, McGarry J, Eldridge J, Albert J, Nkoyo V, Higginbottom G. Improving care for women and girls who have undergone female genital mutilation/cutting: qualitative systematic reviews. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07310] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background
In a context of high migration, there are growing numbers of women living in the UK who have experienced female genital mutilation/cutting. Evidence is needed to understand how best to meet their health-care needs and to shape culturally appropriate service delivery.
Objectives
To undertake two systematic reviews of qualitative evidence to illuminate the experiences, needs, barriers and facilitators around seeking and providing female genital mutilation-/cutting-related health care from the perspectives of (1) women and girls who have experienced female genital mutilation/cutting (review 1) and (2) health professionals (review 2).
Review methods
The reviews were undertaken separately using a thematic synthesis approach and then combined into an overarching synthesis. Sixteen electronic databases (including grey literature sources) were searched from inception to 31 December 2017 and supplemented by reference list searching. Papers from any Organisation for Economic Co-operation and Development country with any date and in any language were included (Organisation for Economic Co-operation and Development membership was considered a proxy for comparable high-income migrant destination countries). Standardised tools were used for quality appraisal and data extraction. Findings were coded and thematically analysed using NVivo 11 (QSR International, Warrington, UK) software. Confidence in the review findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation – Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. All review steps involved two or more reviewers and a team that included community-based and clinical experts.
Results
Seventy-eight papers (74 distinct studies) met the inclusion criteria for both reviews: 57 papers in review 1 (n = 18 from the UK), 30 papers in review 2 (n = 5 from the UK) and nine papers common to both. Review 1 comprised 17 descriptive themes synthesised into five analytical themes. Women’s health-care experiences related to female genital mutilation/cutting were shaped by silence and stigma, which hindered care-seeking and access to care, especially for non-pregnant women. Across all countries, women reported emotionally distressing and disempowering care experiences. There was limited awareness of specialist service provision. Good care depended on having a trusting relationship with a culturally sensitive and knowledgeable provider. Review 2 comprised 20 descriptive themes synthesised into six analytical themes. Providers from many settings reported feeling uncomfortable talking about female genital mutilation/cutting, lacking sufficient knowledge and struggling with language barriers. This led to missed opportunities for, and suboptimal management of, female genital mutilation-/cutting-related care. More positive experiences/practices were reported in contexts where there was input from specialists and where there were clear processes to address language barriers and to support timely identification, referral and follow-up.
Limitations
Most studies had an implicit focus on type III female genital mutilation/cutting and on maternity settings, but many studies combined groups or female genital mutilation/cutting types, making it hard to draw conclusions specific to different communities, conditions or contexts. There were no evaluations of service models, there was no research specifically on girls and there was limited evidence on psychological needs.
Conclusions
The evidence suggests that care and communication around female genital mutilation/cutting can pose significant challenges for women and health-care providers. Appropriate models of service delivery include language support, continuity models, clear care pathways (including for mental health and non-pregnant women), specialist provision and community engagement. Routinisation of female genital mutilation/cutting discussions within different health-care settings may be an important strategy to ensure timely entry into, and appropriate receipt of, female genital mutilation-/cutting-related care. Staff training is an ongoing need.
Future work
Future research should evaluate the most-effective models of training and of service delivery.
Study registration
This study is registered as PROSPERO CRD420150300012015 (review 1) and PROSPERO CRD420150300042015 (review 2).
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Ritah Tweheyo
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Julie McGarry
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Mbanya VN, Terragni L, Gele AA, Diaz E, Kumar BN. Access to Norwegian healthcare system - challenges for sub-Saharan African immigrants. Int J Equity Health 2019; 18:125. [PMID: 31412853 PMCID: PMC6693278 DOI: 10.1186/s12939-019-1027-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/28/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Immigrants face barriers in accessing healthcare services in high-income countries. Inequalities in health and access to healthcare services among immigrants have been previously investigated. However, little is known on the sub-Saharan African immigrants' (SSA) access to the Norwegian healthcare system. METHODS The study had a qualitative research design. We used the snowball technique to recruit participants from networks including faith-based organizations and cultural groups. Forty-seven qualitative in-depth interview and two focus group discussions with immigrants from sub-Saharan African were conducted from October 2017 to July 2018 in Oslo and its environs. Interviews were conducted in Norwegian, English or French, audio-recorded and transcribed verbatim into English. The analysis was based on a thematic approach, using NVivo software. Interview data were analyzed searching for themes and sub-themes that emerged inductively from the interviews. RESULTS Our findings reveal barriers in two main categories when accessing the Norwegian healthcare services. The first category includes difficulties before accessing the healthcare system (information access, preference for doctors with an immigrant background, financial barriers, long waiting time and family and job responsibility). The second category includes difficulties experienced within the system (comprehension/expression and language, the black elephant in the room and dissatisfaction with healthcare providers). CONCLUSION Healthcare is not equally accessible to all Norwegian residents. This ultimately leads to avoidance of the healthcare system by those most in need. Lack of seeking healthcare services by immigrants from Sub Saharan Africa may have significant implications for the long-term health of this group of immigrants. Therefore measures to address the issues raised should be prioritized and further examined.
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Affiliation(s)
- Vivian N Mbanya
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Abdi A Gele
- Unit for Migration Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
| | - Esperanza Diaz
- Unit for Migration Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bernadette N Kumar
- Unit for Migration Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
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21
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Jager MJ, van der Sande R, Essink-Bot ML, van den Muijsenbergh METC. Views and experiences of ethnic minority diabetes patients on dietetic care in the Netherlands - a qualitative study. Eur J Public Health 2019; 29:208-213. [PMID: 30204883 PMCID: PMC6426026 DOI: 10.1093/eurpub/cky186] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Diabetes type 2 is more prevalent in people from ethnic minorities in the Netherlands, and outcomes of care are worse compared with other Dutch people. Dieticians experience difficulties in managing these groups in self-management and adherence to dietary advice. The aim of this study was to explore the views regarding a healthy diet and dietetic care among ethnic minority type 2 diabetes patients. Methods Semi-structured interviews were held with 12 migrants with diabetes from Turkey, Morocco, Iraq and Curacao, who visited a dietician. Inclusion went on until saturation was reached. The interview guide was based on the Attitudes, Social influence and self-Efficacy (ASE) model and Kleinman’s explanatory model of illness. Interviews were held in the language preferred by the respondent. Transcripts were coded and thematically analyzed. Results Several respondents expected a more rigorous, directive and technical approach of the dietician. All respondents acknowledged the importance of a healthy diet. What they considered healthy was determined by culturally influenced ideas about health benefits of specific foods. Important hindrances for dietary change were lack of self-efficacy and social support. Social influences were experienced both as supportive and a hindrance. Conclusions Migrant diabetic patients’ opinions about healthy food are determined by culturally influenced ideas rather than by dietary guidelines. Dutch dietary care is not tailored to the needs of these patients and should take into account migrants’ expectations, cultural differences in dietary habits and specifically address the role of family.
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Affiliation(s)
- Mirjam J Jager
- Nutrition and Dietetics, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - Rob van der Sande
- Primary and Community Care, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Maria E T C van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Prevention and care programme, Pharos, National Centre of Expertise on Health Disparities, Utrecht, The Netherlands
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22
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Baker JR, Raman S, Kohlhoff J, George A, Kaplun C, Dadich A, Best CT, Arora A, Zwi K, Schmied V, Eapen V. Optimising refugee children's health/wellbeing in preparation for primary and secondary school: a qualitative inquiry. BMC Public Health 2019; 19:812. [PMID: 31242897 PMCID: PMC6595577 DOI: 10.1186/s12889-019-7183-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/16/2019] [Indexed: 01/27/2023] Open
Abstract
Background Children from refugee backgrounds are less likely to access appropriate health and social care than non-refugee children. Our aim was to identify refugee children’s health/wellbeing strengths and needs, and the barriers and enablers to accessing services while preparing for primary and secondary school, in a low socio-economic multicultural community in Australia. Method Ten focus groups were facilitated with Arabic-speaking refugee parents of children aged 2–5 years (n = 11) or in first year secondary school (n = 22); refugee adolescents starting high school (n = 16); and key service providers to refugee families (n = 27). Vignettes about a healthy child and a child with difficulties guided the discussions. Data was thematically analysed and feedback sought from the community via the World Café method. Results Personal resilience and strong family systems were identified as strengths. Mental health was identified as a complex primary need; and whilst refugees were aware of available services, there were issues in knowing how to access them. Opportunities for play/socialisation were recognised as unmet adolescent needs. Adults spoke of a need to support integration of “old” and “new” cultural values. Parents identified community as facilitating health knowledge transfer for new arrivals; whilst stakeholders saw this as a barrier when systems change. Most parents had not heard of early childhood services, and reported difficulty accessing child healthcare. Preschooler parents identified the family “GP” as the main source of health support; whilst parents of adolescents valued their child’s school. Health communication in written (not spoken) English was a significant roadblock. Differences in refugee family and service provider perceptions were also evident. Conclusions Refugee families face challenges to accessing services, but also have strengths that enable them to optimise their children’s wellbeing. Culturally-tailored models of care embedded within GP services and school systems may assist improved healthcare for refugee families. Electronic supplementary material The online version of this article (10.1186/s12889-019-7183-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jess R Baker
- the University of New South Wales, Liverpool Hospital Mental Health Centre Level 1, Liverpool, NSW, 2170, Australia.
| | - Shanti Raman
- South Western Sydney Local Health District, Health Services Building Level 3, Cnr Campbell & Goulburn St, Liverpool, NSW, 2170, Australia
| | - Jane Kohlhoff
- School of Psychiatry, University of New South Wales, Hospital Rd, Randwick, NSW, 2031, Australia.,Karitane, 138-150 The Horsley Dr, Carramar, NSW, 2163, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.,South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.,University of Sydney, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.,Ingham Institute for Applied Medical Research, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - Catherine Kaplun
- Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Ingham Institute for Applied Medical Research, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia
| | - Catherine T Best
- Western Sydney University, The MARCS Institute, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Amit Arora
- School of Science and Health, Penrith, NSW, 2751, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.,Oral Health Service, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia
| | - Karen Zwi
- Sydney Children's Hospital, Corner Avoca and Barker Street, Randwick, NSW, 2031, Australia
| | - Virginia Schmied
- Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Valsamma Eapen
- Academic Unit of Child Psychiatry South West Sydney (AUCS), University of New South Wales & Ingham Institute, Elizabeth Street, Liverpool, Sydney, 2170, Australia.,Liverpool Hospital, Elizabeth Street, Liverpool, Sydney, 2170, Australia
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Evans C, Tweheyo R, McGarry J, Eldridge J, Albert J, Nkoyo V, Higginbottom GMA. Seeking culturally safe care: a qualitative systematic review of the healthcare experiences of women and girls who have undergone female genital mutilation/cutting. BMJ Open 2019; 9:e027452. [PMID: 31147364 PMCID: PMC6549627 DOI: 10.1136/bmjopen-2018-027452] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/15/2019] [Accepted: 04/15/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To explore the experiences of accessing and receiving healthcare related to female genital mutilation/cutting (FGM/C) across the life course from the perspective of women and girls who have undergone FGM/C. DESIGN A systematic review of qualitative research studies using a thematic synthesis approach. METHODS Inclusion criteria were qualitative studies (including grey literature) of any design, from Organisation for Economic Co-operation and Development (OECD) countries, of any date and any language. Sixteen electronic databases were searched from inception to December 2017, supplemented by reference list searching. Papers were screened, selected and quality-appraised by two reviewers using established tools from the Joanna Briggs Institute. NVivo software was used to extract study characteristics and code study findings. An inductive thematic synthesis approach was undertaken to identify descriptive themes and interpret these into higher order analytical constructs. Confidence in the review findings was assessed using Grading of Recommendations, Assessment, Development and Evaluations-Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual). RESULTS Fifty-seven papers (from 55 distinct studies) from 14 different OECD countries were included (50% published within the last 8 years). One-third of studies focused exclusively on maternity care experiences, whereas others covered a range of foci. No studies reported explicitly on girls' experiences or on experiences of health service-led safeguarding interventions. Only three studies addressed psychological care. The synthesis developed 17 descriptive themes, organised into 5 analytical constructs. These related to communication, access to care, experiences of cultural dissonance/integrity, disempowering care experiences and positive care encounters. The themes illuminate significant challenges to obtaining timely and holistic care (especially for deinfibulation), and highlight different ways in which women may experience care as disrespectful, unsafe and disempowering. Key elements of 'culturally safe care' are identified. CONCLUSIONS This review has highlighted key knowledge gaps, especially around (1) girls'/unmarried women's experiences and (2) the impact of recent safeguarding interventions. There is an ongoing need for community engagement, service development and staff training. PROSPERO REGISTRATION NUMBER CRD420150300012015.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Ritah Tweheyo
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Julie McGarry
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jeanette Eldridge
- Research and Learning Services, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Juliet Albert
- Department of Midwifery, Imperial College Healthcare NHS Trust, London, UK
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Chuah FLH, Tan ST, Yeo J, Legido-Quigley H. Health System Responses to the Health Needs of Refugees and Asylum-seekers in Malaysia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1584. [PMID: 31064139 PMCID: PMC6539766 DOI: 10.3390/ijerph16091584] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/25/2019] [Accepted: 04/27/2019] [Indexed: 11/16/2022]
Abstract
Background: This study was conducted to examine the responses and challenges in addressing the health needs of refugees and asylum-seekers in Malaysia from a health systems and policy perspective. Methods: Twenty semi-structured in-depth interviews were conducted with key informants comprising experts, healthcare professionals and program personnel with professional experience in refugee health issues. Deductive and inductive analyses were conducted to identify themes. Results: Our study identified a broad range of actors involved in the response to refugee health locally, of which a greater alignment of interests, collaboration and sharing of responsibility is needed. From a health systems and policy perspective, financial constraints are among the key challenges in addressing the health needs of the refugee and asylum-seeker population in Malaysia. While participants reported high quality healthcare being present in Malaysia, this was not affordable to refugees and asylum seekers. Cultural and language discordance are also key challenges faced by healthcare workers in the delivery of services; accentuating the need for greater cultural competence and language support. Improved access to medication is needed for those with chronic illnesses in order to effectively address the comprehensive health needs of the refugee and asylum-seeker population. Conclusions: Suggested ways forward include adopting a comprehensive health advocacy strategy grounded in the right to healthcare for all; adopting a multi-sectoral approach; tackling the social determinants of health; seeking diversified funding at the global and national level; and improving coordination and collaboration between the various actors.
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Affiliation(s)
- Fiona Leh Hoon Chuah
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore 117549, Singapore.
| | - Sok Teng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore 117549, Singapore.
| | - Jason Yeo
- United Nations High Commissioner for Refugees Malaysia, 570, Jalan Bukit Petaling, Bukit Petaling, Wilayah Persekutuan Kuala Lumpur, Kuala Lumpur 50460, Malaysia.
- Department of Nutrition and Dietetics, Universiti Putra Malaysia, Jalan Upm, Serdang 43400, Selangor, Malaysia.
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore 117549, Singapore.
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
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Kohler G, Holland T, Sharpe A, Irwin M, Sampalli T, MacDonell K, Kidd N, Edwards L, Gibson R, Legate A, Ampi Kanakam R. The Newcomer Health Clinic in Nova Scotia: A Beacon Clinic to Support the Health Needs of the Refugee Population. Int J Health Policy Manag 2018; 7:1085-1089. [PMID: 30709083 PMCID: PMC6358655 DOI: 10.15171/ijhpm.2018.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/03/2018] [Indexed: 11/16/2022] Open
Abstract
Refugees tend to have greater vulnerability compared to the general population reporting greater need for physical,
emotional, or dental problems compared to the general population. Despite the importance of creating strong
primary care supports for these patients, it has been demonstrated that there is a significant gap in accessing
primary care providers who are willing to accept the refugee population. These have resulted in bottlenecks in the
transition or bridge clinics and have left patients orphaned without a primary care provider. This in turn results
in higher use of emergency service and other unnecessary costs to the healthcare system. Currently there are few
studies that have explored these challenges from primary care provider perspectives and very few to none from
patient perspectives. A novel collaborative implementation initiative in primary healthcare (PHC) is seeking to
improve primary medical care for the refugee population by creating a globally recommended transition or beacon
clinic to support care needs of new arrivals and transitions to primary care providers. We discuss the innovative
elements of the clinic model in this paper.
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Affiliation(s)
- Graeme Kohler
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Timothy Holland
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Ashley Sharpe
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Mandi Irwin
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Tara Sampalli
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Kolten MacDonell
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Natalie Kidd
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lynn Edwards
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Rick Gibson
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Amy Legate
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Ruth Ampi Kanakam
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
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Jonzon R, Lindkvist P, Hurtig AK. Structural and procedural barriers to health assessment for asylum seekers and other migrants - an explorative survey in Sweden. BMC Health Serv Res 2018; 18:813. [PMID: 30352595 PMCID: PMC6199803 DOI: 10.1186/s12913-018-3588-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health assessments (HAs) for newly arrived asylum seekers have become a regular practice in most EU countries, but what is performed, how they are organized, and whether it is mandatory or not to attend varies between countries. Swedish national statistics have shown that only about 45% of asylum seekers attend the optional HA offered upon their arrival in Sweden. There are significant variations among Sweden's 21 counties, ranging from 20 to 90%. The reasons for the low attendance have not yet been fully explored, though there are indications of structural weaknesses within the healthcare system. This study aimed to identify variations in policies and implementation of HAs targeting asylum seekers and other migrants. The study analyzes the structure and processes in different Swedish counties and discusses how this might influence the coverage. METHODS This research project had an exploratory quantitative descriptive design applying a cross-sectional survey based on two structured questionnaires. Descriptive statistics were performed to summarize the data. RESULTS The number of healthcare centers in each county that carried out HAs on asylum seekers varied independently of the size of the county. Variations in regard to structure, organization, processes, and performance monitoring of the HA process also appeared diverse, and these were in some cases also reported differently by administrators and healthcare professionals in the same county. Most commonly, the HAs were carried out in ordinary health centers, though some counties presented alternative solutions on how to organize the HAs. CONCLUSIONS There seems to be no coherent national system for carrying out HAs on asylum seekers in Sweden. The structure, organization, processes, and outcomes vary between the counties, and the reasons for the low coverage of HAs appear to be multifaceted.
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Affiliation(s)
- Robert Jonzon
- The Public Health Agency of Sweden, Nobels väg 18, SE-171 82 Solna, Sweden
- Deparment of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Pille Lindkvist
- Center for Family Medicine (CeFAM), Karolinska Institute, Stockholm, Sweden
| | - Anna-Karin Hurtig
- Deparment of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Meyer-Weitz A, Oppong Asante K, Lukobeka BJ. Healthcare service delivery to refugee children from the Democratic Republic of Congo living in Durban, South Africa: a caregivers' perspective. BMC Med 2018; 16:163. [PMID: 30257682 PMCID: PMC6158903 DOI: 10.1186/s12916-018-1153-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 08/14/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Refugees are generally considered a vulnerable population, with refugee children (newborn and young children) being particularly so. Access to healthcare for this population remains a challenge. The main purpose of this study was to explore refugee caregivers' perceptions of their children's access to quality health service delivery to their young children in Durban, South Africa. METHODS This study used an explanatory mixed methods design, purposively sampling 120 and 10 participants for the quantitative and qualitative phases, respectively. Participants were administered a self-developed questionnaire that assessed demographic information of participants, socioeconomic status and living standard, medical history of children, satisfaction and experiences with healthcare services and refugees' networks and social support. A semi-structured interview schedule was developed to elicit in-depth and more detailed information from the participants on the quantitative areas that were investigated. Frequencies were calculated and a χ2 test was used to explore the factors associated with refugees' satisfaction of the healthcare provided and thematic analysis was used to analyse the qualitative data. RESULTS The majority (89%) of caregivers were women, with over 70% of them aged between 30 and 35 years. Over 74% of caregivers visited public clinics for their children's healthcare needs. The majority of caregivers (95%) were not satisfied with healthcare services delivery to their children due to the long waiting hours and the negative attitudes and discriminatory behaviours of healthcare workers, particularly in public healthcare facilities. CONCLUSION These findings underscore the need to address health professionals' attitudes when providing healthcare for refugees. Attitudinal change may improve the relationship between service providers and caregivers of refugee children in South Africa, which may improve the health-related outcomes in refugee children.
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Affiliation(s)
- Anna Meyer-Weitz
- Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa
| | - Kwaku Oppong Asante
- Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa. .,Department of Psychology, University of Ghana, P. O. Box LG 84, Legon, Accra, Ghana.
| | - Bukenge J Lukobeka
- Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa
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Mangrio E, Sjögren Forss K. Refugees' experiences of healthcare in the host country: a scoping review. BMC Health Serv Res 2017; 17:814. [PMID: 29216876 PMCID: PMC5721651 DOI: 10.1186/s12913-017-2731-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022] Open
Abstract
Background During the last years, Europe experienced an increase in immigration due to a variety of worldwide wars and conflicts, which in turn resulted in a greater number of physical and mental health issues present among the refugees. These factors place high demands not only on the refugees, but also on healthcare professionals who meet the refugees in different situations. Information about the refugees’ experiences of the healthcare systems in their host countries is urgently needed to improve the quality of healthcare delivered, as well as to provide opportunities for better access. The aim of this scoping review is to compile research about the experiences that the refugees have with the healthcare systems in their host countries. Methods This study was conducted as a scoping review and the methodology is derived from Levac et al. and with inspiration from the framework of Arksey & O’Malley. A systematic article search was done in Medline, Cinahl and Psychinfo. A total of 619 articles were found in the search and finally 26 articles met the inclusion criteria and were included. Results The results show that communication between healthcare professionals and refugees is important, however, insufficient language knowledge acts as an effective communication barrier. There is a need for more information to be given to the refugees about the reception country’s healthcare system in both oral and written formats, as well as the right to healthcare. Support from healthcare professionals is also important for refugees to have a positive experience with healthcare. In some of the studies included, refugees experienced discrimination due to low proficiency in the language of the host country, and/or because of their race or accent, which shows that culturally appropriate healthcare is needed for them. Conclusions Since refugees are suffering from poor mental and physical health and could therefore be at a greater risk of morbidity and mortality in comparison to the rest of the population of the host country, there is an urgent need for improvements in communication, interpretation, support, and deliverance of culturally appropriate healthcare.
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Affiliation(s)
- Elisabeth Mangrio
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden. .,MIM, Malmö Institute for Studies of Migration, Diversity and Welfare, Malmö University, Malmö, Sweden.
| | - Katarina Sjögren Forss
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,MIM, Malmö Institute for Studies of Migration, Diversity and Welfare, Malmö University, Malmö, Sweden
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29
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Keizer E, Bakker P, Giesen P, Wensing M, Atsma F, Smits M, van den Muijsenbergh M. Migrants' motives and expectations for contacting out-of-hours primary care: a survey study. BMC FAMILY PRACTICE 2017; 18:92. [PMID: 29162044 PMCID: PMC5699192 DOI: 10.1186/s12875-017-0664-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/15/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Migrants are more likely to use out-of-hours primary care, especially for nonurgent problems. Their motives and expectations for help-seeking are as yet unknown. The objective of this study is to examine the motives and expectations of migrants for contacting out-of-hours primary care. METHODS We used data from a survey study of 11,483 patients who contacted a General Practitioner (GP) cooperative in the Netherlands between 2009 and 2014 (response rate 45.6%). Logistic regression analysis was used to test differences in motives and expectations between non-western and western migrants and native Dutch patients. RESULTS The main motives for contacting a GP cooperative for non-western and western migrants were an urgent need for contact with a GP (54.9%-52.4%), worry (49.3%-43.0%), and a need for medical information (21.3%-26.2%). These were also the most important motives for native Dutch patients. Compared to native Dutch patients, non-western migrants more often perceived an urgent need for a GP (OR 1.65; 99% CI 1.27-2.16), less often needed information (OR 0.59; 99% CI 0.43-0.81), and more often experienced problems contacting their own GP during office hours (OR 1.71; 99% CI 1.21-2.43). Western migrants also reported experiencing problems more often in contacting their own GP (OR 1.38; 99% CI 1.04-1.84). As well as for natives, most non-western and western migrants expected to see a doctor (46.2%-46.6%) or get advice (39.6%-41.5%). Non-western migrants expected more often to get physical examination (OR 1.53; 99% CI 1.14-2.04), and prescription (OR 1.37; 99% CI 1.00-1.88). We found no differences in expectations between western migrants and native Dutch patients. CONCLUSION The main motives and expectations of migrants are similar to native Dutch patients, yet non-western migrants more often wanted action from the GP, e.g. examination or prescription, and less often passive forms of assistance such as giving information. At the same time they experience problems accessing their own GP. We recommend stimulation of self-care, education about the purpose of a GP cooperative, and examination and improvement of accessibility of daytime primary care.
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Affiliation(s)
- Ellen Keizer
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Peter Bakker
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Paul Giesen
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Michel Wensing
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Femke Atsma
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Marleen Smits
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.,Pharos, Centre of Expertise of Health Disparities, P.O. Box 13318, 3507, LH, Utrecht, The Netherlands
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Madden H, Harris J, Blickem C, Harrison R, Timpson H. "Always paracetamol, they give them paracetamol for everything": a qualitative study examining Eastern European migrants' experiences of the UK health service. BMC Health Serv Res 2017; 17:604. [PMID: 28851364 PMCID: PMC5575835 DOI: 10.1186/s12913-017-2526-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/08/2017] [Indexed: 01/02/2023] Open
Abstract
Background The enlargement of the European Union since 2004 has led to an increase in the number of Eastern European migrants living in the UK. The health of this group is under-researched though some mixed evidence shows they are at higher risk of certain physical health conditions such as heart attacks, strokes, HIV and alcohol use and have poorer mental health. This is compounded by poor or insecure housing, low pay, isolation and prejudice. We aimed to understand the health needs and health service experiences of the Eastern European population in a town in Northern England. Methods Five semi structured one-to-one and small group interviews and five focus groups were conducted with 42 Eastern European participants between June and September 2014. The majority of participants were Polish and other participants were from Belarus, Hungary, Latvia, Russia, Slovakia and Ukraine. The data were analysed using thematic framework analysis. Results Key findings included a good understanding the UK health service structure and high registration and use of general practice/primary care services. However, overall, there were high levels of dissatisfaction, frustration and distrust in General Practitioners (GP). The majority of participants viewed the GP as unhelpful and dismissive; a barrier to secondary/acute care; reluctant to prescribe antibiotics; and that GPs too often advised them to take paracetamol (acetaminophen) and rest. Conclusions Overwhelmingly participants had strong opinions about access to primary care and the role of the general practitioners. Although the design of the UK health service was well understood, participants were unhappy with the system of GP as gatekeeper and felt it inferior to the consumer-focused health systems in their country of origin. More work is needed to promote the importance of self-care, reduce antibiotic and medication use, and to increase trust in the GP.
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Affiliation(s)
- Hannah Madden
- Public Health Institute, Liverpool John Moores University, Liverpool, UK.
| | - Jane Harris
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Christian Blickem
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Rebecca Harrison
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Hannah Timpson
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
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31
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Shenouda JEA, Cooper MJF. "One Big Family": Pastoral Care and Treatment Seeking in an Egyptian Coptic Church in England. JOURNAL OF RELIGION AND HEALTH 2017; 56:1450-1459. [PMID: 28342143 DOI: 10.1007/s10943-017-0381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Little is known about Coptic migrants' chronic disease health beliefs and treatment-seeking behaviours. Interviews to explore these issues and their relationship with church membership were conducted with 15 Coptic migrants in Southern England. Obesity and cardiovascular disease (CVD) were most frequently identified as health risks for Coptic migrants. CVD was ascribed to stress and considered amenable to spiritual healing. Lay referral to medical practitioners who were church members was common but may devalue perceptions of family medicine. The Coptic Church functions as a community that addresses members' wider vulnerability. Central to this is the "parish nurse" role of the priest.
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Affiliation(s)
- John E A Shenouda
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House, University of Brighton, Falmer, Brighton, BN1 9PH, England, UK.
| | - Maxwell J F Cooper
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House, University of Brighton, Falmer, Brighton, BN1 9PH, England, UK
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Mengesha ZB, Perz J, Dune T, Ussher J. Refugee and migrant women's engagement with sexual and reproductive health care in Australia: A socio-ecological analysis of health care professional perspectives. PLoS One 2017; 12:e0181421. [PMID: 28727833 PMCID: PMC5519071 DOI: 10.1371/journal.pone.0181421] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/08/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In Australia only 2.2% of published health research has focused on multi-cultural health despite the increase of culturally and linguistically diverse populations. Research on the perceptions and experiences of health care professionals (HCPs) in engaging with refugee and migrant women is also lacking. Given the integral role of HCPs in providing sexual and reproductive health (SRH) care for these populations, an understanding of the challenges they experience is required. Therefore, this study sought to examine the perspectives and practices of Australian HCPs with regard to the provision of SRH care for refugee and migrant women. METHODS Employing qualitative methods, twenty-one semi-structured interviews were conducted with HCPs representing various professions, work experiences, cultural backgrounds, age and healthcare sectors. The interviews were analysed using thematic analysis and the socio-ecological model was utilised to interpret the data. RESULTS The complexities of HCP's engagement with refugee and migrant women were identified in three major themes: Being a Migrant; Gender Roles and SRH Decision-making; and Women in the Healthcare System. HCPs discussed the impact of accessing SRH care in women's country of origin and the influence of re-settlement contexts on their SRH knowledge, engagement with care and care provision. Perception of gender roles was integral to SRH decision-making with the need to involve male partners having an impact on the provision of women-centred care. Barriers within the healthcare system included the lack of services to address sexual functioning and relationship issues, as well as lack of resources, time constraints, cost of services, and funding. CONCLUSION Australian HCPs interviewed reported that migrant and refugee women do not have appropriate access to SRH care due to multifaceted challenges. These challenges are present across the entire socio-ecological arena, from individual to systemic levels. Multiple and multidimensional interventions are required to increase SRH utilisation and improve outcomes for refugee and migrant women.
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Affiliation(s)
- Zelalem B. Mengesha
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Janette Perz
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Tinashe Dune
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Jane Ussher
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
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Mkanta WN, Ibekwe O, Mejia de Grubb MC, Korupolu C. Patient satisfaction and its potential impact on refugee integration into the healthcare system. PROCEEDINGS OF SINGAPORE HEALTHCARE 2017. [DOI: 10.1177/2010105817704207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Health care constitutes an important aspect of services in the resettlement processes for newly arriving and resettling refugees. Objectives: We conducted a study to investigate levels of satisfaction related to health services delivered to refugee populations in a resettlement community and its surrounding areas. Methods: We used the experience of 92 adult refugee patients to examine social-cultural, clinical and economic characteristics affecting satisfaction with health care. A cross-sectional study using the Patient Satisfaction Questionnaire (PSQ) was conducted. Item analysis was conducted by considering each question on the PSQ as an item and by developing dimensions of satisfaction. Chi-square analyses were used to assess the relationships between satisfaction and patient factors. Results: Patients were satisfied with the initial health assessment (90%) and overall quality (86%). Only 59% of the patients were satisfied with phone interpreters. The general satisfaction dimension had a score of 4.05 on a scale of 5, while time spent with the doctor had the lowest score of 2.98. Having pre-arrival medical conditions was associated with poor satisfaction with both the initial health assessment (χ2=10.260; p=.036) and regular health services (χ2=4.550; p=.033). Conclusion: Although patients were generally satisfied with health services, improvements are recommended in different aspects of care to create a favorable environment of care and increase levels of satisfaction and trust with the healthcare system among refugee populations.
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Affiliation(s)
- William N Mkanta
- Department of Public Health, Western Kentucky University, Bowling Green, KY, USA
| | - Opuruiche Ibekwe
- School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
| | - Maria C Mejia de Grubb
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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Migrant women’s knowledge and perceived sociocultural barriers to cervical cancer screening programme: a qualitative study of African women in Poland. HEALTH PSYCHOLOGY REPORT 2017. [DOI: 10.5114/hpr.2017.65238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article explores both the knowledge and perception of African women about the importance of screening as a recommended health action to counter the growing rate of cervical cancer in women. The theoretical framework is influenced by the postulations of behavioural theories, sociology of health and the health belief model (HBM) on how people perceive health issues such as cervical cancer and its screening measures. In addition, this study tries to explore the acculturation challenges involved in migration, which adversely affects health knowledge and behaviour of African women. To achieve this, one focus group discussion was conducted with twelve women between the ages of 25 and 54 years old from Egypt, Eritrea, Kenya and Nigeria to share their knowledge of cervical cancer screening programmes in Poland. They constituted a mixture of women from different parts of Africa with cultural differences and different belief systems. Little or no in-depth understanding of Polish language, lack of information about the disease and its screening methods, lack of understanding of the Polish health care systems and social economic factors were issues discussed by these women as socio-cultural barriers to their non-participation in the organised cervical cancer screening programme in Poland. Based on this study, migrant women lack adequate information about cervical cancer, its causes, risk factors and its screening methods. Therefore, this study proposes that good understanding of health care systems, language translation support in the health care system, health awareness campaigns and social relationships are important motivating factors that could encourage migrant women to participate in the cancer screening programmes in Poland.
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Abstract
Background Immigration rates have increased recently in the UK. Migrant patients may have particular needs that are inadequately met by existing primary care provision. In the absence of national guidance, local adaptations are emerging in response to these new demands. Aim To formatively assess the primary care services offered to new migrants and the ways in which practitioners and practices are adapting to meet need. Design & setting Online survey and case studies of current practice across primary care in the UK. Case studies were selected from mainstream and specialist general practice as well as primary care provision in the third sector. Method Non-probability sample survey of primary care practitioners (n = 70) with descriptive statistical analysis. Qualitative case studies (n = 8) selected purposively; in-depth exploration of organisational and practitioner adaptations to services. Analysis is structured around the principles of equitable care. Results Survey results indicated that practitioners focused on working with communities and external agencies and adapting processes of, for example, screening, vaccination, and health checks. Lack of funding was cited most frequently as a barrier to service development (n = 51; 73%). Case studies highlighted the prominence partnership working and of an organisational and practitioner focus on equitable care. Adaptations centred on addressing wider social determinants, trauma, and violence, and additional individual needs; and on delivering culturally-competent care. Conclusion Despite significant resource constraints, some primary care services are adapting to the needs of new migrants. Many adapted approaches can be characterised as equity-oriented.
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Digital communication between clinician and patient and the impact on marginalised groups: a realist review in general practice. Br J Gen Pract 2016; 65:e813-21. [PMID: 26622034 DOI: 10.3399/bjgp15x687853] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Increasingly, the NHS is embracing the use of digital communication technology for communication between clinicians and patients. Policymakers deem digital clinical communication as presenting a solution to the capacity issues currently faced by general practice. There is some concern that these technologies may exacerbate existing inequalities in accessing health care. It is not known what impact they may have on groups who are already marginalised in their ability to access general practice. AIM To assess the potential impact of the availability of digital clinician-patient communication on marginalised groups' access to general practice in the UK. DESIGN AND SETTING Realist review in general practice. METHOD A four-step realist review process was used: to define the scope of the review; to search for and scrutinise evidence; to extract and synthesise evidence; and to develop a narrative, including hypotheses. RESULTS Digital communication has the potential to overcome the following barriers for marginalised groups: practical access issues, previous negative experiences with healthcare service/staff, and stigmatising reactions from staff and other patients. It may reduce patient-related barriers by offering anonymity and offers advantages to patients who require an interpreter. It does not impact on inability to communicate with healthcare professionals or on a lack of candidacy. It is likely to work best in the context of a pre-existing clinician-patient relationship. CONCLUSION Digital communication technology offers increased opportunities for marginalised groups to access health care. However, it cannot remove all barriers to care for these groups. It is likely that they will remain disadvantaged relative to other population groups after their introduction.
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Lindenmeyer A, Redwood S, Griffith L, Ahmed S, Phillimore J. Recent migrants' perspectives on antibiotic use and prescribing in primary care: a qualitative study. Br J Gen Pract 2016; 66:e802-e809. [PMID: 27578814 PMCID: PMC5072918 DOI: 10.3399/bjgp16x686809] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/11/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Currently there is great interest in antibiotic prescribing practices in the UK, but little is known about the experiences of the increasing numbers of recent migrants (those present in the UK for >1 year but <5 years) registered at GP practices. Qualitative research has suggested that reasons for not prescribing antibiotics may not be clearly communicated to migrants. AIM This study aimed to explore the factors that shape migrants' experiences of and attitudes to antibiotics, and to suggest ways to improve effective communication around their use. DESIGN AND SETTING A qualitative study on recent migrants' health beliefs, values, and experiences in a community setting in primary care. METHOD Twenty-three recent migrants were interviewed in their preferred language by trained community researchers. The research team conducted a thematic analysis, focusing on health beliefs, engaging with health services, transnational medicine, and concepts of fairness. Experiences around antibiotics were a strong emerging theme. RESULTS Three reasons were identified for antibiotics seeking: first, holding an 'infectious model' of illness implying that antibiotics are required quickly to avoid illness becoming worse or spreading to others; second, reasoning that other medications will be less effective for people 'used to' antibiotics'; and third, perceiving antibiotic prescription as a sign of being taken seriously. Some participants obtained antibiotics from their country of origin or migrant networks in the UK; others changed their mind and accepted alternatives. CONCLUSION Primary care professionals should aim to understand migrants' perspectives to improve communication with patients. Further research is needed to identify different strategies needed to respond to the varying understandings of antibiotics held by migrants.
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Affiliation(s)
| | - Sabi Redwood
- School of Social and Community Medicine, University of Bristol, Bristol
| | | | | | - Jenny Phillimore
- Institute of Research into Superdiversity, University of Birmingham, Birmingham
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Lindenmeyer A, Redwood S, Griffith L, Teladia Z, Phillimore J. Experiences of primary care professionals providing healthcare to recently arrived migrants: a qualitative study. BMJ Open 2016; 6:e012561. [PMID: 27660320 PMCID: PMC5051449 DOI: 10.1136/bmjopen-2016-012561] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The main objectives of the study were to explore the experiences of primary care professionals providing care to recent migrants in a superdiverse city and to elicit barriers and facilitators to meeting migrants' care needs. This paper focuses on a strong emergent theme: participants' descriptions and understandings of creating a fit between patients and practices. DESIGN An exploratory, qualitative study based on the thematic analysis of semistructured interviews. SETTING AND PARTICIPANTS A purposive sample of 10 practices. We interviewed 6 general practitioners, 5 nurses and 6 administrative staff; those based at the same practice opted to be interviewed together. 10 interviewees were from an ethnic minority background; some discussed their own experiences of migration. RESULTS Creating a fit between patients and practice was complex and could be problematic. Some participants defined this in a positive way (reaching out, creating rapport) while others also focused on ways in which patients did not fit in, for example, different expectations or lack of medical records. A small but vocal minority put the responsibility to fit in on to migrant patients. Some participants believed that practice staff and patients sharing a language could contribute to achieving a fit but others outlined the disadvantages of over-reliance on language concordance. A clearly articulated, team-based strategy to create bridges between practice and patients was often seen as preferable. CONCLUSIONS Although participants agreed that a fit between patients and practice was desirable, some aimed to adapt to the needs of recently arrived migrants, while others thought that it was the responsibility of migrants to adapt to practice needs; a few viewed migrant patients as a burden to the system. Practices wishing to improve fit might consider developing strategies such as introducing link workers and other 'bridging' people; however, they could also aim to foster a general stance of openness to diversity.
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Affiliation(s)
- Antje Lindenmeyer
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sabi Redwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Laura Griffith
- Health Services Management Centre, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - Zaheera Teladia
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jenny Phillimore
- Institute of Research into Superdiversity, College of Social Sciences, University of Birmingham, Birmingham, UK
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Rivas C, Matheson L, Nayoan J, Glaser A, Gavin A, Wright P, Wagland R, Watson E. Ethnicity and the prostate cancer experience: a qualitative metasynthesis. Psychooncology 2016; 25:1147-1156. [PMID: 27416079 PMCID: PMC5096040 DOI: 10.1002/pon.4222] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 12/29/2022]
Abstract
Objectives To summarize black and minority ethnic (BME) patients' and partners experiences of prostate cancer by examining the findings of existing qualitative studies. Methods We undertook a systematic metasynthesis of qualitative studies using a modified version of Noblit and Hare's “meta‐ethnography” approach, with a 2000‐2015 search of 7 databases. Results Thirteen studies of men from US and UK BME groups were included. We explored constructs with BME‐specific features. Health care provider relationships, formation of a spiritual alliance with God (which enhanced the participants' feeling of empowerment and ability to cope with the cancer), and living on for others (generally to increase cancer awareness), often connected to spiritual regrowth, were the 3 constructs most commonly reported. A magnified effect from erectile dysfunction was also common. Initially, this affected men's disclosure to others about their cancer and their sexual problems, but eventually men responded by shifting their conceptualizations of masculinity to sustain self and social identities. There was also evidence of inequality resulting from financial constraints and adversity that necessitated resilience in coping. Conclusions The prostate cancer experience of BME men and their partners is affected by a complex intersection of ethnicity with other factors. Health care services should acknowledge this. If providers recognize the men's felt masculinities, social identities, and spiritual beliefs and their shifting nature, services could be improved, with community as well as individual benefits. More studies are needed in diverse ethnic groups.
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Affiliation(s)
- Carol Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Lauren Matheson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Johana Nayoan
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Adam Glaser
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Anna Gavin
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Penny Wright
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Lionis C, Papadakaki M, Saridaki A, Dowrick C, O'Donnell CA, Mair FS, van den Muijsenbergh M, Burns N, de Brún T, O'Reilly de Brún M, van Weel-Baumgarten E, Spiegel W, MacFarlane A. Engaging migrants and other stakeholders to improve communication in cross-cultural consultation in primary care: a theoretically informed participatory study. BMJ Open 2016; 6:e010822. [PMID: 27449890 PMCID: PMC4964217 DOI: 10.1136/bmjopen-2015-010822] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Guidelines and training initiatives (G/TIs) are available to support communication in cross-cultural consultations but are rarely implemented in routine practice in primary care. As part of the European Union RESTORE project, our objective was to explore whether the available G/TIs make sense to migrants and other key stakeholders and whether they could collectively choose G/TIs and engage in their implementation in primary care settings. SETTING As part of a comparative analysis of 5 linked qualitative case studies, we used purposeful and snowball sampling to recruit migrants and other key stakeholders in primary care settings in Austria, England, Greece, Ireland and the Netherlands. PARTICIPANTS A total of 78 stakeholders participated in the study (Austria 15, England 9, Ireland 11, Greece 16, Netherlands 27), covering a range of groups (migrants, general practitioners, nurses, administrative staff, interpreters, health service planners). PRIMARY AND SECONDARY OUTCOME MEASURES We combined Normalisation Process Theory (NPT) and Participatory Learning and Action (PLA) research to conduct a series of PLA style focus groups. Using a standardised protocol, stakeholders' discussions about a set of G/TIs were recorded on PLA commentary charts and their selection process was recorded through a PLA direct-ranking technique. We performed inductive and deductive thematic analysis to investigate sensemaking and engagement with the G/TIs. RESULTS The need for new ways of working was strongly endorsed by most stakeholders. Stakeholders considered that they were the right people to drive the work forward and were keen to enrol others to support the implementation work. This was evidenced by the democratic selection by stakeholders in each setting of one G/TI as a local implementation project. CONCLUSIONS This theoretically informed participatory approach used across 5 countries with diverse healthcare systems could be used in other settings to establish positive conditions for the start of implementation journeys for G/TIs to improve healthcare for migrants.
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Affiliation(s)
| | - Maria Papadakaki
- Faculty of Medicine, University of Crete, Heraklion, Greece
- Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Heraklion, Greece
| | | | - Christopher Dowrick
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Catherine A O'Donnell
- Department of General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Frances S Mair
- Department of General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Pharos Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Nicola Burns
- Department of General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
- Faculty of Health and Medicine, Lancaster Medical School, Furness College, University of Lancaster, Lancaster University, Lancaster, UK
| | - Tomas de Brún
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Mary O'Reilly de Brún
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | | | - Wolfgang Spiegel
- Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Anne MacFarlane
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Hansen L, Maidment L, Ahmad R. Early observations on the health of Syrian refugees in Canada. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2016; 42:S8-S10. [PMID: 29770038 PMCID: PMC5868581 DOI: 10.14745/ccdr.v42is2a03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Between November 4, 2015 and February 29, 2016, a total of 26,166 refugees came to Canada. Of those, only two (0.01%) were found to have signs of a notifiable disease in the Immigration Medical Examination and these individuals were referred to public health for follow-up. Most refugees - 24,640 (94.17%) - arrived by government-coordinated charter flights and underwent enhanced screening. Upon arrival in Canada, 274 refugees (1.11%) were assessed by Quarantine Officers for signs of a potential communicable disease (such as fever) and 10 (0.04%) were referred to hospital. Paramedics onsite at the airport assessed 1,212 refugees (4.92%). Fifty-four (0.22%) were transferred to hospital and many of these were known to require urgent medical care. Provincial and local public health authorities and community networks have been instrumental in providing immediate and longer-term health care to arriving refugees. The two most immediate care needs were catch-up immunizations and dental care. Arriving in Canada at the height of the influenza season, a number of refugees experienced time-limited upper respiratory infections. When referring refugees to Canadian authorities, the United Nations High Commissioner for Refugees (UNHCR) advised that the Syrian refugee population may be expected to have high medical needs. These were not necessarily identified beforehand and may include diabetes, developmental disabilities, conflict-related injuries or mental health issues. These health care needs of Syrians will be identified and addressed as they integrate into the local health care systems. The arrival of Syrian refugees in Canada has not resulted in any urgent public health concerns or need for public health intervention. Canada's experience to date indicates that the arrival of Syrian refugees in this country can be managed in a way that will integrate them into the health care system without increased risk to public health.
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Affiliation(s)
- L Hansen
- Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, ON
| | - L Maidment
- Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, ON
| | - R Ahmad
- Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, ON
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Doocy S, Lyles E, Roberton T, Akhu-Zaheya L, Oweis A, Burnham G. Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan. BMC Public Health 2015; 15:1097. [PMID: 26521231 PMCID: PMC4628338 DOI: 10.1186/s12889-015-2429-3] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/16/2015] [Indexed: 11/23/2022] Open
Abstract
Background There are currently more people displaced by conflict than at any time since World War II. The profile of displaced populations has evolved with displacement increasingly occurring in urban and middle-income settings. Consequently, an epidemiological shift away from communicable diseases that have historically characterized refugee populations has occurred. The high prevalence of non-communicable diseases (NCDs) poses a challenge to in terms of provision of appropriate secondary and tertiary services, continuity of care, access to medications, and costs. In light of the increasing burden of NCDs faced by refugees, we undertook this study to characterize the prevalence of NCDs and better understand issues related to care-seeking for NCDs among Syrian refugees in non-camp settings in Jordan. Methods A cross-sectional survey of 1550 refugees was conducted using a multi-stage cluster design with probability proportional to size sampling to obtain a nationally representative sample of Syrian refugees outside of camps. To obtain information on chronic conditions, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences by care-seeking for these conditions were examined using chi-square and t-test methods and characteristics of interest were included in the adjusted logistic regression model. Results Among adults, hypertension prevalence was the highest (9.7 %, CI: 8.8–10.6), followed by arthritis (6.8 %, CI: 5.9–7.6), diabetes (5.3 %, CI: 4.6–6.0), chronic respiratory diseases (3.1 %, CI: 2.4–3.8), and cardiovascular disease (3.7 %, CI: 3.2, 4.3). Of the 1363 NCD cases, 84.7 % (CI: 81.6–87.3) received care in Jordan; of the five NCDs assessed, arthritis cases had the lowest rates of care seeking at 65 %, (CI:0–88, p = 0.005). Individuals from households in which the head completed post-secondary and primary education, respectively, had 89 % (CI: 22–98) and 88 % (CI: 13–98) lower odds of seeking care than those with no education (p = 0.028 and p = 0.037, respectively). Refugees in North Jordan were most likely to seek care for their condition; refugees in Central Jordan had 68 % (CI: 1–90) lower odds of care-seeking than those in the North (p = 0.047). Conclusion More than half of Syrian refugee households in Jordan reported a member with a NCD. A significant minority did not receive care, citing cost as the primary barrier. As funding limitations persist, identifying the means to maintain and improve access to NCD care for Syrian refugees in Jordan is essential.
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Affiliation(s)
- Shannon Doocy
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Suite E8132, Baltimore, MD, 21205, USA.
| | - Emily Lyles
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Suite E8132, Baltimore, MD, 21205, USA
| | - Timothy Roberton
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Suite E8132, Baltimore, MD, 21205, USA
| | - Laila Akhu-Zaheya
- School of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Arwa Oweis
- School of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Gilbert Burnham
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Suite E8132, Baltimore, MD, 21205, USA
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Sweeney L, Owiti JA, Beharry A, Bhui K, Gomes J, Foster GR, Greenhalgh T. Informing the design of a national screening and treatment programme for chronic viral hepatitis in primary care: qualitative study of at-risk immigrant communities and healthcare professionals. BMC Health Serv Res 2015; 15:97. [PMID: 25890125 PMCID: PMC4372168 DOI: 10.1186/s12913-015-0746-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 02/17/2015] [Indexed: 01/03/2023] Open
Abstract
Background Effective strategies are needed to provide screening and treatment for hepatitis B and C to immigrant groups in the UK at high risk of chronic infection. This study aimed to build an understanding of the knowledge, beliefs and attitudes towards these conditions and their management in a range of high-risk minority ethnic communities and health professionals, in order to inform the design of a screening and treatment programme in primary care. Methods Qualitative data collection consisted of three sequential phases- (i) semi-structured interviews with key informants (n = 17), (ii) focus groups with people from Chinese, Pakistani, Roma, Somali, and French- and English-speaking African communities (n = 95), and (iii) semi-structured interviews with general practitioners (n = 6). Datasets from each phase were analysed using the Framework method. Results Key informants and general practitioners perceived that there was limited knowledge and understanding about hepatitis B and C within high-risk immigrant communities, and that chronic viral hepatitis did not typically feature in community discourses about serious illness. Many focus group participants were confused about the differences between types of viral hepatitis, held misconceptions regarding transmission, and were unaware of the asymptomatic nature of chronic infection. Most welcomed the idea of a screening programme, but key informants and focus group participants also identified numerous practical barriers to engagement with primary care-based screening and treatment; including language and communication difficulties, limited time (due to long working hours), and (for some) low levels of trust and confidence in general practice-based care. General practitioners expressed concerns about the workload implications and sustainability of screening and treating immigrant patients for chronic viral hepatitis in primary care. Conclusions Strategies to reduce the burden of chronic viral hepatitis in immigrant communities will need to consider how levels of understanding about hepatitis B and C within these communities, and barriers to accessing healthcare, may affect capacity to engage with screening and treatment. Services may need to work with community groups and language support services to provide information and wider encouragement for screening. Primary care services will need ongoing consultation regarding their support needs to deliver hepatitis screening and treatment programmes.
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Affiliation(s)
- Lorna Sweeney
- Institute for Health and Human Development, University of East London, UH250, Stratford Campus, Water Lane, London, E15 4LZ, UK.
| | - John A Owiti
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Andrew Beharry
- Internal Medicine and Gastroenterology, San Fernando General Hospital, Independence Avenue, San Fernando, Trinidad and Tobago.
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Jessica Gomes
- The Liver Unit, Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Graham R Foster
- The Liver Unit, Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
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Cheng IH, Drillich A, Schattner P. Refugee experiences of general practice in countries of resettlement: a literature review. Br J Gen Pract 2015; 65:e171-6. [PMID: 25733438 PMCID: PMC4337305 DOI: 10.3399/bjgp15x683977] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 09/09/2014] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Refugees and asylum seekers often struggle to use general practice services in resettlement countries. AIM To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. DESIGN AND SETTING Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. METHOD Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker's personal experiences of general practice services were identified, coded, and analysed. RESULTS From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor-patient relationships, and problems with the cultural acceptability of medical care. CONCLUSION The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management.
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Affiliation(s)
- I-Hao Cheng
- Southern Academic Primary Care Research Unit (Monash University School of Primary Health Care, South Eastern Melbourne Medicare Local, Monash Health), Dandenong, Victoria, Australia
| | - Ann Drillich
- Department of General Practice, School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia
| | - Peter Schattner
- Department of General Practice, School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia
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Amara AH, Aljunid SM. Noncommunicable diseases among urban refugees and asylum-seekers in developing countries: a neglected health care need. Global Health 2014; 10:24. [PMID: 24708876 PMCID: PMC3978000 DOI: 10.1186/1744-8603-10-24] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 02/24/2014] [Indexed: 11/25/2022] Open
Abstract
With the increasing trend in refugee urbanisation, growing numbers of refugees are diagnosed with chronic noncommunicable diseases (NCDs). However, with few exceptions, the local and international communities prioritise communicable diseases. The aim of this study is to review the literature to determine the prevalence and distribution of chronic NCDs among urban refugees living in developing countries, to report refugee access to health care for NCDs and to compare the prevalence of NCDs among urban refugees with the prevalence in their home countries. Major search engines and refugee agency websites were systematically searched between June and July 2012 for articles and reports on NCD prevalence among urban refugees. Most studies were conducted in the Middle East and indicated a high prevalence of NCDs among urban refugees in this region, but in general, the prevalence varied by refugees’ region or country of origin. Hypertension, musculoskeletal disease, diabetes and chronic respiratory disease were the major diseases observed. In general, most urban refugees in developing countries have adequate access to primary health care services. Further investigations are needed to document the burden of NCDs among urban refugees and to identify their need for health care in developing countries.
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Affiliation(s)
- Ahmed Hassan Amara
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Spandauer Damm 130, Haus 10, Berlin D-14050, Germany.
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Suurmond J, Rupp I, Seeleman C, Goosen S, Stronks K. The first contacts between healthcare providers and newly-arrived asylum seekers: a qualitative study about which issues need to be addressed. Public Health 2013; 127:668-73. [DOI: 10.1016/j.puhe.2013.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 11/06/2012] [Accepted: 04/08/2013] [Indexed: 11/24/2022]
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Cooper M, Harding S, Mullen K, O'Donnell C. 'A chronic disease is a disease which keeps coming back…it is like the flu': chronic disease risk perception and explanatory models among French- and Swahili-speaking African migrants. ETHNICITY & HEALTH 2012; 17:597-613. [PMID: 23153320 DOI: 10.1080/13557858.2012.740003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND African migrants to the West are at increased risk of hypertensive related diseases and certain cancers compared with other ethnic groups. Little is known about their awareness of this risk or knowledge of associated risk factors. OBJECTIVES To explore African migrants' perceptions of chronic disease risk, risk factors and underlying explanatory models. DESIGN In-depth interviews with 19 Africans from French- or Swahili-speaking countries living in Glasgow were conducted. Interviews were transcribed and 10 translated (3 Swahili and 7 French). Analysis was informed by a grounded theory approach. RESULTS Narratives suggested low awareness of chronic disease risk among participants. Africans reported a positive outlook on life that discouraged thought about future sickness. Infectious diseases were considered the dominant health threat for African migrants, mainly HIV but also TB and 'flu'. Chronic diseases were sometimes described as contagious. Explanatory models of chronic disease included bodily/dietary imbalance, stress/exertion, heredity/predisposition and food contamination. Cancer was feared but not considered a major threat. Cancer was considered more common in Europe than Africa and attributed to chemical contamination from fertilisers, food preservatives and industrial pollution. Evidence cited for these chemicals was rapid livestock/vegetable production, large size of livestock (e.g., fish), softness of meat and flavourless food. Chemicals were reported to circulate silently inside the body and cancer to form in the part where they deposit, sometimes years later. Cardiovascular diseases were described in terms of acute symptoms that required short-term medication. Confidentiality concerns were reported to prevent discussion of chronic disease between Africans. CONCLUSION This study suggests a need to improve chronic disease health literacy among African migrants to promote engagement with preventive behaviours. This should build on not only participants' existing knowledge of disease causation and risk factors but also their self-reliance in the pursuit of a healthy lifestyle and desire to retain cultural knowledge and practice.
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Affiliation(s)
- Maxwell Cooper
- General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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Pfortmueller CA, Graf F, Tabbara M, Tabarra M, Lindner G, Zimmermann H, Exadaktylos AK. Acute health problems in African refugees: ten years' experience in a Swiss emergency department. Wien Klin Wochenschr 2012; 124:647-52. [PMID: 22893449 DOI: 10.1007/s00508-012-0227-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 07/16/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Over the last two decades, the total number of applications from Africans for asylum in the countries of the European Union has increased from 578,000 to more than 2.9 million. About 20 % (7,196/36,100) of the asylum seekers in Switzerland originate from Africa. The disease profile of African asylum seekers is remarkably different from that of the native population in the country of application. We have therefore conducted an analysis of African asylum seekers presenting themselves to our emergency department. METHODS In a retrospective analysis, the central patient registry database was searched for patients originating from Africa admitted from 1 January 2000 to 30 November 2011 and labelled as "Asylbewerber" (asylum seeker) or "Flüchtling" (refugee). RESULTS Three thousand six hundred and seventy-five African asylum seekers were admitted to our emergency department between 2000 and 2010. Thirty-four percent (n = 1,247) were female and 66 % (n = 2,426) male. Eighty percent (n = 1,940) of the men and 70 % (n = 823) of the women were younger than 40 years. Most of our patients originated from Algeria (n = 612). Forty-five percent (n = 1,628) of all patients presented with internal medical problems, 40 % (n = 1,487) with injuries. 3.5 % (n = 130) of all patients presented with psychiatric problems. Admission for psychiatric problems increased steadily from 2 % (n = 4) in 2001 to 10 % (n = 35) in 2011. CONCLUSION The causes of presentation are manifold, including internal medical problems and injuries. Admissions for psychiatric problems are increasing. Establishing simple screening scores for somatization should be a key priority in providing more focused treatment in emergency departments.
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Caring for migrant patients in the UK: how the Migrant Health Guide can help. Br J Gen Pract 2012; 61:546-7. [PMID: 22152730 DOI: 10.3399/bjgp11x593758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Jackowska M, von Wagner C, Wardle J, Juszczyk D, Luszczynska A, Waller J. Cervical screening among migrant women: a qualitative study of Polish, Slovak and Romanian women in London, UK. ACTA ACUST UNITED AC 2012; 38:229-38. [PMID: 22219504 PMCID: PMC3970719 DOI: 10.1136/jfprhc-2011-100144] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore awareness of and participation in cervical screening services in women from Poland, Slovakia and Romania living in London, UK. METHODS Three qualitative studies were carried out in London in 2008-2009: an interview study of professionals working with Central and Eastern European migrants (n=11); a focus group study including three Polish, one Slovak and one Romanian focus group; and an interview study of Polish (n=11), Slovak (n=7) and Romanian (n=2) women. RESULTS Awareness of the cervical screening programme was good, but understanding of the purpose of screening was sometimes limited. Some women were fully engaged with the UK screening programme; others used screening both in the UK and their countries of origin; and a third group only had screening in their home countries. Women welcomed the fact that screening is free and that reminders are sent, but some were concerned about the screening interval and the age of the first invitation. CONCLUSIONS Migrant women from Poland, Slovakia and Romania living in London vary in their level of participation in the National Health Service Cervical Screening Programme. More needs to be done to address concerns regarding screening services, and to ensure that language is not a barrier to participation.
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Affiliation(s)
- Marta Jackowska
- Department of Epidemiology and Public Health, University College London, UK
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