Factors that affect the health of immigrants: Qualitative meta synthesis

BACKGROUND

Migration has challenged society. Most people who move do so for economic reasons, but others move for more tragic reasons. The proportion of female migrants was slightly higher than that of male migrants, partly due to the longer life expectancy of women and the higher demand for female migrants in care-related Jobs. The process may affect migrants' health, particularly in countries where healthcare is associated with high economic costs or insurance availability. A global systematic review of qualitative studies with meta-synthesis was conducted. The results can be used to support health policy and clinical practice.

OBJECTIVE

To describe how migrants perceive and experience the process of migrating and how it affects their health.

SEARCH STRATEGY

Databases consulted were Medline, PsychInfo, Cuiden, Cinahl, WOS, Scopus, Social Science Database, and Epistemonikos. Thirty-four articles were selected for final meta-synthesis.

INCLUSION CRITERIA

All qualitative primary studies were included that describe the experiences or perceptions of migrants and refugees over 18 years that talk about their migration process and the impact on their health; written in English or Spanish between 2016 and 2021. Articles referring to second generations and those dealing with pathologies that pre-date the migration process were excluded.

DATA EXTRACTION AND SYNTHESIS

The COREQ and JBI templates were used as quality criteria. Studies mostly used a phenomenological methodology and in-depth interviews, both individual and group, were used for data collection and narrative synthesis.

MAIN RESULTS

Uncertainty emerges as a main category. Three other interrelated themes have a direct impact on migrants' health: Language, Social Networks and Work. There are several conditions in each of these that have a positive or negative impact on health. The gender condition appears in both work and social networks, positively and negatively.

DISCUSSION AND CONCLUSIONS

Health would be improved by having a stable job, which would facilitate access to health resources. Social networks and language are facilitators of access to a better job, but not the only condition. From a gender perspective, social networks can become a source of health problems, especially for women. The process of migration places women in a position of vulnerability due to the difficulties of reconciling family and work life. Job insecurity, workload, loss of family life or social isolation increase hopelessness and anxiety, leading to health problems.

PUBLIC OR PATIENT CONTRIBUTION

As an academic review study, no patient contribution was required, and this study serves as a theoretical framework for more in-depth research that will work with migrant populations. As a public contribution, this work provides evidence of the need to improve access to health for some populations, in line with the Sustainable Development Goals (SDGs) set for 2030.

The Impacts of Inclusionary State Immigrant Policies on Psychosocial Outcomes Among Latinx Adolescents

OBJECTIVE

State-level policies that exclude immigrants, primarily undocumented, from public services and benefits have been found to have negative psychosocial impacts on Latinx adults, regardless of nativity. The effects of inclusionary policies-that is, extending public benefits to all immigrants-remain underexamined, as well as the impacts on adolescents.

METHOD

We used data from the Youth Risk Behavior Survey from 2009 to 2019 to examine the association between 7 state-level inclusionary policies and bullying victimization, low mood, and suicidality among Latinx adolescents via 2-way fixed-effects log-binomial regression models.

RESULTS

Banning the use of eVerify in employment was associated with decreased bullying victimization (prevalence ratio [PR] = 0.63, 95% CI: 0.53-0.74), low mood (PR = 0.87, 95% CI: 0.78-0.98), and suicidality (PR = 0.73, 95% CI: 0.62-0.86). Extending public health insurance coverage was associated with decreased bullying victimization (PR = 0.57, 95% CI: 0.49-0.67), and mandating Culturally and Linguistically Appropriate Services (CLAS) training for health care workers was associated with decreased low mood (PR = 0.79, 95% CI: 0.69-0.91). Extending in-state tuition to undocumented students was associated with increased bullying victimization (PR = 1.16, 95% CI: 1.04-1.30), and extending financial aid was associated with increased bullying victimization (PR = 1.54, 95% CI: 1.08-2.19), low mood (PR = 1.23, 95% CI: 1.08-1.40), and suicidality (PR = 1.38, 95% CI: 1.01-1.89).

CONCLUSION

The relationships between inclusionary state-level policies and Latinx adolescent psychosocial outcomes were mixed. Although most inclusionary policies were associated with improved psychosocial outcomes, Latinx adolescents residing in states with inclusionary policies related to higher education had worse psychosocial outcomes. Results suggest the importance of elucidating the unintended consequences of well-intentioned policies and the importance of continued efforts to reduce anti-immigrant sentiment.

Criminality, chaos and corruption: Analyzing the narratives of labor migration dynamics in Malaysia

This paper analyzes how policy-relevant actors understand the causes and effects of labor immigration to Malaysia, the country that receives the highest number of migrant workers in Southeast Asia. Whereas most research on international migration governance has focused on governance system outputs, this paper adopts an actor-centered perspective to investigate how actors narratively construct labor migration dynamics in Malaysia and how they conceptualize the drivers and impacts of labor migration policies and practices. The empirical material comes from 41 in-depth interviews with government officials, policymakers, international and regional organizations, nongovernmental organizations, employers' organizations, trade unions, and embassy representatives. The study found that Malaysia's migration governance system was perceived as "chaotic" due to the seemingly inconsistent, unclear "ad hoc" policy measures implemented, and that the governance system is perceived as "corrupt." Economic incentives were also seen as the primary driver of labor immigration, yet the main impact on Malaysian society was perceived as the spread of criminality, violence and disease, a narrative centered on migrant men. This paper argues that this discourse is problematic as it may drive types of policy measures that target migrant men.

"There's so much more to that sinking island!"-Restorying migration from Kiribati and Tuvalu to Aotearoa New Zealand

BACKGROUND AND AIMS

Many Pacific people are considering cross-border mobility in response to the climate crisis, despite exclusion from international protection frameworks. The 'Migration with dignity' concept facilitates immigration within existing laws but without host government support. Through the metaphor of Pacific navigation, we explore the role of dignity in the lives of I-Kiribati and Tuvaluans in Aotearoa New Zealand.

METHODS

Combining talanoa (pacific research method) with I-Kiribati and Tuvaluan community members, alongside critical community psychology and thematic analysis, we depict climate mobility as a wa or vaka moana (ocean-going canoes) journey.

ANALYSIS

Participants are expert navigators, navigating immigration obstacles to (re)grow their roots in Aotearoa New Zealand before charting a course for future generations to thrive. They draw strength from culture and community to overcome the adversity of precarious living and visa non-recognition.

CONCLUSION

Reconceptualising climate mobility through a Pacific lens imagines both dignity and cultural preservation as possible, despite the indignities and limitations of socio-political systems and protections for climate migrants.

Indonesian Nurses' Journey in Passing the Japan National Nursing Licensure Examination

Background

Despite the significant number of Indonesian nurses joining the Japanese National Nursing Licensure Examination (JNNLE), only a few of those were successful. Indonesian nurses as one of active migration player to Japan's market remain a critical support in supporting human resources for health in Japan. However, the successful nurses' perspectives have yet to be understood entirely. This study aimed to explore the experiences of Indonesian nurses who successfully passed the JNNLE.

Methods

This study used a descriptive qualitative approach. The participants were twenty Indonesian nurses who have passed the licensure examination. This study was carried out by semi-structured interviews conducted virtually. The data were analyzed using thematic content analysis.

Results

Five themes were discovered in this study: language ability as the key to succeeding in the exam, strategies to passing the exam, supporting resources as factors to increase the passing rate, understanding the nature of nursing exam, and internal motivation to be recognized as a professional nurse in a foreign country.

Conclusion

Indonesian nurses who passed the Japanese national nursing licensure examination tend to deploy planned strategies. Honing the language skills while working and living in Japan is very important, while structured support systems in the hospital, government, and social network are imperative to learning the new knowledge in the area of nursing care in Japan.

European Urban Strategies for Attracting Highly Skilled Migrants

In the context of globalization and rapid technological changes, the preservation of human capital and its multiplication are becoming an increasingly important factor of economic growth. These challenges are particularly acute for the European Union and the UK, which have been gradually losing their competitive positions in the world economy over the past decades. In this context it is particularly important to analyze policies aimed at stimulating highly skilled migration carried out at different levels, including the municipal level. Despite their limited competences in the field of migration regulation, municipal administrations are able to influence its dynamics and structure by creating a comfortable urban environment and housing policy, increasing transport accessibility, facilitating employment of local university graduates, supporting return migration, and using other soft measures to attract highly qualified specialists and representatives of the creative class. This process, however, has both winners and losers. Many cities, primarily in the peripheral EU countries, are not able to cope with the competition and handle the ever increasing brain drain problem, which requires comprehensive solutions involving not only municipal administrations but also central authorities and supranational European institutions.

Governing Migration through Multi-Level Governance? City Networks in Europe and the United States

City networks (CNs) are often enthusiastically regarded as key actors in processes of Europeanization and multi-level governance (MLG) policy-making in Europe and beyond. However, systematic research on highly contentious issues like migration is still scarce. Building on an understanding of MLG as a specific mode or instance of policy-making, in this article I seek to understand why and how CNs engage in MLG-like policy-making on a typical issue of state sovereignty. I apply the causal process-tracing method to analyse the genesis and policy actions undertaken in the last two decades by two migration CNs in different multi-level political settings: the Eurocities Working Group on Migration and Integration (WGM&I) in the EU and Welcoming America (WA) in the US. The results show that, notwithstanding the differences in the institutional settings, in both contexts instances of MLG policy-making have taken place in the shadow of the will of the national governments, which remain fundamental gate-keepers even in the EU supranational polity, where the European Commission has been particularly active in supporting migration CNs' initiatives.

Experiences of Healthcare Worker Returnees in Their Home Countries: A Scoping Review

Background

International migration of healthcare workers is a global phenomenon driven by growing demand in developed countries and expectations of healthcare workers from developing countries to have improved employment and lives. This migration has been understood to impact both the individuals and countries involved, with positive and negative consequences. However, little is known about returnees' experiences that could be used to address challenges and optimize benefits. The aim of this review was to understand what is known about experiences of migrant health workers after returning to their home countries.

Methods

A scoping review of primary research addressing experiences of migrant health workers upon their return to their homelands. A range of database were searched including Career and Technical Education Database via ProQuest, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education database via ProQuest, Excerpta Medica Care (EMCare) via Ovid, Education Resources Information Center (ERIC), Excerpta Medica database (EMBASE) via Ovid, MEDLINE and Scopus. A systematic process was performed guided by the work of Arksey and O'Malley. Eight databases were searched and 226 articles were retrieved. After screening articles and abstracts, 15 full-texts were assessed for eligibility, and finally seven studies were further analyzed and synthesized.

Results

Five qualitative studies, one quantitative study and one mixed methods study met inclusion criteria. Five themes emerged: (1) reasons to return, (2) upskilling and deskilling, (3) impact on human, financial, and social capital, (4) challenges and opportunities in the home country, and (5) facilitation supports.

Conclusion

Return migration is portrayed as a complex situation experienced by returnees. Structured policy and supports are required to help healthcare worker returnees prepare, and to adjust to life after their return. This study highlights the importance of comprehensive approach in return migration stage. Return migration policy should support healthcare worker returnees in their home country and facilitate utilization of their skills. Multi-stakeholder partnerships are vital to develop platforms for helping and facilitating returnees in the reintegration process at their home countries.

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The migrations of people and communities are an age-old phenomenon. However, the current geopolitical, technological and climatic context is leading to an intensification of migratory flows from multiple departure points, some of which are voluntary, others forced. Agreeing on measures to ensure the security, legal and health protection of these people is a global priority. Many migrants fall victim to human trafficking and violence. The International Organization for Migration works to protect migrants, their rights and their health.

'It is a dilemma': perspectives of nurse practitioners on health screening of newly arrived migrants

BACKGROUND

Screening newly arrived migrants from countries with high burden of communicable diseases of public health significance is part of the Swedish national strategy against the spread of these diseases. However, little is known about its implementation.

OBJECTIVE

This study aimed at exploring caregivers' experiences in screening newly arrived migrants to generate knowledge that could inform policy and clinical practice.

DESIGN

Using an interpretive description framework, we conducted semistructured interviews between November and December 2011 in four Swedish counties, with 15 purposively selected nurses with experience in screening migrants. Data were analyzed using thematic analysis.

RESULTS

Participants described a range of challenges including discordant views between migrants and the nurses about medical screening, inconsistencies in rules and practices, and conflicting policies. Participants indicated that sociocultural differences resulted in divergent expectations with migrants viewing the participants as agents of migration authorities. They also expressed concern over being given a new assignment without training and being expected to share responsibilities with staff from other agencies without adequate coordination. Finally, they indicated that existing policies can be confusing and raise ethical issues. All these were compounded by language barriers, making their work environment extremely complex and stressful.

CONCLUSIONS

These findings illuminate complex challenges that could limit access to, uptake, and delivery of health screening and undermine public health goals, and highlight the need for a multilevel approach. This entails avoiding the conflation of migration with health issues, harmonizing existing policies to make health care services more accessible and acceptable to migrants, and facilitating health professionals' work in promoting public health, improving interagency collaboration and the skills of all staff involved in understanding and effectively responding to migrants' needs, and improving migrants' health literacy through community outreach interventions.

The health of immigrants and refugees in Canada

Canada admits between more than 200,000 immigrants every year. National policy emphasizes rigorous selection to ensure that Canada admits healthy immigrants. However, remarkably little policy is directed to ensuring that they stay healthy. This neglect is wrong-headed: keeping new settlers healthy is just, humane, and consistent with national self-interest. By identifying personal vulnerabilities, salient resettlement stressors that act alone or interact with predisposition in order to create health risk, and the personal and social resources that reduce risk and promote well-being, health research can enlighten policy and practice. However, the paradigms that have dominated immigrant health research over the past 100 years--the "sick" and "healthy immigrant," respectively--have been inadequate. Part of the problem is that socio-political controversy has influenced the questions asked about immigrant health, and the manner of their investigation. Beginning with a review of studies that point out the shortcomings of the sick immigrant and healthy immigrant paradigms, this article argues that an interaction model that takes into account both predisposition and socio-environmental factors, provides the best explanatory framework for extant findings, and the best guide for future research. Finally, the article argues that forging stronger links between research, policy and the delivery of services will not only help make resettlement a more humane process, it will help ensure that Canada benefits from the human capital that its newest settlers bring with them.