Journal of Immigrant and Minority Health最新文献

Undocumented immigrants in the US rely on community health clinics (CHCs) and emergency departments (EDs) for preventive and acute care due to health insurance ineligibility and financial constraints. CHCs provide low-cost, accessible healthcare for thousands of undocumented immigrants in cities throughout the U.S. Limited evidence exists on this population's use of EDs despite establishing care in CHCs. This cross-sectional study described the key characteristics of ED visits among undocumented immigrants with established care at a single CHC in a major US city. ED visits (n = 319) were extracted using a random sample of patient records from a CHC serving a largely undocumented population between April 1, 2023, and April 1, 2024. The most common discharge diagnoses were categorized as infections (23%), injuries (22%), gastrointestinal diseases (16%), and OB/GYN diseases (11%). Disposition data showed that 81% of patients were discharged directly from the ED, 14% were admitted to the hospital, and 4% were placed under observation. For 309 visits, 61% were classified as preventable by the NYU ED algorithm (NYU-EDA). These findings suggest that most visits were preventable or primary care treatable, often driven by acute health issues rather than chronic care needs. Study results inform how CHCs, EDs, and health systems can address care gaps, enhance preventative care strategies, and advance equitable care delivery.

This study assessed the impact of reproductive health literacy training for general, digital, and reproductive health literacy among Afghan and Arab refugees. From September 2023 to June 2024, the research team offered reproductive health literacy training (RHLT) series to Dari-, Pashto-, and Arabic-speaking refugees online and at public libraries in Sacramento, California. The RHLT series presented information on cervical cancer prevention, family planning, and maternal health with an emphasis on participants' ability to independently find reliable health information and use it for their own and their families' health decisions. A total of 203 participants completed the pre-assessment and post-assessment, administered two weeks after the final training session. Each assessment included validated scales, including the European Health Literacy Survey Questionnaire 6 (HLS-EU-Q6) and the eHealth Literacy Scale (eHEALS). Study participants in all three language groups significantly improved general health literacy, reproductive health literacy and reproductive knowledge (p < 0.05). Improvements in the digital health literacy scale (eHEALS) were borderline significant (p = 0.0506) and significant for Dari speakers (p < 0.05). There were no differences among the three language groups when controlling for age, education, and length of stay in the United States. These results showed that reproductive health literacy training that focuses on understanding and using health information is effective in increasing health literacy among Afghan and Arab refugee women with diverse cultural and demographic backgrounds. Scalable health literacy modules have the potential to reduce health disparities and empower informed decision-making within underserved populations.

Despite ongoing efforts to improve faculty diversity, systemic barriers have historically marginalized racial and ethnic minorities, particularly women, in academic positions. This systematic review addresses a critical gap in the literature by synthesizing longitudinal trends in the racial and gender composition of academic faculty, shedding light on the evolution of these disparities over time. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, with a systematic search of five databases (Sociological Abstracts, APA PsycINFO, CINAHL, Gender Studies Database, and MEDLINE) conducted between 2014 and July 2024 without language restrictions. Of the 8,423 records initially identified, 52 peer-reviewed articles, predominantly from medical and health-related departments, met the inclusion criteria for review. Using the Joanna Briggs Institute critical appraisal checklist, the methodological design of most included articles was assessed as high quality. Key findings revealed a general increase in the representation of underrepresented in medicine (URiM) faculty in some fields but stagnation or decline in others, particularly at senior levels. An intersectional analysis of race and gender highlighted that URiM women face unique challenges, including lower promotion rates and higher attrition risks. While these findings point to some progress in the overall representation of URiM faculty, substantial inequities persist, particularly at leadership levels and in promotion and retention processes. These challenges are further exacerbated by intersectional factors. Future research should incorporate qualitative data to better understand barriers and guide the development of targeted interventions.

Telehealth use increased dramatically after the COVID-19 pandemic enabled largely by regulatory changes. Health policy experts recommend telehealth as a viable option for healthcare delivery in the post-pandemic world. As investment in telehealth continues, it is important to ensure that existing health disparities are not exacerbated. One group that is particularly vulnerable to telehealth challenges includes patients with limited English Proficiency. This study aimed to examine whether English proficiency is associated with completion of telerehabilitation visits. Electronic Health Records were retrieved for all patients scheduled for a telerehabilitation visit (physical/occupational therapy) in adult or pediatric outpatient clinics at a large academic medical center between April 1, 2020 and April 30, 2022. Using data from 3,871 video visits involving 1414 patients, binomial logistic regression models were estimated to examine associations between sociodemographic variables (age, gender, race, ethnicity, insurance status, income, language preference) and visit completion rate using multivariable logistic regression models. 6.4% of telerehabilitation visits were conducted in a language other than English. 24% patients had a 0% completion rate, 9% had a completion rate of > 0% and < 100%, and 67% had a 100% completion rate. Being older and publicly insured was significantly associated with decreased odds of 100% completion. Patients with English as their preferred language showed higher odds of visit completion. Age, type of insurance, and language preference were associated with successful completion of telerehabilitation video visits. Future research is needed to reveal specific barriers to telerehabilitation for older patients and those with limited English proficiency.

This article describes the steps involved in creating a prototype with a gamified approach aimed at highlighting the challenges encountered by immigrants in foreign countries. This serious game sought to provide an interactive experience that mirrored the real-life obstacles faced by immigrants, fostering empathy among non-immigrant players in these scenarios, with the goal of improving attitudes toward immigrants. During the development phase of the game, a user-centered design approach was employed. The project was divided into several phases: understanding the context, comprehending user needs, iterative prototyping, and usability testing. Both immigrants and non-immigrants participated in the study, directly contributing to defining requirements and evaluating the game. The serious game "Typical Day," designed to simulate everyday situations faced by immigrants through interactive scenarios and critical decisions, demonstrated positive acceptance in terms of usability and engagement. The results indicated that "Typical Day" provided an engaging and educational gaming experience, successfully balancing entertainment and information. Positive feedback from 45 non-immigrant participants highlighted its potential as an educational tool to raise awareness about the experiences of immigrants. However, further studies are needed to evaluate its long-term impact on attitudes and behaviors. In conclusion, this study contributes to the literature by addressing a gap in gamified approaches to immigrant challenges, laying the foundation for future developments in serious games aimed at promoting attitude change.

Migrant and minority women in the United States face a high likelihood of experiencing poor reproductive health outcomes. Hispanic/Latina women are an especially high-risk population. Comprehensive and high-quality sexual and reproductive healthcare (SRHC) is desperately needed among this population, yet many Latina women face substantial barriers in accessing care. This study builds upon the three-delays model to better understand why Latina women experience delays in accessing quality SRHC in the state of South Carolina. Data for this study were drawn from semi-structed interviews with 14 adult women identifying as either Hispanic or Latina. Findings reveal that structural factors, including long distances to facilities, high costs of care, and difficulties navigating local healthcare and insurance systems, served as barriers to accessing quality SRHC. Socio-cultural factors, such as communication challenges and low cultural competency among healthcare providers, further inhibited access to care, even among women who spoke fluent English. These findings indicate a need for SRHC education and services to be more culturally-centered, by accounting for cultural knowledge and historical dynamics, and by giving patients more agency with respect to their care. Regarding the three-delays model, future applications should seek to better incorporate preventive services and consider that perceptions of quality SRHC are both individually- and contextually-mediated. This will be an important step toward developing policies and programs that are appropriately tailored to specific populations' cultural backgrounds and contextual needs.

In Australia, Middle Eastern refugees, notably the Ezidi community (an ethnic and religious minority from Northern Iraq and Syria) are disproportionately affected by high rates of vitamin and iron deficiencies. These deficiencies pose significant health risks and can impact overall well-being. Recent studies have suggested a possible correlation between Helicobacter pylori (H. pylori) infection and deficiencies in essential vitamins and iron, highlighting an important area of research that warrants further exploration. Understanding the relationship between H. pylori infection and nutrient deficiencies in newly arrived Ezidi refugees is critical for several reasons. First, it may provide insights into the underlying health challenges faced by this population, who often arrive with pre-existing health issues. Second, establishing this association could inform current screening practices, allowing for targeted interventions that address both H. pylori infection and nutritional deficiencies. Ultimately, this research aims to contribute to the development of effective health strategies that enhance the well-being of Ezidi refugees, ensuring they receive the necessary support to thrive in their new environment. By focusing on this intersection of infectious disease and nutritional health, we can better understand and mitigate the risks faced by this vulnerable group. A retrospective cohort study was performed using data collected from Ezidi refugees in Armidale Medical Centre and Armidale Hospital from 2018 to 2024. The data was analysed to determine the prevalence of H. pylori and deficiencies in iron, vitamin B12, and vitamin D. Further analysis was done with data from Armidale Medical Center only, to study any potential association between H. pylori infection and those same micronutrient deficiencies. H. pylori infection was detected in 76.7% of refugees tested. The rates of iron deficiency were 35.2% at Armidale Medical Centre and 41.9% at Armidale Hospital. Vitamin B12 deficiency was found in 50.7% and 58% of individuals, and vitamin D deficiency was present in 79.6% and 82.6%, respectively. No statistically significant associations were found between H. pylori infection and iron or vitamin D deficiency. However, a statistically significant association was observed between the absence of H. pylori and vitamin B12 deficiency. There is a significantly higher prevalence of H. pylori infection, iron deficiency, vitamin B12 deficiency, and vitamin D deficiency among Ezidi refugees in Armidale. The relationship between H. pylori infection and micronutrient deficiencies remains unclear. Further research is needed to clarify these associations and guide future screening protocols for Ezidi refugees.

Food insecurity (FI) prevalence rates among U.S. refugees can range up to 85%. FI-related health outcomes, such as hypertension and obesity, are also prevalent among refugees. The Supplemental Nutrition Assistance Program (SNAP) is an evidence-based federal nutrition assistance program that can reduce FI and improve health outcomes. Previous research shows that not every eligible refugee can access SNAP. What remains unknown is the SNAP nonparticipation rate among a representative sample of U.S. refugees. We estimated this rate using the 2021 Annual Survey of Refugees, which provides nationally representative data of U.S. refugees who were resettled between fiscal years 2016 and 2020. We determined the eligibility for SNAP by using the average monthly net household income of a household, the household size (i.e., the number of people residing in a household), and the SNAP net income eligibility thresholds for 2021. Percentages and their 95% confidence intervals were calculated with weighted data to be nationally representative of the U.S. refugee population. Results suggest that 28.6% (95% confidence interval: 23.4-33.8) of income-eligible refugee households (those with a net income below the federal poverty level) did not participate in SNAP. Future research should comprehensively identify barriers and facilitators in accessing SNAP and develop strategies to improve refugees' access to SNAP.