Journal of Immigrant and Minority Health最新文献

The increasing global nursing shortage has led to a rise in the migration of African-educated nurses (AENs) to the United States. Despite being essential to the U.S. healthcare workforce, AENs face significant challenges during their transition, including cultural, professional, and emotional adjustments. This study aimed to explore the lived experiences of AENs transitioning into the American healthcare system and to identify the specific support needs required for their successful integration. A phenomenological approach guided by Ricoeur's interpretive phenomenology framework and Afaf Meleis's transitions theory was used. A combination of purposive and convenience sampling was employed to select 19 AENs who were trained in Africa but are currently working in various U.S. health institutions, and they participated in in-depth, unstructured interviews. Data were analyzed thematically to capture the essence of participants' experiences. Five main themes emerged: (1) Navigating an Unfamiliar Ground, including culture shock, language barriers, and differences in patient care standards; (2) Developing a Thriving Mindset, highlighting resilience, determination, and the importance of social support; (3) Institutional Factors Affecting Transitioning, such as the role of mentorship programs and perceived racial biases; (4) Heavy Performance Demands, reflecting the need for constant skill demonstration and managing high workloads; and (5) Leveraging Opportunities for Growth, focusing on career progression, financial benefits, and access to advanced healthcare technologies. AENs experience a complex transition into the U.S. healthcare system characterized by significant challenges and growth opportunities. Targeted support interventions, including cultural competence training, mentorship, and institutional support systems, are essential to facilitate their successful integration and enhance their contributions to patient care.

Employment is a social determinant of health, providing differential access to health insurance, social networks, and other resources that influence health trajectories. Asylum seekers are a subgroup of immigrants who have fled persecution in their home countries and with both precarious immigration status and employment access while they await adjudication of their asylum claims. We explored U.S. asylum seekers' experiences at the intersections of immigration, employment, and health and wellbeing. English and Spanish-speaking asylum seekers (age >/=18 years old) were recruited predominantly from an academic medical center-based Asylum Clinic. Interviews were conducted over the phone by a bilingual research coordinator, recorded, transcribed, and analyzed thematically. We identified four themes: (1) Work as essential yet inaccessible within the asylum process, marked by waiting, limited ability to access basic necessities and health services, and people resorting to desperate methods to obtain income; (2) Underemployment, which involved suboptimal opportunities due to devaluing of experience in their home country, transportation challenges, and competing demands; (3) Workplace inequity and exploitation; and (4) Employment as a source of stability, identity, and purpose. Our study highlights the employment challenges faced by U.S. asylum seekers, which can harm their health and wellbeing. Increasing pathways to employment during the asylum adjudication process can be one mechanism for promoting health and wellbeing in this population. Further, asylum policy, and the labor regulations connected to it, must be examined through the lens of structural vulnerability.

Migrant workers are vulnerable to poor mental health conditions due to various challenges that surround them in foreign countries away from home. This study aims to assess the mental health literacy (MHL) status among Myanmar migrant workers in Malaysia, exploring factors related to it. A cross-sectional study using a convenience sampling method was conducted from September to October 2023 to select 395 Myanmar migrant workers within the Klang Valley, Malaysia. Mental health literacy level was evaluated using the Mental Health Literacy Scale (MHLS). The study encompassed 395 eligible participants, who are predominantly male (60%), younger than 32 years old (69.1%), Buddhists (93.9%), with secondary education (75.4%), outdoor field workers (57.7%), and obtained a lower monthly income (93.3%). Most (62.9%) did not have prior experience with mental illness. Low social support was reported by the majority (63%). The MHL score was 94.43 (SD = 9.563), which is significantly lower among males (p = 0.042), the lower-income group (p = 0.045), and those who did not have previous experience with mental health practitioners (p = 0.002). The predictors revealed are education level (p = 0.016) and previous experiences with mental health practitioners (p = 0.018). The mental health literacy of the Myanmar migrant workers was found to be low. To improve mental health literacy among Myanmar migrant workers, culturally appropriate education programs in their native language, peer support networks, and accessible digital resources should be implemented, with collaboration from community leaders, NGOs, and government bodies. Additionally, advocacy for supportive policies and further research on mental health literacy are crucial to address psychological challenges and enhance overall well-being in this population.

United States (U.S.) Immigration and Customs Enforcement (ICE) detention facilities have been criticized for medical mismanagement and lack of transparency of health care and outcomes. In this study we analyzed call logs from individuals detained in a southern Georgia ICE detention facility to better understand the specific medical challenges they faced. Thematic analysis of 254 call logs identified three primary themes: mismanagement of medical and psychiatric conditions; detention as the cause of mental health symptoms, and concerns related to facility operations and conditions. Reports described delays in healthcare delivery, hazardous facility conditions, and deterrence from seeking medical care due to fear of segregation. Our results contribute to growing literature highlighting medical mismanagement and substandard conditions in ICE facilities.

Healthcare provided by bilingual providers or with assistance from qualified interpreters is intended to improve patient-provider communication. Despite federal laws requiring healthcare facilities to provide access to appropriate interpretation language assistance services for patients not proficient in English, many Spanish-preferring patients receive primary care from providers not fluent in Spanish or who regularly use formal interpreters. Partnering with two urban SafetyNet providers in Southern California, we conducted focus groups in Spanish with Spanish-preferring patients who received care from providers who: (1) were Spanish-qualified, (2) used formal interpreters, and (3) used informal interpreters or other communication strategies. We coded transcripts to identify themes and compared patient experiences across provider types. Our study included 62 adult Spanish-preferring primary care patients. Spanish-preferring patients reported preference for continuity with their English-speaking providers despite language barriers because of established rapport. Patients receiving care from Spanish-language-qualified providers reported greater trust, more comprehensive care (i.e., covered more issues with minimal detail), yet with many interactions rushed. Formal interpreters facilitated better understanding and professional communication, however, impersonalized some patient-provider interactions. Informal interpreters or ad-hoc strategies led to mixed experiences, often dependent on patient or provider ability to accurately convey medical information. Overall, Spanish-preferring patient experiences highlighted the necessity for healthcare systems to support robust language and interpretation services that enhance direct communication, ensure interpreter quality, and maintain long-term patient-provider relationships. Improvements in policy and practice are needed to optimize healthcare communication for Spanish-preferring patients, since patient-provider communication is critical for high-quality health outcomes and experiences in multilingual settings.

In 2021, following the Taliban's control of Afghanistan, Aotearoa New Zealand (NZ) welcomed over 1,700 Afghan nationals at risk due to their association with NZ agencies. The New Settlers Family and Community Trust (NFACT) was contracted to provide tailored resettlement support. This study evaluated NFACT's Afghan evacuee resettlement programme using a mixed-methods approach, including a cross-sectional survey, interviews, and focus groups with Afghan evacuees and NFACT staff. Of the 101 surveyed evacuees, most (93.1%) expressed satisfaction with the support they received, and almost all (97.0%) would recommend NFACT's programme to newcomers. Analysis across integration domains revealed consistently high ratings for services and support. Qualitative findings from Afghan evacuees (n = 12) highlighted the challenges of adjusting to new systems, the crucial guidance provided by NFACT, and the need for ongoing, tailored support to foster their dreams and sense of purpose. NFACT staff (n = 11) emphasised their dedication to support evacuees beyond contractual obligations, how limited resourcing constrained their efforts, and how their shared values and experiences underpinned the success of the programme. The findings underscore the need for comprehensive, culturally sensitive, and sustainable resettlement programmes. These findings have implications for governments to strengthen support for humanitarian evacuation responses within the evolving geopolitical landscape.

This study evaluated the effectiveness of a culturally- and linguistically-adapted, patient navigator-led telehealth model in expanding mental health access and reducing depression and anxiety symptoms among Afghan refugees resettled across several U.S. states. We conducted a retrospective chart review of electronic medical records from 679 Afghan patients, assessing changes in PHQ-9 and GAD-7 scores using paired samples t-tests. Additionally, we explored which patients benefited most, analyzing variations in outcomes based on treatment plans, age, and gender. We observed statistically significant reductions in depression and anxiety symptoms between baseline and follow-up for all treatment groups (p < .001), with large effect sizes ranging from d = 0.80 to 1.06. For example, high-need patients showed a mean PHQ-9 reduction of 4.44 points (d = 1.05) and a GAD-7 reduction of 3.70 points (d = 0.94). The model was equally effective across genders and age groups. This patient navigator-led model demonstrates a promising strategy for improving mental health outcomes among Afghan newcomers. Its success highlights the potential for scalable mental health care solutions to address both clinical symptoms and structural barriers to care.

Immigrants constitute a substantial portion of the United States population and represent a significant minoritized group whose health is impacted by the country's migration policies as social determinants of health. This qualitative study used a phenomenological approach to document and explore the lived experiences of highly educated Iranian immigrants and International Students within the context of U.S. migration policies while considering the Social Determinants of Health framework. In-depth semi-structured interviews were conducted with 23 participants. Reflexive thematic analysis of the data revealed four major themes (1) entry and reentry visa restrictions for Iranians; (2) the emotional and social impact of the U.S. Travel Ban; (3) family separation and emotional distress; and (4) mental health impacts of immigration uncertainty. Findings highlight significant challenges faced by this population, including extended family separations, career uncertainties, and psychological distress. Participants reported heightened anxiety, insomnia, and feelings of isolation, aligning with research on migration-related mental health disparities. This research contributes to the limited literature on the experiences of Iranian immigrants in the U.S. and has implications for minoritized population health and policy reforms aimed at mitigating the adverse effects of immigration-related stress.

Refugee women face unique challenges in accessing preventive healthcare services upon resettlement, particularly for cervical cancer screening and HPV vaccination. Despite national efforts to reduce cervical cancer incidence, uptake remains disproportionately low among newly arrived refugee populations. Emerging research suggests that trust in healthcare systems and providers plays a pivotal role in shaping engagement with these services, yet little is known about how trust is built or broken in the early resettlement period. This study explores how trust and medical mistrust shape cervical cancer prevention behaviors among newly arrived refugee women in the United States, with attention to the multilevel relational and contextual factors that influence screening and vaccination. We conducted in-depth, semi-structured interviews with 17 refugee women resettled within the past two years in a Mid-western City, recruited through a community-based organization. Interviews were conducted in participants' preferred languages and lasted approximately 60 min. Data were thematically analyzed using Braun and Clarke's six-step framework, supported by Dedoose software. A codebook was developed through double coding and refined via consensus meetings. Themes were reviewed collaboratively and verified through member checking to enhance analytical rigor. Participants (n = 17) ranged in age from 21 to 56 and represented five countries, with the majority from Rwanda and Congo. Most had less than a high school education, and nearly all reported limited or no prior knowledge of cervical cancer, Pap smears, or HPV vaccination. Some confused HPV with other illnesses, while others attributed cervical cancer to unrelated factors such as stress or diet. Four themes emerged: trust as a precondition for engagement; provider trust shaped by cultural concordance, communication, and respect; systemic mistrust shaped by health literacy, practical/access issues and social influences; and the importance of community-based relationships in rebuilding trust and supporting preventive care engagement. Refugee women's engagement with cervical cancer prevention is shaped not only by knowledge but also by cultural safety, provider concordance, and systemic trust. Interventions must prioritize community-rooted education, gender-concordant care, and culturally responsive communication to improve prevention outcomes.