Journal of Immigrant and Minority Health最新文献

Refugees in the United States (US) face complex barriers to access healthcare. Sustainable access to primary care is critical for refugees' health and quality of life in the US. Synthesizing existing literature on refugees' experiences in accessing primary care will enhance understanding of how the healthcare system can better support this population. We applied the qualitative meta-synthesis method developed by Sandelowski and Barroso (Handbook for synthesizing qualitative research, Springer Pub. Co., New York, 2007) to integrate the literature on refugees' experiences accessing primary care in the US. We searched PubMED, CINAHL, Web of Science, and Google Scholar for published literature using the PRISMA guideline (2020). 14 of 1,053 articles met inclusion criteria and were included in our analysis. Each selected article underwent critical appraisal using the Critical Review Form - Qualitative Studies (version 2.0) developed by Letts et al. (Guidelines for critical review form: Qualitative studies (Version 2.0). McMaster university occupational therapy evidence-based practice research group 1-12, 2007). Using inductive approach through a reciprocal translation process, findings of the 14 articles were synthesized into three themes highlighting refugees' experiences accessing primary care in the US: (1) differences in medical practices and the healthcare system between the home country and the US; (2) complexity in navigating access to primary care in the US; and (3) diverse experiences from person to person include both positive and negative moments. Primary care professionals need to recognize that refugees may view the US healthcare system, primary care services, and non-verbal communication differently than the non-refugee population. Interventions and policies for improving the quality of interpretation and community resources could encourage refugees' access to primary care in the US.

In 2011, the Director of U.S. Immigration and Customs Enforcement (ICE) issued a memorandum titled, "Enforcement Actions at or Focused on Sensitive Locations." The memorandum stated that immigration enforcement actions should not occur at specified sensitive locations, which included schools, healthcare facilities, places of worship, sites of public religious ceremony, and sites of public demonstration. These policies were rescinded in January 2025, creating the possibility of enforcement actions in these locations. The aim of this study was to investigate U.S. public opinion regarding immigration enforcement in sensitive locations. We conducted an online survey of 3,563 American adults with quotas implemented on gender, age, race, and geographic location. The survey ran from January 23 to February 3, 2025. 3,563 individuals completed the survey. Age and political identification were the most consistent predictors of support for rescinding sensitive locations policy, as well as in the belief that such enforcement would not deter care seeking. Sympathy towards immigrants was also a predictor of support for sensitive locations policy. Our findings suggest that the majority of Americans do not think that ICE's sensitive locations policy should be rescinded and believe that rescinding this policy will deter undocumented immigrants from seeking needed medical care for themselves and their children. A lack of support for rescinding this policy suggests that it should be reinstated, a move that would help to protect healthcare access for undocumented people and their families.

Excluded from state- or federal- insurance coverage, undocumented dialysis-dependent patients in Houston, Texas, were unable to receive outpatient, scheduled dialysis treatments in 2005. These patients presented to the hospital with life-threatening complications, often resulting in repeated hospitalizations. This narrative chronicles a nephrologist's two-decade journey (2005-2025) advocating for this vulnerable population. Motivated by firsthand experiences during residency, the author pursued nephrology and collaborated with clinicians, social workers, and policy advocates to improve access to scheduled dialysis. Key milestones included publishing influential research, forming a national coalition, and securing local and state-level policy changes. These efforts led to expanded outpatient dialysis capacity, innovative insurance enrollment strategies, and improved clinical outcomes. The story highlights ethical challenges, the power of community-driven solutions, and the resilience of patients who became advocates themselves. It underscores the importance of compassionate care, policy reform, and persistent advocacy in transforming a medically and morally troubling model into one that promotes dignity and health for vulnerable populations.

Stable and adequate housing is essential for mental and physical well-being. However, housing insecurity is a growing global issue, particularly affecting migrants. This review synthesizes the available evidence on the determinants and health outcomes associated with housing insecurity among culturally and linguistically diverse (CaLD) populations living in high-income countries. A scoping review was conducted of literature published in English, focusing on migrants from CaLD backgrounds living in high-income countries. The review followed the framework outlined by Arksey and O'Malley and PRISMA Extension for Scoping Reviews (PRISMA-ScR). Once data were extracted and categorized, a bibliometric analysis was performed to examine core research and author networks. The review included 57 studies; the highest proportions were from the USA (n = 13, 22.8%) and Canada (n = 9, 15.8%). The review found that housing insecurity among migrants of CaLD backgrounds was shaped by a range of micro-level, meso-level, and macro-level factors, increasing migrants' vulnerability to adverse health outcomes. Four themes were identified: negative mental health outcomes, negative physical health outcomes, social and developmental challenges, and health-related barriers and increased health risks. The bibliometric analysis illustrated fragmented research networks, while the keyword analysis highlighted thematic clusters on housing, migration, and mental health. Addressing housing insecurity demands a multi-level approach that integrates mental and physical health support and reduces barriers to healthcare access. By addressing housing insecurity as a health issue, decision-makers can help reduce the significant health inequalities experienced by migrants from CaLD backgrounds and promote equitable, accessible, and health-enabling housing environments.

To explore the role of health literacy in surgical decision making in a predominately Hispanic population, we designed a mixed-methods approach to assess patient's literacy and explore what drives their choices for their healthcare. Understanding these factors will guide physicians to improve patient education, engagement and provide equitable care. In this IRB-approved study, English- and Spanish-speaking patients offered urogynecology surgery at our tertiary center were recruited. Participants completed the Short Assessment of Health Literacy (SAHL), a demographic survey, and a semi-structured interview to gain insight into their medical decision-making process. Data were analyzed using chi-square and t-tests, with p < 0.05 considered statistically significant. Grounded theory guided qualitative analysis of interview transcripts. Among 62 participants, most patients (90.3%) had sufficient health literacy. Mean SAHL scores did not differ between those electing for surgery and those declining. While Hispanic patients did tend to have lower SAHL scores (16.3) than non-Hispanic patients (17.1) (p = 0.04), the average still suggested adequate literacy. Interviews revealed that patients electing surgery often cited comfort with their physician (p = 0.01), definitive treatment (p = < 0.01), and friends' experiences (p = 0.04) as influential factors. The influence of personal faith was brought up by nineteen participants (13 electing for surgery, 6 declining surgery, p = 0.11). Our research revealed that our patient population tends to have adequate health literacy. Interviews revealed themes that influence choices, such as trust in their physician and patient's faith. Further investigation into the role that social factors play will be critical for better understanding patient surgical decision making.

Small Vulnerable Newborns (SVNs)-including low birth weight (LBW), preterm birth (PB), and small for gestational age (SGA)-represent a major global concern, with 35.3 million cases reported in 2020. Despite the growing overlap between migration and perinatal health, evidence on birth outcomes among Venezuelan migrants in Colombia remains limited. This study examined the association between maternal nationality and the likelihood of SVN, LBW, and PB among live births in Colombia from 2018 to 2022. We conducted a cross-sectional analysis of 3,111,716 births using national vital statistics (DANE). The primary exposure was maternal nationality. Outcomes included LBW (< 2,500 g), PB (< 37 weeks), and the combined SVN indicator. Logistic regression models were adjusted for sociodemographic variables (maternal age, education, marital status, region, newborn sex, and year), followed by additional adjustment for maternal factors (parity, interbirth interval, multiple births). Interaction models were also developed between maternal origin and maternal education, marital status, region, and interbirth interval. After sociodemographic and maternal-factor adjustment, Venezuelan mothers had higher odds of SVN (OR: 1.18, 95% CI: 1.13-1.22), LBW (OR: 1.19, 95% CI: 1.15-1.24), and PB (OR 1.06, 95% CI: 1.02-1.10). Interaction analyses showed that associations varied across geographic, educational, and reproductive contexts. For SVN, differences emerged particularly among women with missing education, missing marital status, and shorter interbirth intervals. These findings highlight the vulnerability of migrant mothers and underscore the need for equity-oriented maternal and child health policies in host countries.

COVID-19 vaccine uptake in pregnant and lactating refugee women remains understudied despite their high risk of severe health outcomes. Our survey of 672 refugee women who gave birth at an urban hospital in a southwestern U.S. state between 2020 and 2023 revealed a concerningly low vaccination rate, with only 45.4% receiving one or more COVID-19 vaccine doses. Vaccination status was highly heterogeneous, with uptake ranging from 76.9% among women relocated from Afghanistan and South Asia to merely 23.8% among those from Congo, Tanzania, and several other African nations. Women residing in low-income areas and socioeconomically segregated communities were less likely to be vaccinated. Importantly, engagement with cultural health navigators (CHNs)-certified, multilingual, and bicultural individuals who share lived experiences of forced displacement with refugees and facilitate their healthcare navigation, education, and trust-building-helped mitigate these disparities. CHN support increased vaccination uptake among initially reluctant individuals, with some initiating vaccination during pregnancy. The effectiveness of CHN support varied by country of origin, underscoring the need for culturally tailored interventions to promote health equity in underserved populations.