Journal of Immigrant and Minority Health最新文献

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.

Immigrants to Canada face unique barriers that result in them accessing publicly funded healthcare services differently than non-immigrants. These barriers are particularly critical in the context of Emergency General Surgery (EGS) where timely access to healthcare is essential for better health outcomes. This study compares preoperative healthcare utilization between immigrants undergoing EGS with non-immigrants. EGS procedures in British Columbia between 2013 and 2021 were analyzed using population-based linked immigration, physician billing, and hospital discharge summary data. Preoperative primary care visits, specialist consults, imaging, and emergency department (ED) visits in the one-year period preceding the EGS were compared between immigrants with non-immigrants. Sub-analyses examined years since immigration and ethnic minority status. Of 77,937 EGS procedures, immigrants accounted for 14.6%. Immigrants had fewer pre-operative primary care visits (RR: 0.94, 95%CI: 0.92-0.96), specialist consults (RR: 0.88, 95%CI: 0.85-0.91), imaging services (RR: 0.96, 95%CI: 0.93-0.99), and ED visits (RR: 0.70, 95%CI: 0.68-0.72). Within the immigrant cohort, fewer primary care and ED visits were observed among the newest immigrants and among ethnic minorities. Immigrants accessed fewer healthcare services in the period preceding their EGS. Differences were most pronounced among new immigrants and immigrants from culturally-diverse countries who may be unfamiliar with the structure or processes for accessing healthcare services. Policy interventions are needed to prospectively link immigrants at highest risk of EGS with appropriate health services.

Medication errors are common after pediatric hospital discharge, and families who use languages other than English may be at increased risk. In this study, we aimed to determine the association between caregiver language and medication errors after pediatric hospital discharge across two different clinical sites. We performed a cross-sectional study surveying parents who speak English and Spanish of hospitalized children < 18 years old who were prescribed a new scheduled oral medication upon discharge. We recruited patients between March 2022-November 2023 from two clinical sites, an academic tertiary care center and a community-based hospital. We surveyed parents about management of their children's medication at home and collected patient demographics as well as visit/ hospital characteristics. Bivariate analyses compared subject/visit-level factors and discharge processes with medication errors. We surveyed 145 parents, 59 of whom use Spanish and 86 who use English. Liquid medications (88%) and antibiotics (78%) were prescribed most frequently. Overall, 50 medication errors made by 39 unique individuals were identified, including 18 dosing errors. 19% of parents who use Spanish reported dosing errors compared to 8.1% of parents who use English (p = 0.06). Parents whose children were discharged from the academic tertiary care center were more likely to make a medication administration error (p = 0.03). Medication errors were common after pediatric hospital discharge and were more frequent among parents whose children were discharged from an academic children's hospital. Language of care was not associated with statistically significant differences in medication error rates. Future studies should explore factors related to site of care and language that may contribute to post-discharge errors.

Empathic communication is known to play a pivotal role in healthcare, by building trust and ensuring patients feel respected. Yet, increases in global migration have added novel intercultural complexity to interactions within a variety of domestic work contexts, including healthcare. Despite this trend, the question of how Western-trained healthcare providers navigate intercultural communication challenges in clinical encounters remains under explored. Considering Canada's growing Middle Eastern immigrant population, this study sought to investigate how Ontario healthcare providers have conceptualized, enacted, and evaluated empathic communication with Middle Eastern newcomer patients. Using a qualitative methodology, we conducted 26 semi-structured interviews with healthcare providers. Our results revealed three interrelated conceptual themes: attentive perspective-taking, conveying active listening, and accommodating/empowering patients. These findings advance existing scholarship on empathic healthcare communication by underscoring how healthcare providers balance professional boundaries with cultural accommodation. On a practical level, this study also offers guidance for intercultural communication training: it identifies practical behavioural strategies that foreground relational attunement and behavioural flexibility, which can equip providers to navigate complex, diverse care encounters with confidence and efficacy.

Immigrant caregivers and their children encounter manifold barriers to mental health service use with unique challenges in the U.S.-Mexico border region. This study examined predisposing, enabling and need factors associated with mental health service use by immigrant caregivers and their children. A cross-sectional survey of 240 immigrant caregivers with children living in New Mexico was conducted. Three domains were examined for their associations with mental health service utilization among caregivers and children. Domains included predisposing (caregiver age, household composition, gender, education, religiosity, duration of US residency, adverse childhood experiences, English proficiency), enabling (caregiver resilience, employment, income, insurance status, health/social service use, social safety net use, resource navigation, help-seeking attitudes), and need (depression symptoms, immigration stress, housing insecurity) factors. Multiple logistic regression models were constructed for each domain and significant variables at a p < 0.05 level were included in final models. In the final model, caregiver mental health service utilization was positively associated with help-seeking attitudes and depression symptoms. For children, mental health service utilization was positively associated with health/social service use. This study identifies factors that may impact the use of mental health services by immigrant families living along the US-Mexico border. Results highlight the importance of culturally informed mental health outreach and integrating mental health services within coordinated and supportive health, social, and safety net services.

Primary health care (PHC) in Thailand's border regions remains challenged by the needs of mobile and marginalized populations, despite the country's progressive Universal Health Coverage (UHC). This qualitative study explores the dynamics of cross-border PHC systems along Thailand's borders with Myanmar, Lao PDR, and Cambodia through a people-centered lens. We conducted 101 semi-structured interviews with diverse stakeholders across six border provinces. Findings reveal that migrants and refugees face complex barriers, including legal exclusion, geographic isolation, and fear of deportation, leading to reliance on self-medication and delayed care. Health priorities consistently included communicable diseases, maternal and child health, and occupational risks, yet the context varied significantly by border. The Myanmar border was characterized by Non-Government Organizations (NGOs)-dependent, fragmented services for undocumented migrants and refugees. In contrast, the Lao PDR border demonstrated more stable, seasonal migration and smoother bilateral health cooperation. The Cambodia border was defined by labor migration and inconsistent employer-based health arrangements. Multi-stakeholder collaboration-particularly through migrant health volunteers and NGOs-was identified as both feasible and essential for service delivery, but remains ad hoc and donor-dependent. Sustainable solutions require formalizing the roles of community-based actors, creating institutionalized coordination platforms, and developing tailored, context-specific strategies that address the fundamental social determinants of health. Achieving health equity in these borderlands necessitates inclusive policies that bridge the gap between national UHC ambitions and the realities of cross-border mobility.