Journal of Immigrant and Minority Health最新文献

Cancer screening rates among immigrant and refugee populations in high income countries is significantly lower than native born populations. The objective of this study is to systematically review the effectiveness of interventions to improve screening adherence for breast, cervical and colorectal cancer among Somali immigrants. A literature search was conducted for the years 2000-2021 and eight studies met eligibility criteria. The following intervention components were found to increase adherence to cervical cancer screening: home HPV test, educational workshop for women and education for general practitioners. A patient navigator intervention was found to increase screening for breast cancer. Educational workshops motivated or increased knowledge regarding cancer screening for breast, cervical and colorectal cancer. However, most of the studies had limitations due to methodology with potential for introduction of bias. Therefore, future studies comparing effectiveness of specific intervention components to reduce disparities in cancer screening among Somali immigrants and refugees are encouraged.

The purpose of this systematic review was to identify the mental health symptoms endorsed by DACA recipients. This study included qualitative and quantitative original, peer-reviewed articles related to mental health or psychological state or wellbeing of DACA recipients. Articles were abstracted from PsychInfo, PubMed, and GoogleScholar. The results included a total of fifteen articles, which were divided into qualitative and quantitative findings. The qualitative articles had a common theme of endorsement of depressive symptoms and negative affect associated to changes in familial and financial responsibilities and living in a difficult sociopolitical climate in the United States. The quantitative articles identified lower odds or symptom severity of depression and other internalizing symptoms compared to undocumented individuals. This summary review was limited by the ample exclusion of access to health care studies among DACamented individuals, which could have provided a broader picture about the health and accessibility for DACA recipients. Despite the limitations, this review identifies DACA as a policy that allows this group to improve their social function and quality of life compared to undocumented individuals but still endorse high levels of negative affect related to perceived challenging sociopolitical atmospheres

Haitian immigrant women living in the U.S. have a higher rate of cervical cancer mortality than any other ethnic group, primarily due to lower rates of screening test utilization. Therefore, it is important to understand the issues affecting their pap smear screening behaviors. We conducted a narrative review of articles from PubMed, SCOPUS, Embase, CINAHL/Nursing, and Psych Info. Inclusion criteria: U.S. Haitian immigrant, screening, cervical cancer, health beliefs/perceptions. Exclusion criteria: HPV-vaccine. Primary barriers: (1) lack of knowledge of cervical cancer, HPV, and pap smears; (2) lack of culturally appropriate dissemination of information; and (3) difficulty obtaining the test. Primary facilitators: (1) provider recommendations, (2) Haitian media to disseminate health information, and (3) having health insurance. This review highlights the points for intervention by health professionals and policy makers to address this group’s low pap smear utilization.

The health system in Aotearoa New Zealand is predicated on equity in access to health services as a fundamental objective yet barriers to equitable access for migrant and refugees continue to exist. There is a paucity of studies that synthesise the experiences and realities of migrants, refugees and healthcare providers that hinder access to healthcare and provide recommendations to improve services. This review synthesised these barriers and recommendations, with an aim to improve equitable access to healthcare to migrants and refugees. An integrative review of 13 peer-reviewed research studies from EBSCOhost research databases published between January 2016 and September 2022. Studies included: (i) related to Aotearoa; (ii) had a focus on equitable delivery of healthcare to migrants and refugees; and (iii) had a full English text available. The PRISMA framework guided the reporting of the review. The findings were thematically analysed and presented using a narrative empirical synthesis. The findings were organised into three broad themes: attitudinal barriers, structural barriers, and recommendations. Attitudinal barriers included the lack of culturally competent healthcare providers, discrimination by healthcare providers, and personal, social, and cultural attributes. Structural barriers referred to policies and frameworks that regulated the accessibility of health services such as the cost of healthcare, accessibility and acceptability of interpreter services, length of allocated appointments and long waiting times for an appointment, difficulties navigating the health system, and logistical barriers. Recommendations focused on promoting a sense of belonging, enabling a whole-of-society approach that brings together all sectors involved in providing health care for collective impact, and advocating for government policies to create a system that addresses the core health service access needs. This review provides rich context-specific findings on the barriers to equitable access to healthcare and proposed interventions to enhance equitable health outcomes for migrants and refugees in Aotearoa. The review contributes to relevant policy decisions and has practical implications to build responsive health systems which are inclusive, equitable and best address the health needs of populations from diverse cultural backgrounds.

We evaluated the contribution of place of birth to ethnocultural inequality in pregnancy outcomes. We analyzed a cohort of 1,487,723 births between 1998 and 2019 among minority Anglophones and majority Francophones in Quebec, Canada. We estimated the association (adjusted risk ratio, RR; 95% confidence interval, CI) of language with preterm birth and stillbirth, and incorporated interaction terms to determine the contribution of place of birth and distance traveled. Compared with Francophones, minority Anglophones had a greater risk of preterm birth (RR 1.03; 95% CI 1.01-1.06) and were less likely to deliver farther from home (RR 0.95; 95% CI 0.94-0.95). Anglophones who delivered close to home had a higher risk of preterm birth (RR 1.07; 95% CI 1.04-1.11), whereas Anglophones who delivered farther had a lower risk (RR 0.69; 95% CI 0.64-0.75). Patterns were similar for stillbirth. Ethnocultural inequality in adverse birth outcomes may be influenced by place of birth.

This perspective identifies harmful phrasing and frames in current clinician and researcher work relating to immigrant health and provides equity-centered alternatives. Recommendations are organized within two broad categories, one focused on shifting terminology toward more humanizing language and the second focused on changing frames around immigration discourse. With regards to shifting terminology, this includes: 1) avoiding language that conflates immigrants with criminality (i.e., "illegal"); 2) using person-first language (i.e., "person applying for asylum" or "detained person" rather than "asylum-seeker" or "detainee"); 3) avoiding comparisons to "native" populations to mean non-foreign-born populations, as this contributes to the erasure of Native Americans and indigenous people; 4) avoiding hyperbolic and stigmatizing "crisis" language about immigrants; and 5) understanding inherent limitations of terms like "refugee," "asylum seeker," "undocumented" that are legal not clinical terms. With regards to challenging dominant frames, recommendations include: 6) avoiding problematization of certain borders compared to others (i.e., U.S.-Mexico versus U.S.- Canada border) that contributes to selectively subjecting people to heightened surveillance; 7) recognizing the heterogeneity among immigrants, such as varying reasons for migration along a continuum of agency, ranging from voluntary to involuntary; 8) avoiding setting up a refugee vs. migrant dichotomy, such that only the former is worthy of sympathy; and 9) representing mistrust among immigrants as justified, instead shifting focus to clinicians, researchers, and healthcare systems who must build or rebuild trustworthiness. Ensuring inclusive and humanizing language use and frames is one critical dimension of striving for immigrant health equity.

An unwelcoming policy climate can create barriers to health care access and produce a 'Chilling Effect' among immigrant communities. For undocumented immigrants, barriers may be unique and have a greater impact. We used administrative emergency department (ED) data from 2015 to 2019 for a Midwestern state provided under a data use agreement with the state hospital association. General linear modelling was used to estimate the impact of anti-immigrant rhetoric on ED visit intensity among non-elderly adults who were likely Hispanic/Latino with undocumented status. Compared to 2015, the average ED visit intensity among adults who were likely Hispanic/Latino with undocumented status was significantly higher during 2016-2019 when anti-immigrant rhetoric was heightened. The magnitude of this change increased over time (0.013, 0.014, 0.021, and 0.020, respectively). Additionally, this change over time was not observed in the comparison groups. Our findings suggest that anti-immigrant rhetoric may alter health care utilization for adults who are likely Hispanic/Latino with undocumented status. Limitations to our findings include the use of only those likely to be Hispanic/Latino, data from only one Midwestern state and the loss of data due to non-classification using the NYU ED algorithm. Further research should focus on validating these findings and investigating these identification methods and anti-immigrant rhetoric effects among other undocumented groups including children and adults of different race or ethnicity such as black, both those that identify as Hispanic/Latino and those that do not. Developing strategies to improve health care access for undocumented Hispanic/Latino adults also warrants future research.

Literature suggests that access to health information improves health outcomes in various medical domains. This study investigated health-related Internet use levels and examined which factors influence health-related Internet use in Korean American women, grounded by Andersen's Behavioral Model. Participants included 243 Korean American women aged 19-85 years old residing in a Southeastern metropolitan area. Health-related Internet use was assessed by 11 items taken from HINTS 4 Cycle 2. Multiple regression analysis was conducted to reveal factors significantly associated with health-related Internet use of Korean American women. Predisposing factors of being aged 60 or older (β = - 0.329, SE = 0.694, p = 0.004) and employment status (β = 0.179, SE = 0.404, p = 0.037), as well as an enabling factor of having a primary care physician (β = 0.217, SE = 0.423, p = 0.013), were significantly associated with health-related Internet use. The differences in health-related Internet use may exacerbate disparities in access to healthcare services. The primary care physician's role is important in enhancing health-related Internet use. Research, policy, and programmatic attention are necessary to enhance physicians' encouragement and education for patients to use existing digital technology to improve their health and wellness.

Gestational diabetes mellitus (GDM) is a strong risk factor for type 2 diabetes mellitus, but many women with GDM do not return for postpartum diabetes screening. Interventions utilizing community health workers have demonstrated improvements in health knowledge and participation in other disease settings. The objective of this study was to therefore determine whether bilingual, bicultural community health workers (i.e., promotoras) increase participation in postpartum disease screening and referral for diabetes prevention or care in an urban, low-resource Hispanic community. Ninety-four women with GDM were recruited from the postpartum ward of a safety-net hospital and randomized equally to receive either standard-of-care alone or standard-of-care with a promotora-based intervention consisting of education, appointment reminders, and assistance navigating the healthcare system. Adherence to diabetes screening visits by 12 weeks postpartum and referral for preventive or diabetes care by 18 weeks postpartum was assessed through electronic medical record review. Compared to controls, women in the promotora group completed more diabetes screening visits (74% vs. 96%; relative risk [RR] 3.9; 95% Confidence Interval [CI] 1.1-14.1; p = 0.04). Among those who completed diabetes screening visits, women in the promotora group were also more likely to complete a subsequent referral visit for preventive or diabetes care (17% vs. 83%; RR 4.0; 95% CI 2.1-7.4; p < 0.01). A promotora-based intervention consisting of bilingual, bicultural community health workers improved diabetes screening, prevention, and treatment visits in a resource-limited community of Hispanic women with GDM. ClinicalTrials.gov Identifier: NCT00998595.

This study reports how refugees experienced care at an integrated clinic during their first year in Canada and how they transitioned to a community physician. A survey was completed by 75 Government Assisted Refugees followed at the REACH clinic between 2018 and 2020; 16 agreed to an additional interview. Regression modelling explored the relationship between "perceived health status at one year" and several independent variables. Qualitative thematic analysis provided context. Tailored access to care and enhanced communication through interpretation contributed to satisfaction with clinic services. A significant positive relationship was found between their perceived health status and frequency of visits (p < 0.042), and "doctors' advice about how to stay healthy" (p < 0.039). Interview findings highlighted the important role of settlement agencies, timing for a successful transition and physicians' support resources. While refugees benefit from attending integrated clinics, these should also prepare the care transition to community physicians. Targeted government funding and continued medical education could enhance refugees' transition experience.