Pub Date : 2024-01-01DOI: 10.1016/j.jmh.2024.100246
Margubur Rahaman , Kailash Chandra Das
Background
Limited studies have covered the nexus between homelessness, migration, and maternal health. However, most homeless women are migrants and have high-risk fertility behaviors. Therefore, the present study examines the variation in antenatal health and healthcare behavior among homeless women, focusing on migration status.
Methods
The present study employed a mixed-methods approach. A cross-sectional quantitative survey using Time and Location sampling (TLS) and face-to-face interviews was carried out for the quantitative component. Further, qualitative data was gathered through in-depth interviews using purposive sampling. Descriptive statistics, bivariate analysis with the Pearson chi-square test, and multivariate logistic models estimated qualitative results. Further, the thematic analysis presented qualitative findings.
Results
Out of 400 respondents, 76 % were migrants, and 57 % reported poor SRH. The likelihood of poor SRH was 1.07 times higher among migrants than non-migrants. A higher likelihood of poor SRH was found among beggars and ragpickers. Similarly, it was prevalent among the respondents who lived alone, mainly migrants. Almost 80 % of migrants reported experiencing depression. The unmet need for health visits was substantial among the study population (41 %), and it was found to be noteworthy among migrants (51 %). Several individual, socioeconomic, and structural factors were identified as barriers to healthcare utilization.
Conclusion
Poor antenatal health was substantial among homeless women, mainly migrants. Public and private healthcare visits were inadequate among homeless women who were migrants. Several individual, socioeconomic, and structural factors affected healthcare utilization. The study highlights the urgent need to introduce population-centric programs and policies to promote reproductive health among homeless women.
{"title":"Differentials in self-reported health status and healthcare utilization among homeless women during the antenatal period in urban settings: Does migration status matter?","authors":"Margubur Rahaman , Kailash Chandra Das","doi":"10.1016/j.jmh.2024.100246","DOIUrl":"10.1016/j.jmh.2024.100246","url":null,"abstract":"<div><h3>Background</h3><p>Limited studies have covered the nexus between homelessness, migration, and maternal health. However, most homeless women are migrants and have high-risk fertility behaviors. Therefore, the present study examines the variation in antenatal health and healthcare behavior among homeless women, focusing on migration status.</p></div><div><h3>Methods</h3><p>The present study employed a mixed-methods approach. A cross-sectional quantitative survey using Time and Location sampling (TLS) and face-to-face interviews was carried out for the quantitative component. Further, qualitative data was gathered through in-depth interviews using purposive sampling. Descriptive statistics, bivariate analysis with the Pearson chi-square test, and multivariate logistic models estimated qualitative results. Further, the thematic analysis presented qualitative findings.</p></div><div><h3>Results</h3><p>Out of 400 respondents, 76 % were migrants, and 57 % reported poor SRH. The likelihood of poor SRH was 1.07 times higher among migrants than non-migrants. A higher likelihood of poor SRH was found among beggars and ragpickers. Similarly, it was prevalent among the respondents who lived alone, mainly migrants. Almost 80 % of migrants reported experiencing depression. The unmet need for health visits was substantial among the study population (41 %), and it was found to be noteworthy among migrants (51 %). Several individual, socioeconomic, and structural factors were identified as barriers to healthcare utilization.</p></div><div><h3>Conclusion</h3><p>Poor antenatal health was substantial among homeless women, mainly migrants. Public and private healthcare visits were inadequate among homeless women who were migrants. Several individual, socioeconomic, and structural factors affected healthcare utilization. The study highlights the urgent need to introduce population-centric programs and policies to promote reproductive health among homeless women.</p></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":"10 ","pages":"Article 100246"},"PeriodicalIF":3.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000357/pdfft?md5=a8fc9ac2875b59f0d40f99e84e8a208c&pid=1-s2.0-S2666623524000357-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In 2014 the UK government rolled out the then called hostile environment as a series of punitive policies designed to disenfranchise undocumented migrants from living in Britain. As part of these measures upfront charging was introduced in 2017 which saw patients being denied treatment without prior full payment based on their immigration status.
Aim
Assess the knowledge of the charging regulations in a sample of primary care practitioners. Assess the impact of the regulations on both patients and practitioners in a primary care setting.
Methods
Building on a previous survey by the RCPCH, a cross sectional survey was circulated through the RCGP faculties and GP training groups within England. Demographic information and likert responses were collected from over 300 responses. Thematic analysis of over 120 white space questions was undertaken to create themes and sub-themes.
Results
Results showed an overall poor knowledge of the regulations. Thematic analysis was split into two main categories, (i) human impact of the policies and (ii) the economic and political impact of the policies. Key points were (i) lack of knowledge and awareness of the regulations, (ii) evidence of patient harm through patients’ being denied care, avoiding care or having care delayed, (iii) evidence of clinician harm through burnout, stress, a loss of faith in practice and concerns over extra work and (iv) concerns over implicit bias and structural racism within primary care and (v) concerns over lack of economic analysis.
Conclusion
Charging of overseas visitors is poorly understood within primary care despite having an impact on both patients and practitioners within this setting. Recommendations to help tackle this issue and reduce harm include training of staff, systematic reporting of harm, and a system wide economic analysis.
{"title":"The hostile environment in primary care: Qualitative analysis of a cross sectional survey of health care professionals in primary care","authors":"Joanna Dobbin , Francesca Burns , Sebastian Casalotti , Mariam Jaffer , Monica Sharman , Catarina Soares , Josie Reynolds","doi":"10.1016/j.jmh.2024.100276","DOIUrl":"10.1016/j.jmh.2024.100276","url":null,"abstract":"<div><h3>Background</h3><div>In 2014 the UK government rolled out the then called hostile environment as a series of punitive policies designed to disenfranchise undocumented migrants from living in Britain. As part of these measures upfront charging was introduced in 2017 which saw patients being denied treatment without prior full payment based on their immigration status.</div></div><div><h3>Aim</h3><div>Assess the knowledge of the charging regulations in a sample of primary care practitioners. Assess the impact of the regulations on both patients and practitioners in a primary care setting.</div></div><div><h3>Methods</h3><div>Building on a previous survey by the RCPCH, a cross sectional survey was circulated through the RCGP faculties and GP training groups within England. Demographic information and likert responses were collected from over 300 responses. Thematic analysis of over 120 white space questions was undertaken to create themes and sub-themes.</div></div><div><h3>Results</h3><div>Results showed an overall poor knowledge of the regulations. Thematic analysis was split into two main categories, (i) human impact of the policies and (ii) the economic and political impact of the policies. Key points were (i) lack of knowledge and awareness of the regulations, (ii) evidence of patient harm through patients’ being denied care, avoiding care or having care delayed, (iii) evidence of clinician harm through burnout, stress, a loss of faith in practice and concerns over extra work and (iv) concerns over implicit bias and structural racism within primary care and (v) concerns over lack of economic analysis.</div></div><div><h3>Conclusion</h3><div>Charging of overseas visitors is poorly understood within primary care despite having an impact on both patients and practitioners within this setting. Recommendations to help tackle this issue and reduce harm include training of staff, systematic reporting of harm, and a system wide economic analysis.</div></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":"10 ","pages":"Article 100276"},"PeriodicalIF":3.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jmh.2024.100258
Dr Jelena Arsenijevic , Dr Verena Seibel
Introduction
The Netherlands was one of the first countries in Europe to offer breast, colorectal and cervical cancer screening tests free of charge. Yet, a significant share of migrants in the Netherlands forgo the use of these preventive screenings. Qualitative research suggests, that lack of system knowledge on how the healthcare system operates (e.g. age eligibility of cancer screenings), is one factor contributing to this underuse among migrants. However, little is known about the extent to which migrants differ from natives in their system knowledge and about potential causes of this ethnic gap. The contribution of this study is therefore twofold: First, we examine whether migrants in the Netherlands have lower system knowledge regarding cancer screenings than the natives. Second, we examine which factors explain potential ethnic differences in system knowledge between migrants and non-migrants.
Method
Using the Longitudinal Internet Study for Social Sciences (LISS), we matched newly collected data on system knowledge about healthcare with Health module (wave 14). To assess the difference in system knowledge among migrants and non-migrants, while taking into account potential selection bias, we applied propensity score matching, one-to-one matching procedure with no replacement. We compared first generation non - Western migrants (FNWM) and second-generation non-western migrants (SNWM) with their most similar non-migrants group regarding their knowledge about breast, colorectal, and cervical screening. A Blinder-Oaxaca decomposition with non-matched samples was used to examine which factors can explain the differences in system knowledge among migrants and non-migrants.
Results
Our results show that first generation migrants have lower system knowledge about all three screening tests, while second generation migrants differ from non-migrants only with regard to knowledge about breast and colorectal cancer screenings. The ethnic differences found are not caused by personal or social factors such as education or income.
Conclusion
We recommend Dutch healthcare policy makes to focus in the strengthen of cancer screening system knowledge among migrant populations in order to increase their participation in these screening programs.
{"title":"Do immigrants know less than natives about cancer screening tests? – the case of Netherlands","authors":"Dr Jelena Arsenijevic , Dr Verena Seibel","doi":"10.1016/j.jmh.2024.100258","DOIUrl":"10.1016/j.jmh.2024.100258","url":null,"abstract":"<div><h3>Introduction</h3><p>The Netherlands was one of the first countries in Europe to offer breast, colorectal and cervical cancer screening tests free of charge. Yet, a significant share of migrants in the Netherlands forgo the use of these preventive screenings. Qualitative research suggests, that lack of system knowledge on how the healthcare system operates (e.g. age eligibility of cancer screenings), is one factor contributing to this underuse among migrants. However, little is known about the extent to which migrants differ from natives in their system knowledge and about potential causes of this ethnic gap. The contribution of this study is therefore twofold: First, we examine whether migrants in the Netherlands have lower system knowledge regarding cancer screenings than the natives. Second, we examine which factors explain potential ethnic differences in system knowledge between migrants and non-migrants.</p></div><div><h3>Method</h3><p>Using the Longitudinal Internet Study for Social Sciences (LISS), we matched newly collected data on system knowledge about healthcare with Health module (wave 14). To assess the difference in system knowledge among migrants and non-migrants, while taking into account potential selection bias, we applied propensity score matching, one-to-one matching procedure with no replacement. We compared first generation non - Western migrants (FNWM) and second-generation non-western migrants (SNWM) with their most similar non-migrants group regarding their knowledge about breast, colorectal, and cervical screening. A Blinder-Oaxaca decomposition with non-matched samples was used to examine which factors can explain the differences in system knowledge among migrants and non-migrants.</p></div><div><h3>Results</h3><p>Our results show that first generation migrants have lower system knowledge about all three screening tests, while second generation migrants differ from non-migrants only with regard to knowledge about breast and colorectal cancer screenings. The ethnic differences found are not caused by personal or social factors such as education or income.</p></div><div><h3>Conclusion</h3><p>We recommend Dutch healthcare policy makes to focus in the strengthen of cancer screening system knowledge among migrant populations in order to increase their participation in these screening programs.</p></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":"10 ","pages":"Article 100258"},"PeriodicalIF":3.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000473/pdfft?md5=73732445eca0d6bde61f8ee0f5aa2abb&pid=1-s2.0-S2666623524000473-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141963011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health of immigrant population changes with time of residence and under the effect of social determinants of health. This study analyses the health status of the immigrant population in the Basque Country according to groups of origin assessing the effect of time of residence on health in the different origin groups considering social and migration-related determinants of health. A cross-sectional study of the immigrant population in the Basque Country using the Foreign Origin Population Survey was conducted. A descriptive analysis is performed of each group of origin and Poisson models are applied. The main variable is self-rated health, and the independent variables are divided into three groups: demographic, socioeconomic and migration-related. For the study, immigrants are divided into six origin groups. Results show that the health and the effects of socioeconomic and migratory variables on health vary according to origin. Immigrants with greater economic difficulties present poorer health, though to different extents and the effects on health of educational level and perception of discrimination differ according to origin. Finally, the relation between time of residence and self-rated health varies according to origin: Colombian, Ecuadorian, Peruvian, Eastern EU and sub-Saharan immigrants living in Spain for 10 or more years report poorer health even when controlling for socioeconomic and migration-related variables, while people from the Maghreb and Asia do not. Therefore, the effects on health of time of residence, living conditions and the migratory experience differ according to migrant group, leading to the importance of analysing the health of immigrants as a heterogeneous group.
{"title":"Self-rated health, time of residence and social determinants of health in immigrant populations: A complex relationship in groups of different origins in a Southern European region","authors":"Antía Domínguez-Rodríguez , Yolanda González-Rábago","doi":"10.1016/j.jmh.2024.100216","DOIUrl":"10.1016/j.jmh.2024.100216","url":null,"abstract":"<div><p>Health of immigrant population changes with time of residence and under the effect of social determinants of health. This study analyses the health status of the immigrant population in the Basque Country according to groups of origin assessing the effect of time of residence on health in the different origin groups considering social and migration-related determinants of health. A cross-sectional study of the immigrant population in the Basque Country using the Foreign Origin Population Survey was conducted. A descriptive analysis is performed of each group of origin and Poisson models are applied. The main variable is self-rated health, and the independent variables are divided into three groups: demographic, socioeconomic and migration-related. For the study, immigrants are divided into six origin groups. Results show that the health and the effects of socioeconomic and migratory variables on health vary according to origin. Immigrants with greater economic difficulties present poorer health, though to different extents and the effects on health of educational level and perception of discrimination differ according to origin. Finally, the relation between time of residence and self-rated health varies according to origin: Colombian, Ecuadorian, Peruvian, Eastern EU and sub-Saharan immigrants living in Spain for 10 or more years report poorer health even when controlling for socioeconomic and migration-related variables, while people from the Maghreb and Asia do not. Therefore, the effects on health of time of residence, living conditions and the migratory experience differ according to migrant group, leading to the importance of analysing the health of immigrants as a heterogeneous group.</p></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":"9 ","pages":"Article 100216"},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000060/pdfft?md5=267d0da1ff416fcdf9ec71da7ad250d9&pid=1-s2.0-S2666623524000060-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139684463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jmh.2024.100226
Elin Ternström , Anna Akselsson , Rhonda Small , Johanna Andersson , Helena Lindgren
Introduction
In Sweden almost one third of the population is born in another country and a large number of the women who do not speak Swedish are of reproductive age. Women migrating from low-income countries have higher risks for poor obstetric outcomes than receiving country-born citizens. INFOR (a Swedish word for “before” or “ahead of”) is an intervention offering language-assisted, individual birth preparation for non-Swedish speaking pregnant women unfamiliar with the maternity care system. The aim of this study was to describe the uptake of care and obstetric outcomes among non-Swedish speaking migrant women attending INFOR.
Methods
A descriptive study of the obstetric outcomes and uptake of care was conducted of the 149 non-Swedish speaking pregnant women who participated in INFOR between 2016 and 2020. The data were accessed retrospectively from the medical record system Obstetrix and the population-based Swedish Pregnancy Registry and analysed descriptively.
Results
Women participating in INFOR originated from 44 countries and spoke 35 different languages. During late pregnancy, 20 percent of the women sought care for decreased fetal movements and 80 percent of the women attended the postpartum visit. While the majority of the participants were offered professional language support during pregnancy, almost none had a professional interpreter present during labour and birth. After birth, 80 percent of the primiparous women were asked to rate their birth experience, but only half of the multiparous women were asked. Further, only half of the primiparous women attending the postpartum visit were asked about their self-rated health.
Conclusion
INFOR may increase uptake of some important aspects of care during pregnancy, birth and postpartum among migrants of diverse backgrounds. The findings raise concerns however about communication support for migrant women, especially during labour and birth. The offer of professional interpreting as part of standard maternity care for women who need it is essential and must be improved in order to provide equitable care for all.
{"title":"Obstetric outcomes and uptake of care among 149 non-Swedish speaking migrant women attending a birth preparation visit during pregnancy – An observational study from Sweden","authors":"Elin Ternström , Anna Akselsson , Rhonda Small , Johanna Andersson , Helena Lindgren","doi":"10.1016/j.jmh.2024.100226","DOIUrl":"https://doi.org/10.1016/j.jmh.2024.100226","url":null,"abstract":"<div><h3>Introduction</h3><p>In Sweden almost one third of the population is born in another country and a large number of the women who do not speak Swedish are of reproductive age. Women migrating from low-income countries have higher risks for poor obstetric outcomes than receiving country-born citizens. INFOR (a Swedish word for “before” or “ahead of”) is an intervention offering language-assisted, individual birth preparation for non-Swedish speaking pregnant women unfamiliar with the maternity care system. The aim of this study was to describe the uptake of care and obstetric outcomes among non-Swedish speaking migrant women attending INFOR.</p></div><div><h3>Methods</h3><p>A descriptive study of the obstetric outcomes and uptake of care was conducted of the 149 non-Swedish speaking pregnant women who participated in INFOR between 2016 and 2020. The data were accessed retrospectively from the medical record system Obstetrix and the population-based Swedish Pregnancy Registry and analysed descriptively.</p></div><div><h3>Results</h3><p>Women participating in INFOR originated from 44 countries and spoke 35 different languages. During late pregnancy, 20 percent of the women sought care for decreased fetal movements and 80 percent of the women attended the postpartum visit. While the majority of the participants were offered professional language support during pregnancy, almost none had a professional interpreter present during labour and birth. After birth, 80 percent of the primiparous women were asked to rate their birth experience, but only half of the multiparous women were asked. Further, only half of the primiparous women attending the postpartum visit were asked about their self-rated health.</p></div><div><h3>Conclusion</h3><p>INFOR may increase uptake of some important aspects of care during pregnancy, birth and postpartum among migrants of diverse backgrounds. The findings raise concerns however about communication support for migrant women, especially during labour and birth. The offer of professional interpreting as part of standard maternity care for women who need it is essential and must be improved in order to provide equitable care for all.</p></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":"9 ","pages":"Article 100226"},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000163/pdfft?md5=4055586a0a9088d3c287796a7c16e1f4&pid=1-s2.0-S2666623524000163-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140347960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jmh.2024.100251
Susan Hillis , Sydney Tucker , Nicole Baldonado , Evgenia Taradaika , Lyudmyla Bryn , Svitlana Kharchenko , Tetiana Machabelii , Roisin Taylor , Phil Green , Philip Goldman , Isang Awah , Joshua Baldonado , Praveen Gomez , Seth Flaxman , Oliver Ratmann , Jamie M. Lachman , Andres Villaveces , Lorraine Sherr , Lucie Cluver
<div><h3>Background</h3><p>Nearly one in six children lived in war zones in 2023. Evidence-based psychosocial and parenting support has potential to mitigate negative impacts for parents and children co-exposed to war and displacement, especially in relation to mental health and harsh parenting reactions. In the current war in Ukraine, local mental health experts co-created and evaluated, with global experts, the effectiveness of psychosocial and parenting support groups, called <em>‘Hope Groups’</em> on improvements in mental health, positive parenting, and violence against children. This paper aimed to assess the effectiveness of psychosocial and parenting support groups, called 'Hope Groups,' on improvements in caregiver mental health, positive parenting, and prevention of violence against children, for families affected by the war in Ukraine, using a pre/post study design.</p></div><div><h3>Methods</h3><p>Participants (<em>n</em> = 577) included Ukrainian caregivers, 66% (381) of whom were parents and co-residing caregivers of children ages 0–17, while the remaining 34% were non-resident informal caregivers. Internally displaced, externally displaced, and those living at-home in war-torn regions were invited to groups by trained Ukrainian peer facilitators. Using a pre-post design, we compared individual level frequency measures at three time-points – baseline, midline, and endline, to assess changes in 4 mental health, and 9 parenting and child health outcomes. We analyzed these outcomes using paired <em>t</em>-tests to compare outcomes at baseline-to-midline (after 4-sessions) and baseline-to-endline (after 10-sessions), which estimated the mean changes in days per week and associated percent change, during the respective periods; we quantified uncertainties using bias-corrected and accelerated (BCa) bootstrapping with 95% uncertainty ranges for baseline-midline and baseline-endline estimates. We used this same approach for stratified analyses to assess potential effect modification by displacement status and facilitator type. We further used linear models to adjust for age and sex.</p></div><div><h3>Findings</h3><p>Compared to baseline, every mental health, parenting, and child health outcome improved significantly at midline and endline. Mental health ratings showed endline reductions in depressive symptoms of 56.8% (95% CI: -59.0,-54.3; -1.8 days/week), and increases in hopefulness, coping with grief, and self-care, ranging from 62.0% (95% CI: 53.6,71.3; 2.2 days/week) to 77.0% (95% CI: 66.3,88.3; 2.2 days/week). Significant improvements in parenting and child health outcomes included monitoring children, reinforcing positive behavior, supporting child development, protecting child, nonviolent discipline, and child verbalizing emotions. By endline, emotional violence, physical violence, and child despondency had dropped by 57.7% (95% CI: -63.0%,-51.9; -1.3 days/week), 64.0% (95% CI: -79.0,-39.5; -0.22 days/week), and 51.9% (95% CI: -45.1
{"title":"The effectiveness of Hope Groups, a mental health, parenting support, and violence prevention program for families affected by the war in Ukraine: Findings from a pre-post study","authors":"Susan Hillis , Sydney Tucker , Nicole Baldonado , Evgenia Taradaika , Lyudmyla Bryn , Svitlana Kharchenko , Tetiana Machabelii , Roisin Taylor , Phil Green , Philip Goldman , Isang Awah , Joshua Baldonado , Praveen Gomez , Seth Flaxman , Oliver Ratmann , Jamie M. Lachman , Andres Villaveces , Lorraine Sherr , Lucie Cluver","doi":"10.1016/j.jmh.2024.100251","DOIUrl":"10.1016/j.jmh.2024.100251","url":null,"abstract":"<div><h3>Background</h3><p>Nearly one in six children lived in war zones in 2023. Evidence-based psychosocial and parenting support has potential to mitigate negative impacts for parents and children co-exposed to war and displacement, especially in relation to mental health and harsh parenting reactions. In the current war in Ukraine, local mental health experts co-created and evaluated, with global experts, the effectiveness of psychosocial and parenting support groups, called <em>‘Hope Groups’</em> on improvements in mental health, positive parenting, and violence against children. This paper aimed to assess the effectiveness of psychosocial and parenting support groups, called 'Hope Groups,' on improvements in caregiver mental health, positive parenting, and prevention of violence against children, for families affected by the war in Ukraine, using a pre/post study design.</p></div><div><h3>Methods</h3><p>Participants (<em>n</em> = 577) included Ukrainian caregivers, 66% (381) of whom were parents and co-residing caregivers of children ages 0–17, while the remaining 34% were non-resident informal caregivers. Internally displaced, externally displaced, and those living at-home in war-torn regions were invited to groups by trained Ukrainian peer facilitators. Using a pre-post design, we compared individual level frequency measures at three time-points – baseline, midline, and endline, to assess changes in 4 mental health, and 9 parenting and child health outcomes. We analyzed these outcomes using paired <em>t</em>-tests to compare outcomes at baseline-to-midline (after 4-sessions) and baseline-to-endline (after 10-sessions), which estimated the mean changes in days per week and associated percent change, during the respective periods; we quantified uncertainties using bias-corrected and accelerated (BCa) bootstrapping with 95% uncertainty ranges for baseline-midline and baseline-endline estimates. We used this same approach for stratified analyses to assess potential effect modification by displacement status and facilitator type. We further used linear models to adjust for age and sex.</p></div><div><h3>Findings</h3><p>Compared to baseline, every mental health, parenting, and child health outcome improved significantly at midline and endline. Mental health ratings showed endline reductions in depressive symptoms of 56.8% (95% CI: -59.0,-54.3; -1.8 days/week), and increases in hopefulness, coping with grief, and self-care, ranging from 62.0% (95% CI: 53.6,71.3; 2.2 days/week) to 77.0% (95% CI: 66.3,88.3; 2.2 days/week). Significant improvements in parenting and child health outcomes included monitoring children, reinforcing positive behavior, supporting child development, protecting child, nonviolent discipline, and child verbalizing emotions. By endline, emotional violence, physical violence, and child despondency had dropped by 57.7% (95% CI: -63.0%,-51.9; -1.3 days/week), 64.0% (95% CI: -79.0,-39.5; -0.22 days/week), and 51.9% (95% CI: -45.1","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":"10 ","pages":"Article 100251"},"PeriodicalIF":3.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000400/pdfft?md5=06a9fad0600780675f5250c57a7e361f&pid=1-s2.0-S2666623524000400-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jmh.2024.100282
Munjireen S. Sifat , Sarah Kenney , Venera Bekteshi , Shawn C. Chiang , Motolani Ogunsanya , Laili K. Boozary , Adam C. Alexander , Darla E. Kendzor
Background
The resettlement of Afghan refugees in Oklahoma City, OK, provides a critical context for examining the mental health challenges faced by this population due to post-migration stressors.
Methods
This study utilized online surveys to recently resettled Afghan refugees in Oklahoma City, with support provided by bilingual research assistants to accommodate low literacy rates. Surveys, initially in English, were professionally translated into Dari and Pashto and validated through back-translation.
Results
Participants (N = 348) were majority of Pashtun ethnicity. High rates of mental health issues were evident, with 62.1 % of participants screening positive for depression and 20.1 % for probable GAD. Logistic regression analysis revealed that lower pre-migration socioeconomic status (SES) and high post-migration stressors such as discrimination and loss of homeland were significantly associated with increased mental health problems. Stress related to the worry for and loss of their homeland was a substantial predictor of high distress (AOR = 2.71, p < 0.001), anxiety (AOR = 1.99, p = 0.001) and depression (AOR = 2.65, p<.001). Experiences of discrimination post-resettlement was also associated with anxiety (AOR 4.92, p < 0.001).
Discussion
The findings highlight the profound impact of post-migration stressors on the mental health of Afghan refugees. This study underscores the need for targeted interventions to address the specific challenges faced by refugees, such as language barriers, employment, legal support, and anti-discrimination measures, to facilitate better integration and improve mental health outcomes.
Conclusion
Enhanced community integration programs and comprehensive support services are essential to mitigate the mental health challenges faced by Afghan refugees, suggesting a broader application for such approaches in similar resettlement contexts globally.
{"title":"The association of migration-related stress with poor mental health among recently resettled Afghan refugees","authors":"Munjireen S. Sifat , Sarah Kenney , Venera Bekteshi , Shawn C. Chiang , Motolani Ogunsanya , Laili K. Boozary , Adam C. Alexander , Darla E. Kendzor","doi":"10.1016/j.jmh.2024.100282","DOIUrl":"10.1016/j.jmh.2024.100282","url":null,"abstract":"<div><h3>Background</h3><div>The resettlement of Afghan refugees in Oklahoma City, OK, provides a critical context for examining the mental health challenges faced by this population due to post-migration stressors.</div></div><div><h3>Methods</h3><div>This study utilized online surveys to recently resettled Afghan refugees in Oklahoma City, with support provided by bilingual research assistants to accommodate low literacy rates. Surveys, initially in English, were professionally translated into Dari and Pashto and validated through back-translation.</div></div><div><h3>Results</h3><div>Participants (<em>N</em> = 348) were majority of Pashtun ethnicity. High rates of mental health issues were evident, with 62.1 % of participants screening positive for depression and 20.1 % for probable GAD. Logistic regression analysis revealed that lower pre-migration socioeconomic status (SES) and high post-migration stressors such as discrimination and loss of homeland were significantly associated with increased mental health problems. Stress related to the worry for and loss of their homeland was a substantial predictor of high distress (AOR = 2.71, <em>p</em> < 0.001), anxiety (AOR = 1.99, <em>p</em> = 0.001) and depression (AOR = 2.65, <em>p</em><.001). Experiences of discrimination post-resettlement was also associated with anxiety (AOR 4.92, <em>p</em> < 0.001).</div></div><div><h3>Discussion</h3><div>The findings highlight the profound impact of post-migration stressors on the mental health of Afghan refugees. This study underscores the need for targeted interventions to address the specific challenges faced by refugees, such as language barriers, employment, legal support, and anti-discrimination measures, to facilitate better integration and improve mental health outcomes.</div></div><div><h3>Conclusion</h3><div>Enhanced community integration programs and comprehensive support services are essential to mitigate the mental health challenges faced by Afghan refugees, suggesting a broader application for such approaches in similar resettlement contexts globally.</div></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":"10 ","pages":"Article 100282"},"PeriodicalIF":3.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142657529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jmh.2024.100250
Majel McGranahan , Elizabeth Augarde , Danielle Schoenaker , Helen Duncan , Sue Mann , Debra Bick , Felicity Boardman , Oyinlola Oyebode
Background
Perinatal outcomes are poor among migrant women in vulnerable situations, but little is known about their health preconception. We investigated preconception health inequalities between migrant women in vulnerable situations and non-migrant women.
Methods
This national cross-sectional study used data from the NHS Maternity Services Data Set (MSDS) version 1.5, incorporating NHS maternity services in England. All 652,880 women with an antenatal booking appointment between 1/4/2018 and 31/3/2019 were included. Migration category data were available for 66.2 % (n = 432,022). Odds ratios were calculated comparing preconception indicators among probable migrants in vulnerable situations (English not their first language with complex social factors (CSF)), probable migrants not in vulnerable situations (English not their first language without CSF), probable non-migrants in vulnerable situations (English their first language with CSF) and probable non-migrants not in vulnerable situations (English their first language without CSF). CSF include recent migrants, asylum seekers, refugees, difficulty reading/speaking English; alcohol and/or drugs misuse; aged under 20; and/or experiencing domestic abuse.
Findings
We identified 3.8 % (25,070 women) of the study population as probable migrants in vulnerable situations, 10.2 % (66,783 women) as probable migrants not in vulnerable situations, 5.6 % (36,433 women) as probable non-migrants in vulnerable situations, 46.5 % (303,737 women) as probable non-migrants not in vulnerable situations, and 33.8 % as having missing migration category data. Probable migrants in vulnerable situations (n = 25,070) had over twice the odds of not taking folic acid preconception compared to probable non-migrants not in vulnerable situations (odds ratio 2.15, 95 % confidence interval 2.06–2.25). They had increased odds of previous obstetric complications and being underweight, but lower odds of physical and mental health conditions (apart from diabetes and hepatitis b), smoking and overweight or obesity.
Interpretation
Inequalities exist across many preconception indicators, highlighting opportunities to improve preconception health in this population to reduce health inequalities and improve perinatal and neonatal outcomes.
{"title":"Preconception health among migrant women in England: A cross-sectional analysis of maternity services data 2018–2019","authors":"Majel McGranahan , Elizabeth Augarde , Danielle Schoenaker , Helen Duncan , Sue Mann , Debra Bick , Felicity Boardman , Oyinlola Oyebode","doi":"10.1016/j.jmh.2024.100250","DOIUrl":"10.1016/j.jmh.2024.100250","url":null,"abstract":"<div><h3>Background</h3><p>Perinatal outcomes are poor among migrant women in vulnerable situations, but little is known about their health preconception. We investigated preconception health inequalities between migrant women in vulnerable situations and non-migrant women.</p></div><div><h3>Methods</h3><p>This national cross-sectional study used data from the NHS Maternity Services Data Set (MSDS) version 1.5, incorporating NHS maternity services in England. All 652,880 women with an antenatal booking appointment between 1/4/2018 and 31/3/2019 were included. Migration category data were available for 66.2 % (<em>n</em> = 432,022). Odds ratios were calculated comparing preconception indicators among probable migrants in vulnerable situations (English not their first language with complex social factors (CSF)), probable migrants not in vulnerable situations (English not their first language without CSF), probable non-migrants in vulnerable situations (English their first language with CSF) and probable non-migrants not in vulnerable situations (English their first language without CSF). CSF include recent migrants, asylum seekers, refugees, difficulty reading/speaking English; alcohol and/or drugs misuse; aged under 20; and/or experiencing domestic abuse.</p></div><div><h3>Findings</h3><p>We identified 3.8 % (25,070 women) of the study population as probable migrants in vulnerable situations, 10.2 % (66,783 women) as probable migrants not in vulnerable situations, 5.6 % (36,433 women) as probable non-migrants in vulnerable situations, 46.5 % (303,737 women) as probable non-migrants not in vulnerable situations, and 33.8 % as having missing migration category data. Probable migrants in vulnerable situations (<em>n</em> = 25,070) had over twice the odds of not taking folic acid preconception compared to probable non-migrants not in vulnerable situations (odds ratio 2.15, 95 % confidence interval 2.06–2.25). They had increased odds of previous obstetric complications and being underweight, but lower odds of physical and mental health conditions (apart from diabetes and hepatitis b), smoking and overweight or obesity.</p></div><div><h3>Interpretation</h3><p>Inequalities exist across many preconception indicators, highlighting opportunities to improve preconception health in this population to reduce health inequalities and improve perinatal and neonatal outcomes.</p></div><div><h3>Funding</h3><p>Medical Research Council.</p></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":"10 ","pages":"Article 100250"},"PeriodicalIF":3.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000394/pdfft?md5=623b63df301b53c30adaea8f7534ec30&pid=1-s2.0-S2666623524000394-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite the Canadian universal healthcare system, new immigrants face a number of challenges in accessing primary healthcare (PHC) services. As immigration to Canada consistently increases, understanding various types of barriers to PHC and how they differ across different sub-groups is critical. We conducted a qualitative study among Nepalese immigrant men to learn from their experience with PHC access to inform healthcare providers, stakeholders, and policymakers to devise feasible approaches to enhancing access to care.
Methods
We undertook a qualitative research approach employing focus groups among a sample of first-generation Nepalese immigrant men who had prior experience with accessing PHC in Canada.
Data collection and analysis
We conducted six focus groups in total with 34 participants (each group comprising 5–7 participants) in their preferred language, Nepalese, or English. Demographic information was collected prior to each focus group. Transcriptions of the discussions were prepared, and thematic analysis was employed in the qualitative data set.
Results
Participants reported experiencing barriers at two stages: before accessing PHC services and after accessing PHC services. The barriers before accessing PHC were long wait time for an appointment with physicians, limited knowledge of own health- and services-related issues, limited service availability hours, cultural differences in health practices, and transportation and work-related challenges. The barriers after accessing PHC were long wait time in the clinic to meet with the physicians at the time of appointment, communication challenges and misunderstandings, high healthcare costs associated with dental and vision care and prescribed medicines, and inappropriate behaviours and practices of doctors and service providers. To our knowledge, this is the first study in Canada which explored barriers faced by Nepalese immigrant men in accessing PHC.
Conclusions
This study identifies barriers to accessing PHC in Canada from a group of immigrant men's perspective. It is important to account for these while making any reforms and adding new care services to the existing healthcare system so that they are equitable for these groups of individuals as well.
{"title":"Patient-reported primary health care experiences in Canada: The challenges faced by Nepalese immigrant men","authors":"Rudra Dahal , Bishnu Bahadur Bajgain , Kalpana Thapa-Bajgain , Kamala Adhikari , Iffat Naeem , Nashit Chowdhury , Tanvir C Turin","doi":"10.1016/j.jmh.2024.100223","DOIUrl":"https://doi.org/10.1016/j.jmh.2024.100223","url":null,"abstract":"<div><h3>Background</h3><p>Despite the Canadian universal healthcare system, new immigrants face a number of challenges in accessing primary healthcare (PHC) services. As immigration to Canada consistently increases, understanding various types of barriers to PHC and how they differ across different sub-groups is critical. We conducted a qualitative study among Nepalese immigrant men to learn from their experience with PHC access to inform healthcare providers, stakeholders, and policymakers to devise feasible approaches to enhancing access to care.</p></div><div><h3>Methods</h3><p>We undertook a qualitative research approach employing focus groups among a sample of first-generation Nepalese immigrant men who had prior experience with accessing PHC in Canada.</p></div><div><h3>Data collection and analysis</h3><p>We conducted six focus groups in total with 34 participants (each group comprising 5–7 participants) in their preferred language, Nepalese, or English. Demographic information was collected prior to each focus group. Transcriptions of the discussions were prepared, and thematic analysis was employed in the qualitative data set.</p></div><div><h3>Results</h3><p>Participants reported experiencing barriers at two stages: before accessing PHC services and after accessing PHC services. The barriers before accessing PHC were long wait time for an appointment with physicians, limited knowledge of own health- and services-related issues, limited service availability hours, cultural differences in health practices, and transportation and work-related challenges. The barriers after accessing PHC were long wait time in the clinic to meet with the physicians at the time of appointment, communication challenges and misunderstandings, high healthcare costs associated with dental and vision care and prescribed medicines, and inappropriate behaviours and practices of doctors and service providers. To our knowledge, this is the first study in Canada which explored barriers faced by Nepalese immigrant men in accessing PHC.</p></div><div><h3>Conclusions</h3><p>This study identifies barriers to accessing PHC in Canada from a group of immigrant men's perspective. It is important to account for these while making any reforms and adding new care services to the existing healthcare system so that they are equitable for these groups of individuals as well.</p></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":"9 ","pages":"Article 100223"},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000138/pdfft?md5=61ac14a049a3657ac9bd0c716598de9c&pid=1-s2.0-S2666623524000138-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140063158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jmh.2024.100235
Galaxy Rokadji, Arie Dijkstra
Objective
People with different cultural backgrounds can evaluate the appropriateness of direct and indirect support seeking differently. In this study we explored how direct and indirect communication rules for verbal support seeking by patients with diabetes were perceived among Dutch and Surinamese female participants, and whether the appropriateness differed for the ingroup, outgroup and intercultural support seeker-support provider interactions.
Methods
The study applied a 2 (direct versus indirect support seeking) X 2 (Surinamese patient versus Dutch patient) X 2 (Surinamese support provider versus Dutch support provider)-design. Dutch and Surinamese participants (N = 686) were randomly assigned to one of the eight conditions in which they were provided with a depiction of the patient, the direct or indirect request for help, and the help provider. The main outcome was the rated appropriateness of the help-seeking request in the specific context.
Results
The results revealed a significant main effect of communication style: both, Surinamese and Dutch participants evaluated the direct help-seeking as more appropriate compared to indirect help-seeking, independent of patient or provider culture. This effect was particularly strong in participants who scored high on the individual difference in independent self, as shown by a significant interaction.
Discussion
Literature usually identifies that Surinamese and Dutch populations have different cultural backgrounds and values that express themselves in different attitudes, in general more collectivistic and more individualistic, respectively. However, with regard to help seeking preferences the study results did not verify this expectation. These findings underscore the importance of the support providers’ role in assessing and understanding the individuals’ communication style with regard to help-seeking, rather than assuming communication preferences on the basis of cultural background.
{"title":"Communication rules regarding support seeking in patients with a physical illness, according to people with a Surinamese or a Dutch cultural background","authors":"Galaxy Rokadji, Arie Dijkstra","doi":"10.1016/j.jmh.2024.100235","DOIUrl":"https://doi.org/10.1016/j.jmh.2024.100235","url":null,"abstract":"<div><h3>Objective</h3><p>People with different cultural backgrounds can evaluate the appropriateness of direct and indirect support seeking differently. In this study we explored how direct and indirect communication rules for verbal support seeking by patients with diabetes were perceived among Dutch and Surinamese female participants, and whether the appropriateness differed for the ingroup, outgroup and intercultural support seeker-support provider interactions.</p></div><div><h3>Methods</h3><p>The study applied a 2 (direct versus indirect support seeking) X 2 (Surinamese patient versus Dutch patient) X 2 (Surinamese support provider versus Dutch support provider)-design. Dutch and Surinamese participants (<em>N</em> = 686) were randomly assigned to one of the eight conditions in which they were provided with a depiction of the patient, the direct or indirect request for help, and the help provider. The main outcome was the rated appropriateness of the help-seeking request in the specific context.</p></div><div><h3>Results</h3><p>The results revealed a significant main effect of communication style: both, Surinamese and Dutch participants evaluated the direct help-seeking as more appropriate compared to indirect help-seeking, independent of patient or provider culture. This effect was particularly strong in participants who scored high on the individual difference in independent self, as shown by a significant interaction.</p></div><div><h3>Discussion</h3><p>Literature usually identifies that Surinamese and Dutch populations have different cultural backgrounds and values that express themselves in different attitudes, in general more collectivistic and more individualistic, respectively. However, with regard to help seeking preferences the study results did not verify this expectation. These findings underscore the importance of the support providers’ role in assessing and understanding the individuals’ communication style with regard to help-seeking, rather than assuming communication preferences on the basis of cultural background.</p></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":"9 ","pages":"Article 100235"},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000254/pdfft?md5=7b462b203c1b60784f8583b97b76619f&pid=1-s2.0-S2666623524000254-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140906381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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