Pub Date : 2024-01-01DOI: 10.1016/j.jmh.2024.100276
Background
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":"","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":null,"pages":null},"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.2024.100240
Andrea Tortelli , Anne Perozziello , Alain Mercuel , Valérie Dauriac-Le Masson , Florence Perquier
Background
In the last decades, there has been a documented increase in the proportion of migrants among homeless people in Europe. While homelessness is associated with psychosis, little is known about the factors associated with psychosis among migrants in this context.
Methods
Our study analyzed data collected in the SAMENTA cross-sectional survey conducted among 859 adult French-speaking homeless people living in the Greater Paris area. We analyzed the prevalence of psychosis and psychotic-like experiences (PLE) and associated factors by migrant status, using bivariate analysis and multivariable logistic regression models.
Results
Our sample comprised 280 natives and 559 migrants in France. Psychosis was significantly more prevalent among natives (21.6 %) than among migrants (7.5 %) (p = 0.003). The total prevalence of PLE was 30.8% (95 % CI: 24.3 – 38.2), and not statistically different between groups (p = 0.215) or sex (p = 0.528). Adverse events over the past year were associated with the increased odds of psychosis in both groups and with PLE among migrants. Sexual abuse during childhood was associated with both outcomes among natives. Among migrants, exposure to war or life-threatening events increased the odds of psychosis and PLE. Increased odds of psychosis were found among migrants who had been living in France for more than 10 years (OR = 3.34, 95 % CI: 1.41–7.93, p = 0.007).
Conclusion
Differences were found in the factors associated with the psychosis continuum by migrant status, they highlight the impact of experiences related to migration. Prospective studies are needed to better understand these underlying pathways.
{"title":"Factors associated with the psychosis continuum among homeless people: Comparison between natives and migrants in the SAMENTA study","authors":"Andrea Tortelli , Anne Perozziello , Alain Mercuel , Valérie Dauriac-Le Masson , Florence Perquier","doi":"10.1016/j.jmh.2024.100240","DOIUrl":"https://doi.org/10.1016/j.jmh.2024.100240","url":null,"abstract":"<div><h3>Background</h3><p>In the last decades, there has been a documented increase in the proportion of migrants among homeless people in Europe. While homelessness is associated with psychosis, little is known about the factors associated with psychosis among migrants in this context.</p></div><div><h3>Methods</h3><p>Our study analyzed data collected in the SAMENTA cross-sectional survey conducted among 859 adult French-speaking homeless people living in the Greater Paris area. We analyzed the prevalence of psychosis and psychotic-like experiences (PLE) and associated factors by migrant status, using bivariate analysis and multivariable logistic regression models.</p></div><div><h3>Results</h3><p>Our sample comprised 280 natives and 559 migrants in France. Psychosis was significantly more prevalent among natives (21.6 %) than among migrants (7.5 %) (<em>p</em> = 0.003). The total prevalence of PLE was 30.8% (95 % CI: 24.3 – 38.2), and not statistically different between groups (<em>p</em> = 0.215) or sex (<em>p</em> = 0.528). Adverse events over the past year were associated with the increased odds of psychosis in both groups and with PLE among migrants. Sexual abuse during childhood was associated with both outcomes among natives. Among migrants, exposure to war or life-threatening events increased the odds of psychosis and PLE. Increased odds of psychosis were found among migrants who had been living in France for more than 10 years (OR = 3.34, 95 % CI: 1.41–7.93, <em>p</em> = 0.007).</p></div><div><h3>Conclusion</h3><p>Differences were found in the factors associated with the psychosis continuum by migrant status, they highlight the impact of experiences related to migration. Prospective studies are needed to better understand these underlying pathways.</p></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000308/pdfft?md5=af1f567e6f687c61aa9a770d2712cbe5&pid=1-s2.0-S2666623524000308-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486105","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":null,"pages":null},"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":null,"pages":null},"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}
Pub Date : 2024-01-01DOI: 10.1016/j.jmh.2024.100250
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":"","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":null,"pages":null},"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}
Pub Date : 2024-01-01DOI: 10.1016/j.jmh.2024.100275
Objectives
Immigration policies significantly affect immigrants and their families' access to social programs. This study examines the role of legal status and familial composition in Asian and Latino adults’ avoidance of social programs and assesses differences between the groups. We categorized respondents’ familial composition based on whether all household members had the same citizenship status. We created two groups: respondents with cross-status ties and those without.
Methods
We use data from 1000 U.S. adults with proximal or distant ties to noncitizens (collected in September 2021) to employ multivariable generalized linear models with binomial family and logit link to assess avoidance of needed social programs due to immigration concerns.
Results
Our fully adjusted model reveals that compared to U.S. citizens without familial cross-status ties (i.e., all-citizen household members), legally precarious immigrants (LPI) without cross-status ties (odds ratio (OR)= 3.64, 95 % CI: 1.67–7.96), LPI with cross-status ties (OR=1.71, 95 % CI: 1.14–2.57), and U.S. citizens with cross-status ties (OR=1.66, 95 % CI: 1.14–2.40), were more likely to report avoidance of needed social support programs. Further, an interaction analysis shows that Asian lawful permanent residents with cross-status ties exhibit a higher likelihood of avoiding social programs due to immigration concerns compared to their Latino counterparts.
Conclusion
The far-reaching consequences of anti-immigrant policies on noncitizen individuals and their families, including U.S. citizens, may lead to disparities in access to social assistance programs that may exacerbate health disparities. Further, our findings suggest that immigrants’ cross-status ties to U.S. citizen family members may be protective against the harmful effects of anti-immigrant policies.
{"title":"Immigration concerns and social program avoidance: The roles of legal status and family composition among asian and latino communities","authors":"","doi":"10.1016/j.jmh.2024.100275","DOIUrl":"10.1016/j.jmh.2024.100275","url":null,"abstract":"<div><h3>Objectives</h3><div>Immigration policies significantly affect immigrants and their families' access to social programs. This study examines the role of legal status and familial composition in Asian and Latino adults’ avoidance of social programs and assesses differences between the groups. We categorized respondents’ familial composition based on whether all household members had the same citizenship status. We created two groups: respondents with cross-status ties and those without.</div></div><div><h3>Methods</h3><div>We use data from 1000 U.S. adults with proximal or distant ties to noncitizens (collected in September 2021) to employ multivariable generalized linear models with binomial family and logit link to assess avoidance of needed social programs due to immigration concerns.</div></div><div><h3>Results</h3><div>Our fully adjusted model reveals that compared to U.S. citizens without familial cross-status ties (i.e., all-citizen household members), legally precarious immigrants (LPI) without cross-status ties (odds ratio (OR)= 3.64, 95 % CI: 1.67–7.96), LPI with cross-status ties (OR=1.71, 95 % CI: 1.14–2.57), and U.S. citizens with cross-status ties (OR=1.66, 95 % CI: 1.14–2.40), were more likely to report avoidance of needed social support programs. Further, an interaction analysis shows that Asian lawful permanent residents with cross-status ties exhibit a higher likelihood of avoiding social programs due to immigration concerns compared to their Latino counterparts.</div></div><div><h3>Conclusion</h3><div>The far-reaching consequences of anti-immigrant policies on noncitizen individuals and their families, including U.S. citizens, may lead to disparities in access to social assistance programs that may exacerbate health disparities. Further, our findings suggest that immigrants’ cross-status ties to U.S. citizen family members may be protective against the harmful effects of anti-immigrant policies.</div></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538189","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.2024.100274
Refugees often experience multiple losses. Despite this, and even though the loss is often due to unnatural causes and violent killings, the presence of Prolonged Grief (PG) among refugees may be obscured by other diagnoses such as depression and post-traumatic stress disorder (PTSD). In this cross-sectional study, we assessed the prevalence of PG and its comorbidity with depression and PTSD among 679 adult refugees in Sweden. Results showed that 401 (59.06 %) individuals had lost someone close to them, whom they were grieving intensely. Of these, 76 individuals (18.95 % of 401) fulfilled the criteria for PG. In the full sample, 304 individuals fulfilled the criteria for depression and 56 (18.42 % of 304) of these individuals also fulfilled the criteria for PG. Similarly, 315 fulfilled the criteria for PTSD. Among these individuals, 201 reported loss and 64 (20.32 % of 315) also fulfilled the criteria for PG. The results indicate that behind symptoms of depression and PTSD, there may be a layer of grief. This needs to be considered if we are to provide accurate and effective assessments and interventions for refugees.
{"title":"Unrecognized grief - Prevalence and comorbidity of prolonged grief among refugees in Sweden","authors":"","doi":"10.1016/j.jmh.2024.100274","DOIUrl":"10.1016/j.jmh.2024.100274","url":null,"abstract":"<div><div>Refugees often experience multiple losses. Despite this, and even though the loss is often due to unnatural causes and violent killings, the presence of Prolonged Grief (PG) among refugees may be obscured by other diagnoses such as depression and post-traumatic stress disorder (PTSD). In this cross-sectional study, we assessed the prevalence of PG and its comorbidity with depression and PTSD among 679 adult refugees in Sweden. Results showed that 401 (59.06 %) individuals had lost someone close to them, whom they were grieving intensely. Of these, 76 individuals (18.95 % of 401) fulfilled the criteria for PG. In the full sample, 304 individuals fulfilled the criteria for depression and 56 (18.42 % of 304) of these individuals also fulfilled the criteria for PG. Similarly, 315 fulfilled the criteria for PTSD. Among these individuals, 201 reported loss and 64 (20.32 % of 315) also fulfilled the criteria for PG. The results indicate that behind symptoms of depression and PTSD, there may be a layer of grief. This needs to be considered if we are to provide accurate and effective assessments and interventions for refugees.</div></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538190","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.2024.100214
Neha Pathak , Claire X. Zhang , Yamina Boukari , Rachel Burns , Dee Menezes , Gregory Hugenholtz , Rebecca S French , Arturo Gonzalez-Izquierdo , Rohini Mathur , Spiros Denaxas , Andrew Hayward , Pam Sonnenberg , Robert W. Aldridge
Background
Evidence on the sexual and reproductive health and rights (SRHR) of migrants is lacking globally. We describe SRHR healthcare resource use and long-acting reversible contraceptives (LARCs) prescriptions for migrant versus non-migrant women attending primary care in England (2009–2018).
Methods
This population-based observational cohort study, using Clinical Practice Research Datalink (CPRD) GOLD, included females living in England aged 15 to 49. Migration was defined using a validated codelist. Rates per 100 person years at risk (pyar) and adjusted rate ratios (RRs) were measured in migrants versus non-migrants for consultations related to all-causes, six exemplar SRHR outcomes, and LARC prescriptions. Proportions of migrants and non-migrants ever prescribed LARC were calculated.
Findings
There were 25,112,116 consultations across 1,246,353 eligible individuals. 98,214 (7.9 %) individuals were migrants. All-cause consultation rates were lower in migrants versus non-migrants (509 vs 583/100pyar;RR 0.9;95 %CI 0.9–0.9), as were consultations rates for emergency contraception (RR 0.7;95 %CI 0.7–0.7) and cervical screening (RR 0.96;95 %CI 0.95–0.97). Higher rates of consultations were found in migrants for abortion (RR 1.2;95 %CI 1.1–1.2) and management of fertility problems (RR 1.39;95 %CI 1.08–1.79). No significant difference was observed for chlamydia testing and domestic violence. Of 1,205,258 individuals eligible for contraception, the proportion of non-migrants ever prescribed LARC (12.2 %;135,047/1,107,894) was almost double that of migrants (6.91 %;6,728/97,364). Higher copper intrauterine devices prescription rates were found in migrants (RR 1.53;95 %CI 1.45–1.61), whilst hormonal LARC rates were lower for migrants: levonorgestrel intrauterine device (RR 0.63;95 %CI 0.60–0.66), subdermal implant (RR 0.72;95 %CI 0.69–0.75), and progesterone-only injection (RR 0.35;95 %CI 0.34–0.36).
Interpretation
Healthcare resource use differs between migrant and non-migrant women of reproductive age. Opportunities identified for tailored interventions include access to primary care, LARCs, emergency contraception and cervical screening. An inclusive approach to examining health needs is essential to actualise sexual and reproductive health as a human right.
{"title":"Sexual and reproductive health and rights of migrant women attending primary care in England: A population-based cohort study of 1.2 million individuals of reproductive age (2009–2018)","authors":"Neha Pathak , Claire X. Zhang , Yamina Boukari , Rachel Burns , Dee Menezes , Gregory Hugenholtz , Rebecca S French , Arturo Gonzalez-Izquierdo , Rohini Mathur , Spiros Denaxas , Andrew Hayward , Pam Sonnenberg , Robert W. Aldridge","doi":"10.1016/j.jmh.2024.100214","DOIUrl":"10.1016/j.jmh.2024.100214","url":null,"abstract":"<div><h3>Background</h3><p>Evidence on the sexual and reproductive health and rights (SRHR) of migrants is lacking globally. We describe SRHR healthcare resource use and long-acting reversible contraceptives (LARCs) prescriptions for migrant versus non-migrant women attending primary care in England (2009–2018).</p></div><div><h3>Methods</h3><p>This population-based observational cohort study, using Clinical Practice Research Datalink (CPRD) GOLD, included females living in England aged 15 to 49. Migration was defined using a validated codelist. Rates per 100 person years at risk (pyar) and adjusted rate ratios (RRs) were measured in migrants versus non-migrants for consultations related to all-causes, six exemplar SRHR outcomes, and LARC prescriptions. Proportions of migrants and non-migrants ever prescribed LARC were calculated.</p></div><div><h3>Findings</h3><p>There were 25,112,116 consultations across 1,246,353 eligible individuals. 98,214 (7.9 %) individuals were migrants. All-cause consultation rates were lower in migrants versus non-migrants (509 vs 583/100pyar;RR 0.9;95 %CI 0.9–0.9), as were consultations rates for emergency contraception (RR 0.7;95 %CI 0.7–0.7) and cervical screening (RR 0.96;95 %CI 0.95–0.97). Higher rates of consultations were found in migrants for abortion (RR 1.2;95 %CI 1.1–1.2) and management of fertility problems (RR 1.39;95 %CI 1.08–1.79). No significant difference was observed for chlamydia testing and domestic violence. Of 1,205,258 individuals eligible for contraception, the proportion of non-migrants ever prescribed LARC (12.2 %;135,047/1,107,894) was almost double that of migrants (6.91 %;6,728/97,364). Higher copper intrauterine devices prescription rates were found in migrants (RR 1.53;95 %CI 1.45–1.61), whilst hormonal LARC rates were lower for migrants: levonorgestrel intrauterine device (RR 0.63;95 %CI 0.60–0.66), subdermal implant (RR 0.72;95 %CI 0.69–0.75), and progesterone-only injection (RR 0.35;95 %CI 0.34–0.36).</p></div><div><h3>Interpretation</h3><p>Healthcare resource use differs between migrant and non-migrant women of reproductive age. Opportunities identified for tailored interventions include access to primary care, LARCs, emergency contraception and cervical screening. An inclusive approach to examining health needs is essential to actualise sexual and reproductive health as a human right.</p></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000047/pdfft?md5=950709e67ec64622dbbf172be9a9b2b7&pid=1-s2.0-S2666623524000047-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139636554","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.2024.100219
Z Ouzounidou , HC Maltezou , K Chrysoula , E Polysiou , O Christofilea , G Dounias , A Pavli
Background
The number of migrants to Greece has increased considerably the last decade. This study assessed the knowledge and attitudes of healthcare personnel (HCP) toward vaccination of newly-arrived children and adolescents in the Aegean islands, a major port of entry of migrants and refugees to Europe.
Methods
The study was conducted from September 2020 to January 2021. All (166) HCP employed in the public health sector of the Aegean islands were invited to participate. A structured questionnaire was used to collect demographic data and data about their knowledge and attitudes toward vaccinations for migrant and refugees.
Results
A total of 120 HCP participated (72 % response rate), including 54 (45 %) physicians, 43 nurses (35.8 %), and 23 health visitors (19.2 %). Sixty-seven (55.8 %) HCP were aware of the national vaccination guidelines. Health visitors had higher rates of knowledge about the national vaccination guidelines, compared with nurses and physicians (87% versus 44,2% and 51,9%; p-value-0.001). Overall, 73 (60.8 %) HCP were aware of vaccinations during the first examination upon arrival. Primary-healthcare physicians were more likely to be aware about the time of vaccine administration compared with hospital-based physicians (74 % versus 50 %; p-value = 0.006). Out of 120 HCP, 45 % knew that vaccination guidelines apply to all newly-arrived migrant and refugees and 65 % that vaccinations are free-of-charge. Overall, 67.5 % of participants supported no serology testing before vaccination, 21.8 % were against free-of-charge vaccinations, and 55 % recommended only priority vaccinations.
Conclusions
There is a need to increase HCP’ awareness and knowledge through training programs and tailored protocols focusing on vaccinations for newly-arrived migrant and refugee children and adolescents in order to promote effective vaccination of this vulnerable population.
{"title":"Knowledge and attitudes of healthcare personnel about vaccination of migrant and refugee children and adolescents","authors":"Z Ouzounidou , HC Maltezou , K Chrysoula , E Polysiou , O Christofilea , G Dounias , A Pavli","doi":"10.1016/j.jmh.2024.100219","DOIUrl":"https://doi.org/10.1016/j.jmh.2024.100219","url":null,"abstract":"<div><h3>Background</h3><p>The number of migrants to Greece has increased considerably the last decade. This study assessed the knowledge and attitudes of healthcare personnel (HCP) toward vaccination of newly-arrived children and adolescents in the Aegean islands, a major port of entry of migrants and refugees to Europe.</p></div><div><h3>Methods</h3><p>The study was conducted from September 2020 to January 2021. All (166) HCP employed in the public health sector of the Aegean islands were invited to participate. A structured questionnaire was used to collect demographic data and data about their knowledge and attitudes toward vaccinations for migrant and refugees.</p></div><div><h3>Results</h3><p>A total of 120 HCP participated (72 % response rate), including 54 (45 %) physicians, 43 nurses (35.8 %), and 23 health visitors (19.2 %). Sixty-seven (55.8 %) HCP were aware of the national vaccination guidelines. Health visitors had higher rates of knowledge about the national vaccination guidelines, compared with nurses and physicians (87% versus 44,2% and 51,9%; p-value-0.001). Overall, 73 (60.8 %) HCP were aware of vaccinations during the first examination upon arrival. Primary-healthcare physicians were more likely to be aware about the time of vaccine administration compared with hospital-based physicians (74 % versus 50 %; p-value = 0.006). Out of 120 HCP, 45 % knew that vaccination guidelines apply to all newly-arrived migrant and refugees and 65 % that vaccinations are free-of-charge. Overall, 67.5 % of participants supported no serology testing before vaccination, 21.8 % were against free-of-charge vaccinations, and 55 % recommended only priority vaccinations.</p></div><div><h3>Conclusions</h3><p>There is a need to increase HCP’ awareness and knowledge through training programs and tailored protocols focusing on vaccinations for newly-arrived migrant and refugee children and adolescents in order to promote effective vaccination of this vulnerable population.</p></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000096/pdfft?md5=bf9d6144b56a5989523dd894e9302129&pid=1-s2.0-S2666623524000096-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140063141","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.2024.100228
Lavanya Vijayasingham , Éimhín Ansbro , Carla Zmeter , Linda Abou Abbas , Benjamin Schmid , Leah Sanga , Lars Bruun Larsen , Sigiriya Aebischer Perone , Pablo Perel
In this commentary, we advocate for the wider implementation of integrated care models for NCDs within humanitarian preparedness, response, and resilience efforts. Since experience and evidence on integrated NCD care in humanitarian settings is limited, we discuss potential benefits, key lessons learned from other settings, and lessons from the integration of other conditions that may be useful for stakeholders considering an integrated model of NCD care. We also introduce our ongoing project in North Lebanon as a case example currently undergoing parallel tracks of program implementation and process evaluation that aims to strengthen the evidence base on implementing an integrated NCD care model in a crisis setting.
{"title":"Implementing and evaluating integrated care models for non-communicable diseases in fragile and humanitarian settings","authors":"Lavanya Vijayasingham , Éimhín Ansbro , Carla Zmeter , Linda Abou Abbas , Benjamin Schmid , Leah Sanga , Lars Bruun Larsen , Sigiriya Aebischer Perone , Pablo Perel","doi":"10.1016/j.jmh.2024.100228","DOIUrl":"https://doi.org/10.1016/j.jmh.2024.100228","url":null,"abstract":"<div><p>In this commentary, we advocate for the wider implementation of integrated care models for NCDs within humanitarian preparedness, response, and resilience efforts. Since experience and evidence on integrated NCD care in humanitarian settings is limited, we discuss potential benefits, key lessons learned from other settings, and lessons from the integration of other conditions that may be useful for stakeholders considering an integrated model of NCD care. We also introduce our ongoing project in North Lebanon as a case example currently undergoing parallel tracks of program implementation and process evaluation that aims to strengthen the evidence base on implementing an integrated NCD care model in a crisis setting.</p></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000187/pdfft?md5=a7baaf0610bdabb29b4a743355815ef1&pid=1-s2.0-S2666623524000187-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140328616","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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