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.2024.100275
Alein Y. Haro-Ramos , Gabriel Sanchez , Matt Barreto
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":"Alein Y. Haro-Ramos , Gabriel Sanchez , Matt Barreto","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":"10 ","pages":"Article 100275"},"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
Anna Leiler , Jennifer Meurling , Elisabet Rondung , Shervin Shahnavaz , Gerhard Andersson , Anna Bjärtå
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":"Anna Leiler , Jennifer Meurling , Elisabet Rondung , Shervin Shahnavaz , Gerhard Andersson , Anna Bjärtå","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":"10 ","pages":"Article 100274"},"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.2024.100235
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}
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":"10 ","pages":"Article 100240"},"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}
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":"9 ","pages":"Article 100214"},"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.2024.100228
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":"9 ","pages":"Article 100228"},"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}
Pub Date : 2024-01-01DOI: 10.1016/j.jmh.2024.100224
Sofia Argibay , Amy H. Auchincloss , M. Pia Chaparro , Caroline Kravitz , Alexandra Eastus , Brent A. Langellier
Introduction
Low-income immigrants who are eligible to participate in the Supplemental Nutrition Assistance Program (SNAP) participate at lower rates compared to non-immigrants. Immigrant households may be more likely to participate in SNAP if they live in areas with policies that integrate them into society and protect them from deportation.
Methods
Data on low-income immigrant households came from the 2019 American Community Survey (N = 87,678). The outcome was whether any household member received SNAP in the previous 12 months. Immigrant policy exposures came from two sources: the State Immigration Policy Resource, which includes 18 immigrant criminalizing and integrating policies, and a database that identified ‘sanctuary policies’ (SP), which we summarized at the county level. Multivariable logistic regression adjusted for person/household-level and area-level confounders.
Results
Living in a jurisdiction with a SP was associated with 21% higher odds of enrolling in SNAP compared to living in a jurisdiction without a SP (adjusted odds ratio [aOR] 1.21, 95% CI=1.11,1.31). Relative to the least immigrant friendly states, living in the most immigrant-friendly states was associated with 16% higher odds of SNAP enrollment (aOR=1.16, 95%CI=1.06–1.28). When SP and state-level immigrant friendly policy environment were cross-classified, SNAP participation was 23% and 26% higher for those living in jurisdictions with one- and both- exposures, respectively, relative to those with neither (aOR 1.23; CI 1.12,1.36; aOR 1.26; CI 1.15,1.37).
Conclusions
Many at high risk of food insecurity – including immigrants and citizens in households with immigrants – are eligible for SNAP but under-enroll. Policies that welcome and safeguard immigrants could reduce under enrollment.
{"title":"Impact of county and state immigration policies on immigrant household enrollment in the supplemental nutrition assistance program","authors":"Sofia Argibay , Amy H. Auchincloss , M. Pia Chaparro , Caroline Kravitz , Alexandra Eastus , Brent A. Langellier","doi":"10.1016/j.jmh.2024.100224","DOIUrl":"https://doi.org/10.1016/j.jmh.2024.100224","url":null,"abstract":"<div><h3>Introduction</h3><p>Low-income immigrants who are eligible to participate in the Supplemental Nutrition Assistance Program (SNAP) participate at lower rates compared to non-immigrants. Immigrant households may be more likely to participate in SNAP if they live in areas with policies that integrate them into society and protect them from deportation.</p></div><div><h3>Methods</h3><p>Data on low-income immigrant households came from the 2019 American Community Survey (<em>N</em> = 87,678). The outcome was whether any household member received SNAP in the previous 12 months. Immigrant policy exposures came from two sources: the State Immigration Policy Resource, which includes 18 immigrant criminalizing and integrating policies, and a database that identified ‘sanctuary policies’ (SP), which we summarized at the county level. Multivariable logistic regression adjusted for person/household-level and area-level confounders.</p></div><div><h3>Results</h3><p>Living in a jurisdiction with a SP was associated with 21% higher odds of enrolling in SNAP compared to living in a jurisdiction without a SP (adjusted odds ratio [aOR] 1.21, 95% CI=1.11,1.31). Relative to the least immigrant friendly states, living in the most immigrant-friendly states was associated with 16% higher odds of SNAP enrollment (aOR=1.16, 95%CI=1.06–1.28). When SP and state-level immigrant friendly policy environment were cross-classified, SNAP participation was 23% and 26% higher for those living in jurisdictions with one- and both- exposures, respectively, relative to those with neither (aOR 1.23; CI 1.12,1.36; aOR 1.26; CI 1.15,1.37).</p></div><div><h3>Conclusions</h3><p>Many at high risk of food insecurity – including immigrants and citizens in households with immigrants – are eligible for SNAP but under-enroll. Policies that welcome and safeguard immigrants could reduce under enrollment.</p></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":"9 ","pages":"Article 100224"},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266662352400014X/pdfft?md5=7f98a2690aa6e75dda76cf71ba03d07a&pid=1-s2.0-S266662352400014X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140338746","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.2024.100232
Latha S Davda , David R Radford , Sasha Scambler , Jennifer E Gallagher
Introduction
The Global Strategy for Human Resources for Health 2030, requires member states to half their dependency on an international workforce by 2030. In order to design policies towards that goal, country-specific research on migration motivations of the health workforce is required. The United Kingdom (UK) is a net importer of health professionals and whilst there is a body of research on doctors’ and nurses’ migration, there is no research on the migration motivations of migrant dentists in the UK. This research explored the migration motivations of internationally qualified dentists (IQDs) in the UK and presents a typology to understand the global migration of dentists in the context of oral health workforce.
Methods
The paper presents qualitative data from semi-structured interviews conducted between August 2014 and October 2017, of IQDs working in the United Kingdom. The topic guide for interviews was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis.
Results
A total of 38 internationally qualified dentists (M = 18, F = 20), migrating from the five World Health Organization regions, and working in general practice, NHS hospitals and in community dental services across the four nations of the UK were interviewed. Seven types of internationally qualified dentists were identified working in the UK. They were livelihood migrants, career-orientated migrants, dependant migrants, backpacker migrants, commuter migrants, undocumented migrants, and education-tourist migrant. The categories were based on their migration motivations, which were complex, multifactorial, and included personal, professional, national, and international drivers. The typology, based on their migration motivations, offered a structured, comprehensive understanding of the migrant dental workforce. This typology involving dentists provides additional dimensions to commuter and undocumented migrants described in the context of other health professionals. The education-tourist migrant is a new category proposed as an extension to existing typology in health professional migration.
Conclusions
The typology of internationally qualified dentists has congruency with other health professionals’ typology in categories previously described and demonstrates that each of these categories are complex, fluid and change in response to policy changes. The new category of education-tourist migrant along with oral health dimensions of commuter and undocumented migrants adds to the existing typology in health professional migration.
{"title":"A typology of internationally qualified dentists in the United Kingdom","authors":"Latha S Davda , David R Radford , Sasha Scambler , Jennifer E Gallagher","doi":"10.1016/j.jmh.2024.100232","DOIUrl":"https://doi.org/10.1016/j.jmh.2024.100232","url":null,"abstract":"<div><h3>Introduction</h3><p>The Global Strategy for Human Resources for Health 2030, requires member states to half their dependency on an international workforce by 2030. In order to design policies towards that goal, country-specific research on migration motivations of the health workforce is required. The United Kingdom (UK) is a net importer of health professionals and whilst there is a body of research on doctors’ and nurses’ migration, there is no research on the migration motivations of migrant dentists in the UK. This research explored the migration motivations of internationally qualified dentists (IQDs) in the UK and presents a typology to understand the global migration of dentists in the context of oral health workforce.</p></div><div><h3>Methods</h3><p>The paper presents qualitative data from semi-structured interviews conducted between August 2014 and October 2017, of IQDs working in the United Kingdom. The topic guide for interviews was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis.</p></div><div><h3>Results</h3><p>A total of 38 internationally qualified dentists (<em>M</em> = 18, <em>F</em> = 20), migrating from the five World Health Organization regions, and working in general practice, NHS hospitals and in community dental services across the four nations of the UK were interviewed. Seven types of internationally qualified dentists were identified working in the UK. They were <em>livelihood migrants, career-orientated migrants, dependant migrants, backpacker migrants, commuter migrants, undocumented migrants</em>, and <em>education-tourist migrant</em>. The categories were based on their migration motivations, which were complex, multifactorial, and included personal, professional, national, and international drivers. The typology, based on their migration motivations, offered a structured, comprehensive understanding of the migrant dental workforce. This typology involving dentists provides additional dimensions to <em>commuter</em> and <em>undocumented</em> migrants described in the context of other health professionals. The <em>education-tourist migrant</em> is a new category proposed as an extension to existing typology in health professional migration.</p></div><div><h3>Conclusions</h3><p>The typology of internationally qualified dentists has congruency with other health professionals’ typology in categories previously described and demonstrates that each of these categories are complex, fluid and change in response to policy changes. The new category of <em>education-tourist migrant</em> along with oral health dimensions of <em>commuter</em> and <em>undocumented migrants</em> adds to the existing typology in health professional migration.</p></div>","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":"9 ","pages":"Article 100232"},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000229/pdfft?md5=44568c0083ac3d3721e3abf9074ede44&pid=1-s2.0-S2666623524000229-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141078144","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.2024.100217
Mayuri Gogoi , Christopher A. Martin , Paul W. Bird , Martin J. Wiselka , Judi Gardener , Kate Ellis , Valerie Renals , Adam J. Lewszuk , Sally Hargreaves , Manish Pareek
<div><h3>Background</h3><p>Vaccine preventable diseases (VPDs) such as measles and rubella cause significant morbidity and mortality globally every year. The World Health Organization (WHO), reported vaccine coverage for both measles and rubella to be 71 % in 2019, indicating an immunity gap. Migrants in the EU/EEA may be at high risk of VPDs due to under-immunisation and poor living conditions. However, there are limited data on VPD seroprotection rates amongst migrants living in the United Kingdom (UK).</p></div><div><h3>Methods</h3><p>We conducted an exploratory cross-sectional serosurvey amongst a sample of adult migrants living in Leicester, UK to: (a) determine seroprotection rates for measles, varicella zoster, and rubella in this group; (b) identify risk factors associated with seronegativity and, (c) understand if self-reported vaccine or diseases history is an effective measure of seroprotection. Participants gave a blood sample and completed a questionnaire asking basic demographic details and vaccine and disease history for the three VPDs. We summarised the data using median and interquartile range (IQR) for non-parametric continuous variables and count and percentage for categorical variables. We used logistic regression to establish predictors of seroprotection against these diseases. We examined the reliability of self-reported vaccination/disease history for prediction of seroprotection through a concordance analysis.</p></div><div><h3>Results</h3><p>149 migrants were included in the analysis. Seroprotection rates were: varicella zoster 98 %, rubella 92.6 % and measles 89.3 %. Increasing age was associated with seroprotection (OR 1.07 95 % CI 1.01–1.13 for each year increase in age). Migrants from Africa and the Middle East (aOR 15.16 95 % CI 1.31 - 175.06) and South/East Asia and Pacific regions (aOR 15.43 95 %CI 2.38 - 100.00) are significantly more likely to be seroprotected against measles as compared to migrants from Europe and Central Asia. The proportions of migrants unsure about their vaccination and disease history combined were 53.0 % for measles; 57.7 % for rubella; 43.0 % for varicella. There was no agreement between self-reported vaccination/disease history and serostatus.</p></div><div><h3>Conclusion</h3><p>Our findings suggest lower levels of seroprotection against measles in migrants living in Leicester, UK, with younger migrants and those from Europe and Central Asia more likely to lack seroprotection. A high proportion of surveyed migrants were unaware of their vaccination/disease history and self-reported vaccine/disease was a poor predictor of seroprotection against VPDs which is important for clinical decision-making regarding catch-up vaccination in this population. Our results, although derived from a small sample, suggest that there may be gaps in seroimmunity for certain VPDs in particular migrant populations. These findings should inform future qualitative studies investigating barriers to vaccine uptake
{"title":"Risk of vaccine preventable diseases in UK migrants: A serosurvey and concordance analysis","authors":"Mayuri Gogoi , Christopher A. Martin , Paul W. Bird , Martin J. Wiselka , Judi Gardener , Kate Ellis , Valerie Renals , Adam J. Lewszuk , Sally Hargreaves , Manish Pareek","doi":"10.1016/j.jmh.2024.100217","DOIUrl":"https://doi.org/10.1016/j.jmh.2024.100217","url":null,"abstract":"<div><h3>Background</h3><p>Vaccine preventable diseases (VPDs) such as measles and rubella cause significant morbidity and mortality globally every year. The World Health Organization (WHO), reported vaccine coverage for both measles and rubella to be 71 % in 2019, indicating an immunity gap. Migrants in the EU/EEA may be at high risk of VPDs due to under-immunisation and poor living conditions. However, there are limited data on VPD seroprotection rates amongst migrants living in the United Kingdom (UK).</p></div><div><h3>Methods</h3><p>We conducted an exploratory cross-sectional serosurvey amongst a sample of adult migrants living in Leicester, UK to: (a) determine seroprotection rates for measles, varicella zoster, and rubella in this group; (b) identify risk factors associated with seronegativity and, (c) understand if self-reported vaccine or diseases history is an effective measure of seroprotection. Participants gave a blood sample and completed a questionnaire asking basic demographic details and vaccine and disease history for the three VPDs. We summarised the data using median and interquartile range (IQR) for non-parametric continuous variables and count and percentage for categorical variables. We used logistic regression to establish predictors of seroprotection against these diseases. We examined the reliability of self-reported vaccination/disease history for prediction of seroprotection through a concordance analysis.</p></div><div><h3>Results</h3><p>149 migrants were included in the analysis. Seroprotection rates were: varicella zoster 98 %, rubella 92.6 % and measles 89.3 %. Increasing age was associated with seroprotection (OR 1.07 95 % CI 1.01–1.13 for each year increase in age). Migrants from Africa and the Middle East (aOR 15.16 95 % CI 1.31 - 175.06) and South/East Asia and Pacific regions (aOR 15.43 95 %CI 2.38 - 100.00) are significantly more likely to be seroprotected against measles as compared to migrants from Europe and Central Asia. The proportions of migrants unsure about their vaccination and disease history combined were 53.0 % for measles; 57.7 % for rubella; 43.0 % for varicella. There was no agreement between self-reported vaccination/disease history and serostatus.</p></div><div><h3>Conclusion</h3><p>Our findings suggest lower levels of seroprotection against measles in migrants living in Leicester, UK, with younger migrants and those from Europe and Central Asia more likely to lack seroprotection. A high proportion of surveyed migrants were unaware of their vaccination/disease history and self-reported vaccine/disease was a poor predictor of seroprotection against VPDs which is important for clinical decision-making regarding catch-up vaccination in this population. Our results, although derived from a small sample, suggest that there may be gaps in seroimmunity for certain VPDs in particular migrant populations. These findings should inform future qualitative studies investigating barriers to vaccine uptake ","PeriodicalId":34448,"journal":{"name":"Journal of Migration and Health","volume":"9 ","pages":"Article 100217"},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666623524000072/pdfft?md5=af99e35884ca593e5840986a4b7e97c0&pid=1-s2.0-S2666623524000072-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139999058","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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