Health Care For Migrants Research Articles

Blessed be the Ties: Health and Healthcare for Migrants and Migrant Families in the United States

Blessed be the Ties: Health and Healthcare for Migrants and Migrant Families in the United States

Neuropsychiatric characteristics of antiterrorist operation combatants in the Donbass (Ukraine).

The present paper aimed to explore the neuropsychiatric characteristics of the antiterrorism (ATO) combatants in the Donets Basin (Donbass) and to propose therapeutic strategies for managing their mental healthcare. A total of 54 ATO combatants were included in our study and compared with four groups of subjects exposed to other emergencies, including the Chernobyl disaster and the war in Afghanistan. The neuropsychiatric features were assessed through psychopathological assessments, neurological examinations, and quantitative electroencephalography (qEEG). The ATO combatants were characterized by low health self-estimation, somatic concerns, a high prevalence of posttraumatic stress disorder, anxiety, insomnia, depression, social dysfunction, mild cognitive impairment, and neurological soft signs, similar to individuals involved in the Chernobyl disaster and veterans of the Afghan War. Quantitative EEG showed abnormalities suggestive of irritation of the corticolimbic system and diencephalic structures. Some post-conflict personality changes in ATO combatants were recorded. The treatment of ATO combatants included a comprehensive strategy: from psychotropic drugs to different psychotherapies. On the basis of 30 years of experience in the management of the consequences of Chernobyl disaster and the available studies on war veterans, the authors proposed a method for assessment and an approach to providing mental healthcare for ATO combatants, refugees, and migrants from the Donbass, which perhaps can be used as guidelines for other conflicts. Taken together, the findings of the study suggest that voluntary participation in war may decrease but does not eliminate the risk of developing the neuropsychiatric consequences caused by such conflicts. A comprehensive strategy-one that would encompass psychopharmacological, psychological, and rehabilitation techniques-seems to be the most successful approach to managing the main symptoms and disorders involved.

Enabling and Predisposing Factors for the Utilization of Preventive Dental Health Care in Migrants and Non-Migrants in Germany.

In many European countries including Germany, migrants utilize preventive services less frequently than the majority population. This is also true for the utilization of dental checkups. Little is known about which demographic, social, behavioral, and health-related factors influence the decision of migrants to seek preventive dental health care and how these factors differ from those in non-migrants. The aim of the present study was to examine the role of these factors among migrants and non-migrants residing in Germany. Data from cross-sectional national health surveys are used, providing information on preventive dental health behavior from n = 41,220 individuals, of which 15.0% are migrants. Andersen's Behavioral Model of Health Services Use is the conceptual framework of the investigation. Multiple logistic regression models were applied to examine the role of different predisposing and enabling factors. Interaction terms were included in order to examine whether determinants differ between migrants and non-migrants. Average marginal effects (AMEs) are reported in addition to odds ratios (ORs) as measures of effect size which are robust against bias arising from unobserved heterogeneity. Migrants are at an about 36% lower chance of utilizing regular dental checkups than non-migrants [OR = 0.64 (95% confidence interval, 95% CI: 0.61, 0.68); AME = -0.081 (95% CI = -0.093, -0.069)]. Differences are partly explained by the influence of demographic, social, behavioral, and health-related factors [adjusted OR = 0.69 (95% CI: 0.64, 0.73); AME = -0.065 (95% CI = -0.076, -0.053)]. Younger age, being male, lower socioeconomic status, a non-statutory health insurance, not living in a relationship, living in the Western part of Germany and in an urban setting, and poor limited social support were associated with a lower chance of utilizing regular dental checkups. Interaction effects could be observed for age and for the type of health insurance. The study identifies different enabling and predisposing factors that are relevant for the utilization of dental checkups among the population in Germany, some of which differ between migrants and non-migrants. Differences are particularly pronounced for younger ages. This differs from findings on other preventive services where older migrants tend to be more disadvantaged. Additional explanatory factors such as barriers that migrants experience in the dental health care system need to be considered in order to implement patient-oriented services and to reduce disparities in access to dental prevention.

Challenges in the health care of international migrants in Chile

To investigate the perceptions of primary health workers (PHW) about the challenges of health care for migrants. A qualitative multicase study was conducted in eight communes of Chile, using the snowball technique, where 101 PHW and local authorities were recruited. Semi-structured interviews and focal groups were conducted, achieving information saturation. The findings were grouped into two major thematic axes: 1. Technical and administrative difficulties, and 2. Perception of cultural barriers. According to the PHW, although regulations have been established and health care strategies have been generated for the migrant population, these are mostly not stable or known to all PHW. They are also not easy to implement in the various realities investigated. The absence of records on the number of migrants accessing the health system makes it difficult to design specific interventions. Additionally, health care has complications, and the PHW do not necessarily have tools that allow them to provide a care that is culturally sensitive to the needs of the migrant community. The findings put into question the new challenges in health that Chile is facing in the face of the growing migrant population. The needs perceived by PHW are: stability and clarity in the regulations in force in relation to access and provision of services, training in regulations and the concrete way in which they should operate, and sensitization in cultural competence.

Migrant caregiving for family members with mild cognitive impairment: an ethnographic study

Background: Migrant families caring for family members with mild cognitive impairment (MCI) face considerable socioeconomic burden and isolation. Aim: To examine the cultural needs, beliefs and health seeking behaviours of migrant Turkish family member caregivers. Design: An ethnographic approach was used employing in depth interviews. Methods: Turkish caregivers residing in Melbourne, Australia were purposively sampled. Ten participants undertook face-to-face interviews in Turkish and English, followed by coding, transcription and thematic analysis. Results: Common themes were: (i) characteristics of MCI; (ii) care complicates our lives; (iii) beneficial coping strategies; (iv) adherence to cultural beliefs; (v) an uncertain future; (vi) interfacing with community health providers: need to understand Turkish culture (vii) need for long-term support. Migrant caregivers voiced undergoing considerable stress exacerbated by their cultural obligations. Conclusions: Establishing ethnically appropriate community support groups and advocating for a health workforce tier of representative migrant health care workers is recommended as a new role for community nurses.

Exploring barriers to primary care for migrants in Greece in times of austerity: Perspectives of service providers

Background: Migration in Europe is increasing at an unprecedented rate. There is an urgent need to develop ‘migrant-sensitive healthcare systems’. However, there are many barriers to healthcare for migrants. Despite Greece’s recent, significant experiences of inward migration during a period of economic austerity, little is known about Greek primary care service providers’ experiences of delivering care to migrants.Objectives: To identify service providers’ views on the barriers to migrant healthcare.Methods: Qualitative study involving six participatory learning and action (PLA) focus group sessions with nine service providers. Data generation was informed by normalization process theory (NPT). Thematic analysis was applied to identify barriers to efficient migrant healthcare.Results: Three main provider and system-related barriers emerged: (a) emphasis on major challenges in healthcare provision, (b) low perceived control and effectiveness to support migrant healthcare, and (c) attention to impoverished local population.Conclusion: The study identified major provider and system-related barriers in the provision of primary healthcare to migrants. It is important for the healthcare system in Greece to provide appropriate supports for communication in cross-cultural consultations for its diversifying population.

Providing care for migrants and refugees

With growing globalisation and an increasing number of people on the move across boundaries, it has become vital that service providers, policy makers and mental health professionals are aware of the different needs of the patients they are responsible. One of the most fundamental barriers for migrants, refugees and asylum seekers in accessing health services are inadequate legal entitlement and, mechanisms for ensuring that they are well known and respected in practice. Access to the healthcare system is impeded by language and cultural communication problems. Qualified language and cultural mediators are not widely available, and moreover, are not regularly asked to attend. This can lead to misunderstandings, misdiagnosis and incorrect treatment, with serious consequences for the afflicted. The language barrier represents one of the main barriers to access to the healthcare system for people who do not speak the local language; indeed, language is the main working tool of psychiatry and psychotherapy, without which successful communication is impossible. Additionally, the lack of health literacy among the staff of institutions, which provide care for refugees and asylum seekers means that there is a lack of knowledge about the main symptoms of common mental health problems among these groups. The healthcare services, which are currently available, are not well prepared for these increasing specific groups. In dealing with ethnic minorities, including asylum seekers and refugees, mental healthcare professionals need to be culturally competent.In this talk, main models for providing mental health care for migrants and refugees will be presented and discussed.Disclosure of interestThe author has not supplied his declaration of competing interest.

Health problems of newly arrived migrants and refugees in Europe

The number of migrants and refugees in Europe in the past few years has increased dramatically due to war, violence or prosecutions in their homeland. Migration may affect physical, mental and social health. The objective of this article is to assess migrants and refugees' health problems, and to recommend appropriate interventions. A PubMed search of published articles on health problems of newly arrived migrants and refugees was conducted from 2003 through 2016, focusing on the current refugee crisis in Europe. In addition to communicable diseases, such as respiratory, gastrointestinal and dermatologic infections, non-communicable diseases, including chronic conditions, mental and social problems, account for a significant morbidity burden in newly arrived migrants and refugees. Vaccine-preventable diseases are also of outmost importance. The appropriate management of newly arrived refugees and migrants' health problems is affected by barriers to access to health care including legal, communication, cultural and bureaucratic difficulties. There is diversity and lack of integration regarding health care provision across Europe due to policy differences between health care systems and social services. There is a notable burden of communicable and non-communicable diseases among newly arrived migrants and refugees. Provision of health care at reception and temporary centres should be integrated and provided by a multidisciplinary team Appropriate health care of migrants and refugees could greatly enhance their health and social status which will benefit also the host countries at large.

Responding to Migrant and Refugee Healthcare Needs in Ireland

Human migration, both voluntary and precipitated by conflict and persecution, continues to pose challenges to the healthcare infrastructure of host countries. The scale of international migration to Ireland has increased substantially in recent years. Both economic migrants and refugees have complex health needs including those related to infectious diseases, malnourishment, gender-specific issues, cultural adaptation, and mental health. While all refugees are highly vulnerable to physical trauma and illness, this vulnerability is heightened for women and children. Linguistically and culturally accessible care for migrants is essential in developing trust in and respect for Western medicine. Integration of migrants and multiculturalism as a national policy has many benefits for the health of incoming migrants and society in general.

8.G. Oral presentations: Access to health care for migrants and ethnic minorities

8.G. Oral presentations: Access to health care for migrants and ethnic minorities

Aging and health among migrants in a European perspective.

Population aging and the associated changes in demographic structures and healthcare needs is a key challenge across Europe. Healthy aging strategies focus on ensuring the ability to maintain health, quality of life and independent living at old age. Concurrent to the process of population aging, the demographics of Europe are affected by increased migration resulting in substantial ethnic diversity. In this paper, we narratively review the health profile of the growing proportion of aging migrants in Europe, outline key factors shaping health among this diverse group and consider ways of addressing their healthcare needs.Although factors shaping aging processes are largely similar across populations, migrant-specific risk factors exist. These include exposure to health risks before and during migration; a more disadvantaged socioeconomic position; language barriers and low health literacy; cultural factors influencing health-seeking behaviours; and psychosocial vulnerability and discrimination affecting health and quality of life. Overall, migrants experience the same morbidity and mortality causes as the native populations, but with different relative importance, severity and age of onset and with substantial differences within and between migrant groups. Little is known regarding health behaviours among aging migrants, although differences in cancer screening behaviours have been identified. Indications of widening health differentials between migrants and native populations with age and informal barriers to quality healthcare for aging migrants are causes of concern.In conclusion, there is a need for attention to migration alongside other determinants of healthy aging. The diversity in individual characteristics, life course processes and contextual factors shaping aging processes among migrants point to the need for a sensitive and comprehensive approach to policies, practices and research within the field of healthy aging. This is important to accommodate for the needs of the growing number of aging migrants in Europe and counter inequities in health and well-being at old age.

New Form of National Language Policy? The Case of the Economic Partnership Agreement (EPA) in Japan

Language policies in Japan have been mainly discussed in the context of national provisions and regulations regarding the Japanese language, or foreign language education. This paper examines the possible emergence of a new national language policy, embedded in a bilateral economic partnership agreement (EPA) signed between Japan and Southeast Asian countries. Besides its economic orientation, the EPA encourages and regulates the movement of people, in particular migrant healthcare workers from the signatory countries. Under the EPA, the migrants are required to take one year of Japanese language training before they start working in Japan and are expected to pass the national licensure examinations in the Japanese language if they wish to continue to work. In order to address the EPA as a newly emerging form of language policy, I firstly identify three unique features of the EPA: its international outlook, the number of policy actors involved, and its close relationship to Japan’s immigration scheme. Second, I analyse EPA policy documents, demonstrating another distinctive feature of the EPA—the representation of language on the ‘policy-paper’ level, with a focus on preemployment Japanese language training. Third, I examine how language training under the EPA is interpreted and appropriated as a language policy and the potential influence of language ideologies in those processes. This paper concludes with a call for more investigations from the perspective of language policy and planning on implicit language policies in Japan and beyond, in particular those embedded in immigration policies.

Engaging migrants and other stakeholders to improve communication in cross-cultural consultation in primary care: a theoretically informed participatory study

ObjectivesGuidelines and training initiatives (G/TIs) are available to support communication in cross-cultural consultations but are rarely implemented in routine practice in primary care. As part of the European Union RESTORE...

Psychosocial dynamics affecting health and social care of forced migrants: a narrative review

Purpose – Through the overview of studies on social representations of forced migrants (socio-cultural level of analysis), the purpose of this paper is to highlight how the variables implicated at the macro levels of analysis may affect the way social and health workers relate to and care for forced migrants (inter-personal level of analysis), as well as the settlement process of forced migrants and their identity reconstruction during the post-migration period. Design/methodology/approach – The narrative review analyses empirical studies from peer-reviewed journals in the field of social psychology that address forced migration. Indeed, the framework used for analysing this literature is the interplay within different levels of analysis, as proposed by Willem Doise’s (1982) using the socio-psychological approach. Findings – Psychosocial factors play influential roles on structuring the way natives health and social professionals relate with forced migrants: among others, needs related to possible traumatising processes are attributed to forced migrants by natives providers. Therefore, identity negotiation process in the forced migration shows a tendency of migrants to reshape the definition of the self within those narrative boundaries that would ensure the protection by the law and that reinforce the social representation of the “medicalised” victim. Originality/value – The review would represent a possibility to reflect around dynamics created by the complex interplay within different social actors that contact during the settlement process of forced migrants inside host societies.

The experience of nurses working within a voluntary network: a qualitative study of health care for undocumented migrants

To illuminate the experience of nurses providing health care to undocumented migrants in a voluntary network. In a qualitative study, semistructured interviews were conducted with RNs regarding their experience of providing health care to undocumented migrants within a voluntary network. The interview transcripts were analysed using the inductive method of content analysis. Three main categories emerged - structural inadequacy, ethical dilemmas and challenges, and personal impact and insights. The informants were driven by a strong ethical approach and a great sense of responsibility as human beings and as nurses. Engaging with the voluntary network allowed the informants to cope with their frustration and feelings of inadequacy which emerged when confronted with institutionalised injustice in the conventional healthcare system.

Demagnetisation of Social Security and Health Care for Migrants to the UK

Over the past two decades, starting with the social security ‘habitual residence’ test, UK governments have maintained a consistent policy of restricting the access of migrants to welfare benefits and public health care. It has represented a response to increased levels of inward migration flow, including anticipated increases arising from enlarged European Union (EU) membership, and the supposed ‘magnetic pull’ of UK welfare and health care systems to migrants. Adjustment of the benefit rules affecting EU migrants, which has at times come very close to crossing lines of legality under EU law, has lately featured prominently in the UK's proposals to the EU over the terms of its Union membership. The article focuses on the policy changes and legal developments, including case law, across the areas of social assistance benefits, state retirement pensions and health care, and assesses their impact, seeking to analyse the changing position of residence as an issue in entitlement and its implications.

GP attitudes to migrant health care across Europe.

The current refugee crisis is the biggest humanitarian emergency Europe has faced since the Second World War. Displacement has a devastating effect on the physical and mental health of refugees. WONCA Europe (representing family doctors and their member organisations across Europe) released a statement urging governments to take action ‘… so that all people living permanently or temporarily in Europe will have access to equitable, affordable and high-quality health care services’. 1 Unfortunately, the inadequate response of many governments to the crisis has obliged charities such as Doctors of the World (DOTW) to step in and provide urgent health care. During the WONCA Istanbul conference in 2015, the RCGP Junior International Committee conducted a survey of family doctors’ knowledge of migrant health and attitudes towards provision of health care. There were 45 responders (predominantly family doctor trainees) …

UTILIZATION OF MATERNAL HEALTH SERVICES AMONG INTERNAL MIGRANTS IN MUMBAI, INDIA.

This study aimed to understand access to maternal health care and the factors shaping it amongst poor migrants in Mumbai, India. A cross-sectional mixed methods approach was used. It included multistage cluster sampling and face-to-face interviews, through structured interview schedules, of 234 migrant women who had delivered in the two years previous to the date they were interviewed. Qualitative in-depth interviews of migrant women, health care providers and health officials were also conducted to understand community and provider perspectives. The results showed that access to antenatal care was poor among migrants with less than a third of them receiving basic antenatal care and a quarter delivering at home. Multivariate analysis highlighted that amongst migrant women those who stayed in Mumbai during pregnancy and delivery had better access to maternal health care than those who went back to their home towns. Poor maternal health care was also due to weaker demand for health care as a result of the lack of felt-need among migrants due to socio-cultural factors and lack of social support for, and knowledge of, health facilities in the city. Supply-side factors such as inadequate health infrastructure at primary and secondary levels, lack of specific strategies to improve access to health care for migrants and cumbersome administrative procedures that exclude migrants from certain government programmes all need to be addressed. Migrants should be integral to the urban development process and policies should aim at preventing their exclusion from basic amenities and their entitlements as citizens.

Utilization of health-care services among immigrants recruited through non-profit organizations in southern Italy

The study aims were focused on acquiring information about access to health-care services and to investigate the potential barriers affecting full access to health-care services. The study population consisted of immigrants and refugees aged 18 or more living in Italy for at least 12months recruited through non-profit organizations. 961 immigrants took part in the study, with a response rate of 98.9%. Of the participants, 85% had access to a general practitioner (GP) at least once, and 46.6 and 22.4% mentioned a minimum one emergency visit and hospital stay, respectively. Diagnostic procedures and/or drug prescriptions (49.7%), chronic disease control (15.8%), and preventive interventions (13%) were the most reported reasons for GP access. This study yielded current and broader insight into the model of health-care utilization among immigrants. The findings adds to our understanding of the third-sector organizations' role in facilitating immigrants' access to services offered by the Italian National Health Service, contributing to the extensive discussion on how to best manage migrant health care in Italy.

Initial examination and screening of migrants : What makes sense and what is evidence-based?

The medical treatment of migrants and refugees has recently become an important topic in the German healthcare system due to the large numbers of migrants. Healthcare for migrants includes treatment of acute illnesses and trauma on arrival, screening for chronic communicable and non-communicable diseases and in the long term, the integration into the local healthcare system. As health problems of migrants are diverse and dependent on the region of origin, guidelines should be readily available for all healthcare professionals involved in migrant healthcare. A literature search for comprehensive guidelines for screening and treatment of migrant's health problems detected 47 different guidelines including 2 comprehensive ones from the US Centers of Disease Control and Prevention and the Canadian Collaboration for Immigrant and Refugee Health. Comparative analysis of these guidelines could be a starting point for evidence-based European guidelines on migrant health.