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Birtan D, Akpinar A. Ethical challenges in organ transplants for refugees in a healthcare system. Nurs Ethics 2024:9697330241230528. [PMID: 38321969 DOI: 10.1177/09697330241230528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Several ethical issues are associated with providing living organ transplantation services, and there is limited information on these issues faced by the teams providing service to refugees or asylum seekers. AIM To determine the challenges healthcare professionals face in organ transplant centers providing services to Syrians under temporary protection status and discern whether these difficulties align with ethical issues in living organ transplantation. RESEARCH DESIGN This study employed a qualitative design and conducted individual semi-structured, in-depth interviews with 18 transplant team members in Istanbul between September and November 2022. Data analysis was based on Braun and Clarke's thematic analysis. PARTICIPANTS AND RESEARCH CONTEXT The participants comprised 18 healthcare professionals, including 6 physicians and 12 nurses working in organ transplant teams in Istanbul. ETHICAL CONSIDERATIONS The University's Ethics Committee provided approval. Participants were informed regarding confidentiality and signed an informed consent form. RESULTS Three themes emerged from the data on ethical issues faced by organ transplantation services to Syrians: (a) beneficence or double equipoise, (b) autonomy, and (c) justice. Transplant teams experience problems related to preserving double equipoise in the provision of living donor organ transplantation because of language barriers, poor socioeconomic conditions, and cultural factors, which increases transplant teams' individual and indirect social burden. Although problems arise from the language barrier when obtaining informed consent in the autonomy theme, institutional and national policies in preventing donor abuse have a comforting effect. Health workers had the least problems with the justice theme, wherein national health policies are determined. CONCLUSION Fewer issues related to autonomy and justice were reported in providing organ transplantation services to Syrians, with the most intense reported issues being maintaining double equipoise. The results revealed the need to develop institutional, national, and international policies with individual solutions to prevent difficulties healthcare professionals face in this process.
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Affiliation(s)
- Deniz Birtan
- Kocaeli University
- İstanbul University-Cerrahpaşa
| | - Aslihan Akpinar
- Department of History of Medicine and Ethics, School of Medicine, Kocaeli University, Kocaeli
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Huo Y, Kang X, Zhong C, Shi L, Liu R, Hu R. The quality of migrant patients' primary healthcare experiences and patient-centered medical home achievement by community health centers: results from the China greater bay area study. Int J Equity Health 2023; 22:114. [PMID: 37287015 DOI: 10.1186/s12939-023-01929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND In China, Community Health Centers (CHCs) provide primary healthcare (PHC); however, few studies have examined the quality of PHC services experienced by migrant patients. We examined the potential association between the quality of migrant patients' PHC experiences and the achievement of Patient-Centered Medical Home by CHCs in China. METHODS Between August 2019 and September 2021, 482 migrant patients were recruited from ten CHCs in China's Greater Bay Area. We evaluated CHC service quality using the National Committee for Quality Assurance Patient-Centered Medical Home (NCQA-PCMH) questionnaire. We additionally assessed the quality of migrant patients' PHC experiences using the Primary Care Assessment Tools (PCAT). General linear models (GLM) were used to examine the association between the quality of migrant patients' PHC experiences and the achievement of PCMH by CHCs, adjusting for covariates. RESULTS The recruited CHCs performed poorly on PCMH1, Patient-Centered Access (7.2 ± 2.0), and PCMH2, Team-Based Care (7.4 ± 2.5). Similarly, migrant patients assigned low scores to PCAT dimension C-First-contact care-which assesses access (2.98 ± 0.03), and D-Ongoing care (2.89 ± 0.03). On the other hand, higher-quality CHCs were significantly associated with higher total and dimensional PCAT scores, except for dimensions B and J. For example, the total PCAT score increased by 0.11 (95% CI: 0.07-0.16) with each increase of CHC PCMH level. We additionally identified associations between older migrant patients (> 60 years) and total PCAT and dimension scores, except for dimension E. For instance, the average PCAT score for dimension C among older migrant patients increased by 0.42 (95% CI: 0.27-0.57) with each increase of CHC PCMH level. Among younger migrant patients, this dimension only increased by 0.09 (95% CI: 0.03-0.16). CONCLUSION Migrant patients treated at higher-quality CHCs reported better PHC experiences. All observed associations were stronger for older migrants. Our results may inform future healthcare quality improvement studies that focus on the PHC service needs of migrant patients.
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Affiliation(s)
- Yongjun Huo
- Department of Health Management, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - Xun Kang
- The Third People's Hospital of Foshan, Foshan Mental Health Center, Foshan, Guangdong, China
| | - Chenyang Zhong
- Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - Leiyu Shi
- John Hopkins School of Public Health, Baltimore, MD, USA
| | - Ruqing Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China.
| | - Ruwei Hu
- Department of Health Management, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China.
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3
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Kaplan F, Bentwich ME. Do differences exist in cross-cultural caregivers' respect for the autonomy/dignity of people with dementia? Real-time field observations in nursing homes. DEMENTIA 2023:14713012231158410. [PMID: 36946305 DOI: 10.1177/14713012231158410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Although published studies have examined the perceptions of caregivers who are attending to older adults with dementia concerning the values of human dignity and/or autonomy in institutional settings, none have explored the possible differences in actual behavior that relates to these values for caregivers from diverse ethno-cultural backgrounds. AIMS Explore how caregivers with varied cultural backgrounds may differ in their real-time behavior regarding the autonomy and dignity of older adults with dementia and thereby determine whether that real-time behavior reveals new aspects of respect and disrespect for both the autonomy and dignity of those older adults. RESEARCH DESIGN AND METHODS A qualitative research based on non-participatory observations, was meticulously recorded using a written journal and a rigorous microanalysis to analyze the collected data. We made 58 shift-based observations (morning and evening) of 29 caregivers from 3 ethno-cultural groups working in 3 nursing homes in Israel. These groups included Israeli-born Jews (Sabras), Israeli Arab-Muslims (Arabs), and immigrants from the Former Soviet Union (IFSU). RESULTS (1) IFSU caregivers demonstrated more respect for autonomy and dignity, but also demonstrated disrespect for these values. (2) the main difference between the IFSU caregivers and other caregiver groups pertained to respect for their autonomy. The main specific facets of autonomy where IFSU caregivers surpassed their colleagues were information provision and persuasion. (3) toward both autonomy and dignity of these older adults, previously unaccounted for in the models we used, were discovered among the varied groups of caregivers, with only minor gaps between these groups. DISCUSSION AND IMPLICATIONS This study-the first of its kind to focus on the real-time behaviors of caregivers from diverse ethno-cultural backgrounds-reveals the potential effects of culture on applying practices related to dignity and autonomy during daily care. The findings may have important implications for caregiver training in multicultural societies.
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Affiliation(s)
- Felix Kaplan
- School of Social Work, 61315Zefat Academic College, Israel
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4
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Gonçalves AQ, Sequeira-Aymar E, Aguilar Martín C, Dalmau RM, Cruz A, Evangelidou S, Hargreaves S, Requena-Mendez A, Jacques-Aviñó C. Usefulness and practicality of a multidisease screening programme targeting migrant patients in primary care in Spain: a qualitative study of general practitioners. BMJ Open 2022; 12:e065645. [PMID: 36385020 PMCID: PMC9670956 DOI: 10.1136/bmjopen-2022-065645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Some migrant groups are disproportionately affected by key infectious diseases in European countries. These pose a challenge for healthcare systems providing care to these groups. We aimed to explore the views of general practitioners (GPs) on the acceptability, adaptability and feasibility of a multidisease screening programme based on an innovative clinical decision-support system for migrants (the ISMiHealth tool), by examining the current gaps in healthcare provision and areas of good practice and the usefulness and limitations of training in the health needs of migrants. METHODS We undertook a qualitative descriptive study and carried out a series of focus groups (FGs) taking a pragmatic utilitarian approach. Participants were GPs from the four primary healthcare (PHC) centres in Catalonia, Spain, that piloted an intervention of the ISMiHealth tool. GPs were recruited using purposive and convenience sampling. FG discussions were transcribed and analysed using thematic content analysis. RESULTS A total of 29 GPs participated in four FGs. Key themes identified were: (1) GPs found the ISMiHealth tool to be very useful for helping to identify specific health problems in migrants, although there are several additional barriers to screening as part of PHC, (2) the importance of considering cultural perspectives when caring for migrants, and of the impact of migration on mental health, (3) the important role of PHC in healthcare provision for migrants and (4) key proposals to improve screening of migrant populations. GPs also highlighted the urgent need, to shift to a more holistic and adequately resourced approach to healthcare in PHC. CONCLUSIONS GPs supported a multidisease screening programme for migrant populations using the ISMiHealth tool, which aided clinical decision-making. However, intercultural participatory approaches will need to be adopted to address linguistic and cultural barriers to healthcare access that exist in migrant communities.
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Affiliation(s)
- Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Spain
- Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L'Ebre, Institut Català de la Salut, Tortosa, Spain
| | - Ethel Sequeira-Aymar
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Casanova, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Carina Aguilar Martín
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Spain
- Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Spain
| | - Rosa Maria Dalmau
- Equip d'Atenció Primària Tortosa Oest, Institut Català de la Salut, Tortosa, Spain
- Campus Terres de l'Ebre, Universitat Rovira i Virgili, Tortosa, Spain
| | - Angeline Cruz
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Stella Evangelidou
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
| | - Ana Requena-Mendez
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Disease, Karolinska University Hospital, Solna, Stockholm, Sweden
- CIBERINFEC, ISCIII - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Madrid, Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Barcelona, Spain
- Campus Bellaterra, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
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Imafuku R, Nagatani Y, Shoji M. Communication Management Processes of Dentists Providing Healthcare for Migrants with Limited Japanese Proficiency. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14672. [PMID: 36429391 PMCID: PMC9690798 DOI: 10.3390/ijerph192214672] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Low health literacy results in health inequity are linked with poor adherence to medical care. In the globalized Japanese context, the number of migrants with Japanese as a second language is increasing year after year. Since limited Japanese proficiency may pose a greater health risk, dentists are expected to manage cross-cultural communication and provide dental care to foreign patients. This study explored dentists' experiences of treating patients with limited Japanese proficiencies. Semi-structured interviews were conducted with 11 community dentists and the qualitative data were analyzed through a thematic analysis approach. Their major challenges were classified into three themes-linguistic aspect (e.g., complicated explanation regarding root canal treatment), sociolinguistic aspect (e.g., communication with foreign residents with limited dental knowledge), and sociocultural aspect (e.g., cultural differences in their dental aesthetics and insurance treatment system). Several management strategies were employed, including linguistic accommodation, avoidance of complexities, use of various communication tools, and getting help from others. However, they were unsatisfied with their practice because they could not understand the patients' psychosocial aspects due to incomplete communication. These findings provided insights into dentists' practice in the globalized context.
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Affiliation(s)
- Rintaro Imafuku
- Medical Education Development Center, Gifu University, Gifu 501-1194, Japan
| | - Yukiko Nagatani
- Department of Dental Hygiene, University of Shizuoka Junior College, Shizuoka 422-8021, Japan
| | - Masaki Shoji
- Department of Social and Administrative Pharmacy, Osaka Medical and Pharmaceutical University, Takatsuki 569-1094, Japan
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Tirado V, Engberg S, Holmblad IS, Strömdahl S, Ekström AM, Hurtig AK. "One-time interventions, it doesn't lead to much" - healthcare provider views to improving sexual and reproductive health services for young migrants in Sweden. BMC Health Serv Res 2022; 22:668. [PMID: 35585585 PMCID: PMC9115984 DOI: 10.1186/s12913-022-07945-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Sexual and reproductive health and rights (SRHR) is an important aspect for young people. In Sweden, young migrants often encounter barriers to accessing and using sexual and reproductive health (SRH) services, despite that these services are free of charge for young people (ages 15–25). Healthcare providers’ views and best practices are of great importance for improving the utilisation of existing SRH services, particularly for young people. This study aims to understand healthcare providers’ experiences and perspectives on barriers to SRHR among young migrants and their suggestions for strategies to improve the provision of SRH services to this group. Methods Midwives, counsellors and nurses with at least five years of professional experience within SRHR were reached through a purposeful sample at primary care clinics, specialised clinics and youth-friendly clinics, which provide SRH services to migrant youths in Stockholm. Twelve interviews were conducted from May 2018 to February 2020. Qualitative content analysis was performed. Results The analysis identified one theme: Improving the fragmentation in the SRH services, and four sub-themes: 1. Being unaware of SRHR; 2. Creating trust and responsive interactions; 3. Communicating in the same language; and 4. Collaborating to build bridges. The barriers included distrust in the healthcare system, socio-cultural norms surrounding SRHR, incomplete translations, and a need for long-lasting collaboration with SRH services and other range of services for migrants. The strategies for improvement as suggested by participants included involving existing cultural groups and organisations to enable trust, consistent and dependable interpreters, a streamline of SRH services with other healthcare staff and health facilities, and collaborations with homes designated for young migrants and language schools for a direct linkage to service providers. Conclusions Findings indicate that there are fragmentations in SRH services, and these include lack of knowledge about SRHR among migrant youth, language and communication barriers, and a lack of structure needed to build dependable services that go beyond one-time interventions. While initiatives and strategies from healthcare providers for improvement of SRH services exist, the implementation of some strategies may also require involving the regional and national decision-makers and multi-stakeholders like communities, civil society and young migrants themselves.
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Affiliation(s)
- Veronika Tirado
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Siri Engberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Susanne Strömdahl
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Anna Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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7
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Poppleton A, Howells K, Adeyemi I, Chew‐Graham C, Dikomitis L, Sanders C. The perceptions of general practice among Central and Eastern Europeans in the United Kingdom: A systematic scoping review. Health Expect 2022; 25:2107-2123. [DOI: 10.1111/hex.13433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Aaron Poppleton
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
- School of Medicine Keele University Keele UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM‐PSTRC) Manchester UK
| | - Kelly Howells
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
| | - Isabel Adeyemi
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
| | | | - Lisa Dikomitis
- Kent and Medway Medical School University of Kent and Canterbury Christ Church University Canterbury UK
| | - Caroline Sanders
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM‐PSTRC) Manchester UK
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8
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Onarheim KH, Wickramage K, Ingleby D, Subramani S, Miljeteig I. Adopting an ethical approach to migration health policy, practice and research. BMJ Glob Health 2021; 6:e006425. [PMID: 34321236 PMCID: PMC8319989 DOI: 10.1136/bmjgh-2021-006425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/02/2021] [Indexed: 11/05/2022] Open
Abstract
Migration health is affected by decision making at levels ranging from global to local, both within and beyond the health sector. These decisions impact seeking, entitlements, service delivery, policy making and knowledge production on migration health. It is key that ethical challenges faced by decision makers are recognised and addressed in research and data, clinical practice and policy making on migration health. An ethical approach can provide methods to identify ethical issues, frameworks for systematising information and suggesting ethically acceptable solutions, and guidance on procedural concerns and legitimate decision making processes. By unpacking dilemmas, conflicts of interests and values at stake, an ethical approach is relevant for all who make decisions about migration health policy and practice. Adopting an ethical approach to migration health benefits governments, organisations, policy makers, health workers, data managers, researchers and migrants themselves. First, it highlights the inherent normative questions and trade-offs at stake in migration health. Second, it assists decision makers in deciding what is the ethically justifiable thing to do through an 'all things considered' approach. Third, ethical frameworks and technical guidance set normative and practical standards for decision makers facing ethical questions - from 'bedside rationing' to collection of big data or in policy making - that can ensure that migrants' interests are considered. Fourth, there is a need for greater transparency and accountability in decision making, as well as meaningful participation of migrant groups. An ethical approach connects to public health, economic and human rights arguments and highlights the urgent need to mainstream concerns for migrants in global and national health responses.
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Affiliation(s)
| | - Kolitha Wickramage
- Migration Health Division, International Organization of Migration, Manila, Philippines
| | - David Ingleby
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, Netherlands
| | - Supriya Subramani
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Ingrid Miljeteig
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Research and Development, Haukeland Universitetssjukehus, Bergen, Norway
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Tomkow LJ, Kang CP, Farrington RL, Wiggans RE, Wilson RJ, Pushkar P, Tickell-Painter MC, Lee AR, Whitehouse ER, Mahmood NG, Lawton KM, Lee EC. Healthcare access for asylum seekers and refugees in England: a mixed methods study exploring service users' and health care professionals' awareness. Eur J Public Health 2021; 30:556-561. [PMID: 31642914 DOI: 10.1093/eurpub/ckz193] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With the aim of decreasing immigration, the British government extended charging for healthcare in England for certain migrants in 2017. There is concern these policies amplify the barriers to healthcare already faced by asylum seekers and refugees (ASRs). Awareness has been shown to be fundamental to access. This article jointly explores (i) health care professionals' (HCPs) awareness of migrants' eligibility for healthcare, and (ii) ASRs' awareness of health services. METHODS Mixed methods were used. Quantitative survey data explored HCPs' awareness of migrants' eligibility to healthcare after the extension of charging regulations. Qualitative data from semi-structured interviews with ASRs were analyzed thematically using Saurman's domains of awareness as a framework. RESULTS In total 514 HCPs responded to the survey. Significant gaps in HCPs' awareness of definitions, entitlements and charging regulations were identified. 80% of HCP respondents were not confident defining the immigration categories upon which eligibility for care rests. Only a small minority (6%) reported both awareness and understanding of the charging regulations. In parallel, the 18 ASRs interviewed had poor awareness of their eligibility for free National Health Service care and suitability for particular services. This was compounded by language difficulties, social isolation, frequent asylum dispersal accommodation moves, and poverty. CONCLUSION This study identifies significant confusion amongst both HCP and ASR concerning eligibility and healthcare access. The consequent negative impact on health is concerning given the contemporary political climate, where eligibility for healthcare depends on immigration status.
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Affiliation(s)
- Louise J Tomkow
- Humanitarianism and Conflict Response Institute, School of Arts Languages and Culture, University of Manchester, Manchester, UK
| | - Cara Pippa Kang
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Rebecca L Farrington
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Ruth E Wiggans
- Wythenshawe Hospital, Manchester Foundation Trust, Manchester, UK
| | - Rebecca J Wilson
- Royal Manchester Children's Hospital, Manchester Foundation Trust, Manchester, UK
| | - Piyush Pushkar
- School of Social Science, University of Manchester, Manchester, UK
| | | | - Alice R Lee
- Royal Manchester Children's Hospital, Manchester Foundation Trust, Manchester, UK
| | - Emily R Whitehouse
- Preston Royal Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Nadia G Mahmood
- Royal Blackburn Teaching Hospital, East Lancashire Hospital Trust, Lancashire, UK
| | - Katie M Lawton
- Wythenshawe Hospital, Manchester Foundation Trust, Manchester, UK
| | - Ellen C Lee
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Views and experiences of family physicians about Syrian refugee patients in Turkey: a qualitative research. Prim Health Care Res Dev 2021; 22:e19. [PMID: 34034844 PMCID: PMC8165330 DOI: 10.1017/s1463423621000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM The aim of this study was to describe the attitudes, views and solution proposals of family physicians (FPs) about primary healthcare problems of Syrian refugee patients. This study would be the very first study for Turkey that evaluates the attitudes, views and solution proposals of FPs about primary healthcare problems of Syrian refugee patients. BACKGROUND Following the anti-regime demonstrations that started in March 2011, the developments in Syria created one of the biggest humanitarian crises in the world and the largest number of asylum seekers continue to be hosted in Turkey. There are some studies evaluating asylum seekers' access to healthcare services in Europe, and the common result is that refugees have free access to primary healthcare services in most countries; however, they face many obstacles when accessing primary healthcare services. While there are studies in the literature evaluating the situation of access to primary healthcare services from the perspective of asylum seekers; there are few studies evaluating the opinions/views of FPs. METHODS A qualitative methodology informed by the grounded theory was used to guide the research. A total of 20 FPs were interviewed face to face through semi-structured interviews, using 12 questions about their lived experience and views caring of refugee population. Interviews were analysed thematically. FINDING The following themes were revealed: Benefiting from Primary Health Care Services, Benefiting from Rights, Differences Between the Approach/Attitudes of Turkish Citizens and Refugees, Barriers to Healthcare Delivery, Training Needs of Physicians, Solution proposals. FPs reported that there is a need for support in primary care and a need for training them and refugees in this regard and they specified refugee healthcare centres are the best healthcare centres for refugees; however, the number of these and provided services should be increased.
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11
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Social and Structural Barriers to Primary Care Access Among Women Living With HIV in Metro Vancouver, Canada: A Longitudinal Cohort Study. J Assoc Nurses AIDS Care 2021; 32:548-560. [PMID: 33989244 DOI: 10.1097/jnc.0000000000000234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT This study examines correlates of being unable to access primary care in the past 6 months among cisgender (cis) and trans women living with HIV (WLWH). Data were drawn from a longitudinal community-based cohort study of WLWH (ages 14+) in Metro Vancouver, Canada (2014-2017). Of 291 participants contributing 914 observations, 15.5% reported being unable to access primary care at baseline. In multivariable analysis, increased odds of being unable to access primary care was associated with (a) having im/migrated to Canada, and, in the past 6 months, (b) identifying as gender minority, (c) experiencing physical or sexual violence, (d) having suicidal ideation or attempts. Decreased odds were associated with recently accessing HIV-specific resources. Our findings suggest that primary health care for WLWH should address high levels of violence and mental health conditions as well as barriers to services for gender minority and im/migrant WLWH.
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12
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Asfaw BB, Beiersmann C, Keck V, Nikendei C, Benson-Martin J, Schütt I, Lohmann J. Experiences of psychotherapists working with refugees in Germany: a qualitative study. BMC Psychiatry 2020; 20:588. [PMID: 33308187 PMCID: PMC7733283 DOI: 10.1186/s12888-020-02996-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 12/03/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite a high burden of mental health problems among refugees, there is limited knowledge about effective mental health care provision for this group. Although substantial efforts in understanding the complexity of cross-cultural psychotherapy - which in the context of this study we use to refer to therapy with client and therapist of different cultural backgrounds - have been made, there remains a dearth of research exploring barriers for effective cross-cultural psychotherapy. This study aimed at narrowing this gap in knowledge by exploring major challenges encountered by psychotherapists in cross-cultural psychotherapy and strategies which have proven useful in overcoming such challenges. METHODS We employed a qualitative study design, conducting semi-structured in-depth interviews with 10 purposely selected psychotherapists working with refugees in Germany. Respondents were from varying theoretical background and had varying levels of experience. Data were analyzed using a thematic approach, following a mix of deductive and inductive coding. RESULTS Respondents reported three main challenges in their cross-cultural practice: different or unrealistic expectations of clients towards what psychotherapy would offer them; challenges grounded in different illness explanatory models; and communication challenges. In dealing with these challenges, respondents recommended psychoeducation to overcome issues related to problematic expectations towards psychotherapy; "imagining the real", identifying "counter magic" and other client-appropriate resources to deal with issues related to clients' foreign illness attributions; and translators in dealing with communication barriers, though the latter not univocally. CONCLUSIONS Results show that psychotherapy with refugees can be very successful, at least from the psychotherapist perspective, but also poses significant challenges. Our findings underline the importance of developing, testing, and institutionalizing structured and structural approaches to training psychotherapists in cross-cultural therapy at scale, to accommodate the rising mental health care need of refugees as a client group.
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Affiliation(s)
- Baye Berihun Asfaw
- Department of Psychology, College of Social Sciences and Humanities, University of Gonder, P.O. Box: 196, Gonder, Ethiopia.
| | - Claudia Beiersmann
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Verena Keck
- Department of Social and Cultural Anthropology, Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Janine Benson-Martin
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Gesundheitsamt Enzkreis, Pforzheim, Germany
| | | | - Julia Lohmann
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Requena-Méndez A, Bisoffi Z, Vives-Corrons JL, Gascon J, Plasència A. European expert network on rare communicable diseases and other rare diseases linked to mobility and globalisation focused on health care provision (EURaDMoG): a feasibility study. Orphanet J Rare Dis 2020; 15:291. [PMID: 33066818 PMCID: PMC7563907 DOI: 10.1186/s13023-020-01534-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 09/07/2020] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION In the current mobility and globalization context, there is a growing need to identify potential changes on the pattern of diseases in the European Union (EU)/European Economic Area (EEA) and provide accurate diagnosis and treatment for the population. The pattern of rare communicable diseases that can affect people returning to EU/EEA from travel abroad, visiting EU/EEA or establishing in the EU/EEA is of special relevance. The objective of this manuscript is to give an overview about the EURaDMoG study and discuss the feasibility of establishing a European network on rare communicable diseases and other rare conditions linked to mobility and globalization. METHODS We undertook a three-steps process where we first conducted a narrative review to estimate the prevalence and incidence and to list rare communicable and non-communicable diseases linked to mobility and globalization in the EU/EEA; second, we organized an international consultation workshop with experts in the diseases previously selected; and finally, the feasibility study analysed how successful a European expert network on rare diseases linked to mobility and globalization focused on health care provision would be, accounting for different operational and also sustainability criteria. RESULTS First, considering the areas or topics that the network should cover, it was concluded that communicable and non-communicable rare diseases linked to mobility and globalization should be differentiated. Second, since all non-communicable rare diseases linked to mobility and globalization identified are already covered by different European Reference Networks (ERNs), there is no need for them to be included in a new European network. Three scenarios were considered for establishing a potential European network for rare communicable diseases linked to Mobility and Globalisation with a focus on Health Care provision: 1) To maintain the current situation "Status Quo" scenario; 2) to create a specific European expert network (EEN) on rare communicable diseases linked to mobility and globalisation; 3) to develop a new ERN on communicable rare diseases linked to mobility and globalisation. CONCLUSIONS Since the focus is the provision of health care, an ERN could have the potential to better boost the quality of care being facilitated by technological tools and online platforms that permit the safe and ethically acceptable exchange of data. However, this potential new network should not eclipse current existing networks and they should be complementary.
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Affiliation(s)
- Ana Requena-Méndez
- Barcelona Institute for Global Health (Hospital Clínic- Universitat de Barcelona), Barcelona, Spain. .,Department of Medicine, Karolinska Institutet, Solna, 17176, Stockholm, Sweden.
| | - Zeno Bisoffi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar (Verona), Italy.,Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Joaquim Gascon
- Barcelona Institute for Global Health (Hospital Clínic- Universitat de Barcelona), Barcelona, Spain
| | - Antoni Plasència
- Barcelona Institute for Global Health (Hospital Clínic- Universitat de Barcelona), Barcelona, Spain
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Abstract
This study focuses on the experiences of professionals working with refugees and asylum seekers in the North of Italy. In the last years, professionals who work in this sector have been exposed to an increasing risk of physical and emotional malaise because of the number of challenges they daily manage. A qualitative study has been conducted with the aim of exploring the resource and the fatigue factors of professionals, in relation to their state of well-being or discomfort. Eight focus groups with multi-professional teams were held in eight refugee centres, for a total of 28 professionals involved (16 males and 12 females). The results allowed the description of three different professional profile conditions: Fatigued, Idealizing and Engaged.
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Affiliation(s)
| | - Amalia De Leo
- Università degli studi della Campania Luigi Vanvitelli, Italy
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Richard L, Richardson G, Jaye C, Stokes T. Providing care to refugees through mainstream general practice in the southern health region of New Zealand: a qualitative study of primary healthcare professionals' perspectives. BMJ Open 2019; 9:e034323. [PMID: 31892670 PMCID: PMC6955505 DOI: 10.1136/bmjopen-2019-034323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To explore the perspectives of primary healthcare (PHC) professionals providing care to refugees through mainstream general practice. DESIGN Qualitative exploratory design with semistructured interviews subjected to inductive thematic analysis. SETTING AND PARTICIPANTS Nine general practices enrolled in the Dunedin Refugee Resettlement Programme, in New Zealand (NZ)'s southern health region. Participants included nine general practitioners and six practice nurses. RESULTS Three analytical constructs were identified: relational engagement with refugees, refugee healthcare delivery and providers' professional role shaped by complexity. Building meaningful relational connections involved acknowledging refugees' journeys by getting to know them as people. This was instrumental for the development of an empathetic understanding of the complex human trajectories that characterise refugees' journeys to NZ. Participants encountered challenges in providing care to refugees with respect to time-limited consultations, variable use of interpreter services, fragmentation of care between agencies and need for improved health infrastructure to ensure a fluid interface between PHC, secondary care and community support services. The current business model of NZ general practice was perceived to interfere with value-driven care and discouraged tailoring of care to specific patient groups, raising concerns about the 'fit' of mainstream general practice to address the complex healthcare needs of refugees. Meeting the needs of refugees across the social determinants of health involved a lot of 'behind the scenes work' particularly in the absence of shared information systems and the lack of well-established referral pathways to connect refugees to services beyond the health sector. This led to providers feeling overwhelmed and uncertain about their ability to provide appropriate care to refugees. CONCLUSIONS This study provides rich context-specific findings that enhance PHC responsiveness to the needs of refugees in NZ.
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Affiliation(s)
- Lauralie Richard
- General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Georgia Richardson
- General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Chrystal Jaye
- General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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16
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Molina RL, Kasper J. The power of language-concordant care: a call to action for medical schools. BMC MEDICAL EDUCATION 2019; 19:378. [PMID: 31690300 PMCID: PMC6833293 DOI: 10.1186/s12909-019-1807-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/12/2019] [Indexed: 05/23/2023]
Abstract
We live in a world of incredible linguistic diversity; nearly 7000 languages are spoken globally and at least 350 are spoken in the United States. Language-concordant care enhances trust between patients and physicians, optimizes health outcomes, and advances health equity for diverse populations. However, historical and contemporary trauma have impaired trust between communities of color, including immigrants with limited English proficiency, and physicians in the U.S. Threats to informed consent among patients with limited English proficiency persist today. Language concordance has been shown to improve care and serves as a window to broader social determinants of health that disproportionately yield worse health outcomes among patients with limited English proficiency. Language concordance is also relevant for medical students engaged in health care around the world. Global health experiences among medical and dental students have quadrupled in the last 30 years. Yet, language proficiency and skills to address cultural aspects of clinical care, research and education are lacking in pre-departure trainings. We call on medical schools to increase opportunities for medical language courses and integrate them into the curriculum with evidence-based teaching strategies, content about health equity, and standardized language assessments. The languages offered should reflect the needs of the patient population both where the medical school is located and where the school is engaged globally. Key content areas should include how to conduct a history and physical exam; relevant health inequities that commonly affect patients who speak different languages; cultural sensitivity and humility, particularly around beliefs and practices that affect health and wellbeing; and how to work in language-discordant encounters with interpreters and other modalities. Rigorous language assessment is necessary to ensure equity in communication before allowing students or physicians to use their language skills in clinical encounters. Lastly, global health activities in medical schools should assess for language needs and competency prior to departure. By professionalizing language competency in medical schools, we can improve patients' trust in individual physicians and the profession as a whole; improve patient safety and health outcomes; and advance health equity for those we care for and collaborate with in the U.S. and around the world.
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Affiliation(s)
- Rose L. Molina
- Division of Global and Community Health, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215 USA
- Scholars in Medicine Office, Harvard Medical School, Boston, 02115 MA USA
| | - Jennifer Kasper
- Scholars in Medicine Office, Harvard Medical School, Boston, 02115 MA USA
- Pediatrics and Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115 USA
- Department of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115 USA
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Stanzel KA, Hammarberg K, Fisher J. Primary healthcare providers' attitudes and beliefs about the menopause-related care needs of women who have migrated from low- and middle-income countries to Australia. Aust J Prim Health 2019; 26:88-94. [PMID: 31733659 DOI: 10.1071/py19132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/05/2019] [Indexed: 02/28/2024]
Abstract
Health behaviour during midlife is linked to health outcomes in older age. Primary healthcare providers (PHCPs) are ideally placed to provide health-promoting information opportunistically to women in midlife. The aim of this study was to explore PHCPs views about the menopause-related care needs of migrant women from low- and middle-income countries and what they perceive as barriers and enablers for providing this. Of the 139 PHCPs who responded to an anonymous online survey, less than one-third (29.9%) routinely offered menopause-related information during consultations with migrant women. Most agreed that short appointments times (70.8%), lack of culturally and linguistically appropriate menopause information (82.5%) and lack of confidence in providing menopause-related care (32.5%) are barriers for providing comprehensive menopause-related care to migrant women. To overcome these, a menopause-specific Medicare item number and a one-stop website with health information in community languages were suggested. These findings suggest that menopause-related care is not routinely offered by PHCPs to migrant women from low- and middle- income countries and that their capacity to do this may be improved with adequate educational and structural support.
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Affiliation(s)
- Karin A Stanzel
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, Vic. 3004, Australia; and Corresponding author
| | - Karin Hammarberg
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, Vic. 3004, Australia
| | - Jane Fisher
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, Vic. 3004, Australia
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Staniforth R, Such E. Public health practitioners' perspectives of migrant health in an English region. Public Health 2019; 175:79-86. [PMID: 31442610 DOI: 10.1016/j.puhe.2019.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/10/2019] [Accepted: 06/30/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Migration is a complex and contested topic of public debate. Professionals working in public health must negotiate this politicised complexity, yet few studies examine the perspectives and practices of public health professionals in relation to migrant health. This study seeks to redress this by exploring how migrant health is conceptualised and addressed by public health professionals after a key transitional point in the reorganisation of public health in England and the public vote for the UK to leave the EU. STUDY DESIGN This is a qualitative in-depth exploratory study. METHODS Ten interviews and one focus group were conducted with 14 public health professionals working at Public Health England or local authorities in an English region. Recordings were transcribed, and thematic analysis was conducted. RESULTS Professionals viewed migrant health mainly through a health inequalities lens; migrants were considered vulnerable, and their health was often determined by wider social issues. This influenced public health professionals' perceived ability to affect change. Public health professionals were greatly influenced by the societal, policy and institutional, post-Brexit vote context in England, describing nervousness around addressing migrant health. At an institutional level, public health professionals described a sense that migrant health was not prioritised. It was considered 'too hard' and complex, especially with shrinking resources and highly politicised social narratives. Consequently, migrant health was often not directly addressed in current practice. The gaps identified by public health professionals were as follows: lack of knowledge of health needs and cultural difference; lack of access to appropriate training; lack of cultural diversity within the public health workforce; and concerns about meaningful community engagement. CONCLUSIONS These findings raise concerns about public health professionals' ability to address the health needs of migrants living in England. The gaps highlighted require further and deeper examination across relevant organisations including the broader public health infrastructure in the UK.
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Affiliation(s)
- R Staniforth
- Public Health, School of Health and Related Research, Regent Street, Sheffield, S1 4DP, UK.
| | - E Such
- Public Health, School of Health and Related Research, Regent Street, Sheffield, S1 4DP, UK
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19
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Harrison HL, Daker-White G. Beliefs and challenges held by medical staff about providing emergency care to migrants: an international systematic review and translation of findings to the UK context. BMJ Open 2019; 9:e028748. [PMID: 31371292 PMCID: PMC6677953 DOI: 10.1136/bmjopen-2018-028748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Migration has increased globally. Emergency departments (EDs) may be the first and only contact some migrants have with healthcare. Emergency care providers' (ECPs) views concerning migrant patients were examined to identify potential health disparities and enable recommendations for ED policy and practice. DESIGN Systematic review and meta-synthesis of published findings from qualitative studies. DATA SOURCES Electronic databases (Ovid Medline, Embase (via Ovid), PsycINFO (via OVID), CINAHL, Web of Science and PubMed), specialist websites and journals were searched. ELIGIBILITY CRITERIA Studies employing qualitative methods published in English. SETTINGS EDs in high-income countries. PARTICIPANTS ECPs included doctors, nurses and paramedics. TOPIC OF ENQUIRY Staff views on migrant care in ED settings. DATA EXTRACTION AND SYNTHESIS Data that fit the overarching themes of 'beliefs' and 'challenges' were extracted and coded into an evolving framework. Lines of argument were drawn from the main themes identified in order to infer implications for UK policy and practice. RESULTS Eleven qualitative studies from Europe and the USA were included. Three analytical themes were found: challenges in cultural competence; weak system organisation that did not sufficiently support emergency care delivery; and ethical dilemmas over decisions on the rationing of healthcare and reporting of undocumented migrants. CONCLUSION ECPs made cultural and organisational adjustments for migrant patients, however, willingness was dependent on the individual's clinical autonomy. ECPs did not allow legal status to obstruct delivery of emergency care to migrant patients. Reported decisions to inform the authorities were mixed; potentially leading to uncertainty of outcome for undocumented migrants and deterring those in need of healthcare from seeking treatment. If a charging policy for emergency care in the UK was introduced, it is possible that ECPs would resist this through fears of widening healthcare disparities. Further recommendations for service delivery involve training and organisational support.
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Affiliation(s)
- Hooi-Ling Harrison
- Emergency Department, Princess Royal University Hospital, King’s College London School of Medical Education, London, UK
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20
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Bell S, Edelstein M, Zatoński M, Ramsay M, Mounier-Jack S. 'I don't think anybody explained to me how it works': qualitative study exploring vaccination and primary health service access and uptake amongst Polish and Romanian communities in England. BMJ Open 2019; 9:e028228. [PMID: 31289079 PMCID: PMC6615777 DOI: 10.1136/bmjopen-2018-028228] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This study explored vaccination attitudes and behaviours among Polish and Romanian communities, and related access to primary healthcare services. DESIGN A qualitative study using in-depth semistructured interviews with Polish and Romanian community members (CMs) and healthcare workers (HCWs) involved in vaccination in areas with large Polish and Romanian communities. CMs discussed their vaccination attitudes and their experiences of accessing vaccinations in England. HCWs shared their experiences in vaccinating Polish and Romanian communities. SETTING Recruitment focused on three geographical areas in England with large Polish and Romanian populations (in London, Lincolnshire and Berkshire). PARTICIPANTS 20 Polish and 10 Romanian CMs, and 20 HCWs. Most CMs were mothers or pregnant women and were recruited from London or Lincolnshire. HCWs included practice nurses, health visitors and school nurses recruited from the targeted geographical areas. RESULTS Although most CMs reported vaccinating according to the UK schedule, obstacles to vaccination were highlighted. CMs experienced difficulties navigating and trusting the English primary healthcare system, and challenges in accessing credible vaccination information in Polish and Romanian. CM vaccination expectations, largely built on knowledge and experiences from Poland and Romania, were often unmet. This was driven by differences in vaccination scheduling and service provision in England, such as nurses delivering vaccines instead of doctors. CMs reported lower acceptance of the influenza vaccine, largely due to perceptions around the importance and efficacy of this vaccine. HCWs reported challenges translating and understanding vaccination histories, overcoming verbal communication barriers and ensuring vaccination schedule completeness among families travelling between England and Poland or Romania. CONCLUSIONS This study identified vaccination uptake and delivery issues and recommendations for improvement. HCWs should discuss health service expectations, highlight differences in vaccination scheduling and delivery between countries, and promote greater understanding of the English primary healthcare system in order to encourage vaccination in these communities.
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Affiliation(s)
- Sadie Bell
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Edelstein
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
| | | | - Mary Ramsay
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Tavares AM, Garcia AC, Gama A, Abecasis AB, Viveiros M, Dias S. Tuberculosis care for migrant patients in Portugal: a mixed methods study with primary healthcare providers. BMC Health Serv Res 2019; 19:233. [PMID: 30999913 PMCID: PMC6472083 DOI: 10.1186/s12913-019-4050-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/28/2019] [Indexed: 01/01/2023] Open
Abstract
Background Tuberculosis (TB) is still a major global health problem. The increasing number of cases observed among foreign-born populations contrasts with the decreasing trends observed in later years in some high-income countries. Healthcare providers are key interveners in the control of TB and HIV-TB infections. In this study, we aimed to explore the perspectives of healthcare providers working in primary care in Portugal about the provision of TB care for migrant patients with TB or HIV-TB co-infection. Methods We applied a mixed-methods approach using an online survey and semi-structured interviews with primary healthcare providers. A total of 120 Portuguese healthcare providers participated in the survey, and 17 were interviewed. Survey and interview data were analysed applying descriptive statistics and thematic analysis, respectively. Results Migrants’ lack of knowledge on TB disease and its symptoms was the main reason for advanced-stage presentation of cases. Their high mobility and social isolation affect adherence to treatment. The providers also listed several barriers to migrants’ access and use of TB care. The most frequently referred were limited socioeconomic resources, complex bureaucracy at the point of access and registration for healthcare services, especially for undocumented migrants, and obstacles for social protection. Providers also advocated more training initiatives on migrants’ health, social and cultural contexts, on HIV and TB integrated care, and on TB scientific update for general practitioners and nurses working at primary healthcare centres. Conclusions Future efforts should provide measures to overcome social, economic and administrative obstacles to care for TB-infected migrants, and promote regular training initiatives for national healthcare providers in order to raise awareness and facilitate better care to culturally diverse populations with TB.
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Affiliation(s)
- Ana Maria Tavares
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisbon, Portugal.
| | - Ana Cristina Garcia
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisbon, Portugal.,Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA), Av. Padre Cruz, 1649-016, Lisbon, Portugal
| | - Ana Gama
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal
| | - Ana B Abecasis
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisbon, Portugal
| | - Miguel Viveiros
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisbon, Portugal
| | - Sónia Dias
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisbon, Portugal.,Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal
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Bridgwood B, Park J, Hawcroft C, Kay N, Tang E. International exchanges in primary care-learning from thy neighbour. Fam Pract 2018; 35:247-252. [PMID: 29045622 DOI: 10.1093/fampra/cmx101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/15/2017] [Indexed: 11/12/2022] Open
Abstract
This systematic review describes how international exchange programmes in primary care have been received and evaluated. Electronic databases (MEDLINE, Embase, PsycINFO, EBM reviews, CAB abstracts and PubMED) were searched to identify articles where the main focus of the study was exchanges undertaken in primary care/family medicine until March 2016. Articles were included if they (i) discussed participant exchanges in primary care; (ii) presented associated outcome data-this included (a) individual/group experience of exchange; (b) mechanism of exchange and (c) observations during the exchange. A narrative synthesis was performed of the heterogeneous data identified. Twenty-nine studies were included. Exchange locations varied across the world with the largest number in Europe. Participants came from a range of backgrounds including medical students, nurses, General Practitioners (GP), GP trainees (GPTs) and visiting scholars/professors. Exchange duration ranged from 3 days to 2 years. Key themes were identified from analysis of the studies with illustrative quotes from the included studies provided. Four key areas were discussed in relation to exchange experience: learning opportunities and new knowledge; comparative observation; knowledge gained and translational learning. Primary care international exchanges provide a rich source of cross-country learning. This review identified that exchange participants benefit both personally and professionally, equipping them with translatable skills to improve the care provided to their patients.
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Affiliation(s)
| | - John Park
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Claire Hawcroft
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Eugene Tang
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Abstract
INTRODUCTION The migration of large numbers of people and refugees induces various fears in their receiving countries; the arrival of potential terrorists, and, among others, the negative impact that their need for health care can have on the sustainability of health services. In this sense, migrants are considered by many a threat. METHOD In this brief "letter narrative", based on the experience gained in the treatment of various diseases of the perineum, I mean to suggest that the perineal disorders, especially in women, is common event, shared by women of different ethnicity, culture, and religion. Moreover, they do not threaten the sustainability of health services. DICUSSION AND CONCLUSION For the scientific community, there is a need for greater attention and conscious analysis of pathologies and fundamental human rights that accompany these populations to better understand the scope and value also in terms of scientific research in this epochal event.
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Affiliation(s)
- Michele Rubbini
- Programma di Chirurgia Coloproctologica Dept. of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
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