Factors that affect the health of immigrants: Qualitative meta synthesis

BACKGROUND

Migration has challenged society. Most people who move do so for economic reasons, but others move for more tragic reasons. The proportion of female migrants was slightly higher than that of male migrants, partly due to the longer life expectancy of women and the higher demand for female migrants in care-related Jobs. The process may affect migrants' health, particularly in countries where healthcare is associated with high economic costs or insurance availability. A global systematic review of qualitative studies with meta-synthesis was conducted. The results can be used to support health policy and clinical practice.

OBJECTIVE

To describe how migrants perceive and experience the process of migrating and how it affects their health.

SEARCH STRATEGY

Databases consulted were Medline, PsychInfo, Cuiden, Cinahl, WOS, Scopus, Social Science Database, and Epistemonikos. Thirty-four articles were selected for final meta-synthesis.

INCLUSION CRITERIA

All qualitative primary studies were included that describe the experiences or perceptions of migrants and refugees over 18 years that talk about their migration process and the impact on their health; written in English or Spanish between 2016 and 2021. Articles referring to second generations and those dealing with pathologies that pre-date the migration process were excluded.

DATA EXTRACTION AND SYNTHESIS

The COREQ and JBI templates were used as quality criteria. Studies mostly used a phenomenological methodology and in-depth interviews, both individual and group, were used for data collection and narrative synthesis.

MAIN RESULTS

Uncertainty emerges as a main category. Three other interrelated themes have a direct impact on migrants' health: Language, Social Networks and Work. There are several conditions in each of these that have a positive or negative impact on health. The gender condition appears in both work and social networks, positively and negatively.

DISCUSSION AND CONCLUSIONS

Health would be improved by having a stable job, which would facilitate access to health resources. Social networks and language are facilitators of access to a better job, but not the only condition. From a gender perspective, social networks can become a source of health problems, especially for women. The process of migration places women in a position of vulnerability due to the difficulties of reconciling family and work life. Job insecurity, workload, loss of family life or social isolation increase hopelessness and anxiety, leading to health problems.

PUBLIC OR PATIENT CONTRIBUTION

As an academic review study, no patient contribution was required, and this study serves as a theoretical framework for more in-depth research that will work with migrant populations. As a public contribution, this work provides evidence of the need to improve access to health for some populations, in line with the Sustainable Development Goals (SDGs) set for 2030.

Strategies for improving access to primary care services for homeless immigrants in England: a Delphi study

AIM

The aim of the study was to identify the most prioritized strategies in improving access to primary care services (PCS) for homeless immigrants.

BACKGROUND

The issue of improving access to PCS for homeless immigrants is a complex and multifaceted one, and yet there is limited research on the strategies aimed at improving these services. Hence, the need for more studies that directly engage homeless immigrants and service providers in understanding their barriers to accessing PCS and their preferences for improving access to these services.

METHODS

The study used a two round Delphi method to elicit the views of stakeholders. The Delphi process utilized a web-based questionnaire. The stakeholders included healthcare providers and voluntary sector providers. The first round had a total of 58 items belonging to 14 categories. The second round comprised a total of 25 items belonging to 12 categories which were preselected based on participants' ranking of their importance in the first round. Participants were required to rank the relative importance of all the items on a 5-point Likert scale. Data were analysed using the STATA-15 software package.

FINDINGS

A total of 12 stakeholders participated in both rounds of the Delphi survey. The top three strategies encompassed fighting against discrimination and prejudice, improving and promoting mental health services, and empowering homeless immigrants. These evidence-based strategies hold the potential to support the implementation of healthcare interventions aimed at improving access to PCS and healthcare outcomes for homeless immigrants. However, it is crucial to conduct further research that includes homeless immigrants in the Delphi study to gain insights into the strategies that are most important to them in enhancing access to PCS, as they are the primary target users. Such research will contribute to the development of comprehensive and effective interventions tailored to the specific needs of homeless.

Job exhaustion among assigned and self-initiated expatriates – the role of effort and reward

Purpose

This study explores whether expatriation type (assigned expatriates (AEs) versus self-initiated expatriates (SIEs)) is linked to job exhaustion via possible differences in required efforts for their jobs and the rewards they gain from them, and/or the balance between efforts and rewards. Adopting effort–reward imbalance (ERI) and job demands/resources (JD-R) theories, the authors study the possible role of ERI as a mediator between expatriation type and job exhaustion.

Design/methodology/approach

An online survey was carried out in co-operation with two Finnish trade unions, providing representative data from 484 assigned and SIEs. The authors test this study’s hypotheses through latent structural equation modelling, and the analysis was conducted with Stata 17.0 software.

Findings

The results show that ERI between them are correlated with the job exhaustion of expatriates in general and there are no direct links between expatriation type and job exhaustion. The required effort from AEs was higher than that from SIEs though no difference was found for rewards, and the match between effort demands and rewards is less favourable for AEs than SIEs. AEs experienced higher job exhaustion than SIEs because of the higher effort demands and greater imbalance between efforts and rewards.

Originality/value

The study examines the work well-being of two types of expatriates and explores the underlying mechanisms that may explain why they may differ from each other.

How do Individuals Form Their Motivations to Expatriate? A Review and Future Research Agenda

For two decades, individual motivations to expatriate have received substantial attention in the expatriation literature examining self-initiated and assigned expatriation. Recently, however, this literature has changed direction, demonstrating that prior to forming their actual motivations, individuals undergo a process wherein they actively form those motivations. No review has yet unraveled this motivation process, and this systematic literature review fills this gap. Using the Rubicon Action model that discusses the motivation process of expatriation, this article demonstrates that for self-initiated and assigned expatriation, individuals follow similar processes: expatriation expectations are formed; then, they are evaluated; and finally, preferences are built that result in motivations to expatriate. Findings for each stage are discussed in light of their contributions to the expatriation literature. For major gaps, new research suggestions are offered to advance our understanding of the individual motivation process that expats experience prior to forming their motivations to move abroad.

A grounded theory approach to understand the Portuguese emerging adult self-initiated expatriates’ cross-cultural adaptation in the United Kingdom

Purpose

The purpose of this paper is to inductively develop a model of cross-cultural adaptation for emerging adult self-initiated expatriates (SIEs).

Design/methodology/approach

Data were collected through semi-structured interviews with 18 Portuguese emerging adult SIEs, aged between 18 and 29 years, residing in the UK from 5 months to 2 years. The analysis of these interviews through a grounded theory, using computer-assisted qualitative data analysis software (Atlas.ti), allowed describing what constitutes participants’ cross-cultural adaptation and what are its determinants.

Findings

Five dimensions of cross-cultural adaptation emerged (cultural, emotional, social, practical and work), along with 18 determinants related with four different levels: personal, interpersonal, societal and situational. These determinants are related with the pre- and post-relocation phases of participants’ expatriation experience and some of them act as buffers, capturing a more integrative picture of the cross-cultural adaption process.

Research limitations/implications

In order to enhance the validity of the inductively identified relationships between cross-cultural adaptation and its determinants, the authors consider that they could be empirically tested.

Originality/value

This study points to several contributions in the fields of cross-cultural adaptation, emerging adulthood and self-initiated expatriation. By considering this study’s sample, the authors contributed to Farcas and Gonçalves’ (2016) call for more research focusing on emerging adult SIEs. In doing so, the authors simultaneously addressed the gap in the emerging adulthood literature regarding the focus on non-university samples of emerging adults. The methodology of this study can also be considered a contribution. By conducting interviews with emerging adult SIEs and analyzing them through a grounded theory approach, the authors were able to develop a model of cross-cultural adaptation. To the best of the authors’ knowledge, this is the first model which was inductively developed, enabling a broad understanding of emerging adult SIEs’ cross-cultural adaptation, in terms of what constitutes and influences it.

“Life if elsewhere”

Purpose

The purpose of this paper is to examine the motives of female childless self-initiated expatriates (SIEs) in deciding to work abroad, so far under-researched.

Design/methodology/approach

The study departs from prior research in using a new methodological approach, i.e. the analysis of online diaries (blogs) to explore the motives of a specific population to relocate.

Findings

The emergent model of motivations is based upon four main dimensions that emerged from the socially constructed experience of these single childless female SIEs: escape as main motivation, confrontation to reality, identity reconstruction and purpose of expatriation.

Originality/value

The findings reveal new elements of motivations to move abroad such as the complete absence of the notion of career from the blog posts, replaced, however, by a feminist and existentialist reflection.