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Veilleux M, Terrier JE, Bécu M, Lafon M, Bourmaud A, Martin P. Perceptions, expectations, and recommendations of trans adults on gender-affirming care in France: a qualitative study. BMC Public Health 2024; 24:2177. [PMID: 39135007 PMCID: PMC11318127 DOI: 10.1186/s12889-024-19593-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/26/2024] [Indexed: 08/16/2024] Open
Abstract
Trans people have diverse life experiences which may include gender-affirming care (GAC). GAC positively impacts the quality of life of trans adults. However, they are often met with barriers to care and are particularly vulnerable within the healthcare system. The needs and expectations surrounding GAC may vary between individual patients. This article aims to analyze trans adults' perceptions, expectations, and recommendations on GAC. Twenty-seven semi-structured interviews were conducted by a team of academic and peer researchers; transcribed interviews were then analyzed using a codebook and thematic analysis. Three main themes were identified; the liberating experience of GAC; the uneven distribution of knowledge and power between patients and providers; and the recommended practices in GAC. Additional training and research are necessary to facilitate high-quality care for trans adults accessing GAC.
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Affiliation(s)
| | | | | | | | - Aurélie Bourmaud
- Inserm CIC-EC1426 Robert Debré Hospital, Paris, France
- Université Paris Cité, Inserm U1123 ECEVE, Paris, France
| | - Philippe Martin
- Inserm CIC-EC1426 Robert Debré Hospital, Paris, France.
- Université Paris Cité, Inserm U1123 ECEVE, Paris, France.
- Institut National d'Etudes Démographiques (INED), UR14 - Sexual and Reproductive Health and Rights, Aubervilliers, France.
- GDID Santé, Paris, France.
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Strand M, Bäärnhielm S, Fredlund P, Brynedal B, Welch E. Migration background, eating disorder symptoms and healthcare service utilisation: findings from the Stockholm Public Health Cohort. BJPsych Open 2023; 9:e205. [PMID: 38299620 PMCID: PMC10753962 DOI: 10.1192/bjo.2023.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 09/09/2023] [Accepted: 10/05/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND From a global perspective, eating disorders are increasingly common, probably because of societal transformation and improved detection. However, research on the impact of migration on the development of eating disorders is scarce, and previously reported results are conflicting. AIMS To explore if eating disorder symptom prevalence varies according to birth region, parents' birth region and neighbourhood characteristics, and analyse if the observed patterns match the likelihood of being in specialist treatment. METHOD This study uses data from a large population-based health survey (N = 47 662) among adults in Stockholm, Sweden. A general linear model for complex samples, including adjustment for gender and age, was used to explore self-reported eating disorder symptoms. Odds ratios were calculated for individual symptoms. RESULTS Eating disorder symptoms are substantially more common in individuals born abroad, especially for migrants from a non-European country. This holds true for all surveyed symptoms, including restrictive eating (odds ratio 5.5, 95% CI 4.5-6.7), compensatory vomiting (odds ratio 6.1, 95% CI 4.6-8.0), loss-of-control eating (odds ratio 2.6, 95% CI 2.3-3.1) and preoccupation with food (odds ratio 2.3, 95% CI 1.9-2.8). Likewise, symptoms are more common in individuals with both parents born abroad and individuals living in districts with a high percentage of migrant residents. A gap exists between district-level symptom scores and the likelihood of being in specialist eating disorder treatment. CONCLUSIONS These findings call for oversight of current outreach strategies, and highlight the need for efforts to reduce stigma and increase eating disorder symptom recognition in broader groups.
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Affiliation(s)
- Mattias Strand
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; and Transcultural Centre, Northern Stockholm Psychiatry, Stockholm Health Care Services, Region Stockholm, Sweden
| | - Sofie Bäärnhielm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; and Transcultural Centre, Northern Stockholm Psychiatry, Stockholm Health Care Services, Region Stockholm, Sweden
| | - Peeter Fredlund
- Centre for Epidemiology and Community Medicine, Region Stockholm, Sweden; and Department of Global Public Health, Karolinska Institutet, Sweden
| | - Boel Brynedal
- Centre for Epidemiology and Community Medicine, Region Stockholm, Sweden; and Department of Global Public Health, Karolinska Institutet, Sweden
| | - Elisabeth Welch
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; and Department of Women's and Children's Health, Uppsala University, Sweden
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Hall K, Ono M, Kohno A. British and Japanese international retirement migration and creative responses to health and care challenges: a bricolage perspective. COMPARATIVE MIGRATION STUDIES 2021; 9:7. [PMID: 33654657 PMCID: PMC7906765 DOI: 10.1186/s40878-020-00217-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
Most research on international retirement migration has focused on the Western context and the motivations and lifestyle choices of migrants when they are healthy. This paper instead explores how British retirees in Spain and Japanese retirees in Malaysia respond to declining health and increasing care needs through bricolage as they begin to 'age in place'. The paper combines qualitative interviews, focus groups and observations collected by the authors from 215 British and Japanese international retirement migrants. We focus on two key types of bricolage behaviour: 'within-system bricolage' undertaken by migrants to help them access and navigate existing health and care systems; and 'added-to-system bricolage' that is enacted to fill gaps in health and care provision. Our analysis suggests that IRMs engage in 'transnational care bricolage' by combining multiple economic, social and legal resources across local and transnational spaces to address their health and care needs.
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Affiliation(s)
- Kelly Hall
- University of Birmingham, Birmingham, UK
| | - Mayumi Ono
- Notre Dame Seishin University, Okayama, Japan
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Samkange-Zeeb F, Samerski S, Doos L, Humphris R, Padilla B, Bradby H. "It's the First Barrier" - Lack of Common Language a Major Obstacle When Accessing/Providing Healthcare Services Across Europe. FRONTIERS IN SOCIOLOGY 2020; 5:557563. [PMID: 33869495 PMCID: PMC8022480 DOI: 10.3389/fsoc.2020.557563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/12/2020] [Indexed: 06/12/2023]
Abstract
International migration is shaping and changing urban areas as well as impacting on healthcare access and provision in Europe. To investigate how residents of superdiverse neighborhoods put together their healthcare, we conducted qualitative interviews with 76 healthcare providers and 160 residents in four European cities - Bremen, Germany; Birmingham, UK; Lisbon, Portugal and Uppsala, Sweden, between September 2015 and April 2017. A common theme arising from the data was language and communication obstacles, with both healthcare providers and users experiencing language difficulties, despite all four countries having interpretation policies or guidelines to address language barriers in healthcare. Official interpreter services were seen to be unreliable and sometimes of poor quality, leading to a reliance on informal interpretation. Some coping strategies used by both service providers and users led to successful communication despite the lack of a common language. Where communication failed, this led to feelings of dissatisfaction and frustration among both users and providers. Language difficulties came up across all participating countries even though this was not prompted by interview questions, which highlights the widespread nature of language barriers and communication barriers and the need to address them in order to promote equal accessibility to good quality healthcare.
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Affiliation(s)
- Florence Samkange-Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Silja Samerski
- Faculty of Social Work and Health, University of Applied Sciences Emden/Leer, Emden, Germany
| | - Lucy Doos
- Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, United Kingdom
| | - Rachel Humphris
- School of Politics and International Relations, Queen Mary University of London, London, United Kingdom
| | - Beatriz Padilla
- Department of Sociology, University of South Florida, Tampa, FL, United States
- Centre for Research and Studies in Sociology, ISCTE – Instituto Universitário de Lisboa, Lisbon, Portugal
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
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Samkange-Zeeb F, Borisova L, Padilla B, Bradby H, Phillimore J, Zeeb H, Brand T. Superdiversity, migration and use of internet-based health information - results of a cross-sectional survey conducted in 4 European countries. BMC Public Health 2020; 20:1263. [PMID: 32819317 PMCID: PMC7439663 DOI: 10.1186/s12889-020-09329-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies of factors associated with the use of Internet-based health information generally focus on general, rather than migrant populations. This study looked into the reasons why Internet-based health information is used and the effects of migration-related factors, other socio-demographic characteristics and health-related factors on the tendency to consult the Internet. METHODS In a cross-sectional survey conducted in eight superdiverse neighbourhoods - two each in Birmingham, United Kingdom; Bremen, Germany; Lisbon, Portugal and Uppsala, Sweden - participants were presented with six scenarios and asked to indicate the resources they most relied on when addressing a health concern from a given list. The scenarios included establishing the underlying causes of a health concern and seeking information about prescription drugs, treatments and services available as part of the public healthcare system. The list of resources included the public healthcare system, alternative medicine, family and friends, and the Internet. Frequencies for which the Internet was consulted for each different scenario were calculated and compared across the participating cities. The association between consulting Internet-based health information and migration-related factors, and further socio-demographic characteristics as well as health-related factors such as self-reported health and health literacy was assessed using multivariable logistic regressions. RESULTS Of the 2570 participants from all four cities who were included in the analyses, 47% had a migrant background and 35% originated from non-EU countries. About a third reported relying on Internet-based health information for at least one of the given scenarios. The two most frequently chosen scenarios were to find out about other possible treatments and prescription drugs. Generally, using Internet-based health information was negatively associated with being a first generation migrant (OR 0.65; 95% CI 0.46-0.93), having poor local language competency (OR 0.25; 95% CI 0.14-0.45), older age (≥60 years, OR 0.21; 95% CI 0.15-0.31), low education (OR 0.35; 95% CI 0.24-0.50) and positively associated with low trust in physicians (OR 2.13; 95% CI 1.47-3.10). CONCLUSION Our findings indicate the need to consider migration background and language competency when promoting the provision of healthcare services via the Internet so that information and services are widely accessible.
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Affiliation(s)
- Florence Samkange-Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany
| | - Liubov Borisova
- Department of Sociology, Uppsala University, Box 624, Se-751 26, Uppsala, Sweden
| | - Beatriz Padilla
- Department of Sociology, University of South Florida, 42 E Fowler Ave, Tampa, FL, 33620-5550, USA.,Instituto Universitario de Lisboa (ISCTE-IUL), Avenida das Forcas Armadas, 1649-026, Lisbon, Portugal
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Box 624, Se-751 26, Uppsala, Sweden
| | - Jenny Phillimore
- School of Social Policy, Sociology and Criminology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, Great Britain
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany. .,Health Sciences Bremen, University of Bremen, Bibliothekstr.1, 28359, Bremen, Germany.
| | - Tilman Brand
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany
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Bradby H, Lindenmeyer A, Phillimore J, Padilla B, Brand T. 'If there were doctors who could understand our problems, I would already be better': dissatisfactory health care and marginalisation in superdiverse neighbourhoods. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:739-757. [PMID: 32020646 PMCID: PMC7318273 DOI: 10.1111/1467-9566.13061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
How people in community settings describe their experience of disappointing health care, and their responses to such dissatisfaction, sheds light on the role of marginalisation and underlines the need for radically responsive service provision. Making the case for studying unprompted accounts of dissatisfaction with healthcare provision, this is an original analysis of 71 semi-structured interviews with healthcare users in superdiverse neighbourhoods in four European cities. Healthcare users spontaneously express disappointment with services that dismiss their concerns and fail to attend to their priorities. Analysing characteristics of these healthcare users show that no single aspect of marginalisation shapes the expression of disappointment. In response to disappointing health care, users sought out alternative services and to persuade reluctant service providers, and they withdrew from services, in order to access more suitable health care and to achieve personal vindication. Promoting normative quality standards for diverse and diversifying populations that access care from a range of public and private service providers is in tension with prioritising services that are responsive to individual priorities. Without an effort towards radically responsive service provision, the ideal of universal access on the basis of need gives way to normative service provision.
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Affiliation(s)
| | | | - Jenny Phillimore
- Institute for Research into Superdiversity (IRiS)School of Social PolicyUniversity of BirminghamBirminghamUK
| | - Beatriz Padilla
- Department of SociologyUniversity of South FloridaTampaUSA
- Instituto Universitario de Lisboa (ISCTE‐IUL)LisbonPortugal
| | - Tilman Brand
- Department Prevention and EvaluationLeibniz Institute for Prevention Research and Epidemiology – BIPSBremenGermany
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