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23 pages, 731 KiB

Open AccessArticle

Re-Envisioning an Early Years System of Care towards Equity in Canada: A Critical, Rapid Review

by Alison Jayne Gerlach and Alysha McFadden

Int. J. Environ. Res. Public Health 2022, 19(15), 9594; https://doi.org/10.3390/ijerph19159594 - 4 Aug 2022

Cited by 2 | Viewed by 3868

Abstract

Background: Many children in high-income countries, including Canada, experience unjust and preventable health inequities as a result of social and structural forces that are beyond their families’ immediate environment and control. In this context, early years programs, as a key population health initiative, [...] Read more.

Background: Many children in high-income countries, including Canada, experience unjust and preventable health inequities as a result of social and structural forces that are beyond their families’ immediate environment and control. In this context, early years programs, as a key population health initiative, have the potential to play a critical role in fostering family and child wellbeing. Methods: Informed by intersectionality, this rapid literature review captured a broad range of international, transdisciplinary literature in order to identify promising approaches for orienting early years systems of care towards equity in Canada. Results: Findings point to the need for a comprehensive, integrated and socially responsive early years system that has top-down political vision, leadership and accountability and bottom-up community-driven tailoring with an explicit focus on health promotion and maternal, family and community wellness using relational approaches. Conclusions: Advancing child health equity in wealthy countries requires structural government-level changes that support cross-ministerial and intersectoral alliances. Employing intersectionality in this rapid review promotes contextualized and nuanced understandings of what is needed in order to advance a responsive, comprehensive and quality early years system of equity-oriented care. Further research is needed to prevent child health inequities that are disproportionally experienced by Indigenous and racialized children in wealthy countries such as Canada. olicy and research recommendations that have relevance for high-income countries in diverse global contexts are discussed. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

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18 pages, 1362 KiB

Open AccessArticle

Health Status and Access to Healthcare for Uninsured Migrants in Germany: A Qualitative Study on the Involvement of Public Authorities in Nine Cities

by Lukas Kratzsch, Kayvan Bozorgmehr, Joachim Szecsenyi and Stefan Nöst

Int. J. Environ. Res. Public Health 2022, 19(11), 6613; https://doi.org/10.3390/ijerph19116613 - 28 May 2022

Cited by 4 | Viewed by 2791

Abstract

Non-governmental organisations (NGOs) regularly report data on their work with uninsured migrants (UM) within a (so-called) parallel health care system. The role and involvement of public authorities therein have yet been underrepresented in research. Our aim was to gain a better understanding of [...] Read more.

Non-governmental organisations (NGOs) regularly report data on their work with uninsured migrants (UM) within a (so-called) parallel health care system. The role and involvement of public authorities therein have yet been underrepresented in research. Our aim was to gain a better understanding of public authorities’ role in the parallel health care system and their view of the health situation of UM. We conducted qualitative semi-structured interviews with 12 experts recruited by purposive sampling from local public health authorities (LPHAs), state-level public health authorities (SPHAs), and social services offices (SSO) in nine cities, recorded, transcribed, and subjected the data to qualitative content analysis. LPHAs are more often directly involved in providing medical services, while SSOs and SPHAs function as gatekeepers for access to social benefits, including health insurance, and in grant-funded projects. NGOs keep substituting for the lack of access to regular health care from public institutions, but even in settings with extended services, public authorities and NGOs have not been able to provide sufficient care through the parallel health care system: Experts report gaps in the provision of health care with respect to the depth and height of coverage, due to the fragmentation of services and (ostensible) resource scarcity. Our study highlights the necessity for universal access to regular health care to overcome the fragmentation of services and improve access to needed health care for UM in Germany. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

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17 pages, 358 KiB

Open AccessArticle

Assessing Virtual Mental Health Access for Refugees during the COVID-19 Pandemic Using the Levesque Client-Centered Framework: What Have We Learned and How Will We Plan for the Future?

by Michaela Hynie, Annie Jaimes, Anna Oda, Marjolaine Rivest-Beauregard, Laura Perez Gonzalez, Nicole Ives, Farah Ahmad, Ben C. H. Kuo, Neil Arya, Nimo Bokore and Kwame McKenzie

Int. J. Environ. Res. Public Health 2022, 19(9), 5001; https://doi.org/10.3390/ijerph19095001 - 20 Apr 2022

Cited by 16 | Viewed by 4930

Abstract

During the COVID-19 pandemic, mental health services rapidly transitioned to virtual care. Although such services can improve access for underserved populations, they may also present unique challenges, especially for refugee newcomers. This study examined the multidimensional nature of access to virtual mental health [...] Read more.

During the COVID-19 pandemic, mental health services rapidly transitioned to virtual care. Although such services can improve access for underserved populations, they may also present unique challenges, especially for refugee newcomers. This study examined the multidimensional nature of access to virtual mental health (VMH) care for refugee newcomers during the COVID-19 pandemic, using Levesque et al.’s Client-Centered Framework for Assessing Access to Health Care. One hundred and eight structured and semi structured interviews were conducted in four Canadian provinces (8 community leaders, 37 newcomer clients, 63 mental health or service providers or managers). Deductive qualitative analysis, based on the Client-Centered Framework, identified several overarching themes: challenges due to the cost and complexity of using technology; comfort for VMH outside clinical settings; sustainability post-COVID-19; and communication and the therapeutic alliance. Mental health organizations, community organizations, and service providers can improve access to (virtual) mental health care for refugee newcomers by addressing cultural and structural barriers, tailoring services, and offering choice and flexibility to newcomers. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

15 pages, 1397 KiB

Open AccessArticle

Restriction of Access to Healthcare and Discrimination of Individuals of Sexual and Gender Minority: An Analysis of Judgments of the European Court of Human Rights from an Ethical Perspective

by Tobias Skuban, Marcin Orzechowski and Florian Steger

Int. J. Environ. Res. Public Health 2022, 19(5), 2650; https://doi.org/10.3390/ijerph19052650 - 24 Feb 2022

Cited by 6 | Viewed by 3092

Abstract

Individuals of sexual and gender minority (SGM) form a vulnerable group with specific healthcare needs that might be prone to experience discrimination and restrictions regarding their access to healthcare. As the judgments of the European Court of Human Rights (ECtHR) offer a normative [...] Read more.

Individuals of sexual and gender minority (SGM) form a vulnerable group with specific healthcare needs that might be prone to experience discrimination and restrictions regarding their access to healthcare. As the judgments of the European Court of Human Rights (ECtHR) offer a normative perspective on these issues, we analyzed them systematically (1) to identify whether and in what manner ECtHR’s judgments concern restriction of access to healthcare for SGM individuals and (2) to identify and categorize the ways of discrimination to which SGM individuals are exposed. We conducted a systematic search of the database of the ECtHR’s judgments with the use of specified search terms. Descriptive statistics were performed on the identified judgments. Subsequently, we analyzed the judgments with the use of a qualitative method of thematic analysis. We identified n = 73 cases relevant for our study. In n = 7 (9.59%) of judgments, we found limitations of access to healthcare for SGM individuals, e.g., in cases of restrictions for transsexual individuals to receive hormone or surgical therapy. We regard this as a specific form of discrimination. Furthermore, we identified five other categories of discrimination: restriction of parental rights, failure to respect one’s gender identity/sexual orientation, discrimination by jurisdiction, prohibition of promotion, and verbal/physical attacks. The ECtHR proves to have a balanced view on the sensitive topic of sexual self-determination condemning any form of discrimination or restriction of access to healthcare. However, there is a need for further research on discriminatory acts by other individuals, e.g., healthcare providers, rather than by public authorities. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

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12 pages, 1558 KiB

Open AccessArticle

Improving Timely Access to Diagnostic and Treatment Services for Lung Cancer Patients in KwaZulu-Natal, South Africa: Priority-Setting through Nominal Group Techniques

by Buhle Lubuzo, Khumbulani W. Hlongwana and Themba G. Ginindza

Int. J. Environ. Res. Public Health 2022, 19(4), 1918; https://doi.org/10.3390/ijerph19041918 - 9 Feb 2022

Cited by 3 | Viewed by 3024

Abstract

Background: Lung cancer is the most common cancer worldwide, and it disproportionately affects low-income countries (LICs), where over 58% of cases occur. It is an important public health concern, given its poor healthcare outcomes, yet it is under-researched compared to other cancers. Lung [...] Read more.

Background: Lung cancer is the most common cancer worldwide, and it disproportionately affects low-income countries (LICs), where over 58% of cases occur. It is an important public health concern, given its poor healthcare outcomes, yet it is under-researched compared to other cancers. Lung cancer is also very difficult for primary care physicians to diagnose. In many settings, health researchers and clinicians’ resort to engaging in collaborative efforts to determine the best way to implement evidence into routine clinical practice. Methods: This was a grounded theory study comprising seven experts providing oncological services. A Nominal Group Technique (NGT) was used to articulate ideas, identify key problems and reach consensus on the order of priorities for the identified problems. Results: The study findings revealed that access to healthcare facilities providing oncology services and diagnosis was the major barrier to lung cancer care. This was further exacerbated by the manner in which health systems are configured in South Africa. The priorities for the health providers were focused on the lack of specialized resources, whereby referral of patients suspected to have lung cancer was delayed and compounded by the limited availability of treatment. Conclusion: The inadequacy of supportive systems for access to healthcare services negates the government efforts to curb the rising lung cancer-related fatalities in South Africa. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

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18 pages, 371 KiB

Open AccessArticle

Fostering Collective Approaches in Supporting Perinatal Mental Healthcare Access for Migrant Women: A Participatory Health Research Study

by Kathleen Markey, Maria Noonan, Owen Doody, Teresa Tuohy, Tony Daly, Ciara Regan and Claire O’Donnell

Int. J. Environ. Res. Public Health 2022, 19(3), 1124; https://doi.org/10.3390/ijerph19031124 - 20 Jan 2022

Cited by 4 | Viewed by 3337

Abstract

Perinatal mental health is a growing public health concern. The mounting evidence examining the prevalence of perinatal mental illness identifies specific vulnerabilities and risk factors among migrant women. We know that migrant women experience persistent and systematic barriers in accessing healthcare and that [...] Read more.

Perinatal mental health is a growing public health concern. The mounting evidence examining the prevalence of perinatal mental illness identifies specific vulnerabilities and risk factors among migrant women. We know that migrant women experience persistent and systematic barriers in accessing healthcare and that healthcare services do not always respond appropriately to migrant women’s needs, highlighting the need for targeted interventions in supporting positive perinatal mental health among migrant women. The purpose of this participatory health research study was to explore perinatal mental healthcare for migrant women in Ireland, from the perspectives of a diverse range of stakeholders (healthcare service providers, community organisations/networks/associations and migrant women). A key focus of this study was to collaboratively explore solution-focused approaches to improving access to supports and healthcare services for migrant women experiencing perinatal mental illness. Following ethical approval, data were collected during three key convenings, utilising the design principles of world café philosophies. Thematic analysis led to the generation of the following two themes: Building Capability and Capacity and Empowering Migrant Women. The main conclusions lie in the provision of whole-system approaches in collectively, collaboratively and proactively planning strategies that address the many factors that affect access to healthcare services for migrant women experiencing perinatal mental illness. Drawing on the collective perspectives of a wide range of stakeholders, our innovative solution focused on providing recommendations aimed at strengthening supports and healthcare services for migrant women. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

16 pages, 688 KiB

Open AccessArticle

Refugees' Agency: On Resistance, Resilience, and Resources

by José Renkens, Els Rommes and Maria van den Muijsenbergh

Int. J. Environ. Res. Public Health 2022, 19(2), 806; https://doi.org/10.3390/ijerph19020806 - 12 Jan 2022

Cited by 10 | Viewed by 4038

Abstract

This study set out to answer the question ‘Which kinds of agency do refugees perform when dealing with mental health problems of themselves and their children?’. Aiming to gain more insight in why it seems harder for refugee parents and minors than for [...] Read more.

This study set out to answer the question ‘Which kinds of agency do refugees perform when dealing with mental health problems of themselves and their children?’. Aiming to gain more insight in why it seems harder for refugee parents and minors than for the native population to talk to health professionals about their mental health and wellbeing, we combined two theoretical notions of agency to investigate a broad spectrum of informants’ behaviour. We conducted 25 interviews with 30 refugees from 8 countries (Syria, Yemen, Iran, Afghanistan, Armenia, Eritrea, Turkish Kurdistan, Vietnam), whose Dutch residence permit varied from 26 years to less than one year. Data were analysed through open and axial coding, followed by pattern analyses. Although sometimes refugees seek (mental) healthcare, at other times they show agency by doing ‘nothing’ or by deliberately using distracting activities to deal with severe stress. Making use of resources available to them, oftentimes refugees show agency in ways that are less visible to healthcare professionals, by surviving, showing resilience, and suffering. In these cases, we think healthcare for refugees should intervene in a non-medical way, e.g., by supporting them to obtain resources that help refugees to (re)gain agency. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

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16 pages, 617 KiB

Open AccessArticle

The Association of Residence Permits on Utilization of Health Care Services by Migrant Workers in China

by Haochuan Xu, Han Yang, Hui Wang and Xuefeng Li

Int. J. Environ. Res. Public Health 2021, 18(18), 9623; https://doi.org/10.3390/ijerph18189623 - 13 Sep 2021

Cited by 4 | Viewed by 2491

Abstract

Due to the limitations in the verifiability of individual identity, migrant workers have encountered some obstacles in access to public health care services. Residence permits issued by the Chinese government are a solution to address the health care access inequality faced by migrant [...] Read more.

Due to the limitations in the verifiability of individual identity, migrant workers have encountered some obstacles in access to public health care services. Residence permits issued by the Chinese government are a solution to address the health care access inequality faced by migrant workers. In principle, migrant workers with residence permits have similar rights as urban locals. However, the validity of residence permits is still controversial. This study aimed to examine the impact of residence permits on public health care services. Data were taken from the China Migrants Dynamic Survey (CMDS). Our results showed that the utilization of health care services of migrant workers with residence permits was significantly better than others. However, although statistically significant, the substantive significance is modest. In addition, megacities had significant negative moderating effects between residence permits and health care services utilization. Our research results emphasized that reforms of the household registration system, taking the residence permit system as a breakthrough, cannot wholly address the health care access inequality in China. For developing countries with uneven regional development, the health care access inequality faced by migrant workers is a structural issue. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

10 pages, 306 KiB

Open AccessArticle

“I Just Want Some Clear Answers”: Challenges and Tactics Adopted by Migrants in Denmark When Accessing Health Risk Information about COVID-19

by Rasmus Luca Lyager Brønholt, Nina Langer Primdahl, Anja M. B. Jensen, An Verelst, Ilse Derluyn and Morten Skovdal

Int. J. Environ. Res. Public Health 2021, 18(17), 8932; https://doi.org/10.3390/ijerph18178932 - 25 Aug 2021

Cited by 17 | Viewed by 3527

Abstract

Health risk communication plays a crucial role in preventing the spread of infectious disease outbreaks such as the current coronavirus (SARS-CoV-2). Yet, migrants are far too often forgotten in health risk communication responses. We investigate the challenges and efforts made by migrants in [...] Read more.

Health risk communication plays a crucial role in preventing the spread of infectious disease outbreaks such as the current coronavirus (SARS-CoV-2). Yet, migrants are far too often forgotten in health risk communication responses. We investigate the challenges and efforts made by migrants in Denmark—in the initial months of the pandemic—to access information about COVID-19. We draw on 18 semi-structured interviews conducted in May and June 2020. All interviews are thematically coded and analyzed. Our analysis reveals that many of the migrants faced several challenges, including accessing information in a language understandable to them and navigating constant streams of official news flows issuing instructions about which actions to take. However, we also note that the participating migrants found numerous creative ways to address some of these challenges, often aided by digital tools, helping them access crucial health and risk information. This paper highlights that migrants constitute an underserved group in times of crises. They are vulnerable to getting left behind in pandemic communication responses. However, we also identify key protective factors, social resources, and agentic capabilities, which help them cope with health and risk information deficits. National governments need to take heed of these findings to inform future pandemic responses. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

13 pages, 377 KiB

Open AccessArticle

Understanding Cervical Cancer Screening Barriers among Migrant Women: A Qualitative Study with Healthcare and Community Workers in Portugal

by Patrícia Marques, Ana Gama, Mário Santos, Bruno Heleno, Heleen Vermandere and Sónia Dias

Int. J. Environ. Res. Public Health 2021, 18(14), 7248; https://doi.org/10.3390/ijerph18147248 - 6 Jul 2021

Cited by 12 | Viewed by 3556

Abstract

Cervical cancer screening (CCS) has been proven to reducing mortality of cervical cancer; yet migrant women show a lower participation in screening compared to non-migrants. This study explores the perspectives of healthcare workers and community workers on the factors influencing the CCS participation [...] Read more.

Cervical cancer screening (CCS) has been proven to reducing mortality of cervical cancer; yet migrant women show a lower participation in screening compared to non-migrants. This study explores the perspectives of healthcare workers and community workers on the factors influencing the CCS participation of migrant women living in Portugal. A qualitative study with online focus groups was conducted. Healthcare workers experienced in CCS and community workers working with migrant communities were purposively sampled. A semi-structured guide was used covering the participation of migrant women in CCS, barriers, and strategies to overcome them. Data were analyzed using content analysis. Participants considered that migrant women have low participation in CCS related to insufficient knowledge, low risk perception, and lack of interest on preventive care. Other barriers such as difficulties in accessing the healthcare services, relationship with healthcare workers, language, and cultural differences were highlighted. Promoting continuity of care, disseminating culturally tailored information, and use of self-sampling methods were suggested to improve participation in CCS. Inequalities in access to CCS among migrant women are mostly caused by information gaps and healthcare system-related barriers. Building a migrant-friendly healthcare system that creates opportunities for healthcare workers to establish relationships with their patients and delivering culturally and linguistically adapted information may contribute to overcoming those barriers and increasing the participation of migrant women in screening. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

10 pages, 916 KiB

Open AccessArticle

Association between Depressed Mood and Sleep Duration among Various Ethnic Groups—The Helius Study

by Kenneth Anujuo, Karien Stronks, Marieke B. Snijder, Anja Lok, Girardin Jean-Louis and Charles Agyemang

Int. J. Environ. Res. Public Health 2021, 18(13), 7134; https://doi.org/10.3390/ijerph18137134 - 3 Jul 2021

Cited by 2 | Viewed by 2383

Abstract

Background: We examined the association between depressed mood (DM) and sleep duration in a multi-ethnic population in Amsterdam, and the extent to which DM accounts for both short and long sleep. Methods: Cross-sectional data using 21,072 participants (aged 18–71 years) from the HELIUS [...] Read more.

Background: We examined the association between depressed mood (DM) and sleep duration in a multi-ethnic population in Amsterdam, and the extent to which DM accounts for both short and long sleep. Methods: Cross-sectional data using 21,072 participants (aged 18–71 years) from the HELIUS study were analyzed. Sleep duration was classified as: short, healthy, and long (<7, 7–8, and ≥9 h/night). A Patient Health Questionnaire (PHQ-9 sum score ≥10) was used to measure DM. The association between DM and sleep duration was assessed using logistic regression. The extent to which DM accounted for short and long sleep was assessed using a population attributable fraction (PAF). Results: DM was significantly associated with short sleep in all ethnic groups after adjustment for other covariates (OR 1.9 (1.5–2.7) in Ghanaians to 2.5 (1.9–32) in the Dutch). DM was not associated with long sleep except in the Dutch (OR 1.9; 1.3–2.8). DM partly accounted for the prevalence of short sleep with PAF ranging from 3.5% in Ghanaians to 15.5% in Turkish. For long sleep, this was 7.1% in the Dutch. Conclusions: DM was associated with short sleep in all ethnic groups, except in Dutch. If confirmed in longitudinal analyses, strategies to reduce depression may reduce the prevalence of short sleep in concerned groups. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

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20 pages, 360 KiB

Open AccessArticle

Strengthening Country Readiness for Pandemic-Related Mass Movement: Policy Lessons Learned

by Matteo Dembech, Zoltan Katz and Istvan Szilard

Int. J. Environ. Res. Public Health 2021, 18(12), 6377; https://doi.org/10.3390/ijerph18126377 - 12 Jun 2021

Cited by 5 | Viewed by 2655

Abstract

The COVID-19 pandemic has thus far restricted the large movement of people; nonetheless, we cannot exclude the disruptive power of a virus with similar characteristics to COVID-19 affecting both high- and low-income countries, as a factor for future mass migrations. Indeed, the top [...] Read more.

The COVID-19 pandemic has thus far restricted the large movement of people; nonetheless, we cannot exclude the disruptive power of a virus with similar characteristics to COVID-19 affecting both high- and low-income countries, as a factor for future mass migrations. Indeed, the top 15 countries affected by COVID-19 host about 9 million refugees, and it is, therefore, important to investigate and strengthen the readiness of countries’ health policies to ensure they are well equipped to deal with potential large influxes of ‘epidemic-related refugees and migrants.’ Using the Bardach Policy Framework as a tool for analysis, this article investigates the readiness of countries for a potential public health event (mass migration generated by future pandemics), therefore, aiming at a health response forecasting exercise. The article reviews the policies put in place by countries who faced large influxes of migrants between 2011 and 2015 (the policy-prolific years between the Arab Spring migration and the introduction of stringent measures in Europe) and new evidence generated in response to the COVID-19 pandemic (including the ‘ECDC Guidance on infection prevention and control of COVID-19 in migrant and refugee reception and detention centres in the EU/EEA and the UK’ and the ‘WHO Lancet priority for dealing with migration and COVID-19′) to formulate a policy option able to strengthen national system capacities for responding to influxes of epidemic-related migrants and the management of highly infectious diseases. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

14 pages, 540 KiB

Open AccessArticle

Prisoners as Users of Digital Health Care and Social Welfare Services: A Finnish Attitude Survey

by Teemu Rantanen, Eeva Järveläinen and Teppo Leppälahti

Int. J. Environ. Res. Public Health 2021, 18(11), 5528; https://doi.org/10.3390/ijerph18115528 - 21 May 2021

Cited by 14 | Viewed by 5389

Abstract

Prisoners are a group of people with many health and social problems. However, in prisons the use of the Internet is controlled. Thus, prisoners’ access to digital health care and social welfare services is limited. In addition, there are many cognitive and attitudinal [...] Read more.

Prisoners are a group of people with many health and social problems. However, in prisons the use of the Internet is controlled. Thus, prisoners’ access to digital health care and social welfare services is limited. In addition, there are many cognitive and attitudinal barriers to the use of digital health care and social welfare services for prisoners. Cross-sectional survey data (N = 225) were collected from eleven prisons in different parts of Finland and analysed using linear regression analysis. The results are consistent with Ajzen’s theory and previous studies on the acceptance of information systems in health care. Prisoners’ behavioural intentions related to the use of digital health care and social welfare services are influenced by their perceptions of their capacity to use digital services, the expectations of their close people and their attitudes, as well as by trust in the Internet and services. In contrast, the age of prisoners’ indirectly affects their willingness to use digital services. The study recommends that prisoners are supported in the use of digital health care and social welfare services by prison staff and other people. Digital skills training is also needed in order to support digital inclusion, especially for older and long-term prisoners. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

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21 pages, 513 KiB

Open AccessArticle

Use of Health Services and Unmet Need among Adults of Russian, Somali, and Kurdish Origin in Finland

by Katja Çilenti, Shadia Rask, Marko Elovainio, Eero Lilja, Hannamaria Kuusio, Seppo Koskinen, Päivikki Koponen and Anu E. Castaneda

Int. J. Environ. Res. Public Health 2021, 18(5), 2229; https://doi.org/10.3390/ijerph18052229 - 24 Feb 2021

Cited by 12 | Viewed by 3329

Abstract

Equal access to health care is one of the key policy priorities in many European societies. Previous findings suggest that there may be wide differences in the use of health services between people of migrant origin and the general population. We analyzed cross-sectional [...] Read more.

Equal access to health care is one of the key policy priorities in many European societies. Previous findings suggest that there may be wide differences in the use of health services between people of migrant origin and the general population. We analyzed cross-sectional data from a random sample of persons of Russian (n = 692), Somali (n = 489), and Kurdish (n = 614) origin and the Health 2011 survey data (n = 1406) representing the general population in Finland. Having at least one outpatient visit to any medical doctor during the previous 12 months was at the same level for groups of Russian and Kurdish origin, but lower for people of Somali origin, compared with the general population. Clear differences were found when examining where health care services were sought: people of migrant origin predominantly visited a doctor at municipal health centers whereas the general population also used private and occupational health care. Self-reported need for doctor’s treatment was especially high among Russian women and Kurdish men and women. Compared to the general population, all migrant origin groups reported much higher levels of unmet medical need and were less satisfied with the treatment they had received. Improving basic-level health services would serve besides the population at large, the wellbeing of the population of migrant origin. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

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24 pages, 1230 KiB

Open AccessArticle

Community Education for a Dignified Last Phase of Life for Migrants: A Community Engagement, Mixed Methods Study among Moroccan, Surinamese and Turkish Migrants

by Xanthe de Voogd, Dick L. Willems, Bregje Onwuteaka-Philipsen, Marieke Torensma and Jeanine L. Suurmond

Int. J. Environ. Res. Public Health 2020, 17(21), 7797; https://doi.org/10.3390/ijerph17217797 - 24 Oct 2020

Cited by 1 | Viewed by 2709

Abstract

Community engagement and -education are proposed to foster equity in access to care and to ensure dignity of migrant patients in the last phase of life, but evidence is lacking. We evaluated nine community educational interactive meetings about palliative care (136 participants totally)- [...] Read more.

Community engagement and -education are proposed to foster equity in access to care and to ensure dignity of migrant patients in the last phase of life, but evidence is lacking. We evaluated nine community educational interactive meetings about palliative care (136 participants totally)- co-created with educators from our target groups of Moroccan, Surinamese and Turkish migrants—with a mixed methods approach, including 114 questionnaires, nine observations, nine interviews with educators, and 18 pre- and post- group- and individual interviews with participants. Descriptive and thematic analysis was used. 88% of the participants experienced the meetings as good or excellent. Educators bridged an initial resistance toward talking about this sensitive topic with vivid real-life situations. The added value of the educational meetings were: (1) increased knowledge and awareness about palliative care and its services (2) increased comprehensiveness of participant’s wishes and needs regarding dignity in the last phase; (3) sharing experiences for relief and becoming aware of real-life situations. Community engagement and -education about palliative care for migrants effectively increases knowledge about palliative care and is a first step towards improved access to palliative care services, capacity building and a dignified last phase of life among migrants. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

14 pages, 516 KiB

Open AccessArticle

Association between Migrant Women’s Legal Status and Prenatal Care Utilization in the PreCARE Cohort

by Maxime Eslier, Catherine Deneux-Tharaux, Priscille Sauvegrain, Thomas Schmitz, Dominique Luton, Laurent Mandelbrot, Candice Estellat and Elie Azria

Int. J. Environ. Res. Public Health 2020, 17(19), 7174; https://doi.org/10.3390/ijerph17197174 - 30 Sep 2020

Cited by 17 | Viewed by 2826

Abstract

Barriers to access to prenatal care may partially explain the higher risk of adverse pregnancy outcomes among migrants compared with native-born women in Europe. Our aim was to assess the association between women’s legal status and inadequate prenatal care utilization (PCU) in France, [...] Read more.

Barriers to access to prenatal care may partially explain the higher risk of adverse pregnancy outcomes among migrants compared with native-born women in Europe. Our aim was to assess the association between women’s legal status and inadequate prenatal care utilization (PCU) in France, where access to healthcare is supposed to be universal. The study population was extracted from the PreCARE prospective cohort (N = 10,419). The associations between women’s legal status and a composite outcome variable of inadequate PCU were assessed with multivariate logistic regressions. The proportion of women born in sub-Saharan Africa (SSA) was higher among the undocumented than that of other migrants. All groups of migrant women had a higher risk of inadequate PCU (31.6% for legal migrants with European nationalities, 40.3% for other legal migrants, and 52.0% for undocumented migrants) than French-born women (26.4%). The adjusted odds ratio (aOR) for inadequate PCU for undocumented migrants compared with that for French-born women was 2.58 (95% confidence interval 2.16–3.07) overall, and this association was similar for migrant women born in SSA (aOR 2.95, 2.28–3.82) and those born elsewhere (aOR 2.37, 1.89–2.97). Regardless of the maternal place of birth, undocumented migrant status is associated with a higher risk of inadequate PCU. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

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21 pages, 2098 KiB

Open AccessArticle

Do Targeted User Fee Exemptions Reach the Ultra-Poor and Increase their Healthcare Utilisation? A Panel Study from Burkina Faso

by Yvonne Beaugé, Manuela De Allegri, Samiratou Ouédraogo, Emmanuel Bonnet, Naasegnibe Kuunibe and Valéry Ridde

Int. J. Environ. Res. Public Health 2020, 17(18), 6543; https://doi.org/10.3390/ijerph17186543 - 8 Sep 2020

Cited by 9 | Viewed by 3480

Abstract

Background: A component of the performance-based financing intervention implemented in Burkina Faso was to provide free access to healthcare via the distribution of user fee exemption cards to previously identified ultra-poor. This study examines the factors that led to the receipt of user [...] Read more.

Background: A component of the performance-based financing intervention implemented in Burkina Faso was to provide free access to healthcare via the distribution of user fee exemption cards to previously identified ultra-poor. This study examines the factors that led to the receipt of user fee exemption cards, and the effect of card possession on the utilisation of healthcare services. Methods: A panel data set of 1652 randomly selected ultra-poor individuals was used. Logistic regression was applied on the end line data to identify factors associated with the receipt of user fee exemption cards. Random-effects modelling was applied to the panel data to determine the effect of the card possession on healthcare service utilisation among those who reported an illness six months before the surveys. Results: Out of the ultra-poor surveyed in 2017, 75.51% received exemption cards. Basic literacy (p = 0.03), living within 5 km from a healthcare centre (p = 0.02) and being resident in Diébougou or Gourcy (p = 0.00) were positively associated with card possession. Card possession did not increase health service utilisation (β = −0.07; 95% CI = −0.45; 0.32; p = 0.73). Conclusion: A better intervention design and implementation is required. Complementing demand-side strategies could guide the ultra-poor in overcoming all barriers to healthcare access. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

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14 pages, 332 KiB

Open AccessArticle

The Association between Social Integration and Utilization of Essential Public Health Services among Internal Migrants in China: A Multilevel Logistic Analysis

by Jing Liang, Yujia Shi, Mohammedhamid Osman, Bhawana Shrestha and Peigang Wang

Int. J. Environ. Res. Public Health 2020, 17(18), 6524; https://doi.org/10.3390/ijerph17186524 - 8 Sep 2020

Cited by 28 | Viewed by 2842

Abstract

This study investigated the association between social integration and utilization of essential public health services among internal migrants. Data were from the 2017 China Migrants Dynamic Survey. Social integration was measured through four dimensions: economic integration, structural integration, sociocultural adaptation, and self-identity. Multilevel [...] Read more.

This study investigated the association between social integration and utilization of essential public health services among internal migrants. Data were from the 2017 China Migrants Dynamic Survey. Social integration was measured through four dimensions: economic integration, structural integration, sociocultural adaptation, and self-identity. Multilevel logistic regressions were used taking into account heterogeneity in the level of regional development. The utilization of health records and health education was less than 40% and varied widely across regions. Social integration was related to a higher likelihood of utilization of health records and health education. Moreover, sociocultural adaptation had a stronger effect on the utilization of health records in developed regions than in developing regions, and structural integration was strongly and positively related to the utilization of health education in developed regions. Hence, it appears that the relationship of some dimensions of social integration and utilization of essential public health services is moderated by the level of economic development. Promoting structural integration and sociocultural adaptation could strongly improve utilization of essential public health services in developed regions. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

19 pages, 334 KiB

Open AccessArticle

Migrants Are Underrepresented in Mental Health and Rehabilitation Services—Survey and Register-Based Findings of Russian, Somali, and Kurdish Origin Adults in Finland

by Anu E. Castaneda, Katja Çilenti, Shadia Rask, Eero Lilja, Natalia Skogberg, Hannamaria Kuusio, Essi Salama, Jari Lahti, Marko Elovainio, Jaana Suvisaari, Seppo Koskinen and Päivikki Koponen

Int. J. Environ. Res. Public Health 2020, 17(17), 6223; https://doi.org/10.3390/ijerph17176223 - 27 Aug 2020

Cited by 18 | Viewed by 5182

Abstract

Mounting evidence suggests that migration background increases the risk of mental ill health, but that problems exist in accessing healthcare services in people of migrant origin. The present study uses a combination of register- and survey-based data to examine mental health-related health service [...] Read more.

Mounting evidence suggests that migration background increases the risk of mental ill health, but that problems exist in accessing healthcare services in people of migrant origin. The present study uses a combination of register- and survey-based data to examine mental health-related health service use in three migrant origin populations as well as the correspondence between the need and use of services. The data are from the Finnish Migrant Health and Wellbeing Study (Maamu), a comprehensive cross-sectional interview and a health examination survey. A random sample consisted of 5909 working-aged adults of Russian, Somali, and Kurdish origin of which 3000 were invited to participate in the survey and the rest were drawn for a register-based approach. Some of the mental health services, based on registers, were more prevalent in the Kurdish origin group in comparison with the general population and less prevalent in the Russian and Somali origin groups. All the migrant origin groups were underrepresented in rehabilitation services. When affective symptoms were taken into account, all the migrant origin groups were underrepresented in all of the services. This calls for actions to promote mental health, diminish the barriers to access services, and improve the service paths for migrants. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

15 pages, 322 KiB

Open AccessFeature PaperArticle

The Role of Perceived Unjust Treatment in Unmet Needs for Primary Care Among Finnish Roma Adults

by Riikka Lämsä, Anu E. Castaneda, Anneli Weiste, Marianne Laalo, Päivikki Koponen and Hannamaria Kuusio

Int. J. Environ. Res. Public Health 2020, 17(16), 5825; https://doi.org/10.3390/ijerph17165825 - 12 Aug 2020

Cited by 3 | Viewed by 2883

Abstract

The main goal in developing services is to guarantee equal access to healthcare services that are suited to the patients’ needs. Previous studies have shown that the Roma are more likely to experience unjust treatment in health services than the general population. This [...] Read more.

The main goal in developing services is to guarantee equal access to healthcare services that are suited to the patients’ needs. Previous studies have shown that the Roma are more likely to experience unjust treatment in health services than the general population. This study examines the association between perceived unjust treatment in healthcare and self-assessed unmet need for primary care provided by general practitioners (GPs) and nurses among the Finnish Roma. The data from the Finnish Roma Wellbeing Study (Roosa), conducted in 2017–2018, were used. Snowball sampling was used in recruiting study participants (n = 365, 61% women). Logistic regression was used to test the association between perceived unjust treatment and unmet need for primary care. Confounders used were gender, age, marital status, education, employment, and self-rated health. Those who had experienced unjust treatment in healthcare were more likely to report unmet need for care provided by GPs (odds ratios (OR) = 6.44; p < 0.001) and nurses (OR = 11.18; p < 0.001) than those who felt that they had been treated justly. This association remained after adjustments for the confounders. Bidirectional guidance between the Roma and service providers should be improved and the Roma communities involved in service development using participatory methods. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

Other

Jump to: Research

10 pages, 316 KiB

Open AccessStudy Protocol

Service User and Service Provider Perceptions of Enablers and Barriers for Refugee and Asylum-Seeking Women Accessing and Engaging with Perinatal Mental Health Care Services in the WHO European Region: A Scoping Review Protocol

by Kathleen Markey, Anne MacFarlane, Maria Noonan, Mairead Moloney, Susann Huschke, Kate O’Donnell, Claire O'Donnell, Teresa Tuohy, Ahmed Hassan Mohamed and Owen Doody

Int. J. Environ. Res. Public Health 2022, 19(2), 937; https://doi.org/10.3390/ijerph19020937 - 14 Jan 2022

Cited by 3 | Viewed by 3467

Abstract

There is a need to understand the specific perinatal mental health care needs of migrant subgroups who often have differing health care needs and specific barriers to accessing and engaging with health care services. It is important to have evidence about the WHO [...] Read more.

There is a need to understand the specific perinatal mental health care needs of migrant subgroups who often have differing health care needs and specific barriers to accessing and engaging with health care services. It is important to have evidence about the WHO European context given the rising numbers of refugees and asylum seekers in the region. The aim of this scoping review is to map the factors that enable and prevent access and engagement of refugee and asylum-seeking women with perinatal mental health care services in the WHO European Region, from the perspectives of service providers and service users. The database search will include PsycINFO, Cochrane, Web of Science, MEDLINE, EMBASE, CINAHL complete, Scopus, Academic Search Complete, and Maternity and Infant Care (OVID). Search results will be exported to an online tool that provides a platform to help manage the review process, including title, abstract, and full-text screening and voting by reviewers independently. Data concerning access and engagement with health care services will be mapped on to the candidacy framework. Systematically searching evidence within the WHO European region and examining this evidence through the candidacy lens will help develop a more comprehensive and a deeper conceptual understanding of the barriers and levers of access and engagement with perinatal mental health care services, whilst identifying gaps in existing evidence. Exploring factors that influence access and engagement for refugee and asylum-seeking women from the perspective of key stakeholders in the service provision and/or service utilisation of perinatal mental health care services will add a more comprehensive understanding of the recursive relationship between service provision and use. Full article

(This article belongs to the Special Issue Health Care Access among Underserved Groups)

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