Showing papers in "International Journal of Migration, Health and Social Care in 2010"

The Intercultural Challenges of General Practitioners in Norway with Migrant Patients

Abstract: Migrants to Norway disproportionately use emergency medical services while under‐using primary care, obviating the medical and cost advantages of the Regular General Practitioner (RGP) scheme. Little is known about migrants' use of the RGP scheme and the obstacles that affect ability and motivation to obtain or comply with treatment. The authors questioned 12 GPs around Oslo who serve migrants, using a semi‐structured interview guide. GPs defined migrants in terms of socio‐cultural difference rather than legal status, these differences often obstructing doctor‐patient communication and understanding. GPs reported that migrants often seem helpless in dealing with the public health service owing to language difficulties, differences in expectations and a systemic failure to co‐ordinate care. The findings suggest the importance of providing information about health services in a migrant's mother tongue upon arrival in Norway, of GPs taking detailed patient histories from the beginning to identify obstacles to communication and treatment, and of co‐ordinating emergency services with other care.

Refugees from Myanmar and their Health Care Needs in the US: A Qualitative Study at a Refugee Resettlement Agency

Abstract: In response to the recent rapid influx of refugees from Myanmar, Interfaith Ministries for Greater Houston (IM), a refugee resettlement agency, started to support them in June 2007. The study looked at the refugees' perspectives and identified the gaps in their understanding of the US health care system, health‐seeking behaviors and challenges in using health care in the United States. The major issues identified were non‐compliance with tuberculosis prevention medication due to barriers to obtaining medication refills, barriers to accessing speciality care services, transportation issues, written and oral language barriers, difficulties in applying for and using Medicaid and Gold Card, misunderstanding of emergency health services, lack of resources for health education, self‐treatment with Western medicine and income too low to buy private health insurance. In order to transform them into healthy citizens able to contribute to the US workforce, several multi‐faceted and comprehensive approaches and better co‐ordination between agencies are recommended.

Rethinking well-being: from contexts to processes

Abstract: The paper analyses four different perspectives on well‐being: the medical viewpoint and the hegemony of trauma, the cultural approach and the balance of social, spiritual and natural realms, the psycho‐social position and the scrutiny of the social environment, and multi‐levelled ecological models that integrate multiple layers. The paper advocates a shift away from analyses of localities/phases/contexts and well‐being towards those of processes, predicated on the separation of physical dis(re)‐locations from psychological dis(em)‐placements. When examining processes and negotiations with life events, of which displacement is one, well‐being is understood as a process of being ‘of’ rather than being ‘in’.

Applying Socio‐Cultural Lenses to Childhood Obesity Prevention among African Migrants to High‐Income Western Countries: The Role of Acculturation, Parenting and Family Functioning

Abstract: Migration from third‐world and low‐income countries to high‐income Western countries presents significant challenges for individuals and families, and for health service providers in the receiving societies. Cultural conflicts related to preferred body size/shape and parenting practices, together with differential intergenerational rates and styles of acculturation, can affect nutritional and lifestyle choices and be associated with high rates of childhood obesity. Using African cultures as an example, this paper examines these issues. It concludes that, in designing and implementating obesity prevention programmes, health service providers need to understand these factors and how they play out.

A Study of the Emotional and Psychological Well‐being of Refugees in Kakuma Refugee Camp, Kenya

Abstract: This study explores the emotional problems affecting refugees in Kakuma refugee camp (northern Kenya). The freelisting technique was used to interview 52 community members and 32 ‘key informants’. Freelisting was found to be useful in this setting, and provided information which could assist with advocacy, programme planning and programme evaluation. The emotional problems most frequently identified were hopelessness, fear, sadness, anger/aggression and worry. Both current stressors and previous losses were said to affect emotional well‐being. While psychosocial interventions are important, programmes addressing refugees' practical needs (particularly safety and material needs) will therefore have a positive impact on psychosocial well‐being. These findings also suggest that some anti‐social behaviours which contribute to problems within and between communities in Kakuma are due in part to emotional problems; if so, addressing emotional problems would be a worthwhile use of resources.

Stress and coping among migrant labourers in urban Vietnam: an adaptation cycle and health vulnerabilities

Abstract: Rural‐urban migration continues to grow in many developing countries including Vietnam. The experience of stress and coping associated with this process may vary for people from different circumstances. However, there has been little research on migrants to date. This study adopts a qualitative approach to research on unregistered, male, migrant freelance labourers in urban Vietnam and to explore factors contributing to stress and coping among this population. The study revealed an array of stressors related to migrants' life experiences in urban space, including physical, financial and social factors. Coping was diverse, including problem‐focused coping (PFC) and emotion‐focused coping (EFC), pro‐social and anti‐social, active and passive. Less active and anti‐social coping appeared common. Together, weak social network and lack of support from formal systems placed coping and adaptation in a cyclic relationship. The results highlight a multi‐disciplinary approach to help cope and adapt effectively for these men.

Barriers to and Use of Health Care Services among Cross‐Border Migrants in Botswana: Implications for Public Health

Abstract: Despite increased emphasis on improving equity in health among all populations, there is growing consensus in the literature that cross‐border migrants often fail to use health services in host countries. Cross‐border migrants are a sub‐group whose health status and risks have not been widely researched, and who are systematically marginalised in the health care system in any country. This study used purposive sampling and snowballing to gather data from 137 cross‐border migrants from Zimbabwe. The biggest barriers to health care for cross‐border migrants were cost, negative attitudes of medical staff, fear of police or immigration, language and wanting a different doctor. The study has serious implications for public health, in terms of access to health care by non‐citizens, help‐seeking behaviours, cost of care and multicultural practice. Prevention/treatment and care intervention and education programmes in Botswana could also target migrants by acknowledging that they have a right to health.

Social Risks in Successful Educational Careers of Young Female Immigrants in the German Education System: Coping Strategies, Self‐Help and Support Services

Abstract: Education and employment are important elements of successful integration for immigrants in a host country. In Germany, young immigrants and members of the second immigrant generation have only limited access to higher education pathways and academic careers. Their trajectories are shaped mainly by the vocational training system, if they obtain any qualifications at all. Social risks for young people with immigrant backgrounds, and women in particular, such as being unemployed or having unstable careers, have frequently been pointed out by researchers, but little has been said about more qualified pathways available through privileged apprenticeships or academic qualifications. This article explores the social risks in trajectories of female immigrants following middle‐range or higher educational pathways in Germany. The cases discussed focus on young women who arrived in Germany during childhood or adolescence. The paper will first discuss the institutional settings of the German education system, focusing on their impact on pupils with immigrant backgrounds and how they overlap with existing gender inequalities in the recipient country. Discussion of the particular methodological approach will follow, before presentation of the findings of the case studies on female immigrants' transitions from education to work. The concluding discussion considers potential means to support participation in education and work for young women with immigrant backgrounds.

Health, Well‐being and Immigrant Populations in France and Britain

Abstract: This review arises from a series of multidisciplinary Franco‐British workshops which were supported by a grant from the Economic and Social Research Council (ESRC) and the Agence Nationale de la Recherche (ANR). More than 30 participants from a range of institutions and agencies were involved in compiling the material in this review (Appendix I). The workshops offered an opportunity to exchange ideas from research on the relationships between migration, health and well‐being in Britain and France. In the following discussion we compare and contrast experiences in the two countries, with the aim of assessing the importance of international, national and local contexts, in their various cultural, social and political dimensions, for the relationships of interest. Drawing on these ideas, we suggest the definition of a future international research agenda.

Self‐Perceived Health among Migrant and Native Populations in Madrid: A Gender Perspective

Abstract: This paper describes the level of self‐perceived health (SPH) in immigrant and native populations resident in Madrid and the demographic and socioeconomic factors associated with negative self‐perceived health status, from a gender perspective. A population‐based home survey (2005 Madrid Health Survey) was carried out. Subjects were selected by random sampling of bistage clusters. The study was limited to 5704 adults (16 to 64 years). SPH was considered the dependent variable. The independent variables included migration status, social class, age, sex, marital status, level of education, area of residence, work precariousness, family burden and perception of environmental quality. The association was assessed by odds ratios and their 95% confidence intervals obtained by multivariate logistic regression models disaggregated by gender and migration status. Results showed that poor/fair health status was perceived more by natives and by women. The variables associated with fair/poor SPH in immigrant men were the influence of working conditions perceived as negative and perception of the quality of the environment as poor, and in immigrant women, older age, low educational level and the influence of working conditions perceived as negative. Gender inequalities in self‐perceived health exist, and different factors are associated with immigrant and native populations. The results of the study support the need for a health intervention that would diminish gender inequalities in health, which are more accentuated in immigrants.

Contradictions in Public Policies: Immigration and the Struggle against Aids in France

Abstract: Why is social action politically so difficult to manage, especially in the field of health and above all when it concerns health care for immigrant populations? This article examines this question by analysing public policies concerning the situation of migrants living with HIV/Aids in France.

Migrant Social Networks and Health Care: Exploring the Relationship between Women's Social Networks and Migrant Health Care Access in the United States

Abstract: The challenges facing today's Mexican migrant population, almost a third of the US migrant population, are formidable. Such high representation offers not only challenges, but also increased political representation and large networks of social support. Complex relationships established through such networks provide Mexican migrants with avenues of access to communities, opportunities and services. Following a working definition of community and the concept of social capital, this paper examines health care availability for Mexican migrants in the United States. Because Mexican women are traditionally responsible for the health of their families, a case study is used to illustrate how knowledge and information gained through women's social networks gives Mexican women in the US critical decision‐making power with regard to health care. Greater acknowledgement of women as the brokers of health‐preserving information networks is key to recognising their significance as stakeholders in community health care. Future policy developers should recognise the importance of understanding such specific contextual issues, because they create a health care system that is responsive to individual and community needs.

Knowledge about HIV/AIDS among professionals working with migrants in Switzerland

Abstract: Switzerland faces an HIV epidemic that is concentrated among certain groups, including migrants from high‐prevalence countries. This study explores the HIV/AIDS knowledge of professionals providing asylum and integration services at cantonal level, with a view to optimising the role they can play in HIV prevention. Data was collected by means of a self‐administered questionnaire; 266 of the 368 professionals (72%) approached responded. Answers were analysed with regard to the respondent's sex, age, workplace and geographical location. General HIV/AIDS knowledge is sound, although there are deficits regarding the vulnerability of migrants. Staff working for non‐governmental organisations are significantly more likely (39%) to attach high importance to HIV/AIDS than civil servants (25%). They are also significantly more likely to have undergone training in HIV/AIDS (25% compared with 15%). Respondents from the German parts of Switzerland are significantly more likely (75%) than those from Romandie and Tessin (48%) to feel sufficiently well informed to be able to address the HIV/AIDS needs of migrants.Professionals providing asylum and integration services could be familiarised more systematically with HIV/AIDS policy documents and with the HIV/AIDS projects and materials in place for migrants. There is also scope to institutionalise targeted training and knowledge management opportunities better.

Promoting Child Survival in Honduras: Factors for Program Sustainability

Abstract: Child mortality has been a problem in developing countries for many years. This article summarizes the factors that were identified as contributing to the sustainability of a community‐based growth‐monitoring program for the prevention of child mortality in Honduras. The program used community volunteers to measure children's growth from birth until they reached two years of age. Honduras received support from the USAID to implement the program. The authors conducted an evaluation of the program that included responses from 32 health care workers, 45 weight monitors, 96 participating mothers and 32 non‐participating mothers. Individual, community, environmental and institutional factors that contribute to the sustainability of the program are summarized. The implications for program replication are discussed.