Choosing where to give birth can be a matter of life and death for both mother and child. Migrants, registered or unregistered, may face different choices and challenges than non-migrants. Despite ...this, previous research on the factors migrant women consider when deciding where to give birth is very limited. This paper addresses this gap by examining women's decision making in a respective border and urban locale in Thailand.
We held focus group discussions 13 with 72 non-Thai pregnant migrant women at non-government clinics in a rural border area and at two hospitals in Chiang Mai, a large city in Northern Thailand in 2018. We asked women where they will go to give birth and to explain the factors that influenced their decision.
Women identified getting the relevant documentation necessary to register their child's birth, safe birth and medical advice/quality care, as the top three factors that influenced their care seeking decision making. Language of service, free or low cost care, language of services, proximity to home, and limited alternate options for care were also identified as important considerations.
Understanding factors that migrant women value when choosing where to deliver can help health care providers to create services that are responsive to migrants' preferences and encourage provision of relevant information which may influence patient decision making. The desire to obtain birth documentation for their child appears to be important for migrants who understand the importance of personal documentation for the lives of their children. Healthcare institutions may wish to introduce processes to facilitate obtaining documentation for pregnant migrant women and their newborns.
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Thai massage is a highly gendered and culturally specific occupation. Many female Thai masseuses migrate to Norway as marriage migrants and as such are entitled to the same public healthcare as ...Norwegian citizens. Additionally, anyone who is not fluent in Norwegian is entitled to have an interpreter provided by the public healthcare system. Norway and most other countries aspire to universal health coverage, but certain immigrant populations continue to experience difficulties accessing appropriate healthcare. This study examined healthcare access among Thai migrant masseuses in Oslo.
Guided by access to healthcare theory, we conducted a qualitative exploratory study in 2018 with Thai women working as masseuses in Oslo, Norway. Through semi-structured in-depth interviews with 14 Thai women, we explored access to healthcare, health system navigation and care experiences. We analyzed the data using thematic analysis and grouped the information into themes relevant to healthcare access.
Participants did not perceive that their occupation limited their access to healthcare. Most of the barriers participants experienced when accessing care were related to persistent language challenges. Women who presented at healthcare facilities with their Norwegian spouse were rarely offered interpreters, despite their husband's limited capacity to translate effectively. Cultural values inhibit women from demanding the interpretation services to which they are entitled. In seeking healthcare, women sought information about health services from their Thai network and relied on family members, friends and contacts to act as informal interpreters. Some addressed their healthcare needs through self-treatment using imported medication or sought healthcare abroad.
Despite having the same entitlements to public healthcare as Norwegian citizens, Thai migrants experience difficulties accessing healthcare due to pervasive language barriers. A significant gap exists between the official policy that professional interpreters should be provided and the reality experienced by study participants. To improve communication and equitable access to healthcare for Thai immigrant women in Norway, health personnel should offer professional interpreters and not rely on Norwegian spouses to translate. Use of community health workers and outreach through Thai networks, may also improve Thai immigrants' knowledge and ability to navigate the Norwegian healthcare system.
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Many countries aspiring to achieve universal health coverage struggle with how to ensure health coverage for undocumented migrants. Using a case study of maternal health care in a Thailand-Myanmar ...border region this article explores coverage for migrants, service provision challenges and the contribution of a voluntary health insurance program.
In 2018 we interviewed 18 key informants who provided, oversaw or contributed to maternal healthcare services for migrant women in the border region of Tak province, Thailand.
In this region, we found that public and non-profit providers helped increase healthcare coverage beyond undocumented migrants' official entitlements. Interview participants explained that Free and low-cost antenatal care (ANC) is provided to undocumented migrants through migrant specific clinics, outreach programs and health posts. Hospitals offer emergency birth care, although uninsured migrant patients are subsequently billed for the services. Care providers identified sustainability, institutional debt from unpaid obstetric hospital bills, cross border logistical difficulties and the late arrival of patients requiring emergency lifesaving interventions as challenges when providing care to undocumented migrants. An insurance fund was developed to provide coverage for costly emergency interventions at Thai government hospitals. The insurance fund, along with existing free and low-cost services, helped increase population coverage, range of services and financial protection for undocumented migrants.
This case study offers considerations for extending health coverage to undocumented populations. Non-profit insurance funds can help to improve healthcare entitlements, provide financial protection and reduce service providers' debt. However, there are limits to programs that offer voluntary coverage for undocumented migrants. High costs associated with emergency interventions along with gaps in insurance coverage challenge the sustainability for NGO, non-profit and government health providers and may be financially disastrous for patients. Finally, in international border regions with high mobility, it may be valuable to implement and strengthen cross border referrals and health insurance for migrants.
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The Thailand-Myanmar border separates two very different health systems. The healthcare system in eastern Myanmar remains underdeveloped as a result of decades of instability. Comparatively, Tak ...province, Thailand has more healthcare resources. In this Thai border province government hospitals and non-governmental organizations provide tuberculosis (TB) treatment to migrants and refugees.
Our overall study aimed to explore accessibility of TB treatment, TB surveillance and health system responsiveness specific to migrant and refugee populations in Tak province. In this paper, we focus on the perspectives of migrant and refugee TB patients with respect to travel and treatment in Tak province.
In 2014 we conducted focus group discussions with 61 TB, Tuberculosis and Human Immunodeficiency Virus co-infection, and multidrug-resistant TB patients in Tak province. We analyzed the data for content and themes and documented individual travel trajectories.
Migrants are travelling with active TB within the country and between Thailand and Myanmar. Migrants primarily travelled to obtain treatment but two participants reported travelling home to seek family care in Myanmar before returning to Thailand for treatment. Travel, while expensive and arduous, is an adaptive strategy that migrants use to access healthcare.
Migrant's need for travel points to larger difficulties associated with healthcare access in the border region. Long distance travel with an infectious disease can be seen as an indicator that local healthcare is not available or affordable. These findings suggest that public health officials from both sides of the border should discuss the factors that contribute to travel with active TB and explore potential solutions to mitigate disease transmission in migrant populations.
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Millions of women give birth annually without the support of a trained birth attendant. Generally and globally, countries provide maternal health services for their citizens but there is a coverage ...gap for undocumented migrant women who often can't access the same care due to their legal status. The objective of this investigation is to explore undocumented migrants' experiences and perceptions of maternal healthcare accessibility.
We held focus groups discussions with 64 pregnant women at 3 migrant health clinics on the Thailand-Myanmar border and asked how they learned about the clinic, their health care options, travel and past experiences with birth services. In this context undocumented women could sign up for migrant health insurance at the clinic that would allow them to be referred for tertiary care at government hospitals if needed.
Women learned about care options through a network approach often relying on information from community members and trusted care providers. For many, choice of alternate care was limited by lack of antenatal care services close to their homes, limited knowledge of other services and inability to pay fees associated with hospital care. Women travelled up to 4 h to get to the clinic by foot, bicycle, tractor, motorcycle or car, sometimes using multiple modes of transport. Journeys from the Myanmar side of the border were sometimes complicated by nighttime border crossing closures, limited transport and heavy rain.
Undocumented migrant women in our study experienced a type of conditional or variable accessibility where time of day, transport and weather needed to align with the onset of labour to ensure that they could get to the migrant clinic on time to give birth. We anticipate that undocumented migrants in other countries may also experience conditional accessibility to birth care, especially where travel is necessary due to limited local services. Care providers may improve opportunities for undocumented pregnant women to access maternal care by disseminating information on available services through informal networks and addressing travel barriers through mobile services and other travel supports. Trial registration The research project was approved by Research Ethics Committee at the Faculty of Medicine, Chiang Mai University (FAM-2560-05204), and the Department of Community Medicine and Global Health at the University of Oslo-Norwegian Centre for Research Data (58542).
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Migrants experience stress before, during and after migrating to a new country, all of which influences their mental wellbeing. In Norway, migration from Thailand is highly gendered as most Thai ...migrants are women who migrate to live with their Norwegian spouse. Massage shops, often owned by Thai entrepreneurs, are a locale where women use their cultural knowledge to bridge into the local economy. There is little knowledge about Thai migrant masseuses' experience of stress in daily life and associated coping strategies. The objective of this inquiry was to examine stressors and coping strategies among Thai migrant masseuses in Oslo, Norway.
We conducted in-depth interviews with 14 Thai migrants who were working as masseuses in Oslo, Norway. We asked participants about their health, experiences of stress, and coping strategies and subsequently analyzed the data using thematic analysis.
Stress in participants' lives related to settling in, loneliness, finances and spousal relationships. Of these, relationship conflict was the largest source of stress. Women largely embraced self-coping strategies and utilized Thai cultural practices and Buddhist cognitive thinking. Once relationship conflict became untenable, participants fought to change their situation. Limited fluency in Norwegian, Thai stigma about mental health and limited knowledge of the Norwegian health system were barriers to seeking healthcare.
Migrants in our study often adopted "Thainess", the use of Thai cultural practices and Buddhist cognitive thinking, as a strategy for coping with stress. Preferences for self-coping, mental health stigma, and linguistic competency are important considerations when designing mental wellbeing interventions for Thai women. Use of an interpreter or systems navigator can help overcome language barriers. Clinicians can take detailed case histories to better understand Thai patients' stress, coping strategies and wellbeing. Health policy makers could consider network approaches, including using Thai health systems navigators to bridge the health system and Thai communities.
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Purpose
The purpose of this paper is to investigate the health and well-being of Thai immigrant women in transnational marriages.
Design/methodology/approach
Interviews with 13 Thai women living in ...Norway who have (had) a Norwegian spouse/partner were conducted and the transcripts were analysed using thematic analysis.
Findings
Initial culture shock and a mixture of employment issues, transnational ties, marital relationships and social networks intertwined to influence women’s health and well-being over time. Sending financial remittances to family in Thailand could be challenging due to struggles to obtain suitable employment, working in low-paid physical jobs and spouses’ lack of understanding of this cultural practice. Over time, these intertwined factors led to chronic stress and deteriorating health for some. Thai networks and friendships were important for emotional and practical support.
Practical implications
More organised assistance may be beneficial to facilitate integration, reduce social isolation and improve employment opportunities.
Originality/value
Research on Thai women has so far focused on their position as immigrant wives and the vulnerabilities to exploitation and abuse they face. Focusing on only discourses around marital relationships may be limiting when trying to understand factors that influence the health and well-being of Thai immigrant women.
This is a protocol for a co‐registered Cochrane and Campbell Review (Methodology). The objectives are as follows: To identify, describe and assess methods for: when to replicate a systematic review; ...how to replicate a systematic review.
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This article aims to identify how the health system in Tak province, Thailand has responded to migrants’ barriers to tuberculosis (TB) treatment. Our qualitatively driven multi-methods project ...utilized focus group discussions, key informant interviews, and a survey of community health volunteers to collect data in 2014 from multiple perspectives. Migrants identified legal status and transportation difficulties as the primary barriers to seeking TB treatment. Lack of financial resources and difficulties locating appropriate and affordable health services in other Thai provinces or across the border in Myanmar further contributed to migrants’ challenges. TB care providers responded to barriers to treatment by bringing care out into the community, enhancing patient mobility, providing supportive services, and reaching out to potential patients. Interventions to improve migrant access and adherence to TB treatment necessarily extend outside of the health system and require significant resources to expand equitable access to treatment. Although this research is specific to the Thailand–Myanmar border, we anticipate that the findings will contribute to broader conversations around the inputs that are necessary to address disparities and inequities. Our study suggests that migrants need to be provided with resources that help stabilize their financial situation and overcome difficulties associated with their legal status in order to access and continue TB treatment.
Le présent article vise à identifier la réponse du système de santé de la province de Tak, en Thaïlande, aux obstacles rencontrés par les migrants dans le cadre du traitement de la tuberculose. Notre projet multi-méthodes axé sur la qualité a eu recours à des groupes de discussion, des entrevues avec des témoins privilégiés et à une enquête menée en 2014, sous de multiples perspectives, auprès de bénévoles de la santé communautaire afin de recueillir des données. Les migrants ont identifié comme principaux obstacles à la recherche du traitement antituberculeux, les difficultés liées au statut juridique et au transport. La pénurie de ressources financières et les difficultés à accéder à des services de santé appropriés et abordables dans les autres provinces de Thaïlande ou le long de la frontière avec le Myanmar n’ont fait que renforcer les défis posés aux migrants. Les prestataires de soins antituberculeux ont fait face à ces obstacles au traitement par l’introduction des soins de santé au sein de la communauté, l’amélioration de la mobilité des patients, la prestation des services de soutien et le fait de se rapprocher des patients potentiels. Les interventions visant à améliorer l’accès des migrants et leur observance du traitement de la tuberculose s’étendent nécessairement au-delà du système de santé et requièrent des ressources considérables pour un meilleur accès équitable au traitement. Bien que la présente recherche soit spécifique à la frontière entre la Thaïlande et le Myanmar, nous prévoyons que les conclusions permettront d’engager des débats plus larges sur les apports nécessaires pour mettre fin aux disparités et aux inégalités. Notre étude suggère que les migrants doivent bénéficier de ressources qui permettent de stabiliser leur situation financière et de surmonter les difficultés liées à leur statut juridique afin d’avoir accès et de poursuivre le traitement de la tuberculose.
本文旨在明确泰国Tak省的卫生体系如何应对流动人口获得结 核 （TB） 治疗的障碍。本研究为定性研究驱动的混合方法研 究, 于2014年采用焦点小组讨论、关键知情人访谈和社区卫生 志愿者调查, 收集了多角度数据。流动人口反映的法律地位和 交通问题是寻求TB治疗的主要障碍。流动人口面对的其他障 碍还包括缺乏经济资源, 在泰国其他省或跨境到缅甸境内很难 找到合适、价格可以承受的卫生服务。TB服务提供者对治疗 障碍的应对措施是将治疗带入社区, 增强患者流动性, 提供支 持服务, 以及接触潜在患者。改善患者获得并依从TB治疗的 干预必然延伸到卫生体系之外, 且需要大量资源来推广平等可 及的治疗。虽然本研究具体针对泰缅边境, 我们期望上述发现 有助于探讨解决差异和不公平所需的投入。本研究提示, 需要 给流动人口提供资源来稳定他们的经济状况, 克服与法律地位 相关的困难, 从而使他们获得并维持TB治疗。
Este artículo tiene como objetivo identificar cómo el sistema de salud en la provincia de Tak, Tailandia, ha respondido a las barreras al tratamiento de la tuberculosis (TB) de los migrantes. Nuestro proyecto de métodos múltiples conducido cualitativamente utilizó discusiones de grupos focales, entrevistas con informantes claves y una encuesta de voluntarios comunitarios de salud para recoger datos en 2014 desde múltiples perspectivas. Los migrantes identificaron el estado legal y las dificultades de transporte como las principales barreras para buscar tratamiento de la tuberculosis. La falta de recursos financieros y las dificultades para localizar servicios de salud apropiados y asequibles en otras provincias tailandesas o al otro lado de la frontera en Myanmar contribuyeron aún más a los desafíos de los emigrantes. Los proveedores de atención de la TB respondieron a las barreras al tratamiento brindando atención a la comunidad, mejorando la movilidad de los pacientes, brindando servicios de apoyo y llegando a los pacientes potenciales. Las intervenciones para mejorar el acceso de los migrantes y la adherencia al tratamiento de la TB necesariamente se extienden fuera del sistema de salud y requieren recursos significativos para expandir el acceso equitativo al tratamiento. Aunque esta investigación es específica a la frontera entre Tailandia y Myanmar, anticipamos que los hallazgos contribuirán a conversaciones más amplias sobre los insumos que son necesarios para abordar las disparidades e inequidades. Nuestro estudio sugiere que los migrantes necesitan ser provistos con recursos que ayuden a estabilizar su situación financiera y asuperar las dificultades asociadas con su estado legal para poder acceder y continuar el tratamiento de la tuberculosis.
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Summary
Limited access to health education can be a barrier for reaching the Sustainable Development Goals, especially in rural communities in sub-Saharan Africa. We addressed this gap by installing ...community information spots (InfoSpots) with access to the internet and a locally stored digital health education platform (the platform) in Migoli and Izazi, Tanzania. The objective of this case study was to explore the perspectives and experiences of InfoSpot users and non-users in these communities. We conducted 35 semi-structured interviews with participants living, working or studying in Migoli or Izazi in February 2020 and subsequently analysed the data using content analysis.
The 25 InfoSpot users reported variations in use patterns. Users with more education utilized the platform for their own health education and that of others, in addition to internet surfing. High school students also used the platform for practicing English, in addition to health education. Most InfoSpot users found the platform easy to use; however, those with less education received guidance from other users. Non-users reported that they would have used the InfoSpot with the platform if they had been aware of its existence. All participants reported a positive view of the digital health messages, especially animations as a health knowledge transfer tool. In conclusion, different and unintended use of the platform shows that the communities are creative in ways of utilizing the InfoSpots and gaining knowledge. The platform could have been used by more people if it had been promoted better in the communities.
Lay Summary
Access to good-quality health education is crucial for reaching the Sustainable Development Goals. We installed community information spots (InfoSpots) with access to the internet and a locally stored digital health education platform (the platform) in two rural villages in Tanzania in November 2019. This qualitative case study was conducted in Migoli and Izazi in February 2020, and 35 people participated in semi-structured interviews. Content analysis was performed with the software NVivo, and quotations were used to illustrate the themes. Twenty-five participants were classified as InfoSpot users. Variations and creativity in use patterns were reported. Less educated users were guided by others, while users with more education used the platform for their own and for the education of others, in addition to internet surfing. The students who used the InfoSpot for health education and for practicing English demonstrated unintended use of the platform. All non-users reported that they would have used the InfoSpots if they had been aware of their existence. All participants, users and non-users, reported a positive view of the digital health messages, especially animations as a health knowledge transfer tool. The use of such platforms can be an important factor in disease prevention.
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