In 2015 the increased migratory pressure in Europe posed additional challenges for healthcare providers. The aim of this study was to inform the development of a "Resource Package" to support ...European Union (EU) member states in improving access to healthcare for refugees, asylum seekers and other migrants.
A mixed method approach was adopted: i) interviews and focus groups were carried out to gather up-to-date information on the challenges the different healthcare providers were facing related to the refugee crisis; ii) to complement the results of the FGs, a literature review was conducted to collect available evidence on barriers and solutions related to access to healthcare for refugees and migrants.
The different actors providing healthcare for refugees and migrants faced challenges related to the phases of the migration trajectory: arrival, transit and destination. These challenges impacted on the accessibility of healthcare services due to legislative, financial and administrative barriers; lack of interpretation and cultural mediation services; lack of reliable information on the illness and health history of migrant patients; lack of knowledge of entitlements and available services; lack of organisation and coordination between services. These barriers proved particularly problematic for access to specific services: mental health, sexual and reproductive care, child & adolescent care and victim of violence care.
The findings of this study show that solutions that are aimed only at responding to emergencies often lead to fragmented and chaotic interventions, devolving attention from the need to develop structural changes in the EU health systems.
Using a sequential mixed method design, the MADESIO protocol explores the adherence to oral anticancer medications in patients with haematological malignancies and among first and second generation ...migrants of varied origin. Conducted in the ambulatory setting, a first quantitative strand will measure adherence rates and associated risk factors in two sub-groups of patients with haematological malignancies (group A: first and second generation migrants and group B: non-migrants). The second qualitative strand of this study uses semi-structured interviews to address address the patients' subjective meanings and understand the statistical associations observed in the quantitative study (strand one). MADESIO aims to provide a first assessment of whether and why migrants constitute a population at risk concerning adherence to oral anticancer medications. Our protocol is designed to provide a comprehensive understanding of adherence in a specific population. The methodological choices applied allow to explore adherence among patients from diverse linguistic and cultural backgrounds. A particular emphasis has been paid to minimize the biases and increase the reliability of the data collected. Easily reproductible, the MADESIO design may help healthcare services to screen adherence to Oral anticancer medications and to guide providers in choosing the best strategies to address medication adherence of migrants or minority diverse population.
According to Lebanese official data, Lebanon hosts over 1.5 million displaced Syrians (DS). Research shows that migrants encounter barriers when accessing healthcare. The social determinants of ...health (SDOH) related to migration are an additional challenge for DS in Lebanon, though bias plays a significant factor in exacerbating health inequalities. This study aims to identify DS perception of healthcare biases in the Lebanese healthcare system, and its consequences on DS' accessing and receiving quality healthcare in Lebanon.
A qualitative analysis using in-depth, semi-structured interviews was utilized. 28 semi-structured interviews were conducted with doctors (
= 12) and nurses (
= 16) in 2021. Six group interviews were conducted with DS (
= 22) in Lebanese healthcare facilities. The recruitment of participants relied on reasoned and targeted sampling. Thematic analysis was performed to identify common themes in participants' experiences with DS accessing Lebanese healthcare.
The findings indicated that there were barriers to accessing healthcare related to the SDOH, such as transportation and financial resources. The results also suggested that DS perceived health biases, including discriminatory behavior from Lebanese healthcare providers, stereotypes and racism leading to health inequalities.
Based on the perceptions and experiences reported by participants, the underlying causes of biases are due to the fragility of the Lebanese healthcare system when facing a humanitarian crisis as well as a collapsing infrastructure torn by past wars and the current socio-political and financial crises in the country. Global initiatives are required to provide the necessary resources needed for offering equitable health services. Such initiatives involve addressing biases, health inequities, discrimination, and the lack of a Lebanese infrastructure system for the provision of healthcare. Addressing health inequalities remains a major health objective in achieving health equity on the micro level (cultural awareness and competencies) and macro level (equitable distribution of resources, implementation of a universal health coverage) in order to guarantee quality healthcare services to DS.
The study aims to examine cultural differences and discrimination as difficulties encountered by DS when using the Lebanese healthcare system, and to evaluate the equity of DS access to health ...services in Lebanon. This is a qualitative study using in-depth semi-structured interviews with DS and Lebanese healthcare professionals. The participants were selected by visiting two hospitals, one public Primary Healthcare Center, and three PHCs managed by Non-Governmental Organizations. The recruitment of participants was based on reasoned and targeted sampling. Thematic analysis was performed to identify common themes in participants' experiences of DS in accessing Lebanese healthcare. Twenty interviews took place with directors of health facilities (
= 5), health professionals (
= 9), and DS (
= 6) in six different Lebanese healthcare institutions. The results showed barriers of access to care related to transportation and financial issues. Healthcare services provided to the DS appear to be of poor quality due to inequitable access to the health system, attributable to the discriminatory behavior of healthcare providers. Among the several factors contributing to the presence of discrimination in the Lebanese healthcare system, the persisting fragility of the healthcare system-facing a humanitarian crisis-emerged as the major driver of such unequal treatment. The number of DS in Lebanon is roughly equal to a quarter of its citizens; there is an urging need to restore the Lebanese health system to ensure the equitable provision of health services for DS and appropriate working conditions for health professionals.
European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice ...in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants.
A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants.
The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e.g. on the need for prioritising cultural differences, and between countries, e.g. on the need for more consistent governance of health care services for immigrants.
Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some disagreement both within and between countries on specific issues that require further research and debate.
In Europe, progress in the development of health policies that address the needs of migrants and ethnic minorities has been slow. This is partly due to the absence of a strategic commitment by the ...health authorities. The Ministry of Public Health commissioned the ETHEALTH (EThnicity &HEALTH) group to formulate relevant recommendations to the public authorities with a view to reducing health inequalities among ethnic minorities. This paper describes the political process and the outcomes of the ETHEALTH expert group.
After ten meetings, the ETHEALTH group came up with 46 recommendations, which were presented at a national press conference in December 2011. Target groups concerned by these recommendations covered both irregular migrants and migrants entitled to the national insurance coverage. Recommendations were supported by the need of combining universal approaches to health care with more specific approaches. The scope of the recommendations concerned health care as well as prevention, health promotion and access to health care. When analysing the content of the recommendations, some ETHEALTH recommendations were not fully measurable, and time-related; they were, however, quite specific and realistic within the Belgian context. The weak political commitment of an executive agency was identified as a major obstacle to the implementation of the recommendations.
The ETHEALTH group was an example of scientific advice on a global health issue. It also demonstrated the feasibility of coming up with a comprehensive strategy to decrease ethnic health inequalities, even in a political context where migration issues are sensitive. Two final lessons may be highlighted at the end of the first phase of the ETHEALTH project: firstly, the combination of scientific knowledge and practical expertise makes recommendations SMART; and, secondly, the low level of commitment on the part of policymakers might jeopardise the effective implementation of the recommendations.
International migration is a global phenomenon challenging healthcare professionals to provide culturally competent care.
The purpose of this study was to investigate the influence of leaders on the ...cultural competence of healthcare professionals.
A cross-sectional survey was conducted from 2010 to 2012 to obtain data for a social network analysis in 19 inpatient services and five primary care services in Belgium. The Competences in Ethnicity and Health questionnaire was used. A total of 507 healthcare professionals, including 302 nurses, identified their social relationships with other healthcare professionals working in their service. Highest in-degree centrality was used to identify the leaders within each health service. Multiple regressions with the Huber sandwich estimator were used to link cultural competence of leaders with the cultural competence of the rest of the healthcare staff.
Cultural competence of the healthcare staff was associated with the cultural competence of the leaders. This association remained significant for two specific domains of cultural competence-mediation and paradigm-after controlling for contextual and sociodemographic variables. Interaction analysis suggested that the leadership effect varied with the degree of cultural competence of the leaders.
Cultural competence among healthcare professionals is acquired partly through leadership. Social relationships and leadership effects within health services should be considered when developing and implementing culturally competent strategies. This requires a cautious approach as the most central individuals are not always the same persons as the formal leaders.
Health services in Europe face the challenge of delivering care to a heterogeneous group of irregular migrants (IM). There is little empirical evidence on how health professionals cope with this ...challenge. This study explores the experiences of health professionals providing care to IM in three types of health care service across 16 European countries.
Semi-structured interviews were conducted with health professionals in 144 primary care services, 48 mental health services, and 48 Accident & Emergency departments (total n = 240). Although legal health care entitlement for IM varies across countries, health professionals reported facing similar issues when caring for IM. These issues include access problems, limited communication, and associated legal complications. Differences in the experiences with IM across the three types of services were also explored. Respondents from Accident & Emergency departments reported less of a difference between the care for IM patients and patients in a regular situation than did respondents from primary care and mental health services. Primary care services and mental health services were more concerned with language barriers than Accident & Emergency departments. Notifying the authorities was an uncommon practice, even in countries where health professionals are required to do this.
The needs of IM patients and the values of the staff appear to be as important as the national legal framework, with staff in different European countries adopting a similar pragmatic approach to delivering health care to IM. While legislation might help to improve health care for IM, more appropriate organisation and local flexibility are equally important, especially for improving access and care pathways.
In a context of increasing ethnic diversity, culturally competent strategies have been recommended to improve care quality and access to health care for ethnic minorities and migrants; their ...implementation by health professionals, however, has remained patchy. Most programs of cultural competence assume that health professionals accept that they have a responsibility to adapt to migrants, but this assumption has often remained at the level of theory. In this paper, we surveyed health professionals' views on their responsibility to adapt.
Five hundred-and-sixty-nine health professionals from twenty-four inpatient and outpatient health services were selected according to their geographic location. All health care professionals were requested to complete a questionnaire about who should adapt to ethnic diversity: health professionals or patients. After a factorial analysis to identify the underlying responsibility dimensions, we performed a multilevel regression model in order to investigate individual and service covariates of responsibility attribution.
Three dimensions emerged from the factor analysis: responsibility for the adaptation of communication, responsibility for the adaptation to the negotiation of values, and responsibility for the adaptation to health beliefs. Our results showed that the sense of responsibility for the adaptation of health care depended on the nature of the adaptation required: when the adaptation directly concerned communication with the patient, health professionals declared that they should be the ones to adapt; in relation to cultural preferences, however, the responsibility felt on the patient's shoulders. Most respondents were unclear in relation to adaptation to health beliefs. Regression indicated that being Belgian, not being a physician, and working in a primary-care service were associated with placing the burden of responsibility on the patient.
Health care professionals do not consider it to be their responsibility to adapt to ethnic diversity. If health professionals do not feel a responsibility to adapt, they are less likely to be involved in culturally competent health care.
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