Are sexual health survey items understood as intended by African and Asian migrants to Australia? Methods, results and recommendations for qualitative pretesting

IntroductionMore research and policy action are needed to improve migrant health in areas such as sexual health and blood-borne viruses (SHBBV). While Knowledge, Attitudes and Practice Surveys (KAPS) can inform planning, there are no SHBBV KAPS suitable for use across culturally and linguistically diverse contexts. This study pretests one instrument among people born in Sub-Saharan Africa, South-East and North-East Asia living in Australia.MethodsEmployees of multicultural organisations were trained to collect data over three rounds using a hybrid qualitative pretesting method. Two researchers independently coded data. Researchers made revisions to survey items after each round. Responses to feedback questions in the final survey were analysed.ResultsSixty-two participants pretested the survey. Issues were identified in all three rounds of pretesting. Of the 77 final survey respondents who responded to a survey experience question, 21% agreed and 3% strongly agreed with the statement ‘I found it hard to understand some questions/words’.ConclusionIt is essential to pretest SHBBV surveys in migrant contexts. We offer the following pretesting guidance: (1) large samples are needed in heterogeneous populations; (2) intersectionality must be considered; (3) it may be necessary to pretest English language surveys in the participants’ first language; (4) bilingual/bicultural workers must be adequately trained to collect data; (5) results need to be interpreted in the context of other factors, including ethics and research aims; and (6) pretesting should occur over multiple rounds.

Mortality differences between migrants and Italians residing in Rome before, during, and in the aftermath of the great recession. A longitudinal cohort study from 2001 to 2015

Background In Europe, one of the most consistent findings is that of migrant mortality advantage in high-income countries. Furthermore, the literature shows that economic shocks, which bring worse health outcomes, can severely affect the most disadvantaged individuals. We analyse differences and changes in all-cause mortality between Italians and migrants residing in Rome before, during, and in the aftermath of the Great Recession (2001–2015) by birth-cohort. Methods The analysis is a longitudinal open cohort study. Mortality data come from the Register of the Causes of Death (58,637 deaths) and the population denominator (n = 2,454,410) comes from the Municipal Register of Rome. By comparing three time-periods (2001–2005, 2006–2010, and 2011–2015), we analyse all-cause mortality of Rome residents born, respectively, in the intervals 1937–1976, 1942–1981, 1947–1986 (aged 25–64 years at entry into observation). Computing birth-cohort-specific death rates and applying parametric survival models with age as the time-scale, we compare mortality differences between migrants and Italians by gender, area of origin, and time-period. Results Overall, we find a lower risk of dying for migrants than Italians regardless of gender (Women: HR = 0.61, 95% CI 0.56–0.66; Men: HR = 0.49, 95% CI 0.45–0.53), and a lower death risk over time for the total population. Nevertheless, such a pattern changes according to gender and migrants’ area of origin. Conclusion Given the relevance of international migrations in Europe, studying migrants’ health has proved increasingly important. The deterioration in migrant health and the gradual weakening of migrants’ mortality advantage is likely to become a public health issue with important consequences for the healthcare system of all European countries.

Forced migrants and other displaced populations

This chapter provides an overview of the global health dimensions of forced migration and the associated public health challenges. The chapter identifies different categories of forced migrants and examines the main causes of displacement in a global context in which globalization is simultaneously a force for greater integration as well as a contributor to forced migration. Global statistics and legal frameworks relating to forced migrants are examined and formal protections to which refugees and other groups of forced migrants are entitled are identified. The public health situations of forced migrants are varied and often poor, the health situation of different types of forced migrant are outlined and public health responses described. The role of public health professionals in developing a comprehensive understanding of the dynamics of forced migration in order to advocate for forced migrant health, and enable forced migrants to speak and be heard, aiding them in transforming their own health outcome are discussed.

A scoping review on the measurement of transnationalism in migrant health research in high-income countries

Background Migrants commonly maintain transnational ties as they relocate and settle in a new country. There is a growing body of research examining transnationalism and health. We sought to identify how transnationalism has been defined and operationalized in migrant health research in high income countries and to document which populations and health and well-being outcomes have been studied in relation to this concept. Methods We conducted a scoping review using the methodology recommended by the Joanna Briggs Institute (JBI). We searched nine electronic databases; no time restrictions were applied. Studies published in English or French in peer-reviewed journals were considered. Studies were eligible if they included a measure of transnationalism (or one of its dimensions; social, cultural, economic, political and identity ties and/or healthcare use) and examined health or well-being. Results Forty-seven studies, mainly cross-sectional designs (81%), were included; almost half were conducted in the United States. The majority studied immigrants, broadly defined; 23% included refugees and/or asylum-seekers while 36% included undocumented migrants. Definitions of transnationalism varied according to the focus of the study and just over half provided explicit definitions. Most often, transnationalism was defined in terms of social connections to the home country. Studies and measures mainly focused on contacts and visits with family and remittance sending, and only about one third of studies examined and measured more than two dimensions of transnationalism. The operationalization of transnationalism was not consistent and reliability and validity data, and details on language translation, were limited. Almost half of the studies examined mental health outcomes, such as emotional well-being, or symptoms of depression. Other commonly studied outcomes included self-rated health, life satisfaction and perceived discrimination. Conclusion To enhance comparability in this field, researchers should provide a clear, explicit definition of transnationalism based on the scope of their study, and for its measurement, they should draw from validated items/questions and be consistent in its operationalization across studies. To enhance the quality of findings, more complex approaches for operationalizing transnationalism (e.g., latent variable modelling) and longitudinal designs should be used. Further research examining a range of transnationalism dimensions and health and well-being outcomes, and with a diversity of migrant populations, is also warranted.

Psychiatric consequences of a father’s leave policy by nativity: a quasi-experimental study in Sweden

BackgroundParental leave use has been found to promote maternal and child health, with limited evidence of mental health impacts on fathers. How these effects vary for minority populations with poorer mental health and lower leave uptake, such as migrants, remains under-investigated. This study assessed the effects of a Swedish policy to encourage fathers’ leave, the 1995 Father’s quota, on Swedish-born and migrant fathers’ psychiatric hospitalisations.MethodsWe conducted an interrupted time series analysis using Swedish total population register data for first-time fathers of children born before (1992–1994) and after (1995–1997) the reform (n=198 589). Swedish-born and migrant fathers’ 3-year psychiatric hospitalisation rates were modelled using segmented negative binomial regression, adjusting for seasonality and autocorrelation, with stratified analyses by region of origin, duration of residence, and partners’ nativity.ResultsFrom immediately pre-reform to post-reform, the proportion of fathers using parental leave increased from 63.6% to 86.4% of native-born and 37.1% to 51.2% of migrants. Swedish-born fathers exhibited no changes in psychiatric hospitalisation rates post-reform, whereas migrants showed 36% decreased rates (incidence rate ratio (IRR) 0.64, 95% CI 0.47 to 0.86). Migrants from regions not predominantly consisting of Organisation for Economic Cooperation and Development countries (IRR 0.50, 95% CI 0.19 to 1.33), and those with migrant partners (IRR 0.23, 95% CI 0.14 to 0.38), experienced the greatest decreases in psychiatric hospitalisation rates.ConclusionThe findings of this study suggest that policies oriented towards promoting father’s use of parental leave may help to reduce native–migrant health inequalities, with broader benefits for family well-being and child development.

MIPEX vs Country Assessment Tool – Pros and Cons

The 2015 MIPEX (Migrant Integration Policy Index) Health strand was developed to benchmark progress on implementing the Council of Europe's 2011 Recommendations on mobility, migration and access to health care. MIPEX collects data on both ‘downstream' and ‘upstream' policies. Though like we identified in the Road Map, it is paying more attention to the former kind. MIPEX data exist for all countries participating in the JAHEE WP7. Its unique advantage is that it contains a large, uniform collection of carefully standardized and operationalised indicators, enabling comparisons to be made between countries and between countries at different points in time. A common thread in the “Road Map” is that without a solid evidence base, we will not succeed in improving health equity for migrants. Background information on a country migrant population is important for estimating the kinds of demands that health and social services will face. Taking steps to promote the collection of such data is one of the most useful contributions JAHEE can make. While MIPEX covers Migrant Integration Policy, the CA includes a more comprehensive overview that can benefit practitioners, bureaucrats and policymakers in implementing strategic measures to mitigate gaps for better migrant health.

Country Experience with using the Country Assessment Tool (Lessons learned)

Difficulties in completing the CA concerned the availability of data and quality of data, also complicated by complex government structures. UK-level data are collected by various agencies and are often unavailable at Welsh level. Data on migrant health is not collected, apart from the Office of National Statistics scoping collection at UK level. There was no data available regarding refugees after they have been granted leave to remain, and the numbers in Wales not known. Research on migrant health is largely limited to people seeking sanctuary, and there is an ambitious cross-sector plan to make Wales the world's first Nation of Sanctuary. While there is limited visibility of migrants in health-related policies, rather references to ‘diverse communities' or ‘black and minority ethnic groups', Welsh policy in devolved areas e.g. Health are generally more inclusive of migrants than UK policy. Lessons learned: It is difficult to retro fit data systems and trying to gather from mainstream information will vastly underestimate the underserved population groups such as migrants. Especially when sanctions against individuals and mistrust of officialdom may mean an unwillingness to engage. For asylum seekers these stakes are very high eg deportation. Hence specific bespoke systems of data capture are needed. Often using trusted others eg third sector organisations that support health, legal advocacy and other service reports are important.

Country Experience with using the Country Assessment Tool (Lessons learned)

Findings from the CA show that research and data are largely available, but there are several knowledge gaps and we often lack a comprehensive overview. Gaps include longitudinal studies and knowledge of effects of implemented policy and practice. Lack of knowledge-based practice and policy development is a continuous challenge. Furthermore, we identified a lack of coordination of the migration health field, as well as cross-sectional collaboration. Lessons learned: The CA and the JAHEE has provided a starting point for conversations with national partners, such as the directorate of health, about how we can strengthen the migration and health field in Norway. The CA has been presented and used in national conferences to highlight gaps and initiate collaboration to mitigate these gaps. The CA tool can become the comprehensive overview that we do not have today. While MIPEX covers integration policy, the CA covers broader topics touching on the work carried out in different sectors and levels in society that affect migrant health.

How does migratory status affect non-communicable disease risk in a global context? A systematic review

Challenges pertaining to the study of migrant health have been reported in medical and sociological literature. A literature review was thus conducted to gauge what research currently holds about the risk of non-communicable disease within migrant populations globally. The search strategy is outlined; CASP checklists were used to critically appraise articles, and the relevant data was synthesised and analysed. The research identifies several overarching quantitative themes regarding risk patterns. Recommendations are made.