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Good practice in health service provision for migrants

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... For decades, the main aim of CC has been matching health services to the needs of migrant users to bridge "cultural gaps" (Ingleby, 2011). Over time, some authors criticized CC discourse. ...
... Partly because of this criticism, the concept of culture assumed by health services researchers has changed over time and now growing attention is attributed to the notion of intersectionality (Ingleby et al., 2019;Dell'Aversana & Bruno, 2018). Emphasis on its dynamic dimension recognizes that CC involves skills in intercultural communication, attitudes of respect and openness, and relevant knowledge (Ingleby, 2011). Another important dimension is professionals' self-assessment of their own culture and implicit assumptions. ...
... This duplicity does not necessarily represent different kinds of participants; rather, it is present in an ambivalent way in the discourse of most interviews. This seems to be connected to the debate between the categorical and the process approach to CC in the literature (Kleinman & Benson, 2006;Ingleby, 2011). ...
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The paper focuses on the concept of cultural competence and has as the main purpose to explore: a) the perception and representation of Italian midwives regarding the reproductive health and the childbirth cultures of immigrant women; b) strengths and weaknesses of their professional practices. Twenty midwives were interviewed. Data were analyzed using the grounded theory procedures of categoriza-tion and codification, integrated with template analysis. Findings highlighted eight thematic areas showing the presence of difficulties related to the relationships and communication between foreign patients and medical staff. The results also revealed the widespread belief that maternity, childbirth, and breastfeeding have a "universal grammar" linked to the female body and reproductive function can lead to an underestimation of the need for culturally competent services; on the other hands, an ideal-typical contrast appears in the participants' discourse between an apparently egalitarian position of the same service for everyone and a desire for differentiated attention to diversity. Complex political, demographic, and economic dynamics are changing our societies and health systems are dealing with a highly differentiated population. Since the beginning of the 21st century, a growing body of literature has explained the complex relationship between immigration and health, mainly on the basis of three theories (Im & Yang, 2006): selective migration and health (immigrants tend to be healthier than their peers and respond more positively to adaptation), negative effect of immigration on health (immigration is a stressful experience that leads to health impairment), and acculturation and health (acculturation is a desired health-related outcome of immigration). Despite the adopted point of view, research shows health disparities in migrant groups and ethnic minorities and demonstrates the need for culturally competent services; on the other hands, an ideal-typical contrast appears in the participants’ discourse between an apparently egalitarian position of the same service for everyone and a desire for differentiated attention to diversity.
... The presence of dedicated services on migrant healthcare seems to reduce the risk of ASs being excluded from healthcare or of inappropriately using emergency services [123]. This is a consequence of a lack of knowledge about the healthcare system, mostly in the first period after arrival, and a lack of health coverage due to a delay in the processing of an asylum request, especially during periods of large influx [112,113]. ...
... Moreover, these services seem to have specific migrant health competences, while other RHS do not. In spite of this, the presence of dedicated services could reflect the risk of developing separate care pathways both for migrants and host communities [123] that could seem discriminatory. In addition, the presence of dedicated services could impede ASs' empowerment in accessing and taking care of their health and reduces the responsibility of other services, especially of general practitioners. ...
... This variability in models of care adopted by LHOs can have more than one explanation: the regional autonomy towards healthcare and the decentralization to a subnational level of health policies and health management, in coherence with the Italian SSN organization and with the competences of each level [32,33]; the characteristics of the settings, such as the availability of resources or the previous policy [123]; geographical (urban or rural area), cultural or political aspects. In this study, the previous migratory pressure on RHS and the organizational model of the reception systems seemed to be more influential, even if more data and details are needed to better understand the possible correlation between these factors. ...
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The decentralization of the provision of health services at the subnational level produces variations in healthcare offered to asylum seekers (ASs) across the different Italian regions, even if they are entitled to healthcare through the national health service. The present study aims to map the healthcare path and regional policies for ASs upon arrival and identify challenges and best practices. This is a multicentric, qualitative study of migrant health policies and practices at the regional level within four Italian regions. For the analysis, a dedicated tool for the systematic comparison of policies and practices was developed. The collection and analysis of data demonstrated the presence of many items of international recommendations, even if many gaps exist and differences between regions remain. The analysis of practices permitted the identification of three models of care and access. Some aspects identified are as follows: fragmentation and barriers to access; a weakness in or lack of a governance system, with the presence of many actors involved; variability in the response between territories. The inclusion of ASs in healthcare services requires intersectoral actions, involving healthcare sectors and other actors within local social structures, in order to add value to local resources and practices, reinforce networks and contribute to social integration.
... For decades the main aim of CC has been matching health services to the needs of migrant users, to bridge 'cultural gaps' (Ingleby, 2011). Social science criticized CC discourse by highlighting the lack of conceptual clarity around the use of the term 'culture' in clinical encounters and inadequate recognition of the 'culture of medicine' (Thackrah and Thompson, 2013). ...
... Partly as a result of this criticism, the concept of culture assumed by researchers on health services has changed over time. Emphasis on its dynamic dimension permits to recognize that CC involves skills in intercultural communication, attitudes of respect and openness, and relevant knowledge (Ingleby, 2011). Another important dimension is professionals' selfassessment of their own culture and implicit assumptions. ...
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Cultural competence (CC) for professionals and organizations has been recognized as a key strategy to reduce health care inequalities for migrants and to promote responsiveness to diversity. For decades its main aim has been matching health services to the cultural needs of migrant users. Otherwise literature highlighted the need to find a pragmatic middle way between the ‘static’ and the ‘dynamic’ views of culture that are recognizable in CC approaches. A pragmatic middle way to CC will be proposed as the way to respect diversity, even responding to cultural issues, without stereotyping or discriminating. To understand conditions that favor this pragmatic middle way this study aims to explore: (1) perceptions of healthcare providers in managing diversity; (2) strategies used to meet health needs at a professional and organizational level. A qualitative case study was conducted in a healthcare service renowned for its engagement in migrant sensitive care. Four different professional figures involved in CC strategies at different levels, both managerial and non-managerial, were interviewed. Data were analyzed using thematic analysis. Findings indicated that dealing with diversity poses challenges for healthcare providers, by confronting them with multilevel barriers to quality of care. A pragmatic middle way to CC seems to rely on complex understanding of the interaction between patients social conditions and the capacity of the institutional system to promote equity. Professional and organizational strategies, such as inter-professional and intersectional collaboration, cultural food adaptation and professional training can enhance quality of care, patient compliance responding to social and cultural needs.
... Es por ello que, durante los últimos años se ha visto una mayor preocupación por lograr brindar una oferta asistencial tal que la accesibilidad, la mejora en la comunicación (Qureshi, 2011) y la calidad en la atención a todos los pacientes (Bernand, 2006). Se trata de abrirse a distintas miradas, estar a la escucha de lo que los otros transmiten, no sólo a través del lenguaje verbal sino también por medio del lenguaje no verbal y lo no dicho en el discurso (Ingleby, 2011). Entre las temáticas más trabajadas sobre interculturalidad, resaltan las de las creencias, el estilo de vida y los hábitos de cuidado que, en ocasiones, suelen ser muy diferentes entre los pacientes y el personal de la salud, dando lugar a la dificultad de comprensión entre ambos (Salaverry, 2010;Almaguer, García y Vargas, 2014). ...
Article
Este artículo tiene como propósito comprender una revisión respecto a los aportes teóricos y metodológicos que se han hecho entorno a la competencia intercultural. Para ello, la estrategia metodológica se desarrolló con un análisis de diseño cualitativo e interpretativo, documental, construida a partir del estado del arte. Empezando desde la interculturalidad, se ve que ésta no llega a ser exclusiva de un campo en particular, debido a que es utilizada y trabajada desde varias disciplinas como las ciencias humanas y sociales. En el marco de la educación, varios autores que han fungido como promotores de la interculturalidad en la enseñanza de lenguas han hecho evidente la contraposición al modelo de civilización, tomando posición como una nueva parte de la cultura que implica el desarrollo de las capacidades, conocimientos y saberes que le posibiliten al aprendiente regular sus relaciones con las personas pertenecientes a culturas diferentes a la suya. Tras identificar diversas clasificaciones de autores en torno a la competencia intercultural se analizaron cada una de las tipologías, para después integrar una nueva clasificación con sus principales elementos. Así, surgieron cuatro dimensiones de la competencia intercultural: la simbólica, la comunicativa, la conductual y la personal. Éstas con el fin de que posibiliten analizar el nivel de desarrollo de la competencia intercultural que desarrollan los aprendientes de una lengua extranjera.
... Several studies showed that in the EU, immigrants and ethnic minorities face both formal and informal barriers that decrease access to quality medical care. In addition to socio-economic disadvantages [15][16][17][18] this can contribute to health inequalities. In particular, risk factors specifically related to the condition of immigrants in the hosting country, such as their poorer social status and lack of awareness regarding CKD and how to gain access to healthcare, may influence the onset of non-communicable diseases which are related to the onset and progression of CKD [19][20][21]. ...
Article
Introduction: In recent decades, high income countries (HIC) have been exposed to huge human migratory flows. Consistent with this influx, there has been a dramatic increase in the number of chronic kidney disease (CKD) patients in the immigrant population. In Italy, comparisons between Italian and immigrant CKD patients are still lacking, thus we aimed to describe the baseline clinical characteristics and the main outcomes of CKD patients who immigrated to Italy and reside in the Emilia Romagna region. Methods: This is a retrospective cohort study based on CKD patients from the Prevenzione Insufficienza Renale Progressiva (PIRP) project, which included 963 (3.1%) immigrants among the 30,702 patients seen by nephrologists between April 1st, 2004 and June 30th, 2020. We sub-divided the immigrants into seven groups based on their area of origin, and compared their baseline characteristics, CKD progression and time to end-stage kidney disease (ESKD) to those of Italian CKD patients. Results: At presentation, Italian subjects were on average older (73.1 years) and had less preserved kidney function (eGFR 34.3 ml/min), while South and East Asians had the highest proportion of diabetes and obesity (approximately 45% and 30%, respectively). At 4-year follow-up, about 20% of patients from South Asia, Eastern Europe and Arab Countries were diagnosed with ESKD, compared to only 11% of Italians and Latin Americans. Conclusions: We found important differences between Italian and immigrant CKD patients, as well as among immigrant subgroups. First clinical encounters with nephrologists revealed that immigrants had varied patterns of clinical presentation and of nephropathy. During follow-up, immigrants showed faster kidney function decline which led to a higher risk of disease evolution and progression towards ESKD.
... 11 However, a simple translation may not sufficiently provide for cultural differences. 12 An additional cultural adaptation may therefore be needed. ...
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Objectives To evaluate the usefulness of culture-sensitive patient information material compared with standard translated material. Design Multicentre, double-blind randomised controlled trial. Setting 37 primary care practices. Participants 435 adult primary care patients with a migration background with unipolar depressive disorder or non-specific chronic low back pain were randomised. Patients who were unable to read in the language of their respective migration background were excluded. Sufficient data were obtained from 203 women and 106 men. The largest group was of Russian origin (202 patients), followed by those of Turkish (52), Polish (30) and Italian (25) origin. Interventions Intervention group: provision of culture-sensitive adapted material. Control group: provision of standard translated material. Main outcome measures Primary outcome: patient-rated usefulness (USE) assessed immediately after patients received the material. Secondary outcomes: patient-rated usefulness after 8 weeks and 6 months, symptoms of depression (PHQ-9), back pain (Back Pain Core Set) and quality of life (WHO-5) assessed at all time points. Results Usefulness was found to be significantly higher (t=1.708, one-sided p=0.04) in the intervention group (USE-score=65.08, SE=1.43), compared with the control group (61.43, SE=1.63), immediately after patients received the material, in the intention-to-treat analysis, with a mean difference of 3.65 (one-sided 95% lower confidence limit=0.13). No significant differences were found for usefulness at follow-up (p=0.16, p=0.71). No significant effect was found for symptom severity in depression (p=0.95, p=0.66, p=0.58), back pain (p=0.40, p=0.45, p=0.32) or quality of life (p=0.76, p=0.86, p=0.21), either immediately after receiving the material, or at follow-up (8 weeks; 6 months). Patients with a lower level of dominant society immersion benefited substantially and significantly more from the intervention than patients with a high level of immersion (p=0.005). Conclusion Cultural adaptation of patient information material provides benefits over high quality translations. Clinicians are encouraged to use culture-sensitive material in their consultations, particularly with low-acculturated patients. Trial registration number German Register for Clinical Trials: DRKS00004241, Universal Trial Number: U1111-1135-8043, Results.
... Responding to migrants' health needs is a global issue and mainly relies on cultural competence (CC) of healthcare professionals and healthcare organizations (Chiarenza 2012; Horvat et al. 2014; Ingleby 2011). According to the holistic definition of Cross and colleagues, CC is 'a set of congruent behaviors, attitudes and policies that come together in a system , agency or among professionals and enable that system, agency or those professionals to work effectively in cross cultural situations' (Cross et al. 1989 p. 28). ...
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Aim: This study investigated the role of social relationships in the sharing of cultural competence by testing two hypotheses: cultural competence is a socially shared behaviour; and central healthcare professionals are more culturally competent than non-central healthcare professionals. Background: Sustaining cultural competence in healthcare services relies on the assumption that being culturally competent is a socially shared behaviour among health professionals. This assumption has never been tested. Introduction: Organizational aspects surrounding cultural competence are poorly considered. This therefore leads to a heterogeneous implementation of cultural competence - especially in continental Europe. Methods: We carried out a social network analysis in 24 Belgian inpatient and outpatient health services. All healthcare professionals (ego) were requested to fill in a questionnaire (Survey on social relationships of health care professionals) on their level of cultural competence and to identify their professional relationships (alter). We fitted regression models to assess whether (1) at the dyadic level, ego cultural competence was associated with alter cultural competence, and (2) health professionals of greater centrality had greater cultural competence. Results: At the dyadic level, no significant associations were found between ego cultural competence and alter cultural competence, with the exception of subjective exposure to intercultural situations. No significant associations were found between centrality and cultural competence, except for subjective exposure to intercultural situations. Discussion: Being culturally competent is not a shared behaviour among health professionals. The most central healthcare professionals are not more culturally competent than less central health professionals. Conclusions and implications for health policies: Culturally competent health care is not yet a norm in health services. Health care and training authorities should either make cultural competent health care a licensing criteria or reward culturally competent health care.
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This chapter describes the facts and figures of today’s migration patterns and briefly presents the limits and findings of the existing research on the impact of different forms of migration on the mental health of migrants. The article aims at promoting a right-based approach to migrants’ access to mental health care, as supported by international legal instruments. Since this right is at times disregarded due to the legal unavailability and factual inaccessibility for migrants of the existing mental health services, the article proposes a series of actions that could facilitate migrants’ access to mental health care across health systems and countries.
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For immigrants, politics can play a significant role in determining whether and how they assimilate. In Bringing Outsiders In, leading social scientists present individual cases and work toward a comparative synthesis of how immigrants affect-and are affected by-civic life on both sides of the Atlantic. Just as in the United States, large immigrant minority communities have been emerging across Europe. While these communities usually make up less than one-tenth of national populations, they typically have a large presence in urban areas, sometimes approaching a majority. That immigrants can have an even greater political salience than their population might suggest has been demonstrated in recent years in places as diverse as Sweden and France. Attending to how local and national states encourage or discourage political participation, the authors assess the relative involvement of immigrants in a wide range of settings. Jennifer Hochschild and John Mollenkopf provide a context for the particular cases and comparisons and draw a set of analytic and empirical conclusions regarding incorporation.
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There have been strong critiques of the notion that environmental influences can have an important effect on psychological functioning. The substance of these criticisms is considered in order to infer the methodological challenges that have to be met. Concepts of cause and of the testing of causal effects are discussed with a particular focus on the need to consider sample selection and the value (and limitations) of longitudinal data. The designs that may be used to test hypotheses on specific environmental risk mechanisms for psychopathology are discussed in relation to a range of adoption strategies, twin designs, various types of "natural experiments," migration designs, the study of secular change, and intervention designs. In each case, consideration is given to the need for samples that "pull-apart" variables that ordinarily go together, specific hypotheses on possible causal processes, and the specification and testing of key assumptions. It is concluded that environmental risk hypotheses can be (and have been) put to the test but that it is usually necessary to use a combination of research strategies.
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Objectives We examined changes in relative disparities between racial/ethnic populations for the five leading causes of death in the United States from 1990 to 2006. Methods The study was based on age-adjusted death rates for four racial/ethnic populations from 1990–1998 and 1999–2006. We compared the percent change in death rates over time between racial/ethnic populations to assess changes in relative differences. We also computed an index of disparity to assess changes in disparities relative to the most favorable group rate. Results Except for stroke deaths from 1990 to 1998, relative disparities among racial/ethnic populations did not decline between 1990 and 2006. Disparities among racial/ethnic populations increased for heart disease deaths from 1999 to 2006, for chronic obstructive pulmonary disease deaths from 1990 to 1998, and for chronic lower respiratory disease deaths from 1999 to 2006. Conclusions Deaths rates for the leading causes of death are generally declining; however, relative differences between racial/ethnic groups are not declining. The lack of reduction in relative differences indicates that little progress is being made toward the elimination of racial/ethnic disparities.