Article 1: Healthcare access for refugee women with limited literacy: layers of disadvantage.
Authors: Annette Floyd and Dikaios Sakellariou
Published: 25 august 2017
Reason for the study
Refugees have a higher burden of diseases and a compromised access to healthcare. Refugees face many barriers, like limited knowledge on the lived experiences of this population. Strategies that people can use to access healthcare have not been explored in depth.
Research question
‘’What are the living experiences of accessing healthcare in de greater Vancouver area for recently-arrived, government-assisted refugee women, who were non-literate and non-English-speaking when they arrived in the country?’’(Floyd & Sakellariou, 2017).
Research goal
The main goal of this study is to find out the living experiences of accessing healthcare in the greater Vancouver area. This is for recently-arrived and government-assisted refugee women. These women are non-literate and non-English-speaking when they arrive in the country.
Methods/data collection
This study is focused on the subjectivity, the meaning of actions and the human consciousness. The study is adapted on women of 18 years and older from East African origin. The women in this region represent the non-literate refugee policy in British Columbia. Many of these women came from rural backgrounds and refugee camps. All the date were collected through semi-structured interviews. A semi-structured interview is an extensive description of the experiences of women when they want to access health care. These women were asked to think about an experience in which they were worried about their own health or the health of their children, in which they had to get access to health care. The last question is how they felt and what actions they had taken.
Results/conclusion
All participants were dependent on others to access healthcare in their new city, because of the language barriers, an inability to read directions or maps, and general unfamiliarity with an urban environment. It was a big challenge for these women to have the ability to know where appointments were, because they were unable to read an appointment slip or write the date of the appointment on a calendar. For some participants was finding their way to the refugee clinic a big challenge. Most of the women were feeling isolated while accessing healthcare in Canada. They experienced the isolation in a number of ways, like rejection fear and shame. If they asked for help in accessing healthcare, rejection may occur within the women’s own community. The feeling of fear for some women came from the inability to communicate with the surrounding society, both on the way to appointments and within the healthcare setting. For some women calling the ambulance was a better option than trying to get to the hospital by themselves, because it was very challenging for them to negotiate their way to the hospital or clinic.
Relevant for our subject
This article is relevant for our subject because it’s about new arrived, non-literate, refugees trying to find their way in accessing healthcare. The article explains the barriers that the refugees experience while accessing healthcare. We can use these barriers for the development of our app so it’s more useful for our target group.
Level of evidence: Systematic review
Article 2: Refugees’ experiences of healthcare in the host country: a scoping review
Authors: Elisabeth Mangrio, Katharina Sjógren Forss
Date: 08-12-2017
Reason for the investigation
Research suggest that understanding refugees their experiences and access to healthcare is needed to be able to improve their health, as access has been found to be a leading health indicator. However, findings from both Sweden and Canada show lessening in health status among the refugees after they have settled in their host country. Of the participant, 60% reported to have one chronic disease, while 37% reported to have at least two chronic conditions. Numerous other factors also play a role and could also affect the refugees’ health status.
Research goal
The goal of this scoping review is to compose research about experiences that refugees have with the healthcare system in their host countries.
Methods
For this study the scoping review method is used. Studies which had to be conducted with both service holders and refugees, the perceptions of the refugees had to be clearly defined for them to be used. The intervention involved a total number of 619 studies. At first the titles were screened and, if they were in line with the goal, the abstract was read. Using this screening method the number studies was narrowed down to 91. Out of these 91 studies, 10 studies were found to be duplicates and 39 articles appeared to be relevant. The relevant studies were printed in full, and the authors reached consensus regarding which studies should be included. In the third phase, 13 articles were excludes after scientific appraisal, as they did not address the goal of the study. By the end, 26 studies were included and a summary of the eligible studies.
Results
As shown by several studies, more information needs to be provided about the participants’ healthcare rights as asylum seekers, about their disease as well as the delivery room experience. Lack of knowledge about how to access primary healthcare services is another aspect that caused objection. In the study by Fang et al., the informants also lacked familiarity with the UK health system. They also had limited knowledge of the different health services that were available, as well as of the process and procedures for accessing health services. Many were unfamiliar with the healthcare system and avoided to seek help as they were not familiar with the ideas of mental health and available treatments for such illness.
Discussion
1: In several of the included studies, the authors concluded that the asylum seekers and refugees need to be given more information about their rights to healthcare and the healthcare system itself, while in only two of the included studies the participants report receipt of such information.
2: Cultural awareness within healthcare requires genuine efforts to be done for cultural barriers to be understood. Through engagement in the community, as well as trough working closely with members of the community in order to address these barriers.
Conclusion
This review concludes that insufficient language knowledge is perceived as a communication barrier, that both regarding the healthcare system itself the refugees are lacking information and the right of the refugees to access information in the host countries. A great importance for a positive encounter with healthcare is support given by the health professionals. There is also need for further improvement when it comes to provision of culturally appropriate healthcare. There is an urgent need for improvements to be made in the communication, interpretation, support and deliverance of culturally appropriate healthcare, because refugees are at a greater risk of suffering from poor mental and physical health.
Relevant for our subject
This article is relevant for our subject because it’s about the experience of refugees of and access to healthcare. This article discusses the factors that play a role and may affect the health status of the refugees.
Article 3: Using mobile health to enhance outcomes of noncommunicable diseases care in rural stings and refugee camps
Authors: Saleh S., Farah A., Dimassi H., El Arnaout N., Constantin J., Osman M., El Morr C. and Alameddine, M. Date: 13 July 2018
Reason for the study
Characteristic of rural areas and refugee camps is that patients there have poor access to health services due to non-communicable diseases. In order to improve the prevention and control of NCD’s among these population groups, the use of inexpensive innovative eHealth-interventions can help.
Research question
“What is the effect of employing low-cost mobile health tools on the accessibility to health service and improvement of health indicators of individuals with NCDs in rural areas and refugee camps in Lebanon?”
Research goal
The aim of this study was to assess the impact of the use of low-cost mobile health products on the accessibility of healthcare and the improvement of health indicators of people with NCD’s in rural areas and refugee camps in Lebanon.
Methods
This study reports on a community study in which primary health centers (PHCC), along their consecutive service areas, were randomly assigned to control- and intervention sites to assess the change in selected quality of care indicators for NCD’s between individuals and patients from the community. The patients at the locations of the intervention received a one-year mHealth (mobile health) intervention. Their outcomes before and after the intervention were assessed by means of care quality indicators (QI’s). The population that was studied consisted of sixteen primary healthcare centers in Lebanon: of which ten in rural areas and six in Palestinian refugee camps. To participate in this study, patients had to be registered with the PHCC’s as diabetics or hypertensive patients aged for at least 40 years old.
Results
In the analysis were the data of 1433 patients in the intervention groups and 926 patients in the control groups included. The majority of patients were living in Lebanese rural areas. 64,27% of the patients were hypertensive and 35,73% of the patients were diabetic in the intervention group. In the control group were 67.6% of patients hypertensive, and 32.4% of the patients were diabetic. From the results you can conclude that the glycemic control results improved in the intervention group but not in the control group. The proportion of HbA1c poor control remained unchanged in the control group, whereas it decreased significantly in the intervention group. In both groups the proportion of annual HbA1c testing has increased and the proportion of annual eye check-up has decreased in both groups.
Conclusion
In this study, the importance of employment of the integrative approach to disease prevention and control in existing NCD programs in underserved communities, in combination with innovative and inexpensive approaches strengthened.The study reveals that the employment of SMSs may make a difference in NCDs care, this is shown by the statistically significant improvements in clinical measurements of NCD-related QIs among diabetic and hypertensive patients in Lebanese rural areas and Palestinian refugee camps. Mobile Health is a socially acceptable and simple technique that can be integrated into routine care at a low cost.
Level of evidence
Randomized controlled trial, A2
Relevant for our subject:
This article is relevant to our topic, because this article is about how mHealth contributes to prevention of non-communicable diseases in rural stings and refugee camps. This article explains how mHealth helps people in refugee camps to prevent NCDs.
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