bluuebunny/crossref_metadata_2025_split huggingface dataset:
Culturally sensitive diabetes education supporting ethnic minorities with type 2 diabetes
Authors: Hempler N F , Laursen D H , Glümer C 
Published: November 2019

Abstract

Background
Ethnic minorities of non-Western origin are at higher risk of type 2 diabetes and diabetes complications, compared to the general population. Diabetes education programmes are essential to support people with diabetes to initiate and sustain behaviours needed to manage their condition throughout their lives. However, shaping diabetes education that provide culturally sensitive education that is acceptable to and supports diabetes self-management among members of ethnic minorities is needed.

Objectives
In this study, we develop and evaluate a culturally sensitive diabetes education programme in a community health setting, focusing on Arabic, Urdu or Turkish languages (n = 100). The programme aims to support ethnic minorities with type 2 diabetes in making health-promoting decisions about their care. Also, it will produce knowledge about methods and tools to improve content and format, and about the skills of those delivering the education. Using design-based research, the development comprised three phases: needs assessment, co-creation and testing. The target groups were actively involved in all phases.

Results
The needs assessment was based on fieldwork, workshops and interviews with the target groups and educators. Data showed that self-blame and learned helplessness undermined health-promoting decisions in the target groups. Also, a lack of clear roles between educators and peer educators, and a limited focus on goal setting in the educational setting was observed. The needs assessment informed the development of a 6 week group-based programme, supported by 11 dialogue tools. Preliminary findings show a high level of programme acceptability and participation as well as engagement in diabetes and care in the target groups.

Conclusions
By actively involving the target groups, health care professionals and as well as health services directly engaged with the target group, the outcomes of the programme are likely to be relevant to individuals and institutions.

Key messages
This study gives voice to ethnic minorities with type 2 diabetes through the co-creation of a diabetes education programme aiming to support health-promoting decisions. Innovative and involving methods are highly relevant to develop acceptable and effective diabetes education programmes targeting ethnic minority groups.
Migrants’ social determinants of health: living conditions, violence exposure, access to healthcare
Authors: Spoel E , Accoe K , Heymans S , Verbeeren P , de Béthune X 
Published: November 2019

Abstract

Background
WHO and some other authors consider migration as a social determinant of health. MdM identifies it being composed of different factors such as living conditions, exposure to violence and access to healthcare.

Methods
We analysed a comparative quali-quantitative survey in 4 locations, in Niger, Morocco and Tunisia, based on questionnaires and focus groups, with basic statistical tests and a complementary qualitative analysis.

Results
461 migrants were interviewed, 59% women, median age 28 year, 98.5% sub-Saharan African origin, 63% with no legal documents.
46% travelled for more than 6 months, 47% stayed in the country of interview more than 12 months, even if most of them wanted to go on. 83.8% faced violence during their life, 61% during migration.
58% of violence was psychological in nature, confiscation of money and/or documents, or violence by police or army. The types of violence’s vary according to gender and localization. Only 39% did not face barriers to access to healthcare. The 3 main barriers are financial, lack of understanding of the health system and discrimination. 50% of migrants considered their health status as medium, bad or very bad, what is insufficient for such a young population.

Conclusions
Some events are always part of migration: long duration, violence, barriers to access healthcare, with an overall negative impact on health. Recommendations: Authorities should address the structural factors of violence against migrants. The health needs of migrants should be taken into account in policies at all levels. Health services should always consider migrants’ needs: determinants of health, mental health, consequences of violence and difficult access to healthcare. Research needs: What are the specific social determinants of health in migration?

Key messages
The health status of migrants seems to get worse along the road. Some migration events should be considered as social determinants of health and addressed by health services.
Self-reported health conditions among refugees and asylum-seekers (AS) in Italian hosting centres
Authors: Bertoncello C , Fonzo M , Zanovello S , Ferretti S , Brunetta R , Gallo G , Baldo V 
Published: November 2019

Abstract

In recent years, Italy has been facing an increase in migration flows. Migrants are vulnerable: understanding underlying conditions is essential to provide suitable assistance. We investigated health conditions of AS arrived in 2014-2016 and living in hosting centres in northeast Italy. AS filled in a multi-language questionnaire. Demographic characteristics, self-reported health status and travel conditions were recorded. Logistic regression (adjusting for age, sea/land arrival, marital status, education level), χ2 and Fisher’s test were used (significance at .05). 216 AS were included, of which 98% males and 91% aged 15-34; 72% arrived by sea, of which 96% from West Africa (WA), while 94% of land arrivals were from the Indian Subcontinent (IS). 62% experienced health problems after arrival. This condition was significantly associated with sea arrival (aOR 2.9), married status (aOR 3.1) and higher education levels. Most problems involved GI tract (13%), teeth (17%) and skin (25%), being AS from WA (31%) more affected than IS (10%). STDs and alcohol were considered as health threats by more than 30% of AS, while smoking, diet and drugs were ignored; 27% and 23% declared to smoke and consume alcohol, respectively, with no substantial change compared with pre-arrival habits. 88% considered their current health good/satisfactory. While anxiety seemed to affect 10% of AS, 30% reported symptoms of depression, especially those arrived by sea (aOR 3.1) and with higher education. However, physical (94%) and mental (88%) health was considered improved/stable after arrival. Perceived health is overall good. However, AS by sea, with higher education or experiencing family breakdown suffer more from both physical and mental issues, especially depression. Long waiting times to grant refugee status and partial fulfilment of life expectations may worsen health conditions. Customised solutions in hosting centres may be encouraged, considering travel conditions and cultural background.

Key messages
Migrants’ health in hosting centres is good; AS by sea, married and with higher education are more at risk, especially as regards mental health; depression warning signs must not go unnoticed. AS in hosting centres represent a heterogeneous population: they may benefit from a more tailored assistance, considering differences in travel conditions, cultural background and life expectations.
Significance and challenges of assessing health literacy among migrants
Authors: Berens E M , Mensing M , Klinger J , Carol S , Schaeffer D 
Published: November 2019

Abstract

Background
People with a migration background account for a large part of the population in many European countries. Although health literacy - knowledge, motivation, and competencies to process health information - is a key determinant of health, research on health literacy specifically among migrants in Europe is scarce. The aim is therefore to review and further develop the concept and assessment of migrant-specific health literacy for future use in a migrant health literacy survey (HLS-MIG) in Germany.

Methods
A literature search in Pubmed was performed in April 2019 to identify studies regarding health literacy, health outcomes and knowledge among migrant populations in Europe. A special focus was put on the conceptualization and operationalization of health literacy among migrants.

Results
So far, health literacy among migrants has mostly been measured using general health literacy measurement tools, that is, performance-based and self-assessment instruments as the HLS-EU-Q. Migration-specific competences, such as finding information about health in mother tongue, or outcomes of deficient HL have so far received little attention, except for e.g. the GMK-12, developed as a complement to the HLS-EU-Q16 in the Austrian context.

Conclusions
The use of performance-based instruments in the local language primarily provides information about existing linguistic deficits, but hardly on competencies and abilities in dealing with health information. General self-assessment tools, on the other hand, allow the identification of such competences, difficulties and challenges. However, it is necessary to take greater account of migration-specific competences, habits and obstacles in the future, in order to develop tailored interventions for individuals and organizational aspects, supporting health information processing among migrants. Furthermore, studies also need to pay attention to migrant specific health problems and prerequisites.

Key messages
Research focussing on migrant health literacy is scarce. More attention needs to be paid to migrant specific competencies, habits and challenges.
Improving access to health of Migrants in France. Qualitative assessment of a national guide
Authors: Hamel E , Karrer M 
Published: November 2019

Abstract

The National Public Health Agency and the Committee for the healthcare of persons in exile are providing, in the service of professionals, a Practical Guide for the care and the accompaniment of Migrants Foreigners living in precarious conditions, in France. The 2015 edition of this guide has been subjected to qualitative assessment in order to gather information regarding its use, the way it is perceived by its users, as well as their subsequent expectations, in order to design a new version that is more adapted to their needs.
The study was carried out in December 2018 by an independent market research institute with the following design: 24 face-to-face interviews, whose duration was 1h30min, involving current users or past users: 6 working in structures specialised in accommodation for migrants, 6 in health care facilities, 6 in municipal or departmental social service facilities.3 focus groups, of 7-8 people, whose duration was 2H30min, involving potential future users of the guide.
The recruitment of the participants took place in 3 cities as well as the overseas departments.
The findings show: the legitimacy of this guide which is co-produced by an official national agency and an association recognized for its expertise.the interest of a transversal and multi-professional approach which allows to better grasp the social, legal and medical support and carethe need for information and operational resources
This assessment underlines the relevance of the content and the symbolic importance of this guide which ’materializes’ the needs in terms of access to the rights and health of migrant people, often overlooked by professionals and administrations. It is thus a vehicle of vocational training and advocacy on this subject. The study provides concrete ways of optimization, particularly via digitalization, in order to cope with the rapid obsolescence of information, the availability of local directories and the need for exchange of professional practices.

Key messages
A national guide co written by a national agency and an association is a relevant tool to draw attention to migrants needs. Qualitative assessment highlighted the operationnal and symbolic role of this guide to foster cross professionnal work.
Strategies to enhance follow-up response in a cohort study with Berliners of Turkish descent
Authors: Krist L , Dornquast C , Reinhold T , Solak S , Durak M , Keil T 
Published: November 2019

Abstract

Background
Follow-up participation and retention are essential in long-term cohort studies. Loss to follow up may reduce the power of statistical analyses and external validity. The aim of this analysis was to evaluate the response after different contact methods in a cohort study with Berliners of Turkish descent and to compare characteristics of participants with those of non-participants.

Methods
In 2012-2013, Berliners with a Turkish migration background were recruited for this cohort study that initially aimed to examine recruitment strategies. The participants were contacted again 5 years later via postal mail and were asked to complete a questionnaire on the onset of new diseases and health care utilization. Written reminders, phone calls, and home visits were used to increase the response. Study documents were available in German and Turkish language. In descriptive analyses, we examined the response rate in relation to the recruitment approach. A regression analysis was conducted to investigate associations between individual, socioeconomic, and medical factors and the response.

Results
Out of 560 contacted persons, the neutral non-response (unknown address or death) was 13.6%. Of the remaining 484, 234 persons participated in the follow-up (women: 63.1%, mean age±SD: 49.8±12.6 years). The response was 16.1% after the first invitation letter, 24.2% after phone calls, 33.3% and 42.1% with a first and a second reminder letter, respectively, and 48.3% after home visits. The participants had more often German citizenship and a higher net income at baseline than non-participants. Migration generation, age, sex, education, and chronic diseases were not associated with participation (preliminary results).

Conclusions
In our participants with a migration background, every additional contact effort including home visits further increased cohort retention. Investing in comprehensive retention efforts may lead to studies that are more valid to examine the health of migrants.

Key messages
Investing in different contact efforts including reminder letters and home visits can improve follow-up response in longitudinal studies. Retention strategies should be used in longitudinal studies to increase statistical power and external validity.
Family conflict mediates the relationship between past violence and wellbeing among female refugees
Authors: Okenwa Emegwa L , Saboonchi F 
Published: November 2019

Abstract

Background
Past exposure to violence has been suggested to have a lasting effect on subjective well being (SWB). Similarly, family conflict is another known predictor of SWB. Research shows that refugee women exposed to gender based violence (GBV) before resettlement may also face post-resettlement family conflicts due to socio-cultural factors, changes in social network and migration-based shifting gender roles. This study examines the role of family conflict as a likely mediator between past exposure to violence and SWB among Syrian refugee women in Sweden.

Methods
A total of 452 women out of a random sample of 1215 Syrian refugee women in Sweden responded to a questionnaire survey in Arabic. Variables include Past violence i.e. exposure to any of torture, physical or sexual violence preflight or during flight before arriving Sweden; Post-resettlement distressing family conflicts i.e. feeling disrespected or unimportant in the family or distressing conflicts; SWB was measured by WHO-5 wellbeing index. Maximum likelihood estimation with Robust standard errors and bias corrected bootstrapped 95% confidence intervals for all estimates.

Results
Total effect of past violence on SWB was significant (Estimate = -6.63; CI= -12.73 - -0.46). Similarly, family conflicts were associated with decreased SWB (Estimate = -3.80; CI= -5.17 - -2.40), and past violence exposure increased family conflicts (Estimate = 0.57; 0.13 - 1.08). The total effect of violence exposure on decreased SWB was decomposed into a direct and an indirect effect (mediated via family conflicts). The indirect effect via family conflicts was significant (M= -2.19; C1= -4.30 - 0.59), while decomposing rendered the direct effect non-significant (Estimate= -4.44, CI= -10.51 - 1.52).

Conclusions
Post-resettlement distressing family conflicts mediate the effect of prior exposure to violence on reduced SWB among refugee women.

Key messages
Past violence exposure reduces refugee women’s SWB via aggravated family conflicts implying the need for family targeted interventions to improve SWB of female refugees previously exposed to violence. Strategies to improve subjective wellbeing among female refugees should include screening for and addressing all forms of previous and ongoing GBV.
The benefits and challenges of cash transfer programmes in Greece, with a focus on protection
Authors: Rodgers F , Abbara A , Omar M 
Published: November 2019

Abstract

Introduction
This qualitative study evaluates cash transfer programmes (CTPs) in forcibly displaced populations, specifically in Greece. There is a focus on protection, encompassing health, gender, child protection and disability. The Greece Cash Alliance, run by the United Nations High Commissioner for Refugees (UNHCR), currently supports 63,853 individuals with cash via a pre-paid card. This study provides insight into challenges encountered by implementers of cash programmes in Greece, and the potential protection issues faced with the changing climate of the cash programme in Greece.

Methods
A literature review of academic and grey literature and semi-structured key informant interviews with stakeholders including Non-Governmental Organisation and United Nations agency staff were performed. Key informants were identified through purposive sampling. An inductive thematic approach was taken in analysis.

Results
Main emerging themes included the benefits and challenges of CTPs and their role in protection. Challenges included the mobile, heterogenous population and benefits included economic development in Greece and restored choice to beneficiaries. With regards to protection, informants reported a positive impact through allowing refugees to meet their basic needs and prioritise other needs and CTPs providing consistent access to refugees which could allow identification of protection risks. However, protection was not considered in the design of all CTPs.

Conclusions
Due to the multi-sectoral nature of the response, there is no standard integration of protection into cash programmes. Cash programming offers unique, regular contact with beneficiaries and chances to identify protection risks that are not always utilised due to minimal staff training in protection. Cash assistance in Greece allows people to meet their basic needs and gives people space and funds to prioritise other needs such as health and education, inherently improving their protection status.

Key messages
With cash assistance growing in popularity in humanitarian programming, consideration of protection is important as it can improve the health, safety and dignity of beneficiaries. In Greece the cash programme was only designed to meet basic needs but broader effects on protection were seen.
Living conditions, diet and lifestyle of Asian and African undocumented immigrants in Athens, Greece
Authors: Awais S , Sarwar Shah S G 
Published: November 2019

Abstract

Aim
To study the living conditions, diet and lifestyle of undocumented migrants of Asian and African origin living in Athens, Greece.

Methods
An exploratory study involving a snowball sample of 200 participants who completed a questionnaire survey administered by hand at a non-governmental day-care facility for homeless immigrants in Central Athens. Response rate 60 % (120 / 200 surveys returned).

Results
Participants were mainly male (96%), aged 20-40 years (84%) and unmarried (61%) with secondary school education (33%). Participants were from different countries of South Asia (81.7%), Middle East (5%) and Africa (11.5%). 26 % of participants arrived in Greece in the last 12 months and travelled on average for 52 days (median 30 days) from their home countries to Greece. The majority of participants (69%) were without a White Card (formerly the Pink Card) for asylum applicants. Their living conditions included homeless / on streets (13%) and living in a shared house (82%) or basement (13%). Participants had access to a kitchen (77%), toilet (77%), water (76%), electricity (78%), heating (53%), refrigerator (76%), TV (68%), computer (43%) and car (7%). Dietary intake and habits revealed that 86% of participants had normal to very good appetite, 52% ate two meals a day and 38% ate breakfast daily but 35% (n = 42) did not eat any breakfast the whole week. The diet included chicken meat (83%), red meat (63%), eggs (60%), white bread (79%), wholemeal bread (33%), rice or noodles (79%), potatoes (74%), vegetables (77%), fresh fruit (66%), dry fruits and pulses (50%) and dairy products (65%). Lifestyle wise, 59% of participants were non-smokers, 13% took recreational drugs and 77% did not allocate any time for daily exercise.

Conclusions
Undocumented migrants from Asian and African countries take perilous journeys to Europe for a better life but they have very poor social and economic status, which negates the main reasons of leaving their home countries.

Key messages
Undocumented migrants from Asian and African countries take perilous journeys for a better life in Europe. Undocumented migrants have a very poor social and economic status in Greece.
Self-help as a relief strategy for Turkish family caregiver of people with dementia? A Scoping Review
Authors: Tezcan-Güntekin H , Özer-Erdogdu I , Yilmaz-Aslan Y 
Published: November 2019

Abstract

Background
The number of dementia patients with a migration background is rising in the process of demographic change in Germany. For people with a migration background, care is usually provided at home and is accompanied by an increased burden on relatives. Alleviating support services are rarely used.

Methods
The scoping review on burden and self-help as a relief strategy for Turkish family caregiver of people with dementia includes the databases PubMed, Livivo, CINAHL and Web of Science and is completed by a ’by hand’ analysis in Google and Google Scholar. A total of 24 publications were included in the analysis.

Results
Family caregiver of Turkish origin show a high degree of willingness to assume responsibility for care, show knowledge deficits with regard to support services and are exposed to heterogeneous burdens. People with a migration background hardly make use of self-help. Self-help as a relief strategy could be strengthened by needs-oriented and culturally diverse services.

Conclusions
There is a need for action to improve domestic care for people with a migrant background. This requires the involvement of stakeholders such as those in need of care, caring relatives and professional carers. Self-help for people with a migration background can be activated and promoted with target group-oriented approaches. The support measures should be designed to be sensitive to diversity and correspond to the heterogeneity of the users and their life situations.

Key messages
Self-help for migrants must be flexible and user-oriented. Diversity-sensitivity in self-help could address people who are difficult to reach.