Barriers and facilitators of social supports for immigrant and refugee women coping with postpartum depression

An emerging concern for health care providers is how to assist immigrant and refugee women adapt to a new milieu and to cope with postpartum depression (PPD). Thirty women were interviewed to find out their perspective on what factors influence their help-seeking behavior and decision making about postpartum care and what strategies would be helpful in PPD prevention and treatment. Findings reveal that (a) social support networks can be supportive or nonsupportive with widespread effects on physical and psychological health and well-being; (b) cultural background and socioeconomic factors influence seeking support; (c) health care relationship was viewed a critical determinant to seek and accept help for PPD.     

If I was going to kill myself, I wouldn't be calling you. I am asking for help: challenges influencing immigrant and refugee women's mental health

It is estimated that 37% of Canadians experience some types of mental health problem. As a result of the migration process, many immigrant and refugee women suffer serious mental illness such as depression, schizophrenia, posttraumatic stress disorder, suicide, and psychosis. The purpose of this exploratory qualitative study, informed by the ecological conceptual framework and postcolonial feminist perspectives, was to increase understanding of the mental health care experiences of immigrant and refugee women by acquiring information regarding factors that either support or inhibit coping. Ten women (five born in China and five born in Sudan) who were living with mental illness were interviewed. Analysis revealed that (a) women's personal experience with biomedicine, fear, and lack of awareness about mental health issues influences how they seek help to manage mental illness; (b) lack of appropriate services that suit their needs are barriers for these women to access mental health care; and (c) the women often draw upon informal support systems and practices and self-care strategies to cope with their mental illnesses and its related problems. The authors discuss implications for practice and make recommendations for intervention strategies that will facilitate women's mental health care and future research.     

Listening to different voices

Grounded theory research provides the foundation for this case analy sis about listening to the voices of refugee immigrant women in order to improve access to health care. The authors share the case study of "Elena" (pseudonym), a Latin American refugee immigrant to Canada, and explore listening as an individual and collective intervention. The feeling of being degraded, ignored or dismissed by others has serious consequences for refugee immigrants to Canada. The authors recommend a social advocacy approach with both individual and collective strategies for responding to the lack of cultural sensitivity and genuine listening evidenced by Elena's case. Inclusive and partnership approaches, an "inequities imagination" and relational approaches to difference are required to loosen our thinking about what shapes refugee immigrant health. A critical cultural perspective asks that practitioners not only listen for history and context in individual practice, but also take those discoveries further to change policy and practice systemically.     

If I Was Going to Kill Myself,I Wouldn't Be Calling You. I am Asking for Help: Challenges Influencing Immigrant and Refugee Women's Mental Health

It is estimated that 37% of Canadians experience some types of mental health problem. As a result of the migration process, many immigrant and refugee women suffer serious mental illness such as depression, schizophrenia, posttraumatic stress disorder, suicide, and psychosis. The purpose of this exploratory qualitative study, informed by the ecological conceptual framework and postcolonial feminist perspectives, was to increase understanding of the mental health care experiences of immigrant and refugee women by acquiring information regarding factors that either support or inhibit coping. Ten women (five born in China and five born in Sudan) who were living with mental illness were interviewed. Analysis revealed that (a) women's personal experience with biomedicine, fear, and lack of awareness about mental health issues influences how they seek help to manage mental illness; (b) lack of appropriate services that suit their needs are barriers for these women to access mental health care; and (c) the women often draw upon informal support systems and practices and self-care strategies to cope with their mental illnesses and its related problems. The authors discuss implications for practice and make recommendations for intervention strategies that will facilitate women's mental health care and future research.     

Online information on primary care services for refugees and asylum-seekers

Government initiatives concerning equitable services and information provision aim to provide for the whole community. This includes those recently arrived in England as refugees. This study evaluated the information provided online by 16 London primary care trusts (PCTs) on activities under way to meet the needs of the local refugee population and the extent to which government initiatives are being met. Information published on websites of PCTs with a refugee population estimated to be over 2.5% of the London total refugee population was surveyed using a 13-item framework based on guidelines for health professionals working in refugee health (Burnett and Fassil, 2002). The findings show a disparity between different types of information provided and variations in the overall standards achieved by individual PCTs, indicating a need for considerable work if the requirements of the public and government for access to high quality information about services are to be met. The majority of PCTs, however, provide good information regarding coordination of services and evidence of a thorough health needs assessment. The findings are relevant to health professionals working with refugees and to PCT employees involved in publishing information on the internet.     

Mexican immigrant mothers' expectations for children's health services

Women of Mexican descent living in the United States raise children who use health care services. What do immigrant Mexican mothers expect from children's health care services? And how do their expectations for children's health services compare to acculturated Mexican American mothers' expectations? This focused ethnographic study, based on repeated interviews with 28 mothers of varying acculturation levels, describes their expectations and experiences with children's health care services in the United States. Findings support a shared core of expectations for both Mexican immigrant and Mexican American mothers, and differences in health care access and financing, time spent in health care encounters, and cultural and linguistic expectations for care. Health care providers can use this information to approach Mexican-descent mothers and children with their expectations in mind, and craft a negotiated plan of care congruent with their expectations.     

Bosnian and Soviet refugees' experiences with health care

Studies of refugees in the United States rarely address health the first few years following resettlement in part because the refugees become subsumed under the foreign-born or immigrant category. A national study reaffirmed the so-called healthy immigrant effect, but fewer sick days and less physician use may actually reflect access problems, economic concerns, and health beliefs or practices that clash with American health care. Because statistics may mask differences in health and why people seek professional care, it is important to combine qualitative and quantitative approaches. This study examined health, illness, and health care use patterns of refugees in Northern California using a database analysis, a medical record review, and an ethnographic study of the Bosnian and former Soviet Union refugee communities. This article describes some ethnographic findings from participant observation, semistructured interviews, and focus groups, with an emphasis on people's experiences with health care, health risk behaviors, and self-care.     

Comparing learning outcomes of international and local community partnerships for undergraduate nursing students

International health care experiences offer undergraduate nursing students the opportunity for significant personal and professional growth. During a month-long travel course to Cameroon, West Africa, students improved their skills in clinical assessment, data management, intercultural communication, and collaboration based on an empowerment model of international partnership. Although it is not possible for all students to participate in providing health care in another country, it is possible to design a local course in which students are able to meet similar outcomes in a community health experience in partnership with an immigrant and refugee center.     

Comparing Learning Outcomes of International and Local Community Partnerships for Undergraduate Nursing Students

International health care experiences offer undergraduate nursing students the opportunity for significant personal and professional growth. During a month-long travel course to Cameroon, West Africa, students improved their skills in clinical assessment, data management, intercultural communication, and collaboration based on an empowerment model of international partnership. Although it is not possible for all students to participate in providing health care in another country, it is possible to design a local course in which students are able to meet similar outcomes in a community health experience in partnership with an immigrant and refugee center.     

Intersectionalities of influence: researching the health of immigrant and refugee women.

There is a growing recognition of the complexity surrounding multiple axes or dimensions of social identity and how they intersect to influence the health of immigrant and refugee women. The concept of intersectionalities of influence is particularly relevant in addressing diversity in nursing research.The purpose of this paper is to theorize and operationalize the concept in mental health promotion research with immigrant and refugee women. At the conceptual level, the authors propose an approach to inquiry that is informed by critical scholarship and draws from postcolonial and feminist perspectives. At the operational level, they apply an ecosystemic framework to help locate individual health issues within the familial, community, and social realms. They introduce Participatory Action Research as a way of putting these concepts into action within the research process.Their aim is to introduce a new way of inquiry that can benefit immigrant and refugee women while furthering the nursing agenda for community-based research.     

Access to databases in complementary medicine

Access to medical databases is a keystone for obtaining up-to-date and complete information for physicians. In the last few years, the rapid growth of the World Wide Web has given rise to an information revolution, enabling health care providers to gain access (often free) to an expanding volume of information that was previously inaccessible. Search engines and online databases assist the search for health information. In this article we examine the biomedical databases of primary interest in the field of alternative and complementary medicine, dividing them into Web accessible and nonaccessible databases and emphasizing the freely available ones. A further classification is major biomedical bibliographic databases specific to complementary medicine, and dedicated therapy or modality-specific databases.     

A Scoping Review of Nurse Practitioner Roles in Immigrant Health

The provision of adequate health care services to immigrants continues to be an issue in many countries. The objective of this scoping review is to examine the extent, range, nature, and characteristics of the literature for the nurse practitioner (NP) role in immigrant health. A search of 5 databases was completed, yielding 440 studies. After reviewing the abstracts and eliminating studies based on the inclusion and exclusion criteria, only 5 studies qualified for the scoping review. Given that scope of NPs’ roles is expanding, this review reveals how NP care can improve immigrants’ health. Barriers to the utilization of NPs in immigrant health include language, the development of therapeutic relationships, and cultural beliefs. Overall, this review shows that there is a need for more research on the role of NPs in immigrant health, especially from the perspective of service recipients.     

Experiences of Trauma and Implications for Nurses Caring for Undocumented Immigrant Women and Refugee Women

Experiences of trauma affect the health needs of women across all groups, particularly in vulnerable populations such as undocumented immigrant women or refugee women. Nurses across inpatient and outpatient settings providing care to these women can consider how women’s experiences of trauma and barriers they encounter to accessing resources may affect their experience of health care. In this article, we review two recent studies in which researchers examined the experiences of trauma and posttraumatic stress in women who are undocumented immigrants or refugees. Implications for nursing practice, including the importance of providing trauma-informed care, are discussed.     

Afghan Health Education Project: A Community Survey

Abstract This study assessed the health concerns and needs for health education in the Afghan refugee and immigrant community of the San Francisco Bay Area. The study used a telephone survey, seven community meetings and a survey administered to 196 Afghan families through face-to-face interviews. Data were analyzed qualitatively and statistically. Health problems of most concern are mental health problems and stress related to past refugee trauma and loss, current occupational and economic problems, and culture conflict. Physical health problems include heart disease, diabetes and dental problems. Needed health education topics include dealing with stress, heart health, nutrition, raising children in the United States (particularly adolescents), aging in the United States, and diabetes. Using coalition building and involving Afghans in their community assessment, we found that the Afghan community is eager for culture- and language-appropriate health education programs through videos, television, lectures, and written materials. Brief health education talks in community meetings and a health fair revealed enthusiasm and willingness to consider health promotion and disease-prevention practices.     

The weWomen and ourCircle randomized controlled trial protocol: A web-based intervention for immigrant,refugee and indigenous women with intimate partner violence experiences

Intimate partner violence (IPV), including homicides is a widespread and significant public health problem, disproportionately affecting immigrant, refugee and indigenous women in the United States (US). This paper describes the protocol of a randomized control trial testing the utility of administering culturally tailored versions of the danger assessment (DA, measure to assess risk of homicide, near lethality and potentially lethal injury by an intimate partner) along with culturally adapted versions of the safety planning (myPlan) intervention: a) weWomen (designed for immigrant and refugee women) and b) ourCircle (designed for indigenous women). Safety planning is tailored to women's priorities, culture and levels of danger. Many abused women from immigrant, refugee and indigenous groups never access services because of factors such as stigma, and lack of knowledge of resources. Research is, therefore, needed to support interventions that are most effective and suited to the needs of abused women from these populations in the US. In this two-arm trial, 1250 women are being recruited and randomized to either the web-based weWomen or ourCircle intervention or a usual safety planning control website. Data on outcomes (i.e., safety, mental health and empowerment) are collected at baseline and at 3, 6, and 12 months post- baseline. It is anticipated that the findings will result in an evidence-based culturally tailored intervention for use by healthcare and domestic violence providers serving immigrant, refugee and indigenous survivors of IPV. The intervention may not only reduce risk for violence victimization, but also empower abused women and improve their mental health outcomes.     

Health literacy as the missing link in the provision of immigrant health care: A qualitative study of Southeast Asian immigrant women in Taiwan

ObjectivesLanguage and communication barrier are main contributors to poor health outcomes and improper use of health care among immigrants. The purpose of this study was to explore and understand specific language and communication problems experiences by Southeast Asian immigrant women in Taiwan.DesignThis qualitative study used focus groups and in-depth interviews to uncover the experiences of immigrant women regarding their access to and utilization of health care in Taiwan.ParticipantsEight focus groups were conducted with 62 Southeast Asian immigrant women and 23 individual in-depth interviews with a wide range of stakeholders who had diverse background and intimate knowledge of immigrant-relating health care issues were performed.ResultsDirected content analysis was applied and identified four major themes concerning conditions that influenced immigrant women's use of health information and services: (1) gaining access to health information, (2) navigating in health care delivery system, (3) interactions during health care encounters, and (4) capability of using health information and services. Findings from this study suggest that, without basic language and literate skills, the majority of immigrant women had inadequate health literacy to manage health information and navigate the Taiwan health care system. Interpersonal communication gap between immigrant women and health care providers exists because of lack of health literacy in addition al language and cultural barriers.ConclusionWith limited language and health literacy skills, immigrant women face numerous challenges in navigating the health care system, interacting with health care providers, and gaining access to proper health care. Future efforts are necessary to enhance individual's health literacy and establish health literate environment.     

HEALTH CARE PROVIDERS' PERSPECTIVE OF THE GENDER INFLUENCES ON IMMIGRANT WOMEN'S MENTAL HEALTH CARE EXPERIENCES

The number of immigrants coming to Canada has increased in the last three decades. It is well documented that many immigrant women suffer from serious mental health problems such as depression, schizophrenia, and post migration stress disorders. Evidence has shown that immigrant women experience difficulties in accessing and using mental health services. Informed by the post-colonial feminist perspective, this qualitative exploratory study was conducted with seven health care providers who provide mental health services to immigrant women. In-depth interviews were used to obtain information about immigrant women's mental health care experiences. The primary goal was to explore how contextual factors intersect with race, gender, and class to influence the ways in which immigrant women seek help and to increase awareness and understanding of what would be helpful in meeting the mental health care needs of the immigrant women. The study's results reveal that (a) immigrant women face many difficulties accessing mental health care due to insufficient language skills, unfamiliarity/unawareness of services, and low socioeconomic status; (b) participants identified structural barriers and gender roles as barriers to accessing the available mental health services; (c) the health care relationship between health care providers and women had profound effects on whether or not immigrant women seek help for mental health problems.