A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services’ accessibility in economic migrants

Background: Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011). Methods: A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories. Results: We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability. Conclusions: Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed.

Migrantes y migraciones: de nuevo la divergencia en las fuentes estadísticas

Este trabajo plantea una serie de deficiencias presentes en la Encuesta de Migraciones (EM), publicada anualmente por el INE a partir de la EPA. Consciente de la subestimación de la movilidad procedente de esta fuente estadística, el INE ha introducido recientemente ciertos cambios metodológicos. Sin embargo, no se han obtenido mejoras significativas y la misma continúa disponible para los investigadores. Las razones que se encuentran detrás de la limitada calidad de la EM son de tipo estadístico y afectan a la precisión y al sesgo de las estimaciones. Se desatienden principios básicos de la estimación para dominios pequeños, se incumplen los supuestos del muestreo por conglomerados y se incurre en graves sesgos debidos, probablemente, a la falta de respuesta. Consideramos que la investigación del hecho migratorio a través de la técnica del muestreo estratificado de poblaciones exige un tratamiento específico en la encuesta, dado el tamaño y las características de este dominio.

Exiliadas españolas en Francia y Argentina: identidades transnacionales y transferencias culturales

This text reflects on the experiences of women who lived in exile led by the Spanish Civil War and Franco’s dictatorship to France and Argentina, countries where Spanish communities residing abroad were more numerous. The differences in personal backgrounds and political contexts in the host societies, or the constant arrival of new migrants and exiled not prevent some common elements point to the Spanish women exiles: their role in the processes of cultural transfer –with the maintenance of cultural traits and Spanish or regional identity and the incorporation of new elements of the host country- as well as a political militancy with important international contacts, all of which strengthened transnational identities.

Prácticas de autocuidado sexual y reproductivo en mujeres “parejas de” migrantes internacionales de San Luis Potosí, México

Los migrantes y sus parejas han sido incorporados en los discursos institucionales de salud como “sujetos en riesgo” frente a las Infecciones de Trasmisión Sexual (ITS), sin embargo la incorporación de esta población específica en la comunicación y gestión del riesgo de ITS ha sido ambigua en el contexto mexicano. El objetivo del presente acercamiento fue conocer las prácticas de autocuidado sexual y reproductivo que adoptan en su cotidianeidad mujeres parejas de migrantes y la relación de dichas medidas con la comunicación y gestión del riesgo que los Servicios de Salud realizan. Se trató de una aproximación de tipo cualitativo con 20 mujeres “de migrantes” localizadas mediante los servicios de salud, la información se recabó a través de entrevistas a profundidad que focalizaron en las esferas de “percepción del riesgo” y “Autocuidado sexual y reproductivo”. Se encontró que la mayoría de las mujeres no se reconoce vulnerable frente a las ITS y que la percepción del riesgo no es determinante en la confrontación que respecto a la amenaza puedan desarrollar, dado que los imaginarios patriarcales que prevalecen en ellas, sus parejas y el personal de salud desestiman la utilización de medidas de prevención y detección oportuna.

Associative Behaviours and Political Participation of EU migrants

Civic culture is structured on a network of interpersonal associations with different degrees of formalization. According to theories on civic and political action, certain agents, such as associations, play a key role in setting targets, socializing or coordinating sociopolitical actions, among other functions. Associations strengthen the political and civic system of societies. Likewise, they are a vehicle for individuals’ integration, which is particularly important in the case of immigrants. For these, associations are both a vehicle for integration and an instrument for political participation. This article explores the use and purpose of associations according to immigrants from Romania, Poland, the United Kingdom and Germany living in Spain.

Work-related health problems among resident immigrant workers in Italy and Spain

Background: in both Spain and Italy the number of immigrants has strongly increased in the last 20 years, currently representing more than the 10% of workforce in each country. The segregation of immigrants into unskilled or risky jobs brings negative consequences for their health. The objective of this study is to compare prevalence of work-related health problems between immigrants and native workers in Italy and Spain. Methods: data come from the Italian Labour Force Survey (n=65 779) and Spanish Working Conditions Survey (n=11 019), both conducted in 2007. We analyzed merged datasets to evaluate whether interviewees, both natives and migrants, judge their health being affected by their work conditions and, if so, which specific diseases. For migrants, we considered those coming from countries with a value of the Human Development Index lower than 0.85. Logistic regression models were used, including gender, age, and education as adjusting factors. Results: migrants reported skin diseases (Mantel-Haenszel pooled OR=1.49; 95%CI: 0.59-3.74) and musculoskeletal problems among those employed in agricultural sector (Mantel-Haenszel pooled OR=1.16; 95%CI: 0.69-1.96) more frequently than natives; country-specific analysis showed higher risks of musculoskeletal problems among migrants compared to the non-migrant population in Italy (OR=1.17; 95% CI: 0.48-1.59) and of respiratory problems in Spain (OR=2.02; 95%CI: 1.02-4.0). In both countries the risk of psychological stress was predominant among national workers. Conclusions: this collaborative study allows to strength the evidence concerning the health of migrant workers in Southern European countries.

Late life second move housing choices of international retiree migrants

Purpose – Many international retirement migrants are amenity movers undertaking the first move in the late life course model of migration. The purpose of this paper is to examine second moves within the retirement destination community to test whether the model of late life course migration accurately portrays the motivations and housing choices local movers make after retiring to another country. Design/methodology/approach – The paper combines secondary data and survey results to examine the composition of the retiree migrant population in the Alicante province of Spain. The socioeconomic characteristics and housing choices of those who have made a second move since retiring to Spain are compared with those who have not moved through a series of t-tests and chi-square tests. Findings – The paper finds that those who have made a second move within Spain are somewhat typical of second movers in the late life course. They are likely to cite mobility or health problems as a reason for moving and appear to recognize the need for a home that provides living area on one floor. Yet, they are choosing to move within an area that does not provide them with access to informal family care givers. Research limitations/implications – The data are restricted to retirees of two nationalities in one province of Spain. Further research is suggested in other locations and with retirees of other nationalities for comparison. Practical implications – Because many international retirees do not plan to return to their countries of origin, they will create demand for formal in-home care services and supportive retiree housing in the near future in their retirement destination countries. Originality/value – This paper provides understanding of a growing consumer housing segment in retirement destinations.

Examining retirement housing preferences among international retiree migrants

Housing demand models based on individual consumer’s utility function reflect preferences about the structure and lot, neighborhood, and location as related to socioeconomic characteristics of the occupants. As a growing proportion of aging residents in many countries are undertaking late life moves, their preferences will have an influence on destination housing markets. We examine the characteristics, attitudes and preferences about retirement housing among immigrant retirees currently living in traditional housing in a retirement destination in Alicante, Spain. Using results from a survey of German and British retirees living in the region, we find through logistic regression that preference for retirement housing is associated with aging and gaining access to in-home support services.

Linking tourism, retirement migration and social capital

A general trend in the study of international retirement migration has been the increased attention paid to the social contacts and network connections of the migrants in both the destination and the origin areas. These studies have examined the extent to which migrants build social relationships with their neighbours and the host society while also maintaining social links with their countries of origin, addressing the central role that leisure travel plays in sustaining increasingly dispersed social networks and maintaining the social capital of these networks and of the individuals involved in them. Using a case study approach to examine British retirement migration to Spain, we explore the relevance of transnational social networks in the context of international retirement migration, particularly the intensity of bidirectional visiting friends and relatives (VFR) tourism flows and the migrants’ social contacts with friends and/or family back in their home country. Building on the concept of social capital and Putnam's distinction between bonding and bridging social capital, we propose a framework for the analysis of the migrants’ international social networks. The results of a study conducted based on a sample of 365 British retirees living in the coast of Alicante (Spain) show both the strength of the retirees’ international bonding social capital and the role of ‘VFR's travel and communication technologies in sustaining the migrants’ transnational social practices and, ultimately, their international bonding social capital. It also provides evidence for the reinforcing links between tourism-related mobility and amenity-seeking migration in later life.

Impact of economic crisis on mental health of migrant workers: what happened with migrants who came to Spain to work?

Objectives: To assess changes in mental health in a sample of migrant workers after the eruption of the economic crisis in Spain. Methods: 318 migrant workers were interviewed. Mental health, sociodemographic, and economic crisis related variables were obtained through face-to-face (2008) and phone (2011) interviews. Prevalence of poor mental health (PMH) was compared (2011–2008) and multivariate logistic regression models were fitted. Results: Change in prevalence of PMH was higher in men (aOR 4.63; 95 % CI 2.11–10.16). Subgroups of men showing the largest detrimental mental health effects were: unemployed, with low salaries (≤1,200 euros) and those reporting family burden. An increase of PMH was found in women, without significant associations. Conclusions: Mental health of migrant workers in Spain has worsened during the economic crisis.

Is health a right for all? An umbrella review of the barriers to health care access faced by migrants

Objective. To synthesise the scientific evidence concerning barriers to health care access faced by migrants. We sought to critically analyse this evidence with a view to guiding policies. Design. A systematic review methodology was used to identify systematic and scoping reviews which quantitatively or qualitatively analysed data from primary studies. The main variables analysed were structural and contextual barriers (health system organisation) as well as individual (patients and providers). The quality of evidence from the systematic reviews was critically appraised. From 2674 reviews, 79 were retained for further scrutiny, and finally 9 met the inclusion criteria. Results. The structural barriers identified were the lack of health insurance and the high cost of drugs (non-universal health system) and organisational aspects of health system (social insurance system and national health system). The individual barriers were linguistic and cultural. None of the reviews provided a quality appraisal of the studies. Conclusions. Barriers to health care for migrants range from entitlement in non-universal health systems to accessibility in universal ones, and determinants of access to the respective health services should be analysed within the corresponding national context. Generate social and institutional changes that eliminate barriers to access to health services is essential to ensure health for all.

Challenges in Lifestyle Migration Research: Reflections and Findings about the Spanish Crisis

The lifestyle migration conceptual framework is based on the motivation for moving reported by the migrants themselves. We discuss the operability of this approach, which is built on the subjective assessments of individuals. It diminishes the actual importance of economic factors and has an underlying ideological element associated with the categorisation of people according to their nationality. A comparative analysis of residential variations by nationalities between 2005 and 2010 in Alicante (Spain) shows that, when faced with the economic crisis, the so-called lifestyle migrants are changing their mobility patterns in a way similar to the rest of the migrants. This calls into question the adequacy of juxtaposing lifestyle and labour migration. Both theory and research show that this duality, instead of clarifying applied research, makes it more difficult. We argue that the lifestyle migration framework is inadequate to study changes in mobility patterns, particularly when using a quantitative approach.