Self-reported Competences of Expatriate Practicing Nurses in Kuwait: A Descriptive Study.

AIM: The aim of the study was to explore the perceived self-reported competence of nurses who worked in Kuwaiti hospitals and the predictors influencing the level of competence. BACKGROUND: Competence in nursing is found to affect patient safety and the quality of care provided to patients. The vast majority of nurses working in the health system are non-Kuwaitis. Thus, it is of the utmost importance to assess nurses' competences as the first step toward ensuring the best quality of care. METHODS: A cross-sectional, descriptive, correlational design was used. A non-random convenience sample of 220 practicing expatriate nurses working in public hospitals completed the NPC-35 scale and a demographic form. Data collection was done over a period of three weeks from January 26th, 2020 to February 16th, 2020. RESULTS: The findings of the study showed that nurses perceived their competence as good. The results also showed that years of experience, enrollment in a traditional program of study, exposure to training programs, working in accredited hospitals and nationality explained 56% of the variation in the level of Nursing Professional Competence (NPC). CONCLUSION: The results indicate that nurse leaders and policy makers need to improve nursing orientation and training programs so that they are competence based. The results of the study also point to the importance of revisiting the nursing recruitment policy and managing expatriate nurses while making better investment in educating and producing Kuwaiti national nurses.

Foreign workers in the Middle East during COVID-19.

The COVID-19 pandemic is having an unprecedented and consequential impact on global economies, businesses, and workforces. Foreign nationals account for the majority of the population in the Middle East. Throughout this article, the authors address the negative ramifications the COVID-19 pandemic has had on the migrant workforce in the Middle East. This pandemic has intensified various socio-economic and public health crises such as unemployment, income cuts, depletion of savings, repatriation difficulties, inadequate living conditions, and associated burden on healthcare facilities by the COVID-19 infection.

Expatriates on the run: The psychological effects of the COVID-19 pandemic on expatriates' host country withdrawal intentions.

Extant research on expatriation in high-stress environments where stress is caused by ongoing and unexpected natural crises remains limited. Drawing on stress theory, in this study, we develop a model to examine the stress-inducing effects of intra-family concerns and workplace discrimination on the intentions to leave the host country among expatriates in the high-stress environment of the ongoing COVID-19 pandemic. We also explore whether gender and the level of work adjustment moderate the propensity of intra-family health concerns and workplace discrimination to induce psychological stress. Based on our analysis of 381 expatriates living and working in the United Arab Emirates, we find the model to be generally supported. We also reveal an intriguing moderating effect of work adjustment on the relationship between intra-family health concerns and psychological stress. Overall, the analysis is among the first ones to shed light on the role of natural crises' stressors in defining expatriate outcomes.

Predictors of Psychological Distress in Health Care Staff in Qatar during COVID-19 Pandemic.

BACKGROUND & OBJECTIVE: The Coronavirus disease 2019 (COVID-19) pandemic has caused widespread psychological distress. The aims of the study were a) to assess mental health symptoms experienced by expatriate hospital staff and b) to determine the impact of staff wellbeing interventions specific to pandemic related stress. METHODS: The study was conducted from June 2020 until August 2020. A 16-question survey was disseminated online via Survey Monkey to assess the mental health needs of hospital staff during the pandemic. Based on results, a virtual, tiered mental health support model was developed, and staff feedback was collected. RESULTS: Almost 46.2% of respondents (N: 1001) reported at least one mental health symptom in the initial survey. The most common symptoms were anxiety, low mood and feelings of isolation. Being single and in poor health status were predictors of developing mental health symptoms (P <0.01). Female gender was a predictor for experiencing fear of getting infected. Time constraints at work was the most common reason for not accessing mental health support. CONCLUSIONS: As in other parts of the world, hospital staff in Qatar experienced mental health symptoms and significant fear related to the COVID-19 Pandemic. Being single and in poor health status were risk factors. Mental health interventions at work must take into account time constraints experienced by staff.

Cosmopolitan enclaves: An introduction.

Cosmopolitan enclaves emerge at the intersection of global dynamics and local contexts as spaces where the cultivation of a cosmopolitan ethos encounters processes of socio-spatial boundary work and segregation. In the introduction to this special issue, we discuss under which circumstances the intention to cultivate open-mindedness goes hand in hand with keeping the local environment at bay. We argue that ethnographic attention to cosmopolitan enclaves may help bridge macro-level observations regarding globalization and its graduated sovereignties with the micro-level understanding of actual day-to-day interactions and boundary work within concrete spaces. We thus address the paradox of the omnipresence of enclaves in a global world and analyse the ambiguous aspirations and expectations derived from cosmopolitan ideals and how they relate to (under)privilege. While cosmopolitan aspirations exist alongside reproductions of postcolonial representations and hierarchies, they may also express the will to resist the politics of exclusion by demarcating an alternative safe haven.

Living Well in Times of Threat: The Importance of Adjustment Processes to Explain Functional Adaptation to Uncertain Security in Expatriates Deployed in the Sudan.

The present study investigated expatriate humanitarian aid workers' perceptions and responses to uncertain security while deployed in the Sudan. Interviews conducted in Khartoum (n = 7) and Darfur (n = 17) focused on risk perception, concern for personal security, and strategies used to function well in an insecure environment. Despite a high perceived general risk, as well as broad knowledge and experience with security incidents, participants often expressed low concern. General adjustment processes were drawn on to explain this finding, while different constellations of processes resulted in different patterns of adjustment. Functional adjustment, resulting in adequate risk perception, protective behavior, protection, and low concern, was characterized by a constellation of complementary activation of accommodation and assimilation processes.

Health service utilization, unmet healthcare needs, and the potential of telemedicine services among Korean expatriates.

BACKGROUND: With the significant growth of migration and expatriation, facilitated by increased global mobility, the number of Koreans living abroad as of 2016 is approximately 7.4 million (15% of the Korean population). Healthcare utilization or health problems, especially among expatriates in developing countries, have not been well researched despite the various health risks these individuals are exposed to. Consequently, we identified the health utilization patterns and healthcare needs among Korean expatriates in Vietnam, Cambodia, and Uzbekistan. METHODS: This cross-sectional survey examined 429 Korean expatriates living in Vietnam (n = 208), Cambodia (n = 60), and Uzbekistan (n = 161) who had access to the Internet and were living abroad for at least 6 months. A 67-item questionnaire was used, and feedback was received via an online survey program. Stepwise logistic regression analyses were performed to evaluate factors associated with unmet healthcare needs and preferences of certain type of telemedicine. RESULTS: We found that 45.5% (195/429) of respondents had used medical services in their country of stay. Among those who visited health institutions > 3 times, the most popular choice was general hospitals (39.4%, 15/38); however, they initially visited Korean doctors' or local doctors' offices. The most essential criteria for healthcare service facilities was a "skilled professional" (39.3%, 169/429), 42% wanted a health program for chronic disease management, and 30% wanted specialized internal medicine. A substantial number wanted to access telemedicine services and were willing to pay for this service. They were particularly interested in experts' second opinion (61.5%, 264/429) and quick, 24-h medical consultations (60.8%, 261/429). Having unmet healthcare needs and being younger was strongly associated with all types of telemedicine networks. CONCLUSIONS: Nearly half of the expatriates in developing countries had unmet healthcare needs. Telemedicine is one potential solution to meet these needs, especially in developing countries.

Stress of working abroad: a systematic review.

PURPOSE: Many companies target international markets to expand their business. Companies need to manage international teams with a wide variety of skills, knowledge and values to run their business effectively; however, there are many issues of acculturation stress. Not only business travellers and expatriates, but also immigrant workers have issues adjusting to foreign culture. The aim of the present study is to identify the stress factors affecting foreign-born workers via a systematic review. METHODS: The systematic review was conducted using PubMed, PsycINFO, Embase and Cochrane Library databases. Articles on the subject of workers living abroad, such as immigrants, expatriates and business travellers, were included. The risk of bias in the included articles was assessed using the Cochrane Collaboration's tool for assessing risk of bias for randomised controlled trials (RCTs), RoBANS for non-RCT studies, and CASP for qualitative studies. RESULTS: For the systematic review, 45 out of 14,994 articles were analysed. Six components, communication, cultural differences in the workplace, daily life, relationships with family and colleagues, financial problems and social inequality, were extracted. CONCLUSION: Foreign-born workers are suffering from acculturation and occupational stress. The results of the present study can help greatly with understanding of the stress structure of working abroad.

The association between insured male expatriates' knowledge of health insurance benefits and lack of access to health care in Saudi Arabia.

BACKGROUND: Insufficient knowledge of health insurance benefits could be associated with lack of access to health care, particularly for minority populations. This study aims to assess the association between expatriates' knowledge of health insurance benefits and lack of access to health care. METHODS: A cross-sectional study design was conducted from March 2015 to February 2016 among 3398 insured male expatriates in Riyadh, Saudi Arabia. The dependent variable was binary and expresses access or lack of access to health care. Independent variables included perceived and validated knowledge of health insurance benefits and other variables. Data were summarized by computing frequencies and percentage of all quantities of variables. To evaluate variations in knowledge, personal and job characteristics with lack of access to health care, the Chi square test was used. Odds ratio (OR) and 95% confidence interval (CI) were recorded for each independent variable. Multiple logistic regression and stepwise logistic regression were performed and adjusted ORs were extracted. RESULTS: Descriptive analysis showed that 15% of participants lacked access to health care. The majority of these were unskilled laborers, usually with no education (17.5%), who had been working for less than 3 years (28.1%) in Saudi Arabia. A total of 23.3% worked for companies with less than 50 employees and 16.5% earned less than 4500 Saudi Riyals monthly ($1200). Many (20.3%) were young (< 30 years old) or older (17.9% ≥ 56 years old) and had no formal education (24.7%). Nearly half had fair or poor health status (49.5%), were uncomfortable conversing in Arabic (29.7%) or English (16.7%) and lacked previous knowledge of health insurance (18%). For perceived knowledge of health insurance, 55.2% scored 1 or 0 from total of 3. For validated knowledge, 16.9% scored 1 or 0 from total score of 4. Multiple logistic regression analysis showed that only perceived knowledge of health insurance had significant associations with lack of access to health care ((OR) = 0.393, (CI) = 0.335-0.461), but the result was insignificant for validated knowledge. Stepwise logistic regression gave similar findings. CONCLUSIONS: Our results confirmed that low perceived knowledge of health insurance in expatriates was associated with less access to health care.

Social Support, Adjustment, and Psychological Distress of Help-Seeking Expatriates.

The present study aimed to explore the interrelations between support processes, adjustment, and psychological distress within a sample of help-seeking expatriates. Specifically, we examined (1) the association between expatriates' cross-cultural adjustment (i.e., work, interaction and general adjustment) and levels of psychological distress (i.e., depression, anxiety and stress), (2) the association between expatriates' perceptions of socioemotional and instrumental support availability and their level of cross-cultural adjustment, and (3) the moderating role of expatriates' socioemotional and instrumental support needs in the latter association. Findings showed that lower levels of expatriates' work adjustment were associated with higher levels of psychological distress. Further, perceived availability of socioemotional support was positively linked to expatriates' interaction and work adjustment. Finally, instrumental support needs moderated the relationship between instrumental support availability and general adjustment such that higher levels of instrumental support availability were associated with better general adjustment, but only for expatriates reporting high needs for instrumental support. Our study represents a novel contribution to the expatriate literature by shedding light on expatriates' vulnerability for psychological distress and understanding the type of social support that is considered most beneficial for help-seeking expatriates. Suggestions are made for clinical interventions for expatriates in need of support.

Imported Infections with Mansonella perstans Nematodes, Italy.

We report 74 patients in Italy infected with Mansonella perstans nematodes, a poorly described filarial parasite. M. perstans nematodes should be included in the differential diagnosis for patients with eosinophilia from disease-endemic countries. Serologic analysis is useful for screening, and testing for microfilaremia in peripheral blood should be performed for parasite-positive patients.

The personal and workplace characteristics of uninsured expatriate males in Saudi Arabia.

BACKGROUND: A major concern by the health decision makers in Gulf Cooperative Council (GCC) countries is the burden of financing healthcare. While other GCC countries have been examining different options, Saudi Arabia has endeavoured to reform its private healthcare system and control expatriate access to government resources through the provision of Compulsory Employment-Based Health Insurance (CEBHI). The objective of this research was to investigate, in a natural setting, the characteristics of uninsured expatriates based on their personal and workplace characteristics. METHODS: Using a cross-sectional survey, data were collected from a sample of 4,575 male expatriate employees using a multi-stage stratified cluster sampling technique. Descriptive statistics were used to summarize all variables, and the dependent variable was tabulated by access to health insurance and tested using Chi-square. Logistic analysis was performed, guided by the conceptual model. RESULTS: Of survey respondents, 30% were either uninsured or not yet enrolled in a health insurance scheme, 79.4% of these uninsured expatriates did not have valid reasons for being uninsured, with Iqama renewal accounting for 20.6% of the uninsured. The study found both personal and workplace characteristics were important factors influencing health insurance status. Compared with single expatriates, married expatriates (accompanied by their families) are 30% less likely to be uninsured. Moreover, workers occupying technical jobs requiring high school level of education or above were two-thirds more likely to be insured compared to unskilled workers. With regard to firm size, respondents employed in large companies (more than 50 employees) are more likely to be insured compared to those employed in small companies (less than ten employees). In relation to business type, the study found that compared to workers from the agricultural sector, industrial/manufacturing, construction and trading sectors, workers were, respectively, 76%, 85%, and 60% less likely to be uninsured. CONCLUSION: Although the CEBHI is mandatory, this study found that the characteristics of uninsured expatriates, in respect of their personal and workplace characteristics have similarities with the uninsured from other private employment-sponsored health insurance schemes. Other factors influencing access to health insurance, besides employee and workplace characteristics, include the development and extent of the country's insurance industry.

Using WeChat official accounts to improve malaria health literacy among Chinese expatriates in Niger: an intervention study.

BACKGROUND: Malaria is the main health risk for Chinese expatriates working in Niger. Health education is a recommended intervention for prevention of malaria among non-immune travellers and expatriate workers. It is urgent to develop an effective and feasible way for these populations to obtain information about the prevention and treatment of malaria. METHODS: An individually randomized, unblinded, controlled trial was used to evaluate the effectiveness of using WeChat official accounts for health education to improve malaria health literacy among Chinese expatriates in Niger. A total 1441 participants completed a baseline malaria health literacy questionnaire and were randomly assigned to an intervention or comparison group in a ratio of 1:1. From July to October 2014, 50 malaria prevention and treatment messages were sent to the intervention group; 50 health news messages were concurrently sent to the control group. Both groups completed the malaria health literacy questionnaire again 4 months after the start of the education intervention. A questionnaire addressing satisfaction with the health education programme was completed by the intervention group. Malaria morbidity data for 2013 and 2014 were also collected. RESULTS: At baseline, participant health literacy rates were 58.29, 62, 54, and 34% for skills, knowledge, practice, and attitude, respectively. After the intervention, rates for all four aspects of malaria literacy were above 70%. There was greater change in knowledge, attitude, practice, skills, and overall health literacy among the intervention group compared with the controls, with a statistically significant difference (p < 0.01). This was especially true for acquisition of malaria-related knowledge, practice and attitude; comprehensive intervention practices; and, correct use of rapid diagnostic tests (p < 0.001). The reported malaria morbidity during the study period decreased from 23.72 to 15.40%. Participants reported high levels of satisfaction with the WeChat health education programme with over 80% stating that they would continue to follow the programme. CONCLUSIONS: The present health education intervention, via a WeChat official account, for the prevention and treatment of malaria among non-immune travellers and expatriate workers proved to be an effective, sustainable, feasible, and well accepted strategy for improving malaria health literacy among Chinese expatriates in Niger.

Working Remotely, Feeling Remote? The Role of Digitally Mediated Communication in Shaping the Identity of Virtual Expatriates.

Utilizing the social identity theory, this conceptual article has proposed how digitally mediated communication between expatriates and host country nationals (HCNs) in a remote work arrangement is linked with individualized change experiences of virtual expatriates. The conceptualized model proposes that the lack of in-depth conversations via virtual communication platforms leads to the development of weak emotional interactions between virtual expatriates and HCNs. However, weakened emotional interactions might result in positive or negative impact on expatriates' identity based on personality-based differences. In this regard, expatriates with collective self-esteem are likely to experience social identity threats because of weakened social ties with HCNs. Contrary to the above group, expatriates having personal self-esteem would view weak socialization as an opportunity and experience an improvement in their leader identity, thus experience a positive social identity change over time. This research has conceptually explored outcomes of digitally mediated communication between expatriates and HCNs on the identity change experiences of expatriates, and holistically covers the role of positive as well as negative change experiences. Unlike the focus of the majority of literature on traditional expatriation, the proposed model has focused on experiences of virtual expatriates, and how working in remote work settings lead to long-term socio-psychological changes in these individuals.

Me Too? Yes, Me Too! Sexual Harassment of Female Expatriates in China's Overseas Enterprises.

Through in-depth interviews with Chinese female expatriates who have worked in the country's overseas enterprises in developing countries, this study found that female expatriates frequently encountered sexual harassment and other forms of gender-based prejudice from both home and host countries. The lack of organizational gender consciousness and mechanisms to address gender inequality contributes to women's vulnerability to gender-based workplace hostility. Thus, it is necessary for Chinese enterprises to reassess their organizational policies and cultures when expanding their international horizons to create more inclusive workplace environments. Implications to enhance organizational policies and mechanisms against gender discrimination are discussed.

Employment relationships of Chinese expatriates: A multi-foci perspective of psychological contract.

Introduction: Research into expatriation has made a great contribution to the understanding of issues surrounding international human resource management. However, academic discussion around the subject of expatriate management remains Western-centred, neglecting the use of expatriate staffing in multinational corporations (MNCs) from Eastern countries. By adopting a multi-foci perspective of the psychological contract, the overall objective of this research is to explore the content of Chinese expatriates' psychological contracts. Methods: This paper draws on the findings of an organisational case study and is based on semi-structured interviews with 14 expatriates. Results: The findings provide evidence that individuals have multiple simultaneous psychological contracts, each with a different focus. The contracts held by the Chinese expatriates in this sample contain predominately balanced contract beliefs, which contrast sharply to what the other authors find to be salient beliefs (e.g., transactional contract beliefs) for expatriates based on Western samples. Importantly, the most frequently listed exchange partners by the pre-departure expatriates were line managers and department managers in headquarters; individuals appreciate the respective role of each party in shaping their aspects of work conditions whilst acknowledging the simultaneous existence of such influences. Discussion: This paper has implications for expatriate management in the following ways. First, managers are encouraged to appreciate the role of multiple parties in shaping expatriates' psychological contracts. This helps to enhance management's understanding on the motives and demands of those expatriates. Second, policies of support and contact would aid feelings of integration. Finally, more attention should be paid to planning expatriate career prospects.

More than mateship: exploring how Australian male expatriates, longer-term and frequent travellers experience social support.

PURPOSE: Those travelling overseas for work or leisure including male expatriates, longer-term and frequent travellers (ELoFTs) may be at heightened risk for a range of health and wellbeing issues. Social support may mediate this risk. However, from a public health perspective, little is written about how ELoFTs access health information and support and the role of their social networks in facilitating health and wellbeing outcomes. This research was part of a study examining social network processes of Australian male ELoFTs travelling, living, or working in Southeast Asia (SEA). METHODS: Symbolic Interactionism and Grounded Theory were the conceptual framework and methodology supporting semi-structured, in-depth interviews (n = 25) conducted in Australia and Thailand with Australian male ELoFTs to SEA, aged 18 years or older. RESULTS: Findings highlight supports that assist ELoFT transition and adjustment to country of destination or manage their transnational experience. Influential places, people, and points in the migration journey mediated engagement with social support. CONCLUSIONS: ELoFT social networks and the support provided within them may provide a mechanism for intervention across a range of public health issues. Findings may support the development of policy and practice across industries charged with supporting successful ELoFT adjustment.

COVID-19 vaccine acceptance and COVID-19-induced income disruption among migrant workers in Saudi Arabia.

Background: Neither COVID-19 vaccine acceptance nor income changes among migrant workers during the pandemic has been assessed in Saudi Arabia. Aims: To assess the correlates of willingness to take the COVID-19 vaccine and a decrease in income during the pandemic among migrant workers in Saudi Arabia. Methods: An electronic questionnaire was administered to 2403 migrant workers from the Middle East and South Asia employed in agriculture, auto repair, construction, food service (restaurants), municipality, and poultry farms in Al-Qassim Province, Saudi Arabia. The interviews were conducted in the native languages of the workers in 2021. Chi-square was used to assess the associations, and a multiple logistic regression was used to generate the odds ratio. Data analysis was conducted using SPSS version 27. Results: South Asian workers were 2.30 [95% confidence interval (CI): 1.60-3.32] times more likely to accept the COVID-19 vaccine than those from the Middle East (reference group). Restaurant, agriculture and poultry workers were respectively 2.36 (95% CI: 1.41-3.95), 2.13 (95% CI: 1.29-3.51) and 14.56 (95% CI: 5.64-37.59) times more likely to accept the vaccine than construction workers (reference group). Older (≥ 56 years, reference group ≤ 25 years) workers were 2.23 (95% CI: 0.99-5.03) times, auto repair 6.75 (95% CI: 4.33-10.53) times, and restaurant workers 4.04 (95% CI: 2.61-6.25) times more likely to experience a reduction in income than construction workers. Conclusions: Workers from South Asia were more likely to accept the COVID-19 vaccine and less likely to experience an income reduction than those from the Middle East.

The Effects of Urban Living Conditions on Subjective Well-Being: The Case of German Foreign Service Employees.

In an increasingly urbanized world, understanding the determinants of urban well-being will continue to grow in importance. Although the effects of different indicators of living conditions on well-being have been widely studied individually, little is known about their relative impact when examined jointly. In this study, we use a unique multi-source dataset that allows us to investigate the effect and relative importance of a variety of subjectively and objectively assessed aspects of urban living conditions on the subjective well-being (SWB) of German Foreign Service expatriates. The study captures living conditions in metropolises around the world at different stages of development, and assesses living conditions in a culturally comparably homogeneous set of participants, thus being potentially less confounded with cultural differences. Using linear regression and dominance analysis, we find that 'quality of and access to nature' (i.e., green space), 'quality of housing', and 'quality of public goods' (i.e., water, air, and sewage systems) have the strongest associations with SWB. Subjectively rated characteristics show stronger associations with SWB than externally assessed characteristics. Additionally, we examine whether the size of a city or the level of development of a country has an effect on SWB. Both living in a megacity (≥ 10 million inhabitants) and a lower development status have negative effects on SWB. However, these effects disappear when the various indicators of living conditions are controlled for. Our findings can inform organisations sending employees abroad as well as urban planners seeking to improve their policies and decision-making. Supplementary Information: The online version contains supplementary material available at 10.1007/s11482-023-10169-w.

Loneliness and trust issues reshape mental stress of expatriates during early COVID-19: a structural equation modelling approach.

OBJECTIVES: To explore relationship among perceived stress regarding loneliness, interpersonal trust and institutional trust of expatriates during the early COVID-19 period (from 30th March to 30th May 2020). METHODS: Data from  21,439 expatriates were extracted from COVIDiSTRESS global survey. The outcome variable was perceived stress. The explanatory variables were age, perceived loneliness, trust (interpersonal and institutional). Pairwise correlation, and structural equation modelling were used to determine relationship among outcome and explanatory variables. RESULTS: The majority of the expatriates were female (73.85%), married (60.20%), had college degree (47.76%), and employed (48.72%). Over 63% of the total expatriates reported that the COVID-19 pandemic changed their lives. The average age of the respondents was 40.4 years (± 13.7), and the average score of perceived stress, loneliness, interpersonal and institutional trust were 25.5, 7.4, 14.2 and 40.4, respectively. We found a moderate correlation of perceived stress with age, perceived loneliness, interpersonal trust and institutional trust (p < 0.001). They were also found moderately related to each other. Structural equation modelling evaluated that a lack of trust can cause loneliness among expatriates, which later lead to perceived stress. Interpersonal trust was more likely to be associated with stress than institutional trust, whereas perceived loneliness mediated between both trusts and perceived stress. CONCLUSION: Perceived stress can be reduced through trusting others and alleviating the loneliness. Making strong linkage among migrants as well as between migrants and local community is important to ensure proper mental wellbeing of expatriates.