Interventions to improve the mental health or mental well-being of migrants and ethnic minority groups in Europe: A scoping review.

In Europe, migrants and ethnic minority groups are at greater risk for mental disorders compared to the general population. However, little is known about which interventions improve their mental health and well-being and about their underlying mechanisms that reduce existing mental health inequities. To fill this gap, the aim of this scoping review was to synthesise the available evidence on health promotion, prevention, and non-medical treatment interventions targeting migrants and ethnic minority populations. By mapping and synthesising the findings, including facilitators and barriers for intervention uptake, this scoping review provides valuable insights for developing future interventions. We used the PICo strategy and PRISMA guidelines to select peer-reviewed articles assessing studies on interventions. In total, we included 27 studies and synthesised the results based on the type of intervention, intervention mechanisms and outcomes, and barriers and facilitators to intervention uptake. We found that the selected studies implemented tailored interventions to reach these specific populations who are at risk due to structural inequities such as discrimination and racism, stigma associated with mental health, language barriers, and problems in accessing health care. The majority of interventions showed a positive effect on participants' mental health, indicating the importance of using a tailored approach. We identified three main successful mechanisms for intervention development and implementation: a sound theory-base, systematic adaption to make interventions culturally sensitive and participatory approaches. Moreover, this review indicates the need to holistically address social determinants of health through intersectoral programming to promote and improve mental health among migrants and ethnic minority populations. We identified current shortcomings and knowledge gaps within this field: rigorous intervention studies were scarce, there was a large diversity regarding migrant population groups and few studies evaluated the interventions' (cost-)effectiveness.

Advertising of unhealthy foods and beverages around primary and junior high schools in Ghana's most urbanized and populous region.

Introduction: The advertising of energy-dense, nutrient-poor foods and beverages is a common feature in obesogenic food environments. Such advertising, within and around settings where children live, learn, and play, negatively affects their food acquisition and consumption. We examined the extent and nature of food and beverage advertising around primary and junior high schools in Ghana's most populous and urbanized region, Greater Accra. Materials and methods: Outdoor advertisements for foods and beverages within a 250 m road network distance of 200 randomly sampled schools were geocoded. For each food and beverage advertisement, information was collected on the setting, type, size, and number of product types featured in the advertisement. Promotional techniques (promotional characters and premium offers) used in advertisements were documented. Advertised foods and beverages were classified using the INFORMAS and NOVA food classification systems. Results: A total of 5,887 advertisements were identified around the schools surveyed, 42% of which were for foods and beverages. Advertisements were most prevalent at food outlets (78% of all food advertisements), but also along roads and on non-food structures. Overall, 70% of food advertisements featured non-core/unhealthy products, while 12 and 14% had core/healthy and miscellaneous (including soup cubes, seasonings, and tea) products. About 4% of food advertisements had only a product/brand name or logo displayed. One out of two of the foods and beverages advertised were ultra-processed foods, 30% processed, 3% processed culinary ingredients, and 17% unprocessed or minimally processed foods. Sugar-sweetened beverages were the most advertised food product type (32%). Promotional characters were found on 14% of all food advertisements (most-69% were cartoons or manufacturer's characters), while 8% of all food advertisements had premium offers (including price discounts and gift/collectables). Conclusions: There is an abundance of unhealthy food advertisements around primary and junior high schools in the Greater Accra Region. Policy actions such as restricting the promotion of unhealthy foods in children's settings are needed to protect pupils from such advertising practices.

Healthcare Utilisation of Moluccans in the Netherlands: Equal Care for Equal Need after 60 Years of Residence in the Host Country?

BACKGROUND: In many countries, recent migrants have difficulties using healthcare to the same extent as host populations. It is uncertain whether these differences persist for long-settled migrants. This study examined healthcare utilisation of Moluccans in 2012, more than 60 years after they migrated from Indonesia to the Netherlands. METHODS: A survey was held among 715 Moluccans and 3417 Dutch persons. Differences in healthcare utilisation were assessed using regression analyses adjusting for age, gender, indicators of health, religious affiliation, and education. RESULTS: Moluccans had lower rates of healthcare use, including visits to the general practitioner (odds ratio (OR) = 0.67), outpatient medical specialist (OR = 0.50), dentist (OR = 0.65), and physiotherapist (OR = 0.56), as well as the use of paid housekeeping services (OR = 0.37). Among those who visited a healthcare service, no difference was found between Moluccans and Dutch in the frequency of visits, except for physiotherapist visits (rate ratio (RR) = 0.51). For the risk of hospitalisation, no difference was found; however, of those admitted to the hospital, the frequency of admission was lower among Moluccans than Dutch (RR = 0.74). CONCLUSIONS: Despite their long residence in the host country, equal utilisation of healthcare services has not been achieved for Moluccans in the Netherlands. Demand-based factors (e.g., family networks, health beliefs, and use of traditional medicine) may contribute to the persistence of such differences and require further investigation.

Comfy zone hypotheses in migrant health research: time for a paradigm shift.

Migration remains a double-edged sword. Emigration can improve migrants' socio-economic circumstances through better education, higher income and by providing a safety net from persecution and violence. However, migrants remain vulnerable particularly in terms of poor health. Keeping migrants healthy is in the best interest of both destination countries and the countries of origin because of the bidirectional contributions they make towards them. Sadly, migrant health still remains an underresearched area in the health arena. This poses a challenge in gaining a better understanding of the causes of the health burden in order to develop effective prevention and intervention strategies to improve health among migrants. Due to poor understanding of the underlying causes of migrant health differentials, several hypotheses have been proposed including 'healthy migrant effect' and/or 'Salmon bias', for explaining migrant health advantage, and low socio-economic status, poor lifestyle and genetics for migrant health disadvantage relative to the host populations. Although largely untested, these hypotheses have become a standard 'comfy zone' explanatory model in migrant health research field. However, the reliance on these hypotheses have become a standing block for the development of the migrant health research field as they provide untested explanations in communicating their findings. To make progress in gaining better understanding on migrant health differentials, researchers need to move out of their 'comfy zone' explanatory model to test potential factors in the real world and to invest in other explanatory models such as the role of migration and the role of context.

Illness representations and coping practices for self-managing hypertension among sub-Saharan Africans: A comparative study among Ghanaian migrants and non-migrant Ghanaians.

OBJECTIVE: Hypertension (HTN) control is a major obstacle among sub-Saharan African populations partly due to poor self-management. We explored and compared how persons' social and physical context shapes their illness representations regarding HTN and the coping strategies they develop and adapt to mitigate challenges in self-managing HTN. METHODS: A cross sectional multisite qualitative study using semi-structured interviews among 55 Ghanaians with HTN living in The Netherlands and urban and rural Ghana. A thematic approach was used in data analysis. RESULTS: Family HTN history, personal experiences with HTN and outcomes of using biomedical and traditional treatments shaped participants' illness representations and coping strategies. Migrants and urban non-migrants modified medication schedules and integrated taking medication into daily routine activities to cope with experienced side effects of taking antihypertensive medication while rural non-migrants used traditional remedies and medicines to mitigate experienced medication side effects and/or in search for a cure for HTN. CONCLUSION: Contextual factors within participants' social and physical environments shape their illness representations and coping strategies for HTN though interactive phrases. PRACTICE IMPLICATIONS: Health professionals should harness the relationships within peoples' social and physical environments, encourage implementation of family-wide behavioural changes and involve family and communities in HTN treatment to enhance patients' self-management of HTN.

Lay community perceptions and treatment options for hypertension in rural northern Ghana: a qualitative analysis.

OBJECTIVE: Adherence to hypertension treatment is a major public health challenge for low and middle-income countries particularly in sub-Saharan Africa. One potential reason could be the discordance between lay and medical explanatory models of hypertension and its treatment. Understanding community perceptions and practices may contribute to improving hypertension control as they present insights into psychosocial and cultural factors that shape individual behaviour. We explore community perceptions regarding hypertension and its treatment in rural northern Ghana and how they differ from medical understanding. DESIGN: This was a qualitative study using semi-structured interviews and focus group discussions to collect data, which were analysed using a thematic approach. SETTING: A multisite study conducted in four rural communities in two regions of northern Ghana. PARTICIPANTS: We conducted 16 semi-structured interviews and eight focus group discussions with community leaders and members, respectively. RESULTS: Three major themes were identified: community perceptions, treatment options and community support for people with hypertension. Community perceptions about hypertension include hypertension perceived as excess blood in the body and associated with spiritual or witchcraft attacks. Traditional medicine is perceived to cure hypertension completely with concurrent use of biomedical and traditional medicines encouraged in rural communities. Community members did not consider themselves at risk of developing hypertension and reported having inadequate information on how to provide social support for hypertensive community members, which they attributed to low literacy and poverty. CONCLUSION: There is a substantial mismatch between communities' perceptions and medical understanding of hypertension and its treatment. These perceptions partly result from structural factors and social norms shaped by collective processes and traditions that shape lay beliefs and influence individual health behaviour. Socioeconomic factors also thwart access to information and contribute to inadequate social support for persons with hypertension. These findings highlight the need for a public health approach to hypertension control targeting families and communities.

Limited midwifery care for undocumented women in the Netherlands.

BACKGROUND: Ethnic minority women in Western countries have poorer pregnancy outcomes compared to majority populations, and undocumented women are particularly vulnerable. We intended to assess whether midwives adjust their care if women are undocumented and have no health insurance. METHODS: A retrospective matched cohort study in primary midwifery care practices in Amsterdam and Rotterdam, the Netherlands. Undocumented, uninsured women (N?=?141) were matched with documented, insured ethnic minority women (N?=?141). Information was extracted from patient records. RESULTS: Undocumented women attended their first prenatal visit 5 weeks later in their pregnancy and received care elsewhere or disappeared from care more frequently (59.6 versus 34.3%). They frequently have an excess of 110% of the number of expected antenatal visits (32.4% versus 16.9%) and had a preterm birth more frequently (OR 4.59, 95% CI 1.43 to 14.72). Midwives were equally likely to follow referral guidelines in both groups. Undocumented women were more likely to give birth at home (OR 2.14, 95% CI 1.07?4.28) and less likely to receive maternity home care assistance (56.0 versus 79.7%). CONCLUSION: Although referral guidelines are generally followed by midwives, undocumented women are more at risk of adverse perinatal outcomes and inadequate care than documented ethnic minority women.

How Ghanaian, African-Surinamese and Dutch patients perceive and manage antihypertensive drug treatment: a qualitative study.

OBJECTIVES: To explore and compare how Ghanaian, African-Surinamese (Surinamese), and White-Dutch patients perceive and manage antihypertensive drug treatment in Amsterdam, the Netherlands. METHODS: Qualitative study was conducted using detailed interviews with a purposive sample of 46 hypertensive patients without comorbidity who were prescribed antihypertensives. RESULTS: Patients in all the ethnic groups actively decided how to manage their prescribed antihypertensive regimens. In all the groups, confidence in the doctor and beneficial effects of medication were reasons for taking prescribed antihypertensive dosage. Particularly, ethnic-minority patients reported lowering or leaving off the prescribed medication dosage. Explanations for altering prescribed dosage comprised disliking chemical medications, fear of side effects and preference for alternative treatment. Surinamese and Ghanaian men also worried about the negative effects of antihypertensives on their sexual performance. Some Ghanaians mentioned fear of addiction or lack of money as explanations for altering prescribed dosage. Surinamese and Ghanaians often discontinued medication when visiting their homeland. Some respondents from all ethnic groups preferred natural treatments although treatment type varied. CONCLUSION: Patients' explanations for their decisions regarding the use of antihypertensives are often influenced by sociocultural issues and in ethnic-minority groups also by migration-related issues. Self-alteration of prescribed medication among Surinamese and Ghanaians may contribute to the low blood pressure (BP) control rate and high rate of malignant hypertension reported among these populations in the Netherlands. This study provides new information, which can help clinicians to understand how patients of diverse ethnic populations think about managing antihypertensive drug treatment and to address ethnic disparities in medication adherence and BP control.