"We want our freedom back, that's our only need": a qualitative study of health and social needs among asylum seekers and undocumented migrants crossing the borders from Belarus to Lithuania.

Background: The influx of undocumented migrants and asylum seekers into Lithuania, particularly during the COVID-19 pandemic, presents unique public health challenges. This study employs the Social Determinants of Health framework to explore the healthcare and social needs of this vulnerable population. Methods: In May 2022, we carried out a qualitative study through semi-structured interviews with asylum seekers across four centers in Lithuania. Employing both purposive and snowball sampling techniques, we selected participants for our investigation. The study comprised 21 interviews-19 conducted in Arabic and 2 in English-with durations ranging between 20 and 40 min each. We audio-recorded all interviews, transcribed them verbatim, and subsequently performed a thematic analysis using Atlas.ti software. This process of design and analysis strictly followed the principles of thematic analysis as outlined by Braun and Clarke, guaranteeing methodological precision and rigor. Findings: 21 interviews revealed critical insights into the healthcare access challenges, mental health issues, and social integration barriers faced by the participants. Key themes included 'Healthcare Needs and the Impact of the COVID-19 Pandemic 'and 'Social needs and Aspirations Amidst Pandemic-Induced Uncertainty '. The findings highlight the multifaceted healthcare and social needs of asylum seekers, juxtaposed against significant barriers they face. Access to medical services is hindered by long waiting times and financial constraints, especially for specialized care such as dental services. Communication issues during medical appointments due to language barriers and the lack of gender-specific healthcare, such as access to gynecological services, further exacerbate the challenges. Additionally, the COVID-19 pandemic introduces hurdles such as limited testing, isolation measures, language-specific information barriers, and insufficient social distancing practices. Mental health has emerged as a critical concern, with asylum seekers reporting significant stress and emotional exhaustion due to uncertainty and restrictive living conditions. Social needs extend to delayed asylum application processes, inconsistent language education opportunities, inadequate clothing, and nutrition that lacks cultural sensitivity, and living conditions characterized by overcrowding and insufficient facilities. The restricted freedom of movement within asylum seeking centres severely impacts their psychological well-being, underscoring a deep longing for autonomy and a better life despite the myriad of challenges faced. Discussion: The study illustrates the complex interplay between migration, health, and social factors in the context of a global pandemic. It highlights the need for culturally sensitive healthcare services, mental health support, and structured language education programs. Offering educational avenues alongside language courses for children and adults is essential for fostering social inclusion and securing economic prosperity. Addressing the challenge of language barriers is of utmost importance, as these barriers significantly impede undocumented migrants' and asylum seekers employment opportunities and their access to crucial services. The findings emphasized immigration as a health determinant and underscored the importance of inclusive health policies and advocacy for undocumented migrants and asylum seekers' rights and needs. Conclusion: There is an urgent need for comprehensive policies and practices that are grounded in the principles of equity, compassion, and human rights. Additionally, advocating for practice adaptations that are culturally sensitive, linguistically inclusive, and responsive to the unique challenges faced by undocumented migrants and asylum seekers. As global migration continues to rise, these findings are crucial for informing public health strategies and social services that cater to the diverse needs of this vulnerable population.

Potential Implementers' Perspectives on the Development and Implementation of an e-Mental Health Intervention for Caregivers of Adults With Chronic Kidney Disease: Qualitative Interview Study.

BACKGROUND: e-Mental health interventions can improve access to mental health support for caregivers of people living with chronic kidney disease (CKD). However, implementation challenges often prevent effective interventions from being put into practice. To develop an e-mental health intervention for caregivers of people living with CKD that is optimized for future implementation, it is important to engage professionals that may endorse or deliver the intervention (ie, potential implementers) during intervention development. OBJECTIVE: This study aims to explore the perspectives of potential implementers working in kidney care, in mental health care, or at nonprofit organizations regarding the design and implementation of an e-mental health intervention for caregivers of people living with CKD. METHODS: Potential implementers (N=18) were recruited via National Health Service Trusts, email, and social media advertisements to participate in semistructured video interviews. Interview questions were informed by the Consolidated Framework for Implementation Research (CFIR). Data were analyzed using a deductive analysis approach using the CFIR, with inductive coding applied to relevant data not captured by the framework. RESULTS: A total of 29 generic categories, related to 17 CFIR constructs, were identified. The perceived fit between the intervention and implementation context (ie, existing service delivery models and work routines) and existing social networks among potential implementers were perceived as important factors in enhancing implementation potential. However, a need for capacity building among potential implementers to create systems to support the identification and referral of caregivers to an e-mental health intervention was identified. Equity concerns were raised regarding the intervention, highlighting the importance of incorporating an equity lens during intervention design to enhance accessibility and adoption. CONCLUSIONS: Potential implementers provided valuable insights into key design and implementation factors to help inform the development of an e-mental health intervention for caregivers of people living with CKD. Incorporating their feedback can help ensure the intervention is acceptable and inform the selection of future implementation strategies to enhance the implementation potential of the intervention. Potential implementers should continue to be engaged throughout intervention development.

Health and well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons under COVID-19: a scoping review.

Objectives: The objective of this scoping review was to identify what is known about the impact of COVID-19 on the physical and mental well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons. The aim was also to identify barriers influencing access to treatment or prevention. Methods: The search was conducted using PubMed/Medline, CINAHL, Scopus, and ScienceDirect. A mixed methods appraisal tool was used to assess methodological rigor. The study findings were synthesized using a thematic analysis approach. Results and Discussion: This review comprised 24 studies and were conducted utilizing a mixed method approach incorporating both quantitative and qualitative methodologies. Two major themes were identified related to the impact of COVID-19 on the health and wellbeing of refugees, asylum seekers, undocumented migrants, and internally displaced persons and the key barriers influencing access to treatment or prevention of COVID-19. They often have barriers to accessing healthcare due to their legal status, language barriers, and limited resources. The pandemic has further strained already limited health resources, making it even more challenging for these populations to receive healthcare. This review reveals that refugees and asylum seekers in receiving facilities face a higher risk of COVID-19 infection than the general population due to their less favorable living conditions. The various health impacts stem from a lack of access to accurate information about the pandemic, misinformation, and the exacerbation of pre-existing mental health issues caused by heightened stress, anxiety, and uncertainty, fear of deportation among undocumented migrants, and overcrowding camps and detention facilities that increase exposure risk. Social distancing measures are difficult to implement in these settings, and inadequate sanitation, hygiene, and a lack of personal protective equipment further compound the problem. Moreover, the pandemic has had significant economic consequences for these populations. Many of them rely on informal or precarious employment, which has been disproportionately affected by the pandemic. Job losses and reduced working hours, and limited access to social protection can lead to increased poverty, and food insecurity. Children faced specific challenges, such as disruptions to education, additionally, interruptions in support services for pregnant women. Some pregnant women have avoided seeking maternity care due to fears of contracting COVID-19, resulting in increased home births and delays in accessing healthcare services. Factors that play a role in vaccination reluctance include uncertainty of undocumented migrants' inclusion in vaccination programs, furthermore, a growing vaccine hesitancy in the population; skepticism about the safety of vaccines, inadequate knowledge/education, a variety of access barriers such as language barriers, and logistical challenges including remote locations, and inaccurate information. Conclusion: This review highlights that the physical health of refugees, asylum seekers, undocumented migrants, and internally displaced persons has been significantly impacted by various barriers to healthcare access during the pandemic. These barriers include legal and administrative challenges, such as a lack of documentation. Additionally, the shift to digital tools has introduced new obstacles, not only due to language barriers or limited technical knowledge but also because of structural barriers, such as the requirement of a bank ID that is often inaccessible to these groups. Other factors contributing to limited healthcare access include financial constraints, language barriers, and discrimination. Additionally, limited access to accurate information about health services, prevention measures, and available resources may hinder them from seeking care or following public health guidelines. Misinformation and lack of trust in healthcare systems can also contribute to a reluctance to access care or vaccination programs. There is concerning evidence regarding vaccine hesitancy that needs to be addressed to reduce any future pandemic outbreak, in addition there is a need to explore the factors that play a role in vaccination reluctance among children in these populations.

Cultural competency among Lithuanian nurses and preparedness to work with intercultural immigrants: A quantitative study protocol.

Introduction: Health care providers are increasingly required to provide care to patients from diverse cultural backgrounds. A culturally competent approach could be used to address gaps in the health care of migrants, whether they are refugees, asylum seekers, or undocumented migrants. From June 2021 onward, there are estimated to be 4,300 asylum seekers in Lithuania who crossed the Belarusian border. Furthermore, ~65 thousand Ukrainians registered within 6 months of the beginning of the war on 24 February 2022. Aim: To determine the cultural competence of Lithuanian nurses using the Nurse Cultural Competence Scale (NCCS) questionnaire. Methods: A quantitative study evaluating the cultural competency of nursing professionals will be conducted using the Lithuanian version of the Nurse Cultural Competence Scale (NCCS). The study will be conducted in Lithuanian municipalities and will involve primary, secondary, and tertiary health care providers. Discussion: This study will provide data that can guide the development and evaluation of interventions designed to reduce health disparities among migrants, including the need to identify the appropriate type of cultural competency training for nurses. In addition to the results of this study, it may provide an indication of other cultural competency required for nurses. This includes consideration of religion, sexual orientation, gender identity, household classifications on the basis of urban vs. rural areas, language spoken, and country of origin.

Health and social needs of asylum seekers and Ukrainian refugees in Lithuania: A mixed-method protocol.

Refugees, asylum seekers, and migrants often do not end up in the places they expected. Because of the pandemic impacts, their exposure to COVID-19 may be increased as a result of crowded camps and detention centers. A total of 4,537 undocumented migrants entered Lithuania via Belarus from June 2021 to November 30, 2022. In the period 24 February 2022 to 30 November 2022, Lithuania's Immigration Department registered 71,386 Ukrainian refugees. This study investigates the healthcare and social needs of recent asylum seekers who have crossed the Belarusian border and Ukrainian refugees in Lithuania. This is a study protocol for a mixed-methods study which will involve qualitative interviews with asylum seekers who crossed from Belarus in June 2021 and Ukrainian refugees. During a quantitative phase, refugees and asylum seekers will be asked to complete questionnaires. In this study, validated questionnaires will be used, including the Hopkins Symptom Checklist (HSCL-25), the Harvard Trauma Questionnaire (HTQ), and the Short Form 36 (SF-36). Participants will also be asked to self-report sociodemographic information. As a result of the findings of this study, it is possible to provide guidelines for improving access to health care services, including prevention (i.e., vaccination programs) and treatment of chronic and acute illnesses, through primary and secondary healthcare delivery, thereby reducing negative health outcomes. This study may shed light on the social needs of asylum seekers and refugees in Lithuania. In addition, this may provide insight into how they are integrating into the community, such as what their employment and educational prospects are.