Systematic review of electronic health records to manage chronic conditions among displaced populations.

OBJECTIVES: The objective of this study was to assess the impact of electronic health records (EHRs) on health outcomes and care of displaced people with chronic health conditions and determine barriers and facilitators to EHR implementation in displaced populations. DESIGN: A systematic review protocol was developed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Systematic Reviews. DATA SOURCES: MEDLINE, Embase, PsycINFO, CINAHL, Health Technology Assessment, Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was searched from inception to 12 April 2021. ELIGIBILITY CRITERIA FOR SELECTED STUDIES: Inclusion criteria were original research articles, case reports and descriptions of EHR implementation in populations of displaced people, refugees or asylum seekers with related chronic diseases. Grey literature, reviews and research articles unrelated to chronic diseases or the care of refugees or asylum populations were excluded. Studies were assessed for risk of bias using a modified Cochrane, Newcastle-Ottawa and Joanna Briggs Institute tools. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data from each study using Covidence. Due to heterogeneity across study design and specific outcomes, a meta-analysis was not possible. An inductive thematic analysis was conducted using NVivo V.12 (QSR International, Melbourne, Australia). An inductive analysis was used in order to uncover patterns and themes in the experiences, general outcomes and perceptions of EHR implementation. RESULTS: A total of 32 studies across nine countries were included: 14 in refugee camps/settlements and 18 in asylum countries. Our analysis suggested that EHRs improve health outcomes for chronic diseases by increasing provider adherence to guidelines or treatment algorithms, monitoring of disease indicators, patient counselling and patient adherence. In asylum countries, EHRs resource allocation to direct clinical care and public health services, as well as screening efforts. EHR implementation was facilitated by their adaptability and ability to integrate into management systems. However, barriers to EHR development, deployment and data analysis were identified in refugee settings. CONCLUSION: Our results suggest that well-designed and integrated EHRs can be a powerful tool to improve healthcare systems and chronic disease outcomes in refugee settings. However, attention should be paid to the common barriers and facilitating actions that we have identified such as utilising a user-centred design. By implementing adaptable EHR solutions, health systems can be strengthened, providers better supported and the health of refugees improved

Communication in refugee and migrant mental healthcare:A systematic rapid review on the needs, barriers and strategies of seekers and providers of mental health services

BackgroundMigrants and refugees may not access mental health services due to linguistic and cultural discordance between them and health and social care professionals (HSCPs). The aim of this review is to identify the communication needs and barriers experienced by third-country nationals (TCNs), their carers, and HSCPs, as well as the strategies they use and their preferences when accessing/providing mental health services and language barriers are present.MethodsWe undertook a rapid systematic review of the literature (01/01/2011 – 09/03/2022) on seeking and/or providing mental health services in linguistically discordant settings. Quality appraisal was performed, data was extracted, and evidence was reviewed and synthesised qualitatively.Results58/5,650 papers met the inclusion criteria. Both TCNs (and their carers) and HSCPs experience difficulties when seeking or providing mental health services and language barriers are present. TCNs and HSCPs prefer linguistically and culturally concordant provision of mental health services but professional interpreters are often required. However, their use is not always preferred, nor is it without problems.ConclusionsLanguage barriers impede TCNs’ access to mental health services. Improving language support options and cultural competency in mental health services is crucial to ensure that individuals from diverse linguistic and cultural backgrounds can access and/or provide high-quality mental health services

Exploring Iranian political refugees’ experiences in Britain - phoenix rises from the ashes - an existential-phenomenological study

The refugee issue is as old as human history. Today the spiralling crisis for host countries and for the refugees themselves needs to be addressed psychologically, as well as politically and sociologically. This study focuses on the lived experience of nine Iranian political refugees in the UK. My main sampling criterion is the willingness of participants to discuss in depth their lived experiences. I chose Interpretative Phenomenological Analysis (IPA) to carry out the investigation. My literature review developed as themes emerged from the participants’ data, which I collected through semi-structured interviewing. Following IPA criteria, five super-ordinate themes developed: Violation of human rights as a threat to the self; their value system and commitment; Taking risks to create possibilities ; psychological rebirth and overcoming obstacles ; and finally their sense of self and cultural adaptation. Within these super-ordinate themes were twenty-five sub-themes. Recognising the value of reflexivity, I asked an IPA researcher to interview me twice: once before commencing my research and again after completing the data analysis. My research showed my nine participants’ capacity to overcome extreme crisis. Through a challenging and painful process, they created a new life in the UK. This research enabled me to recommend a therapeutic model for working with political refugees in particular, and with all others who face traumatic upheaval

Cultural Issues for Ethnic Minority Muslim Patients in Medical Interpretation

This thesis addresses the issue of cultural gaps in medical interpretation for ethnic minority patients in the UK. The study considers the various roles of the interpreter in health care (HC) settings. It aims to explore the advocate role of the interpreter. It also looks at the significant role of the interpreter's visibility to highlight and interpret some cultural concerns which may impact the patient's health and HC quality. Interpreters are the bridge of language communication. The research engages with Muslim patients and discusses their concerns when receiving treatment from HCPs. The research also involves HCPs who do not share the same cultural backgrounds as their patients. The thesis addresses issues related to Muslim patients' experiences in HC. It highlights differences in religious and cultural backgrounds and how they may impact LEPs' adherence to medical treatment and appointments. The thesis discusses specific experiences of both HCPs and HCUs, using these to shed light on some issues related to cultural difference and the interpreter's role in resolving miscommunication between the HCP and the HCU. This thesis finishes by discussing possible future research directions

Interpreter-Assisted Investigative Interviews: Needs, Challenges and Quality

This thesis researches the yet to be fully explored dynamic of interpretation services needs and interpretation service optimisation (i.e., interview and interpretation quality assurance). The research began with an exploratory analysis of factors affecting interpreter-assisted investigative interviews and then took a subtle experimental swipe at factors affecting intelligibility and informativeness of translation. Recognition of the importance of the context in which interpretation currently takes place led to the addition of a wider range of approaches. This informed a broad review of relevant literature. The empirical work is presented as follows. First, is a Study Space Analysis (SSA) of policy-relevant research, which provides a base for determining the adequacy and depth of the existing body of knowledge. The results show that interpretation service needs and planning appear mildly or infrequently researched, and there exists little or no studies investigating police diversity effects on interpretation service needs. Also, studies investigating cognitive load, language and gender effects on interpreting accuracy are sparse. Finally, this study shows that the literature focuses on interpretation as a service for offenders rather than for victims and witnesses. The implications of this for social harmony are discussed. The second study concerns the optics of a police service that does not resemble the population policed. In a convenience sample of 104 ethnic minority individuals, the descriptive and thematic analysis indicates that police diversity tends to improve trust and impact the need for interpretation service. These findings bring to the fore the benign potency of language education. The third study explores the opinions of 66 International Law Enforcement Agency (ILEA) investigators and 40 interpreters on factors affecting investigative interviews involving the assistance of interpreters. Using descriptive and thematic analysis, it was shown that investigators plan only occasionally with interpreters. The seldom planning practise is found to occur because of investigator’s role perception of interpreters and individualistic culture of investigators. Additionally, interpreter presence is observed to impact rapport building, and the effect of interruption is manageable with the right skills and experience combination. The fourth study uses a complex design to determine factors relevant to the intelligibility and informativeness of translations of witness accounts of a sample of audio depictions of non-violent offences. The study employed 240 aggregated ratings from 4 volunteer assessors of 60 textual interpretation of 15mins, 10mins and 5mins witness accounts using Tiselius (2009) 6-points Intelligibility and informativeness scale. Log-linear analysis revealed a surprising lack of consensus of assessments of intelligibility and informativeness across assessors, but judgements of informativeness relative to intelligibility within individual assessors appear coherent and consistent. Length of audio was not associated with intelligibility or informativeness. A small exploratory follow up to the study investigated what seemed to make translations unintelligible. The next study mapped the opinions of a sample of 51 expert interpreters with a range of experience about the perception of their work and its challenges. This shows consistency with existing literature and studies investigated in the thesis except for opinions on the role of police diversity which is found to increase trust and interpretation service needs

Accesso all'istruzione delle popolazioni colpite da conflitti: studenti IDP in Georgia

This work seeks to understand what kind of impact educational policies have had on the secondary school students among internally displaced persons (IDPs) and their identity reconstruction in Georgia. The study offers a snapshot of the current situation based on desk study and interviews conducted among a sample of secondary school IDP pupils. In the final chapter, the findings will be reflected against the broader political context in Georgia and beyond. The study is interdisciplinary and its methodology is based on social identity theory. I shall compare two groups of IDPs who were displaced as a result of two separate conflicts. The IDPs displaced as a result of conflict in Abkhazia in 1992–1994 are named as old caseload IDPs. The second group of IDPs were displaced after a conflict in South Ossetia in 2008. Additionally, I shall touch upon the situation of the pupils among the returnees, a group of Georgian old caseload IDPs, who have spontaneously returned to de facto Abkhazia. According to the interviews, the secondary school student IDPs identify themselves strongly with the Georgian state, but their group identities are less prevailing. Particularly the old case load IDP students are fully integrated in local communities. Moreover, there seems not to be any tangible bond between the old and new caseload IDP students. The schools have neither tried nor managed to preserve IDP identities which would, for instance, make political mobilisation likely along these lines. Right to education is a human right enshrined in a number of international conventions to which the IDPs are also entitled. Access to education or its denial has a deep impact on individual and societal development. Furthermore, education has a major role in (re)constructing personal as well as national identity.La tesi mira a comprendere l’impatto delle politiche educative su IDP (internally displaced persons, persone internamente dislocate) studenti delle scuole superiori in Georgia e sulla ricostruzione della loro identità. Lo studio offre un quadro della situazione attuale in base a un’analisi on desk e a interviste svolte con un campione di studenti IDP delle scuole superiori. Il capitolo conclusivo illustra i risultati alla luce del più ampio contesto politico georgiano. La ricerca assume carattere interdisciplinare e si basa sulla teoria dell’identità sociale. L’elaborato confronta due gruppi di IDP dislocati in seguito a due conflitti. Gli IDP dislocati a causa del conflitto in Abcasia nel periodo 1992–1994 sono denominati “prima ondata”. Il secondo gruppo proviene dal conflitto in Ossezia del Sud nel 2008. Si è inoltre considerata la situazione degli studenti tra i Ritornati, un gruppo di georgiani della prima ondata tornati spontaneamente in territorio abcaso. Le interviste indicano che gli IDP studenti delle superiori si identificano fortemente con lo Stato georgiano, ma le loro identità di gruppo risultano meno evidenti. Sono in particolare gli IDP della prima ondata a essere completamente integrati nelle comunità locali. Sembra inoltre non sussistere alcun legame tangibile tra la prima e la seconda ondata di studenti dislocati. Le scuole non si sono impegnate per preservare le identità degli IDP, non ottenendo un risultato che avrebbe probabilmente favorito la mobilitazione politica. Il diritto all’istruzione è un diritto dell’uomo sancito da diverse convenzioni internazionali che si applicano anche agli IDP. Consentire o impedire l’accesso all’istruzione ha un profondo impatto sullo sviluppo dell’individuo e della società. L’istruzione svolge inoltre un ruolo primario nella (ri)costruzione dell’identità personale e nazionale