Special Issue "Health Care Access among Underserved Groups"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: 30 November 2021.

Special Issue Editors

Dr. Jeanine Suurmond
E-Mail Website
Guest Editor
Department of Public and Occupational Health, University of Amsterdam, 1012 WX Amsterdam, Netherlands
Interests: diversity-responsiveness; equity; cultural competence
Prof. Dr. Charles Agyemang
E-Mail Website
Guest Editor
Department of Public and Occupational Health, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
Interests: ethnicity; migration; chronic non-communicable diseases
Special Issues and Collections in MDPI journals
Dr. Morten Skovdal
E-Mail Website
Guest Editor
Section for Health Services Research, Department of Public Health, University of Copenhagen, 1165 København, Denmark
Interests: health psychology; qualitative health research; HIV; children and young people; mental health

Special Issue Information

Dear Colleagues,

We are delighted to organize a Special Issue on the health care access among underserved groups in the International Journal of Environmental Research and Public Health.
Underserved populations face persistent and systemic barriers to accessing health care. These barriers are complex and numerous and include cultural, financial, literacy, linguistic and geographical barriers as well as barriers caused by services and health care providers that are not aimed at the needs of underserved populations. Lack of access to health care contributes to profound and enduring health disparities.
Underserved populations include, but are not limited to, the following groups:

  • Ethnic and racial minorities;
  • Migrants, including refugees, asylum seekers and undocumented migrants;
  • Indigenous populations;
  • Roma, travelers;
  • Homeless people;
  • Sex workers;
  • Transgender persons and other sexual minorities;
  • Drug addicts;
  • Prisoners;
  • Religious minorities;
  • People with disabilities.

This Special Issue is open to any subject area, disease/health focus and geographical scope as long as they advance our understanding of pathways for improving health care access of underserved populations. Our interests include, but are not limited to, studies on innovative health care solutions for underserved populations; studies that address intersectionality and how belonging to different (sub)groups influences the access to care; studies that address the health care system as a complex system and apply the principles of complexity science to provide new insights as to why health care barriers are still in place; and studies that combine a high academic standard with a practical focus on improving health care access to underserved populations. The listed keywords below suggest just a few of the many possibilities.

Dr. Jeanine Suurmond
Prof. Charles Agyemang
Dr. Morten Skovdal
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Inclusiveness, responsiveness, equity
  • Discrimination/bias in health care services
  • Underserved populations (including all groups named above)
  • Innovative health care solutions
  • Social inequalities
  • Vulnerability
  • Intersectionality
  • Cultural competence
  • Differentiated care, delivering health care differently to serve individual needs
  • Client- and person-centered health care
  • (Dis)continuities along care cascades

Published Papers (11 papers)

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Research

Article
Understanding Cervical Cancer Screening Barriers among Migrant Women: A Qualitative Study with Healthcare and Community Workers in Portugal
Int. J. Environ. Res. Public Health 2021, 18(14), 7248; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147248 - 06 Jul 2021
Viewed by 438
Abstract
Cervical cancer screening (CCS) has been proven to reducing mortality of cervical cancer; yet migrant women show a lower participation in screening compared to non-migrants. This study explores the perspectives of healthcare workers and community workers on the factors influencing the CCS participation [...] Read more.
Cervical cancer screening (CCS) has been proven to reducing mortality of cervical cancer; yet migrant women show a lower participation in screening compared to non-migrants. This study explores the perspectives of healthcare workers and community workers on the factors influencing the CCS participation of migrant women living in Portugal. A qualitative study with online focus groups was conducted. Healthcare workers experienced in CCS and community workers working with migrant communities were purposively sampled. A semi-structured guide was used covering the participation of migrant women in CCS, barriers, and strategies to overcome them. Data were analyzed using content analysis. Participants considered that migrant women have low participation in CCS related to insufficient knowledge, low risk perception, and lack of interest on preventive care. Other barriers such as difficulties in accessing the healthcare services, relationship with healthcare workers, language, and cultural differences were highlighted. Promoting continuity of care, disseminating culturally tailored information, and use of self-sampling methods were suggested to improve participation in CCS. Inequalities in access to CCS among migrant women are mostly caused by information gaps and healthcare system-related barriers. Building a migrant-friendly healthcare system that creates opportunities for healthcare workers to establish relationships with their patients and delivering culturally and linguistically adapted information may contribute to overcoming those barriers and increasing the participation of migrant women in screening. Full article
(This article belongs to the Special Issue Health Care Access among Underserved Groups)
Article
Association between Depressed Mood and Sleep Duration among Various Ethnic Groups—The Helius Study
Int. J. Environ. Res. Public Health 2021, 18(13), 7134; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18137134 - 03 Jul 2021
Viewed by 440
Abstract
Background: We examined the association between depressed mood (DM) and sleep duration in a multi-ethnic population in Amsterdam, and the extent to which DM accounts for both short and long sleep. Methods: Cross-sectional data using 21,072 participants (aged 18–71 years) from the HELIUS [...] Read more.
Background: We examined the association between depressed mood (DM) and sleep duration in a multi-ethnic population in Amsterdam, and the extent to which DM accounts for both short and long sleep. Methods: Cross-sectional data using 21,072 participants (aged 18–71 years) from the HELIUS study were analyzed. Sleep duration was classified as: short, healthy, and long (<7, 7–8, and ≥9 h/night). A Patient Health Questionnaire (PHQ-9 sum score ≥10) was used to measure DM. The association between DM and sleep duration was assessed using logistic regression. The extent to which DM accounted for short and long sleep was assessed using a population attributable fraction (PAF). Results: DM was significantly associated with short sleep in all ethnic groups after adjustment for other covariates (OR 1.9 (1.5–2.7) in Ghanaians to 2.5 (1.9–32) in the Dutch). DM was not associated with long sleep except in the Dutch (OR 1.9; 1.3–2.8). DM partly accounted for the prevalence of short sleep with PAF ranging from 3.5% in Ghanaians to 15.5% in Turkish. For long sleep, this was 7.1% in the Dutch. Conclusions: DM was associated with short sleep in all ethnic groups, except in Dutch. If confirmed in longitudinal analyses, strategies to reduce depression may reduce the prevalence of short sleep in concerned groups. Full article
(This article belongs to the Special Issue Health Care Access among Underserved Groups)
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Article
Strengthening Country Readiness for Pandemic-Related Mass Movement: Policy Lessons Learned
Int. J. Environ. Res. Public Health 2021, 18(12), 6377; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18126377 - 12 Jun 2021
Viewed by 567
Abstract
The COVID-19 pandemic has thus far restricted the large movement of people; nonetheless, we cannot exclude the disruptive power of a virus with similar characteristics to COVID-19 affecting both high- and low-income countries, as a factor for future mass migrations. Indeed, the top [...] Read more.
The COVID-19 pandemic has thus far restricted the large movement of people; nonetheless, we cannot exclude the disruptive power of a virus with similar characteristics to COVID-19 affecting both high- and low-income countries, as a factor for future mass migrations. Indeed, the top 15 countries affected by COVID-19 host about 9 million refugees, and it is, therefore, important to investigate and strengthen the readiness of countries’ health policies to ensure they are well equipped to deal with potential large influxes of ‘epidemic-related refugees and migrants.’ Using the Bardach Policy Framework as a tool for analysis, this article investigates the readiness of countries for a potential public health event (mass migration generated by future pandemics), therefore, aiming at a health response forecasting exercise. The article reviews the policies put in place by countries who faced large influxes of migrants between 2011 and 2015 (the policy-prolific years between the Arab Spring migration and the introduction of stringent measures in Europe) and new evidence generated in response to the COVID-19 pandemic (including the ‘ECDC Guidance on infection prevention and control of COVID-19 in migrant and refugee reception and detention centres in the EU/EEA and the UK’ and the ‘WHO Lancet priority for dealing with migration and COVID-19′) to formulate a policy option able to strengthen national system capacities for responding to influxes of epidemic-related migrants and the management of highly infectious diseases. Full article
(This article belongs to the Special Issue Health Care Access among Underserved Groups)
Article
Prisoners as Users of Digital Health Care and Social Welfare Services: A Finnish Attitude Survey
Int. J. Environ. Res. Public Health 2021, 18(11), 5528; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115528 - 21 May 2021
Viewed by 707
Abstract
Prisoners are a group of people with many health and social problems. However, in prisons the use of the Internet is controlled. Thus, prisoners’ access to digital health care and social welfare services is limited. In addition, there are many cognitive and attitudinal [...] Read more.
Prisoners are a group of people with many health and social problems. However, in prisons the use of the Internet is controlled. Thus, prisoners’ access to digital health care and social welfare services is limited. In addition, there are many cognitive and attitudinal barriers to the use of digital health care and social welfare services for prisoners. Cross-sectional survey data (N = 225) were collected from eleven prisons in different parts of Finland and analysed using linear regression analysis. The results are consistent with Ajzen’s theory and previous studies on the acceptance of information systems in health care. Prisoners’ behavioural intentions related to the use of digital health care and social welfare services are influenced by their perceptions of their capacity to use digital services, the expectations of their close people and their attitudes, as well as by trust in the Internet and services. In contrast, the age of prisoners’ indirectly affects their willingness to use digital services. The study recommends that prisoners are supported in the use of digital health care and social welfare services by prison staff and other people. Digital skills training is also needed in order to support digital inclusion, especially for older and long-term prisoners. Full article
(This article belongs to the Special Issue Health Care Access among Underserved Groups)
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Article
Use of Health Services and Unmet Need among Adults of Russian, Somali, and Kurdish Origin in Finland
Int. J. Environ. Res. Public Health 2021, 18(5), 2229; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052229 - 24 Feb 2021
Viewed by 805
Abstract
Equal access to health care is one of the key policy priorities in many European societies. Previous findings suggest that there may be wide differences in the use of health services between people of migrant origin and the general population. We analyzed cross-sectional [...] Read more.
Equal access to health care is one of the key policy priorities in many European societies. Previous findings suggest that there may be wide differences in the use of health services between people of migrant origin and the general population. We analyzed cross-sectional data from a random sample of persons of Russian (n = 692), Somali (n = 489), and Kurdish (n = 614) origin and the Health 2011 survey data (n = 1406) representing the general population in Finland. Having at least one outpatient visit to any medical doctor during the previous 12 months was at the same level for groups of Russian and Kurdish origin, but lower for people of Somali origin, compared with the general population. Clear differences were found when examining where health care services were sought: people of migrant origin predominantly visited a doctor at municipal health centers whereas the general population also used private and occupational health care. Self-reported need for doctor’s treatment was especially high among Russian women and Kurdish men and women. Compared to the general population, all migrant origin groups reported much higher levels of unmet medical need and were less satisfied with the treatment they had received. Improving basic-level health services would serve besides the population at large, the wellbeing of the population of migrant origin. Full article
(This article belongs to the Special Issue Health Care Access among Underserved Groups)
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Article
Community Education for a Dignified Last Phase of Life for Migrants: A Community Engagement, Mixed Methods Study among Moroccan, Surinamese and Turkish Migrants
Int. J. Environ. Res. Public Health 2020, 17(21), 7797; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17217797 - 24 Oct 2020
Viewed by 787
Abstract
Community engagement and -education are proposed to foster equity in access to care and to ensure dignity of migrant patients in the last phase of life, but evidence is lacking. We evaluated nine community educational interactive meetings about palliative care (136 participants totally)- [...] Read more.
Community engagement and -education are proposed to foster equity in access to care and to ensure dignity of migrant patients in the last phase of life, but evidence is lacking. We evaluated nine community educational interactive meetings about palliative care (136 participants totally)- co-created with educators from our target groups of Moroccan, Surinamese and Turkish migrants—with a mixed methods approach, including 114 questionnaires, nine observations, nine interviews with educators, and 18 pre- and post- group- and individual interviews with participants. Descriptive and thematic analysis was used. 88% of the participants experienced the meetings as good or excellent. Educators bridged an initial resistance toward talking about this sensitive topic with vivid real-life situations. The added value of the educational meetings were: (1) increased knowledge and awareness about palliative care and its services (2) increased comprehensiveness of participant’s wishes and needs regarding dignity in the last phase; (3) sharing experiences for relief and becoming aware of real-life situations. Community engagement and -education about palliative care for migrants effectively increases knowledge about palliative care and is a first step towards improved access to palliative care services, capacity building and a dignified last phase of life among migrants. Full article
(This article belongs to the Special Issue Health Care Access among Underserved Groups)
Article
Association between Migrant Women’s Legal Status and Prenatal Care Utilization in the PreCARE Cohort
Int. J. Environ. Res. Public Health 2020, 17(19), 7174; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17197174 - 30 Sep 2020
Cited by 1 | Viewed by 656
Abstract
Barriers to access to prenatal care may partially explain the higher risk of adverse pregnancy outcomes among migrants compared with native-born women in Europe. Our aim was to assess the association between women’s legal status and inadequate prenatal care utilization (PCU) in France, [...] Read more.
Barriers to access to prenatal care may partially explain the higher risk of adverse pregnancy outcomes among migrants compared with native-born women in Europe. Our aim was to assess the association between women’s legal status and inadequate prenatal care utilization (PCU) in France, where access to healthcare is supposed to be universal. The study population was extracted from the PreCARE prospective cohort (N = 10,419). The associations between women’s legal status and a composite outcome variable of inadequate PCU were assessed with multivariate logistic regressions. The proportion of women born in sub-Saharan Africa (SSA) was higher among the undocumented than that of other migrants. All groups of migrant women had a higher risk of inadequate PCU (31.6% for legal migrants with European nationalities, 40.3% for other legal migrants, and 52.0% for undocumented migrants) than French-born women (26.4%). The adjusted odds ratio (aOR) for inadequate PCU for undocumented migrants compared with that for French-born women was 2.58 (95% confidence interval 2.16–3.07) overall, and this association was similar for migrant women born in SSA (aOR 2.95, 2.28–3.82) and those born elsewhere (aOR 2.37, 1.89–2.97). Regardless of the maternal place of birth, undocumented migrant status is associated with a higher risk of inadequate PCU. Full article
(This article belongs to the Special Issue Health Care Access among Underserved Groups)
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Article
Do Targeted User Fee Exemptions Reach the Ultra-Poor and Increase their Healthcare Utilisation? A Panel Study from Burkina Faso
Int. J. Environ. Res. Public Health 2020, 17(18), 6543; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17186543 - 08 Sep 2020
Cited by 3 | Viewed by 903
Abstract
Background: A component of the performance-based financing intervention implemented in Burkina Faso was to provide free access to healthcare via the distribution of user fee exemption cards to previously identified ultra-poor. This study examines the factors that led to the receipt of user [...] Read more.
Background: A component of the performance-based financing intervention implemented in Burkina Faso was to provide free access to healthcare via the distribution of user fee exemption cards to previously identified ultra-poor. This study examines the factors that led to the receipt of user fee exemption cards, and the effect of card possession on the utilisation of healthcare services. Methods: A panel data set of 1652 randomly selected ultra-poor individuals was used. Logistic regression was applied on the end line data to identify factors associated with the receipt of user fee exemption cards. Random-effects modelling was applied to the panel data to determine the effect of the card possession on healthcare service utilisation among those who reported an illness six months before the surveys. Results: Out of the ultra-poor surveyed in 2017, 75.51% received exemption cards. Basic literacy (p = 0.03), living within 5 km from a healthcare centre (p = 0.02) and being resident in Diébougou or Gourcy (p = 0.00) were positively associated with card possession. Card possession did not increase health service utilisation (β = −0.07; 95% CI = −0.45; 0.32; p = 0.73). Conclusion: A better intervention design and implementation is required. Complementing demand-side strategies could guide the ultra-poor in overcoming all barriers to healthcare access. Full article
(This article belongs to the Special Issue Health Care Access among Underserved Groups)
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Article
The Association between Social Integration and Utilization of Essential Public Health Services among Internal Migrants in China: A Multilevel Logistic Analysis
Int. J. Environ. Res. Public Health 2020, 17(18), 6524; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17186524 - 08 Sep 2020
Cited by 1 | Viewed by 706
Abstract
This study investigated the association between social integration and utilization of essential public health services among internal migrants. Data were from the 2017 China Migrants Dynamic Survey. Social integration was measured through four dimensions: economic integration, structural integration, sociocultural adaptation, and self-identity. Multilevel [...] Read more.
This study investigated the association between social integration and utilization of essential public health services among internal migrants. Data were from the 2017 China Migrants Dynamic Survey. Social integration was measured through four dimensions: economic integration, structural integration, sociocultural adaptation, and self-identity. Multilevel logistic regressions were used taking into account heterogeneity in the level of regional development. The utilization of health records and health education was less than 40% and varied widely across regions. Social integration was related to a higher likelihood of utilization of health records and health education. Moreover, sociocultural adaptation had a stronger effect on the utilization of health records in developed regions than in developing regions, and structural integration was strongly and positively related to the utilization of health education in developed regions. Hence, it appears that the relationship of some dimensions of social integration and utilization of essential public health services is moderated by the level of economic development. Promoting structural integration and sociocultural adaptation could strongly improve utilization of essential public health services in developed regions. Full article
(This article belongs to the Special Issue Health Care Access among Underserved Groups)
Article
Migrants Are Underrepresented in Mental Health and Rehabilitation Services—Survey and Register-Based Findings of Russian, Somali, and Kurdish Origin Adults in Finland
Int. J. Environ. Res. Public Health 2020, 17(17), 6223; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17176223 - 27 Aug 2020
Cited by 3 | Viewed by 1140
Abstract
Mounting evidence suggests that migration background increases the risk of mental ill health, but that problems exist in accessing healthcare services in people of migrant origin. The present study uses a combination of register- and survey-based data to examine mental health-related health service [...] Read more.
Mounting evidence suggests that migration background increases the risk of mental ill health, but that problems exist in accessing healthcare services in people of migrant origin. The present study uses a combination of register- and survey-based data to examine mental health-related health service use in three migrant origin populations as well as the correspondence between the need and use of services. The data are from the Finnish Migrant Health and Wellbeing Study (Maamu), a comprehensive cross-sectional interview and a health examination survey. A random sample consisted of 5909 working-aged adults of Russian, Somali, and Kurdish origin of which 3000 were invited to participate in the survey and the rest were drawn for a register-based approach. Some of the mental health services, based on registers, were more prevalent in the Kurdish origin group in comparison with the general population and less prevalent in the Russian and Somali origin groups. All the migrant origin groups were underrepresented in rehabilitation services. When affective symptoms were taken into account, all the migrant origin groups were underrepresented in all of the services. This calls for actions to promote mental health, diminish the barriers to access services, and improve the service paths for migrants. Full article
(This article belongs to the Special Issue Health Care Access among Underserved Groups)
Article
The Role of Perceived Unjust Treatment in Unmet Needs for Primary Care Among Finnish Roma Adults
Int. J. Environ. Res. Public Health 2020, 17(16), 5825; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17165825 - 12 Aug 2020
Viewed by 862
Abstract
The main goal in developing services is to guarantee equal access to healthcare services that are suited to the patients’ needs. Previous studies have shown that the Roma are more likely to experience unjust treatment in health services than the general population. This [...] Read more.
The main goal in developing services is to guarantee equal access to healthcare services that are suited to the patients’ needs. Previous studies have shown that the Roma are more likely to experience unjust treatment in health services than the general population. This study examines the association between perceived unjust treatment in healthcare and self-assessed unmet need for primary care provided by general practitioners (GPs) and nurses among the Finnish Roma. The data from the Finnish Roma Wellbeing Study (Roosa), conducted in 2017–2018, were used. Snowball sampling was used in recruiting study participants (n = 365, 61% women). Logistic regression was used to test the association between perceived unjust treatment and unmet need for primary care. Confounders used were gender, age, marital status, education, employment, and self-rated health. Those who had experienced unjust treatment in healthcare were more likely to report unmet need for care provided by GPs (odds ratios (OR) = 6.44; p < 0.001) and nurses (OR = 11.18; p < 0.001) than those who felt that they had been treated justly. This association remained after adjustments for the confounders. Bidirectional guidance between the Roma and service providers should be improved and the Roma communities involved in service development using participatory methods. Full article
(This article belongs to the Special Issue Health Care Access among Underserved Groups)
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