Telehealth use increased dramatically after the COVID-19 pandemic enabled largely by regulatory changes. Health policy experts recommend telehealth as a viable option for healthcare delivery in the post-pandemic world. As investment in telehealth continues, it is important to ensure that existing health disparities are not exacerbated. One group that is particularly vulnerable to telehealth challenges includes patients with limited English Proficiency. This study aimed to examine whether English proficiency is associated with completion of telerehabilitation visits. Electronic Health Records were retrieved for all patients scheduled for a telerehabilitation visit (physical/occupational therapy) in adult or pediatric outpatient clinics at a large academic medical center between April 1, 2020 and April 30, 2022. Using data from 3,871 video visits involving 1414 patients, binomial logistic regression models were estimated to examine associations between sociodemographic variables (age, gender, race, ethnicity, insurance status, income, language preference) and visit completion rate using multivariable logistic regression models. 6.4% of telerehabilitation visits were conducted in a language other than English. 24% patients had a 0% completion rate, 9% had a completion rate of > 0% and < 100%, and 67% had a 100% completion rate. Being older and publicly insured was significantly associated with decreased odds of 100% completion. Patients with English as their preferred language showed higher odds of visit completion. Age, type of insurance, and language preference were associated with successful completion of telerehabilitation video visits. Future research is needed to reveal specific barriers to telerehabilitation for older patients and those with limited English proficiency.

Colorectal cancer (CRC) is the second leading cause of cancer mortality among Latinos who remain underrepresented in screening and are more often diagnosed at later stages, leading to poorer outcomes. Barriers include low health literacy, lack of insurance, limited access to screening, and cultural mistrust of healthcare and research. To implement the Colorectal Health Research Champion (CHRC) Model to address CRC screening disparities among immigrant Latinos, primarily from Central and South America, residing in Richmond, VA's urban Latino community. The CHRC model integrates evidence-based strategies from Screen to Save (S2S), the National Outreach Network Community Health Educator (NON-CHE) program, and Massey Comprehensive Cancer Center's Community Champion program. Five trained champions conducted peer-to-peer chats on CRC symptoms, risk factors, screening guidelines, healthy behaviors, and clinical trials. Pre and post-surveys were collected from 52 Latino participants. The Wilcoxon signed-rank test assessed changes in knowledge and screening intent. Baseline CRC awareness and screening rates were low. Post-intervention, participants showed notable improvements in recognizing CRC risk factors such as physical inactivity, family history, and the importance of early detection. Participants also demonstrated a better understanding of screening options like the FIT test and expressed willingness to adopt healthier behaviors and pursue screening. However, mistrust and limited understanding of research remained challenges. The CHRC model successfully enhanced CRC knowledge, screening, and early detection awareness among Latinos, while encouraging consideration of clinical trial participation. Success was driven by trusted community champions leveraging social networks, culturally tailored education, addressing research hesitancy, and using flexible outreach strategies.

Migrants' use of healthcare services is a critical public health issue, often examined through access barriers. In Chile, research has predominantly focused on South-South migration in urban areas. This study extends that focus to a southern Chilean region with lower migration density, exploring how discrimination, satisfaction, and perceived healthcare quality influence healthcare system use among South American migrants. A total of 239 participants (87% Venezuelan, 13% Colombian; mean age = 34.7 years) completed online questionnaires across two waves. Perceived discrimination increased from 1.81 to 1.99 (d = -.264), and healthcare system use from 2.46 to 2.60 (d = -.153), while dissatisfaction regarding improvement aspects decreased from 2.60 to 2.41 (d = .262), all ps < .05. Structural equation modelling revealed that discrimination negatively predicted satisfaction with personnel (β = -.264, p < .001), improvement aspects (β = -.195, p < .001), and perceived healthcare quality (β = -.330, p < .001). Perceived quality positively predicted healthcare use (β = .171, p = .014). Discrimination had both a direct (β = .104, p = .012) and an indirect effect (β = -.056, p = .015) on use, mediated by perceived quality. Coefficients ranged from -.330 to .171 showing effect sizes from small to moderate. The model explained 3.2% of the variance in healthcare use. Findings highlight that discrimination in healthcare settings can influence migrants' engagement with healthcare services, even where formal access is ensured. These results highlight the need for policies targeting interpersonal and perceived quality in migrant healthcare.

More than five million people from North Africa (NA) lived in Europe in 2019, including youth characterized by intense trans-border mobility, precarious living conditions and high-risk behaviours such as substance use, prostitution and illegal activities. This young population challenges health professionals and health service's ability to deliver medical care. The health literature about them remains scarce. This scoping review aims to map the existing knowledge regarding the health status of adolescent and young adult migrants from NA in Europe, the health services available to address their needs, and their access and use of these services. This scoping review followed the Arksey and O´Malley process and was based on the Population-Concept-Context framework. Six databases (CINAHL, Cochrane, Embase, PubMed, PsycINFO and Web of Science) were consulted for peer-reviewed articles and non-indexed reports. References of selected articles were systematically tracked. Initial search returned 5540 articles, 13 of which met the criteria for final inclusion. They originated from Spain, France and Germany. All records included were observational. Nine included only males and ten focused on unaccompanied minors. All studies explored aspects related to the health status of participants. Five explored aspects related to general health, seven to infectious diseases, six to mental health including substance use, four to oral health, and three to nutritional status. Two studies explored aspects related to the provision of care and related cultural elements. Evidence about the health status, access to services and health service provision of North African adolescent and young adult migrants in Europe is very limited, including important gaps about females and young adults, as well as about healthcare programs and use of services. Further research is needed to enhance a comprehensive, complex and reflective understanding of this population. Research design should emphasize gender perspective, include methodologies adapted to hard-to-reach populations and grounded into international collaboration.

Patients with Non-English Language Preference face significant barriers to healthcare, often due to inadequate use of professional medical interpreters. Despite evidence showing that medical interpreters improve patient outcomes, many healthcare providers lack training in effective medical interpreter use. This study evaluates the impact of the Med Interpreter website on first-year medical students' comfort and proficiency in working with interpreters during clinical encounters. The intervention involved a 30-minute presentation on the Med Interpreter website, which offers guidelines and resources for interpreter use in English and Spanish. Following the presentation, students participated in a simulated patient encounter using standardized patients and interpreters. Pre- and post-intervention surveys assessed changes in students' comfort, confidence, and understanding of interpreter use. A total of 98 out of 130 participants completed both surveys. Statistically significant improvements were observed in student comfort, confidence, and knowledge of interpreter guidelines and resources, highlighting the intervention's effectiveness. The results highlight the effectiveness of Med Interpreter in enhancing students' knowledge and skills related to interpreter use. This intervention demonstrates the importance of structured training in addressing language barriers in healthcare and underscores the potential for scalable tools like Med Interpreter to improve patient-provider communication and reduce health disparities.

Prior research indicates that Hispanic immigrants in the United States face numerous barriers to healthcare. But few studies have considered areas without a history of migrant inclusion, particularly the US South, even though their numbers are growing in this part of the country. This paper investigates the challenges that hinder healthcare-seeking behaviors of Hispanic immigrants in Georgia using a mixed-method approach. In-person surveys, conducted in urban Savannah (n = 30) and rural Vidalia/Lyons (n = 30), identified barriers including difficulty accessing care (68%), not having a primary care doctor (81.4%), and lacking insurance (46.7%). The inability to pay for care services is higher in urban areas (50% vs. 23.3%, p = 0.032), and the inability to pay for medicines is more common in rural areas (rural = 60.0% vs. urban = 33.3, p = 0.038). Qualitative analysis of an urban-based focus group (n = 12), and interviews with immigrants, providers, religious leaders, and community advocates (n = 20) highlight the following barriers: linguistic challenges, discrimination, fears over legal status, transportation issues, and limited times to access care outside of work hours. Non-government organizations, along with a scarce number of free and discounted clinics and health departments, play an important role in facilitating access. Key opportunities for interventions include education on the health system function, costs, insurance options, services, and legal health rights/protections. Facilitating access to healthcare, and ensuring the availability of compassionate, culturally, and language competent healthcare staff has the potential to increase healthcare-seeking behaviors in these populations.

In the United States (U.S.), the number of asylum seekers has increased sixfold in the past decade. Limited research has explored the impact of social determinants of health on asylum seekers. To document evidence of torture and trauma, clinicians in medical-legal asylum clinics conduct Forensic Medical Evaluations (FMEs) according to the standardized United Nations Istanbul Protocol. These evaluations represent an uncommon encounter with the U.S. health system during the multi-year asylum process, during which applicants may not otherwise engage with health systems. This study aimed to determine post-migration factors that influence risk for negative health outcomes in U.S. asylum applicants and to categorize risk factors within the U.S. Department of Health and Human Services' social determinants of health framework. We performed a qualitative, retrospective study of a representative, purposive sample of forensic medical evaluations from 2010 to 2020 from the Weill Cornell Center for Human Rights' database. We identified major themes pertaining to post-migration risk and protective factors organized across social determinant domains. The 58 FMEs represented 29 asylum seekers in the U.S. The mean age was 30 years. Of the participants, 55% were female and 45% were male. The sample represented a global population, with origins from the Americas (41%), Africa (45%), and Asia (14%). Our analysis additionally identified the prolonged asylum process as a novel, unique structural barrier and identified protective factors, including community support. Given numerous barriers to accessing care experienced during the asylum process, this study identified a unique opportunity to utilize forensic medical evaluations to screen for social determinants of health.

Australia's population is shaped by cultural and linguistic diversity, with almost half of its population identifying as culturally and linguistically diverse. It is this diversity, however, that is presenting the Australian health care system with challenges. Health inequalities in Australia are, and have been, prominent features in mental health care despite reforms. This scoping review explores the experiences and views of African Australians regarding the impact of culture, religion, and spirituality on the mental health care provided to them. Five electronic databases-PubMed, Scopus, Embase, PsycInfo, and Web of Science Core Collection were searched between January 2025 and March 2025. Additionally, a manual search of the reference lists and bibliographies of key articles was conducted to identify studies that met the inclusion criteria. This scoping review meticulously utilises the five-step framework in conjunction with thematic data analysis. A total of twenty-one (n = 21) articles were reviewed. Three themes emerged from the review and analysis: aetiology of mental illness, barriers to engagement, and propositions for improvement of care. Findings from this scoping review reveal that culture, religion, and spirituality can have both positive effects by buffering psychotic symptoms and negative effects by acting as barriers to seeking mental health care. Furthermore, evidence from this scoping review is in tandem with previous results, which revealed that Australian mental health services are not offering culturally appropriate care and continue to be lacking when it comes to delivering inclusive or responsive treatment for its diverse population, particularly for African Australians. This is despite decades of research revealing inequalities in mental health provisions for African Australians.

In the context of growing stimulant use among other vulnerable rural populations, this study examines the prevalence and patterns of stimulant use, particularly methamphetamine and cocaine use, among migrant and seasonal agricultural workers. Surveys were conducted with fifty-five male agricultural workers in tobacco cultivation in Eastern North Carolina. Findings demonstrated high levels of commercial energy drink consumption (29% of participants) and limited consumption of illicit stimulants (4% of participants). Despite low reported prevalence, 18% of participants reported concern regarding illicit stimulant use. These findings underscore the need for more research to address the unique challenges faced by migrant and seasonal agricultural workers regarding substance use. This study contributes to the growing body of literature on occupational health disparities and highlights the urgent need for comprehensive strategies to support this vulnerable patient population.

The purpose of this study was to examine associations between psychosocial factors and parenting practices with behavioral outcomes in children from racially/ethnically diverse mothers with a history of adverse childhood experiences (ACEs) and stressful life events (SLEs). This was a secondary analysis of cross-sectional survey data from the Family Matters cohort study. The analytic sample included families with children ages 5-9 with non-White mothers (n = 930) recruited from Minneapolis-St. Paul primary care clinics representing five racial/ethnic backgrounds (Black, Native American, Hmong, Somali, Latino). Multivariable regression models examined associations between maternal ACEs/SLEs, parenting practices, and child behavioral outcomes, adjusting for sociodemographic and contextual factors. Women with ≥ 4 ACEs and/or SLEs reported more permissive (p = < 0.001) and authoritarian parenting (p =.0018), substance use (p = <.001), and levels of moderate and severe psychosocial distress (p = <.001) compared to those with fewer to no ACEs/SLEs. Child behaviors were elevated among mothers reporting severe psychosocial distress (β = 2.85; p < .001), permissive parenting (β = 1.88; p < .001), and authoritarian parenting (β = 1.27; p < .001). There was a significant interaction between authoritarian parenting and community violence (β = 0.714, p = .022), strengthening the association between maternal mental health and child behavioral difficulties. In racially/ethnically diverse women with a history of ACEs/SLEs, maternal mental health distress and parenting practices were independently associated with higher child behavioral problems. Community violence may also play a role in these relationships. It is important to maintain maternal wellbeing by connecting mothers with appropriate mental health and parenting resources.

Refugee populations frequently experience trauma before, during, and after resettlement, necessitating specialized and culturally sensitive healthcare. Traditional didactic methods in medical education often inadequately prepare clinicians to deliver trauma-informed care (TIC) to refugees. This study evaluated a documentary-based educational intervention designed to teach second-year medical students TIC principles specific to refugee healthcare. A targeted needs assessment informed the documentary's creation, incorporating semi-structured interviews with healthcare providers and individuals with lived refugee experiences. The documentary outlined the refugee journey, common healthcare barriers, and TIC strategies, leveraging authentic narratives to enhance emotional engagement and empathy. Pre- and post-test surveys measured the documentary's effectiveness among medical students (n = 160). Results indicated significant improvements across all assessed domains, including understanding refugee healthcare logistics, identifying barriers to care, recognizing trauma presentations, and comprehending TIC principles (p < 0.001 for all). Over 90% of students reported increased motivation to incorporate TIC in their future practice, and the documentary was rated more effective than traditional lectures in both conveying key concepts and fostering understanding of refugees' lived experiences. This study highlights the educational value of a narrative-driven documentary intervention in medical training, providing a comprehensive and empathetic framework for refugee healthcare.

Latina women have higher rates of lactation initiation compared to other minority women in the United States, however, acculturation to the United States is associated with a gradual shift in breastfeeding exclusivity. This study aims to test the effect and acceptability of an intervention to improve breastfeeding outcomes in a Latina population using a Spanish prenatal education course and bilingual postpartum lactation support for the first six months of life. Participants (N = 42) were randomly assigned to an intervention or standard-of-care group. The intervention group attended a prenatal course taught by a bilingual Certified Lactation Counselor (CLC) and received postpartum lactation support in-person and by tele-lactation. The control group received standard-of-care lactation support from their healthcare providers. Data on breastfeeding successes and challenges were collected up to six months postpartum. Participants receiving the intervention had a significantly higher intention to breastfeed scores than the standard-of-care group within one week after delivery (p = 0.0054). The study's findings showed good participation and acceptance of change from three to two classes. Lastly, the intervention group had significantly fewer days of formula exposure compared to the control group (p = 0.031). Prenatal and postnatal lactation education classes and support were well accepted by participants as reflected in higher Infant Feeding Intention scores among women in the intervention group compared to those receiving the standard of care. These results lay a foundation for larger studies on the effectiveness of both prenatal and postnatal lactation support interventions in the Latina population.

Amid the recent global refugee crisis, the United States (U.S.) hosts over 200,000 Afghan refugees, many struggling to integrate into U.S. society. The COVID-19 pandemic and its subsequent health and social sequelae have severely affected Afghan refugees' lives, especially women, further complicating their integration. This study examines how the pandemic has influenced Afghan refugee women's integration through challenges and facilitators at various socio-ecological levels. Semi-structured interviews with 34 Afghan refugee women and 18 service providers in California were conducted. Interview data were analyzed using the thematic framework to identify themes indicating the impacts of COVID-19 on refugee women's integration based on Ager and Stange's integration framework. Findings revealed multifaceted challenges in refugee women's integration across multiple socio-ecological levels exacerbated by the pandemic including changes in roles, financial illiteracy, language barriers, cultural adaptation issues, inefficient policies, patriarchal culture, administrative overload, and systemic barriers in employment and education. However, factors like empowerment through education and employment, family/friends/community support, socializing, childcare support, awareness of laws and women's rights, and access to culturally competent job opportunities facilitated their integration. This study recommends policies and programs addressing Afghan refugee women's integration challenges and facilitators impacted by the pandemic for better integration into the U.S.

Schools serve as a critical site of inclusion for Arabic-speaking refugee and immigrant adolescents as they face unique challenges upon resettlement in the US. This study employs a consensus methodology and ranking procedure with key stakeholders (n = 25) to identify research priorities for supporting newcomer students and families. Results from the consensus activity suggest five key priority areas for future research: (1) exploring culturally responsive psychosocial strategies, (2) meaningful parent engagement and teacher support, (3) longitudinal and context-based approaches, (4) language learning, and (5) policy impacts on newcomer student outcomes. Findings can inform collective learning efforts toward improving school-based supports for refugee and immigrant student populations.

To compare the experience of obstetric care in Quebec between immigrants and Canada-born persons.A cross-sectional survey was conducted among individuals who received obstetric care in Quebec between 2016 and 2023. Participants, recruited mainly via social media, completed an online questionnaire between July and December 2023. Obstetric care experiences, including autonomy measured by the MADM scale (Mothers Autonomy in Decision Making), mistreatment assessed by the MIST index (Pregnant Persons Experience of Mistreatment by Providers Index), discrimination, access to care, and satisfaction towards interpersonal skills of healthcare providers, were compared between immigrant and Canada-born participants. Among 686 participants, 11.2% were immigrants, among which 69.0% had permanent status and 14.3% temporary status. There was no significant difference in MADM scale between immigrant and Canada-born participants (p = 0.903), but immigrants with temporary status were 9.25 times more likely to have low autonomy (CI: 1.06-80.77) compared to those born in Canada controlling for confounding variables. According to the MIST index, at least one of disrespectful behaviors was reported by 28.6% of immigrants and 35.8% Canada-born individuals (p = 0.172). Among immigrant participants, 2.6% reported being treated less favorably due to their ethnic, cultural, or linguistic background, compared to 1.5% of Canada-born participants (p = 0.09). Additionally, 9.1% of immigrants had to paid for obstetric care personally versus 4.4% of Canada-born (p = 0.173). Our study highlights immigration status as a key differentiating factor in obstetric care, with lower autonomy among temporary immigrants, while no significant differences were found between permanent immigrants and Canadian-born participants.

Ethnic enclaves, neighborhoods with high ethnic concentrations, may have a protective effect on their residents' health outcomes, but studies on their associations with cardiometabolic risk in Asian communities are inconsistent. We examined whether ethnic enclave residence was associated with metabolic syndrome (MetS) in a longitudinal sample of 516 Chinese immigrant adults in Philadelphia. Participants were recruited from three types of neighborhoods: established enclaves, emerging enclaves and non-enclave neighborhoods. At baseline (9/18 - 1/20) and follow-up (8/21 - 4/22), research staff conducted interviews and anthropometric and blood pressure measurements and collected fasting blood samples for glucose, triglycerides, and high-density lipoprotein levels. We used logistic regressions estimated by generalized estimating equations to estimate odds ratios (OR) for associations of enclave residence with MetS and its components, and differences in change over time in models stratified on neighborhood type. Overall, no consistent associations between enclave residence and MetS or MetS components emerged. Over an average follow-up of 2.6 years, the occurrence of MetS increased significantly in the overall sample. In stratified analyses, the increase was significant only among non-enclave residents, but interaction p-values indicated no significant differences across neighborhood type. Our findings suggest that ethnic enclaves are not 'monolithically beneficial'. A more nuanced understanding of the resources that different kinds of enclaves offer and of how Chinese immigrants interact with these enclave resources is needed to inform and support effective investment in immigrant communities.

In an increasingly globalized world, intercultural sensitivity (ICS) has become essential for medical professionals. Türkiye's unique position as a bridge between continents and its growing international student population make understanding intercultural sensitivity among medical students particularly relevant. This study aimed to assess intercultural sensitivity levels among medical students and identify associated factors. A cross-sectional study was conducted among 412 medical students at Pamukkale University Faculty of Medicine during 2020-2021. Stratified random sampling ensured representation across all six academic years. Data were collected using a sociodemographic questionnaire, cultural interaction assessment, and the validated Turkish version of the Intercultural Sensitivity Scale (ISS). Bivariate analyses (t‑tests, ANOVA) and multiple linear regression (backward elimination) identified independent predictors of total ISS scores. The overall mean ISS score was 93.02 ± 10.80, indicating moderate-to-high ICS. Students scored highest on "Responsibility in Communication" and "Respect for Cultural Differences". Multiple regression analysis revealed five significant predictors: having international friendships (β = 0.25, p < 0.001), frequent international media consumption (β = 0.15, p = 0.004), higher foreign language proficiency (β = 0.12, p = 0.026), absence of language barriers in cross-cultural interactions (β = 0.18, p = 0.002), and absence of religion-related difficulties (β = 0.13, p = 0.010). Medical students demonstrated moderate intercultural sensitivity, primarily influenced by direct cross-cultural experiences. These findings underscore the importance of fostering international interactions within medical curricula to enhance intercultural sensitivity.

Diabetes self-care is a patient-driven approach to managing diabetes, supported by healthcare professionals, that aims to empower patients to reduce long-term complications associated with the disease. This is particularly important for South Asians, who are among the populations most affected by diabetes. This mixed-methods systematic review synthesises both qualitative and quantitative evidence on diabetes self-care among South Asians living in Western countries and presents an integrated framework covering key areas for optimal self-care. The review followed PRISMA guidelines, and the protocol was registered with PROSPERO. Seven databases were searched for both qualitative and quantitative studies published between January 2000 and December 2024 to provide a comprehensive understanding of the evidence. The Joanna Briggs Institute critical appraisal checklist for quality assessment and the Risk of Bias V2 tool for trials were utilised, with data integrated through the Pillar Integration Process (PIP). Twenty studies met the inclusion criteria and were incorporated into this review. Most qualitative, cohort, and cross-sectional studies met over 70% of quality criteria, and all four randomised controlled trials demonstrated a low risk of bias. Qualitative findings highlighted the significance of culturally relevant education and support, while quantitative studies showed improvements in diabetes outcomes through educational and physical activity interventions. Common barriers included difficulties with self-monitoring, adherence to dietary guidelines, and implementing lifestyle changes. The PIP analysis identified three core pillars: providing adequate diabetes education, involving patients in care planning, and encouraging daily physical activity. Culturally tailored education, improved healthcare access, and patient-centred interventions are vital for enhancing self-care among South Asians. As this population's presence in Western countries increases, broader participation in self-care programmes can promote better integration and health outcomes.

Tuberculosis (TB) disproportionately affects non-US-born people from TB-endemic countries. Previous studies demonstrated that educational interventions effectively increased knowledge, perception, and latent tuberculosis infection (LTBI) screening in at-risk people. Given the high prevalence of LTBI and active TB cases and the large proportion of non-US-born individuals with low LTBI awareness residing in California, this study sought to evaluate the impact of video-based LTBI education in this population. Using a pre-post study design, we evaluated the impact of a 5-minute LTBI educational video on participants using the Health Belief Model (HBM) constructs. We enrolled 84 non-US-born participants during the study period. Participants first completed the pre-survey, which consisted of the HBM LTBI Survey, followed by a demographic survey. Participants then watched the educational intervention video, followed by the post-survey, which consisted of the HBM LTBI Survey. This study found a significant increase in perceived susceptibility, t (83) = 8.82, p < 0.001, perceived severity, t (83) = 2.06, p = 0.043, perceived benefits, t (83) = 3.33, p < 0.001, and behavioral intentions to screen for TB, t (82) = 3.99, p < 0.001, as well as a significant decrease in perceived barriers, t (83) = -3.38, p < 0.001. This study also found that overall, the HBM significantly predicted behavioral intentions to engage in TB screening, F (7, 62) = 10.22, p < 0.001. We found that a health education video improved the self-reported education, awareness, and desire for screening for LTBI in non-US-born populations living in California. Future studies should evaluate whether such interventions result in a higher uptake of LTBI screening and treatment.

In Europe, non-profit organisations provide health care to undocumented immigrants (UDM), filling the gaps left by national healthcare systems: this approach is referred as "structural compensation". Integrating beneficiaries in developing interventions can be a source of effectiveness, but evidence shows that UDM involvement is difficult. This scoping review aimed to identify best practices related to participative approaches in structural compensation interventions targeting UDM. Four electronic databases were searched. Nine studies, which met the final inclusion criteria, reported a variety of health interventions. Findings showed a limited but diverse use of participatory approaches. Furthermore, the structural compensation organisations could be facilitators to support the participation of UDM. Further research is needed to better understand structural compensation and how it is used in practice. This will help develop an appropriate response to participative approaches with UDM.