Association Between Residence Status Regularization and Access to Healthcare for Undocumented Migrants in Switzerland: A Panel Study.

Background: Switzerland has a universal healthcare system. Yet, undocumented migrants face barriers at different levels that hinder their access to healthcare services. The aim of this study is to assess whether undocumented migrants' healthcare utilization improves with residence status regularization. Methods: We used two-wave panel data from the Parchemins study, a study exploring the impact of regularization on undocumented migrants' health in Geneva, Switzerland. First wave data were collected between 2017 and 2018, second wave data between 2019 and 2020. At baseline, the sample consisted of 309 undocumented migrants, recruited after the implementation of a temporary regularization policy in Geneva. We distributed them into two groups according to their residence status 12 months before the second data collection [regularized vs. undocumented (controls)]. Using as dependent variable the number of medical consultations within two distinct 12-months periods (the first before regularization, the second after regularization), we conducted multivariable regression analyses applying hurdle specification to identify factors enhancing healthcare utilization. Then, we estimated first-difference panel models to assess change in healthcare utilization along regularization. Models were adjusted for demographic, economic and health-related factors. Results: Of the 309 participants, 68 (22%) were regularized. For the 12 months before regularization, these migrants did not significantly differ in their healthcare utilization from the controls. At this stage, factors increasing the odds of having consulted at least once included being a female (aOR: 2.70; 95% CI: 1.37-5.30) and having access to a general practitioner (aOR: 3.15; 95% CI: 1.62-6.13). The factors associated with the number of consultations apart from underlying health conditions were the equivalent disposable income (aIRR per additional CHF 100.-: 0.98; 95% CI: 0.97-1.00) and having access to a general practitioner (aIRR: 1.45; 95% CI: 1.09-1.92). For the 12 months after regularization, being regularized was not associated with higher odds of having consulted at least once. However, among participants who consulted at least once, regularized ones reported higher counts of medical consultations than controls (3.7 vs. 2.6, p = 0.02), suggesting a positive impact of regularization. Results from the first-difference panel models confirmed that residence status regularization might have driven migrants' healthcare utilization (aß: 0.90; 95% CI: 0.31-1.77). Conclusions: This study supports the hypothesis that residence status regularization is associated with improved healthcare utilization among undocumented migrants. Future research is needed to understand the mechanisms through which regularization improves undocumented migrants' use of healthcare services.

COVID-19 vaccine hesitancy among undocumented migrants during the early phase of the vaccination campaign: a multicentric cross-sectional study.

STUDY OBJECTIVES: The marginalisation of undocumented migrants raises concerns about equitable access to COVID-19 vaccination. This study aims to describe migrants' hesitancy about the COVID-19 vaccination during the early phase of the vaccination campaign. SETTING: This multicentric cross-sectional survey was conducted in health facilities providing care to undocumented migrants in the USA, Switzerland, Italy and France in February-May 2021. PARTICIPANTS: Eligibility criteria included age >16 years, being of foreign origin and living without valid residency permit in the country of recruitment. A convenience sample of minimum 100 patients per study site was targeted. PRIMARY AND SECONDARY OUTCOME MEASURES: Data were collected using an anonymous structured questionnaire. The main outcomes were perceived access to the local COVID-19 vaccination programme and demand for vaccination. RESULTS: Altogether, 812 undocumented migrants participated (54.3% Geneva, 17.5% Baltimore, 15.5% Milano and 12.7% Paris). Most (60.9%) were women. The median age was 39 years (interquartile range 1). Participants originated from the Americas (55.9%), Africa (12.7%), Western Pacific (11.2%) Eastern Mediterranean (7.9%), Europe (7.6%) and South-East Asia (4.7%). Overall, 14.1% and 26.2% of participants, respectively, reported prior COVID-19 infection and fear of developing severe COVID-19 infection. Risk factors for severe infection were frequently reported (29.5%). Self-perceived accessibility of COVID-19 vaccination was high (86.4%), yet demand was low (41.1%) correlating with age, comorbidity and views on vaccination which were better for vaccination in general (77.3%) than vaccination against COVID-19 (56.5%). Participants mainly searched for information about vaccination in the traditional and social media. CONCLUSIONS: We found a mismatch between perceived accessibility and demand for the COVID-19 vaccination. Public health interventions using different communication modes should build on trust about vaccination in general to tackle undocumented migrants' hesitancy for COVID-19 vaccination with a specific attention to men, younger migrants and those at low clinical risk of severe infection.

The well-being of newly regularized migrant workers: Determinants of their satisfaction with life as compared to undocumented migrant workers and regular local residents.

Subjective assessments of well-being are becoming routine indicators, considering that material resources are insufficient to capture people's satisfaction with life. Examining the unique situation of undocumented migrant workers, driven by aspirations for a better life but constrained by their limited rights in the country of destination, we assess their satisfaction with life and the factors that matter in their evaluations. Data were collected in Geneva (Switzerland), in a study comparing those who have just received a residency permit or about to obtaining it after submitting a regularization request (n = 195) with those who were still undocumented and/or had not submitted a regularization request at the time of our study (n = 231). In addition, comparisons were made with a sample of regular local residents (n = 175). Data obtained through standardized questionnaires include a range of material and non-material determinants, some unique to migrants and others common to the three populations. Satisfaction with life is significantly lower among undocumented migrant workers while those who are regularized and regular local residents report similar levels of well-being. Social participation, self-reported health and discrimination are associated to satisfaction with life among undocumented migrant workers. Among those being regularized, having been longer in the country of destination is associated with lower well-being. Among regular local residents, the only significant factor for a better satisfaction with life is having a partner. Material determinants, while distributed in vastly different levels, do not influence satisfaction with life. Despite the high satisfaction expressed by those who have recently been regularized, policy intervention still have to pay attention to their persisting difficult socioeconomic circumstances amidst a context of overall affluence.

Self-rated health among undocumented and newly regularized migrants in Geneva: a cross-sectional study.

BACKGROUND: In Europe, knowledge about the social determinants of health among undocumented migrants is scarce. The canton of Geneva, Switzerland, implemented in 2017-2018 a pilot public policy aiming at regularizing undocumented migrants. We sought to test for associations between self-rated health, proven eligibility for residence status regularization and social and economic integration. METHODS: This paper reports data from the first wave of the Parchemins Study, a prospective study whose aim is to investigate the effect of residence status regularization on undocumented migrants' living conditions and health. The convenience sample included undocumented migrants living in Geneva for at least 3 years. We categorized them into those who were in the process of receiving or had just been granted a residence permit (eligible or newly regularized) and those who had not applied or were ineligible for regularization (undocumented). We conducted multivariate regression analyses to determine factors associated with better self-rated health, i.e., with excellent/very good vs. good/fair/poor self-rated health. Among these factors, measures of integration, social support and economic resources were included. RESULTS: Of the 437 participants, 202 (46%) belonged to the eligible or newly regularized group. This group reported better health more frequently than the undocumented group (44.6% versus 28.9%, p-value < .001), but the association was no longer significant after adjustment for social support and economic factors (odds ratio (OR): 1.12; 95% confidence interval (CI): 0.67-1.87). Overall, better health was associated with larger social networks (OR: 1.66; 95% CI: 1.04-2.64). This association remained significant even after adjusting for health-related variables. CONCLUSION: At the onset of the regularization program, access to regularization was not associated with better self-rated health. Policies aiming at favouring undocumented migrants' inclusion and engagement in social networks may promote better health. Future research should investigate long-term effects of residence status regularization on self-rated health.

Mental health of undocumented migrants and migrants undergoing regularization in Switzerland: a cross-sectional study.

BACKGROUND: Undocumented migrants live and work in precarious conditions. Few studies have explored the mental health consequences of such environment. The objective of this study is to describe the mental health of migrants at different stages of a regularization program. METHODS: This cross-sectional study included migrants undocumented or in the process of regularization. We screened for symptoms of anxiety, depression and sleep disturbance using validated tools. We created a composite outcome of altered mental health including these components plus self-report of a recent diagnosis of mental health condition by a health professional. RESULTS: We enrolled 456 participants of whom 246 (53.9%) were undocumented. They were predominantly women (71.9%) with a median age of 43.3 (interquartile range: 15.5) years, from Latin America (63.6%) or Asia (20.2%) who had lived in Switzerland for 12 (IQR: 7) years. Overall, 57.2% presented symptoms of altered mental health. Prevalence of symptoms of anxiety, depression and sleep disturbance were 36% (95% confidence interval: 31.6-40.6%), 45.4% (95% CI: 40.8-50.1%) and 23% (95% CI: 19.2-27.2), respectively. Younger age (adjusted odd ratio: 0.7; 95% CI: 0.5-0.9 for each additional decade), social isolation (aOR: 2.4; 95% CI: 1.4-4.2), exposure to abuse (aOR: 1.9; 95% CI: 1.1-3.5), financial instability (aOR: 2.2; 95% CI: 1.4-3.7) and multi-morbidity (aOR: 3.2; 95% CI: 1.7-6.5) were associated with increased risk of having altered mental health while being in the early stages of the process of regularization had no effect (aOR: 1.3: 95% CI: 0.8-2.2). CONCLUSIONS: This study highlights the need for multi-pronged social and health interventions addressing the various domains of undocumented migrants living difficulties as complement to legal status regularization policies. Protection against unfair working conditions and abuse, access to adequate housing, promoting social integration and preventive interventions to tackle the early occurrence of chronic diseases may all contribute to reduce the burden of altered mental health in this group. More research is needed to assess the long-term impact of legal status regularization on mental health.

The Impact of the Covid-19 Pandemic and the Lockdown on the Health and Living Conditions of Undocumented Migrants and Migrants Undergoing Legal Status Regularization.

Introduction: Undocumented migrants are at high risk of adverse consequences during crises because of a lack of access to essential securities and sources of support. This study aims to describe the impact of the COVID-19 crisis on the health and living circumstances of precarious migrants in Switzerland and to assess whether those undergoing legal status regularization fared better than undocumented migrants. Materials and methods: This cross-sectional mixed methods study was conducted during the COVID-19 lockdown in April-May 2020. Undocumented and recently regularized migrants taking part in an ongoing cohort study were asked to respond to an online questionnaire. A subsample was selected to undergo semi-directed phone interviews. Results: Overall, 117 of the 379 (30.9%) cohort study participants responded to the questionnaire. Seventeen interviews were conducted. Migrants faced cumulative and rapidly progressive difficulties in essential life domains. As a consequence, they showed high prevalence of exposure to COVID-19, poor mental health along with frequent avoidance of health care. Moreover, the loss of working hours and the related income overlapped with frequent food and housing insecurity. Around one participant in four had experienced hunger. Despite these unmet needs, half of the participants had not sought external assistance for reasons that differ by legal status. Both groups felt that seeking assistance might represent a threat for the renewal or a future application for a residency permit. While documented migrants were less severely affected in some domains by having accumulated more reserves previously, they also frequently renounced to sources of support. Conclusions: The cumulated difficulties faced by migrants in this period of crisis and their limited search for assistance highlight the need to implement trust-building strategies to bridge the access gap to sources of support along with policies protecting them against the rapid loss of income, the risk of losing their residency permit and the exposure to multi-fold insecurities.

Impact of legal status change on undocumented migrants' health and well-being (Parchemins): protocol of a 4-year, prospective, mixed-methods study.

INTRODUCTION: Migrants without residency permit, known as undocumented, tend to live in precarious conditions and be exposed to an accumulation of adverse determinants of health. Only scarce evidence exists on the social, economic and living conditions-related factors influencing their health status and well-being. No study has assessed the impact of legal status regularisation. The Parchemins study is the first prospective, mixed-methods study aiming at measuring the impact on health and well-being of a regularisation policy on undocumented migrants in Europe. METHODS AND ANALYSIS: The Parchemins study will compare self-rated health and satisfaction with life in a group of adult undocumented migrants who qualify for applying for a residency permit (intervention group) with a group of undocumented migrants who lack one or more eligibility criteria for regularisation (control group) in Geneva Canton, Switzerland. Asylum seekers are not included in this study. The total sample will include 400 participants. Data collection will consist of standardised questionnaires complemented by semidirected interviews in a subsample (n=38) of migrants qualifying for regularisation. The baseline data will be collected just before or during the regularisation, and participants will subsequently be followed up yearly for 3 years. The quantitative part will explore variables about health (ie, health status, occupational health, health-seeking behaviours, access to care, healthcare utilisation), well-being (measured by satisfaction with different dimensions of life), living conditions (ie, employment, accommodation, social support) and economic situation (income, expenditures). Several confounders including sociodemographic characteristics and migration history will be collected. The qualitative part will explore longitudinally the experience of change in legal status at individual and family levels. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of Geneva, Switzerland. All participants provided informed consent. Results will be shared with undocumented migrants and disseminated in scientific journals and conferences. Fully anonymised data will be available to researchers.