Barriers and facilitators to transition from pediatric to adult healthcare for immigrant youth with chronic health conditions.

PURPOSE: The objective of this study was to investigate the experience of first- and second- generation immigrant youth living with chronic health conditions in Canada, their parents or caregivers, and healthcare and service providers who care for immigrant youth, regarding the transition from pediatric to adult healthcare. DESIGN AND METHODS: We conducted semi-structured individual interviews and focus groups. Youth were 1st or 2nd generation immigrants, aged 16-25, with pediatric-onset chronic health conditions. Parents or caregivers had raised youth children as described. Providers delivered healthcare or other services to immigrant populations. Thematic analysis was conducted of all transcripts. RESULTS: Twenty youth, 14 parents/caregivers and five service providers participated. Most participants described healthcare transition as very difficult to navigate. Two major themes emerged across participant narratives: 1. Barriers to transition: lack of family experience in Canada, language, discrimination, financial strain, stigma, and long wait times. Some of these barriers are specific to newcomer families, but others are generalizable to the Canadian population. 2. Facilitators of transition: youth independence, youth acting as cultural bridges within their families, and cross-sector support between healthcare, education, social work and settlement services. CONCLUSIONS: Immigrant youth and their families face a broad range of barriers to healthcare transition. The collaborative nature of cross-sector support effectively addressed some of the barriers faced by newcomer families. PRACTICE IMPLICATIONS: Clinicians should provide immigrant youth and their families with accessible information about the health condition and how to navigate the adult healthcare system prior to transition, particularly when language barriers exist.

Health of African Refugee Children Outside Africa: A Scoping Review.

PROBLEM: Africa is the largest source continent of refugee children. However, we found no published synthesis of the literature on the health of African refugee children outside Africa. Conducting a review of the literature on this particular population will help illuminate the particular contextual health issues faced by African child refugees who live outside Africa. The purpose of this review is to synthesize what is known from the existing literature regarding the health of sub-Saharan African refugee children who live outside Africa. METHODS: We completed a scoping review of the published literature. We included articles published in English with a focus on the health of sub-Saharan African refugee children living outside Africa. We excluded studies of refugees in Africa as the living conditions of these refugees, most of whom reside in camps, are very different from those outside Africa. Using relevant keywords, we searched 10 databases to identify and screen 6602 articles after duplicates were eliminated. SAMPLE: A total of 20 studies were included in this review. FINDINGS: Published research articles on sub-Saharan African child refugees living outside Africa focus on infectious diseases, mental health and neurodevelopmental disorders, food insecurity and psychosocial adjustment, physical health (including obesity), and health promotion strategies. This population is characterized by a high rate of infectious diseases (e.g., malaria), obesity, and mental health problems, especially post-traumatic stress disorder (PTSD). CONCLUSIONS AND IMPLICATIONS: To attend to the health needs of sub-Saharan African refugee children who live outside Africa, interventions should address pre-migration factors as well as post-migration factors (including income and community belonging) while employing a strengths-based perspective.

The health of internally displaced children in sub-Saharan Africa: a scoping review.

BACKGROUND: Internally displaced children are those who have been forced to flee their homes due to severe unfavourable conditions (war, violence or disasters) but have not crossed international borders. Emerging research shows these children face multiple health challenges. However, we found no review focused solely on the health of such internally displaced children. Thus, this review sought to examine what is known about their health and their health concerns. METHODS: A scoping review of the literature was conducted. A total of 10 databases were searched in January 2019, yielding 6602 articles after duplicates were eliminated. Two research assistants independently selected articles that met inclusion criteria. A numerical summary and thematic analysis were conducted to facilitate data extraction and data analysis. RESULTS: A total of 25 articles met the inclusion criteria, including 16 quantitative, 6 qualitative and 3 mixed methods studies. The findings reveal elevated mental health problems and infectious diseases in this population. Findings on the nutritional status of internally displaced children as a broad group are mixed, with some studies showing poorer nutritional status among the children in this group and others showing poorer nutritional health status among host society children. Internally displaced children also experience challenges with access to health services. Premigration factors (trauma) and postmigration factors (humanitarian assistance on displacement) all contribute to the health of internally displaced children. CONCLUSION: Findings provide insight into the complex array of factors influencing the health of internally displaced children. More intervention studies are required to address the needs of this population.