Access to the Health Care System of Undocumented Moroccan Migrant Slum Dwellers in Southern Spain: A Qualitative Study.

Spain has grown economically due to the recent boosts in the industrial sector, the agricultural sector, construction and services. Those who carry out agricultural tasks are mainly undocumented immigrants living in marginal neighborhoods. OBJECTIVES: to know the perception of undocumented Moroccan migrants living in marginal neighborhoods regarding access to the Public Health System. METHODS: A qualitative method with a phenomenological approach was used to get closer to the experience of the participants in the study. In this work, 24 semi-structured interviews were conducted following a guide with a set of open questions to facilitate an in-depth discussion of the topics of interest. The participants were given an informed consent form, which guaranteed anonymity and confidentiality regarding the information obtained. For this, codes were used to identify them. The data were stored, managed, classified, and organized with the ATLAS-ti 9 software. RESULTS: access and use of health services by the immigrants in the study was difficult due to communication problems related to language and culture, the discriminatory attitude and lack of cultural competence of health personnel, and the location of the neighborhoods (which were marginal far from urban centers), as well as the lack of transportation to health centers. CONCLUSIONS: it is an ethical imperative of the Health System to offer greater attention to the population in situations of extreme vulnerability, implement intercultural mediators and train health professionals in cultural competence.

Breaking the Stigma in Mental Health Nursing through High-Fidelity Simulation Training.

The social stigma toward individuals with mental health problems is habitual among nursing students, which can lead to poor quality of health care services for patients with mental illnesses. The purpose of the present study was to learn about nursing students' perceptions of providing care to patients with severe mental disorders before and after participating in a simulated student clinical case. A descriptive qualitative study was conducted through 39 interviews. The difficulties expected by the students and their perceptions about patients were explored before the simulation training. Their perceptions about the use of clinical simulation for learning about the adequate management of these patients were analyzed afterwards. Results: Before the simulation training, the students assessed the case as being complicated, expressed their lack of specific training, and felt fear and insecurity, thus reproducing the stigma towards mental health patients. After this training, they positively valued the usefulness of the clinical simulation for gaining confidence and overcoming the stigma. Discussion: The use of high-fidelity simulation offers nursing students the opportunity to approach patients with mental health conditions, overcoming their fears and normalizing mental disorders. Simulation training allows nursing students to analyze the reasoning of clinical judgment and to detect the influence of previous prejudices about mental illness in their clinical decision. This study was not registered.

Coping Strategies during Childbirth Related to Cultural Identity: Companionship, Choice of Analgesia and Maternal Satisfaction.

Childbirth is a biological process and how it is experienced and managed is influenced by numerous factors, among them, socio-cultural or health care received. OBJECTIVE: The objective of this study is to ascertain whether cultural factors influence the way in which women deal with childbirth through the treatment of pain, companionship and maternal satisfaction. METHODS: This study is a non-experimental, quantitative, ex post facto, cross-sectional study of women who gave birth in a border town in southern Spain. The sample consisted of 249 women. RESULTS: No relationship was found between cultural factors and the choice of epidural analgesia, alternative methods to alleviate pain, being accompanied nor maternal satisfaction. There was a significant relationship between the type of companionship and with maternal satisfaction. CONCLUSIONS: Cultural factors did not influence how women dealt with dilation and childbirth. Results found that the person accompanying the mother was important for increasing maternal satisfaction. The intercultural training of healthcare professionals is necessary.

Migrant Women in Shantytowns in Southern Spain: A Qualitative Study.

The increase in intensive agriculture in Southern Spain, and the increasing need for migrant women, has led to the appearance of numerous shantytowns alongside greenhouses. In the last few years, the number of women who live in them has increased. This qualitative study delves into the experiences and future expectations of migrant women who live in shantytowns. Thirteen women who live in shantytowns in Southern Spain were interviewed. Results: Four themes emerged: dreams vs. reality, life in the settlements, worse for women, and "the papers". Discussion and Conclusions. Priority should be given to the care of women who live in shantytowns with specific programs; society must work to end these shantytowns and facilitate agricultural workers with access to housing; it is necessary to allow the resident registration of the people who live in shantytowns.

Sexuality and Religious Ethics: Analysis in a Multicultural University Context.

Sexuality is still perceived by some cultures as a taboo subject. Although there is now a more open attitude towards sexuality, the maintenance of virginity is one of the most concerning issues in some religions. The aim of this research is to investigate the sexual behavior of university students and analyze how culture and religion influence the beliefs and maintenance of virginity in women and men. A mixed methodology was used, involving 355 students in the quantitative design and 18 informants for the qualitative study who took part in two focus groups. The results indicate that religion and the degree of religious practice are predictor variables for the decision to have penetrative sex, with Muslim women and men giving more importance to the maintenance of a woman's virginity. However, this hymen-centric view does not prevent other sexual practices, such as oral and/or anal sex, among young people who wish to maintain their virginity until marriage. Religious ethics continue to influence the sexual behavior of young people today. Therefore, nursing education must address these issues to improve the affective sexual health of the population.

The Perception of Nurses about Migrants after the COVID-19 Pandemic: Close Contact Improves the Relationship.

Nurses have faced during the COVID-19 pandemic a tough professional situation in which they have had to work in a resource-limited context and with a high probability of COVID-19 transmission. In today's multicultural societies, care for immigrant patients is also included. In our study, we have delved into the perception of hospital nurses towards migrant people in the context of the COVID-19 pandemic. We used a qualitative methodology with a phenomenological approach. Semi-structured interviews were conducted with 16 nurses. Seven categories emerged and were distributed in the three blocks of the interviews: (a) perception before the pandemic: prejudices make a mark and communication problems; (b) perception after the pandemic: prejudices weaken and communication worsens; and (c) how to improve care: improve communication, more nurses, and no need for training. The approach in the interpersonal relationship between nurses and patients during the pandemic has improved health care. Proposals arise to overcome the language barrier such as the incorporation of intercultural translators-mediators and professionals of foreign origin. There is a lack of awareness of the need for training in cultural competence on the part of the nurses in the study.

Romani Women and Health: The Need for a Cultural-Safety Based Approach.

The Romani are the main European ethnic minority. The Romani people's situation of social vulnerability and their difficulties accessing the health system make their health indicators worse than those of the non-Romani population. The present study will delve into health beliefs, and experiences with health services and professionals, through the perspectives of Romani women. In this qualitative study, 16 women of different ages were interviewed in a city located in the South of Spain. Four themes emerged from the analysis of the data: the construction of the identity of Romani women, difficulties in life, health and disease beliefs and barriers to accessing the health system. We conclude that every project for the improvement of the health of the Romani community must take into account the active participation of Romani women and must consider the principles of Cultural Safety, by delving into the intercultural training of health professionals and addressing the social determinants of health which affect the Romani collective.

Primary School Teachers' Perspective of Sexual Education in Spain. A Qualitative Study.

Sexual education is a part of the teaching-learning process that addresses cognitive, psychological, physical and social aspects of sexuality. The purpose of sexual education is to provide people with knowledge, abilities, attitudes and values that will help them to have good sexual health, well-being and dignity. The objective of this study was to explore the perspective of primary school teachers regarding Sexual Education in school. A descriptive qualitative study was designed based on content thematic analysis. Fifteen open-ended interviews with primary school teachers were carried out, followed by inductive data analysis using ATLAS.ti software. Two key themes emerged from the analysis: "In search of a comprehensive approach to Sexual Education" and "Barriers to Sexual Education in schools: From the lack of training to fear of the families". We conclude that despite the efforts to implement a comprehensive approach to Sexual Education that recognises sexuality as a right, primary school teachers face difficulties in delivering Sexual Education in schools due to a lack of training and the fear that parents will reject their children being spoken to about sexuality.

Nursing Students' Attitudes towards Immigrants' Social Rights.

The migrant population has increased in recent years and, as a result, so has cultural diversity. Universities are incorporating specific modules addressing cultural diversity. However, the native population has negative attitudes towards immigrants, as they believe that immigrants receive more social benefits and abuse healthcare services. Nurses may have these attitudes too, which may affect the way they treat patients. The objective of this study was to determine nursing students' attitudes towards the rights of the migrant population. This is a descriptive ex post facto study using a cross-sectional design, with 821 nursing students in Melilla, Ceuta, and Almeria, Spain. An anonymous questionnaire was used for data collection. Students recognize the same rights for both the immigrant and native populations. More than 80% of the sample upholds the right of undocumented immigrants and their families to access publicly funded healthcare. Attitudes were more positive among students with a Berber background and first-year students. Students approved of the right of immigrants and their families to healthcare and education. The students' negative attitudes towards the social rights of immigrants need to be addressed with intercultural training to reduce their prejudices as future professionals in a multicultural society.

Nurse Training in Gender-Based Violence Using Simulated Nursing Video Consultations during the COVID-19 Pandemic: A Qualitative Study.

Gender-based violence (GBV) is a serious global public health problem that becomes aggravated during public health emergencies that involve quarantine measures. It is important to train nursing students on GBV, especially in vulnerable situations, such as the current COVID-19 pandemic. The purpose of our study is to explore the perceptions of third-year nursing students about simulated nursing video consultations for providing assistance to potential cases of GBV victims using a high-fidelity clinical simulation methodology. After all of the simulated scenarios were completed, 48 scripted interviews were carried out following a guide composed of four open-ended questions to facilitate in-depth discussion. A descriptive qualitative study based on the interpretative paradigm was conducted. The nursing students indicated that they improved their knowledge on GBV victim management (mainly their awareness of the problem, recognition of the role of nursing professionals, and performance of non-technical skills), although they also mentioned the need for continuous training (particularly in socio-emotional skills, interview techniques, a holistic nursing care approach, and not presupposing). This innovative high-fidelity simulation methodology allows nursing students to improve their awareness of the GBV problem, acquire a realistic view about their role in addressing GBV, and build their non-technical skills (such as active listening, communication skills, empathy, and generating confidence) required to adequately care for victims of GBV.

Simulated Nursing Video Consultations: An Innovative Proposal During Covid-19 Confinement.

BACKGROUND: In response to the closure of universities and the canceling of in-person classes due to the COVID-19 pandemic, this study was designed to focus on a solution for adapting simulation-based education to this situation. METHOD: A mixed study was conducted to analyze nursing students' satisfaction and perceptions (n = 48) about simulated nursing video consultations. RESULTS: Nursing students expressed a high level of satisfaction and positive perceptions about this innovative proposal. CONCLUSIONS: Simulated nursing video consultations could be considered as another choice of high-fidelity simulation not only in the current COVID-19 situation, but its use could be extended to other contexts.

Hospitalization Experience of Muslim Migrants in Hospitals in Southern Spain-Communication, Relationship with Nurses and Culture. A Focused Ethnography.

The coast of southern Spain is one of the main entry points for Africans who want to reach Europe; in this area, there is an important immigrant community of African origin, mostly Muslims. The objective of this study is to describe and understand the hospitalization experience of Muslim migrants in public hospitals in southern Spain, especially their relationship with the nurses who care for them. Data were collected from May 2016 to June 2017. This study followed the principles associated with focused ethnography. During data collection, open interviews with 37 Muslim patients were conducted. Three themes emerged from the inductive data analysis: lack of communication with nurses, discriminatory experiences at the hospital and their experience of Islam in the hospital. We conclude that caring for Muslim patients requires specific training not only for nurses but also for other health professionals; existing communication problems must be addressed by establishing the role of the intercultural mediator as an idiomatic and cultural bridge between patients and nurses. In addition, hiring health professionals with migrant backgrounds would help convert hospitals into spaces for intercultural coexistence.

La visión del otro y la conflictividad en la relación enfermera-paciente musulmán / The vision of the other and conflicts in the relationship between nurses and muslim patients

Objetivos: - Conocer la visión de las enfermeras de los pacientes de tradición musulmana y si esta se corresponde con la existencia o no de conflictos.- Conocer la visión de los pacientes de tradición musulmana de las enfermeras que los cuidan y si esta se corresponde con la existencia o no de conflictos.- Buscar similitudes y/o diferencias en la visión del otro en la relación enfermera-paciente de tradición musulmana. Método Teoría fundamentada, utilizando como estrategia de recogida de datos las entrevistas en profundidad. Informantes enfermeras de hospitalización (N=32), hombres y mujeres de tradición musulmana que hayan estado hospitalizados en uno de los hospitales públicos de Almería (N=37). Resultados Las enfermeras. En el discurso aparecen numerosos estereotipos y prejuicios hacia los pacientes de tradición musulmana, esta visión negativa contrasta con la ausencia de conflictos con estos pacientes. Los pacientes de tradición musulmana. La valoración que hacen de las enfermeras es positiva, resaltando sobre todo su profesionalidad y la confianza que les transmiten. A las experiencias negativas con el personal se tiende a restarle importancia. Conclusiones Pese a esta visión estereotipada y prejuiciosa del otro por parte de la enfermera, la relación con los pacientes de tradición musulmana no parece estar afectada según la percepción de los pacientes. Es necesario tomar conciencia de que esta visión negativa de los profesionales existe y que hay que trabajar activamente para modificarlas fomentando el conocimiento y el respeto cultural mediante la formación específica en este campo (AU)

Objectives:- To and out the views of nurses on Muslim patients and to determine whether these views are related to the existence of, or lack of conflicts.- To determine what the Muslim patients think of the nurses who look after them, and to see whether this is related to the existence of, or lack of conflicts.- To look for similarities or differences in the ‘‘vision of the other’’ in the nurse-Muslim patient relationship. Method: Grounded Theory, using in-depth interviews. Informants: Nurses (N=32), men and women of Muslim tradition who have been hospitalized in one of the public hospitals in the province of Almeria (N=37). Results: The nurses. In the discourses there were numerous stereotypes and prejudices towards patients of Muslim tradition. This negative view was in contrast with the lack of conflicts with this type of patient. The patients. These patients gave a positive opinion of the nurses, stressing in particular, their professional attitude and the confidence they install in them. They tended to play down any negative experience with the nursing professionals. Conclusions: In spite of this stereotyped and prejudiced ‘‘vision of the other’’ on the part of the nurses, the relationship is not affected from the point of view of the Muslin patients. It is necessary to be aware of this negative vision that the nursing professionals have, and of the need to work actively to modify it, promoting cultural knowledge and respect through specific training in this field (AU)

[The vision of the other and conflicts in the relationship between nurses and muslim patients]. / La visión del otro y la conflictividad en la relación enfermera-paciente musulmán.

OBJECTIVES: -To find out the views of nurses on Muslim patients and to determine whether these views are related to the existence of, or lack of conflicts. - To determine what the Muslim patients think of the nurses who look after them, and to see whether this is related to the existence of, or lack of conflicts. - To look for similarities or differences in the "vision of the other" in the nurse-Muslim patient relationship. METHOD: Grounded Theory, using in-depth interviews. INFORMANTS: Nurses (N=32), men and women of Muslim tradition who have been hospitalized in one of the public hospitals in the province of Almería (N=37) RESULTS: The nurses. In the discourses there were numerous stereotypes and prejudices towards patients of Muslim tradition. This negative view was in contrast with the lack of conflicts with this type of patient. The patients. These patients gave a positive opinion of the nurses, stressing in particular, their professional attitude and the confidence they install in them. They tended to play down any negative experience with the nursing professionals. CONCLUSIONS: In spite of this stereotyped and prejudiced "vision of the other" on the part of the nurses, the relationship is not affected from the point of view of the Muslim patients. It is necessary to be aware of this negative vision that the nursing professionals have, and of the need to work actively to modify it, promoting cultural knowledge and respect through specific training in this field.

Actitud ante la inmigración, Estudio entre profesionales de enfermería / Attitude towards Immigration. A study among nursing professionals

Algo más de 5 millones de extranjeros residen en España, representando el 11,3% del total de la población, lo que implica el aumento en la diversidad cultural de las personas que acuden a los servicios sanitarios públicos. A través de un estudio cuantitativo descriptivo mediante encuestas hemos llegado a conocer las actitudes ante la inmigración que tienen los profesionales de Enfermería de los tres hospitales públicos de la provincia de Almería, analizando si existen o no diferencias significativas entre ellos. Tras analizar los resultados de los más de 200 cuestionarios recogidos podemos concluir que las respuestas claramente positivas o negativas son minoritarias, casi un 75% de la muestra presenta actitudes moderadas, y no existen diferencias estadísticamente significativas por centro de trabajo, por lo que podemos suponer que el porcentaje de pacientes extranjeros atendidos no determina la actitud ante la inmigración de su personal. Esta investigación ha sido financiada por la Consejería de Salud de la Junta de Andalucía en la convocatoria de subvenciones para la Investigación Biomédica y en Ciencias de la Salud en Andalucía de 2007 (BOJA nº 149 de fecha 30 de julio). Expediente: PI 424-2007(AU)

Somewhat more than 5 million foreigners reside in Spain; they make up 11.3% of the total population; their presence implies an increase in the cultural diversity of the people who make use of public health services. By means of a descriptive quantitative study which used interviews, we have been able to discover the attitudes towards immigration which nursing professionals in the three public hospitals in the province of Almeria hold; and to analyze whether or not significant differences exist among them. After analyzing the results of more than 200 questionnaires collected, we can conclude that there are few clearly positive or negative attitudes while almost 75% of this sample show moderate attitudes and there are no statistically significant differences based on work place; therefore, we can suppose that the percentage of foreigners attended to does not determine the attitude toward immigration by personnel in each hospital. This research project was financed by the Andalucian Government’s Health Council as part of those Biomedical and Health Sciences Research Projects subsidized in Andalucia in 2007, according to the official Andalucian Government publication «BOJA nº 149 de fecha 30 de julio. Expediente: PI 424-2007»(AU)

Formación de los profesionales de enfermería: Cuidar en la sociedad multicultural del siglo XXI / The nurse training: To take care in the multicultural society of 21th Century

El papel de la cultura es fundamental en el proceso salud-enfermedad. En las sociedad en las que conviven personas que tienen diferentes referentes culturales, los profesionales de enfermería deberán estar capacitados para comunicarse eficazmente con estos pacientes y, además, deberán conocer y tener en cuenta sus condicionantes culturales respecto al proceso salud y enfermedad. Considerando imprescindible la adquisición por parte de los enfermeros y enfermeras de estos conocimientos culturales, se ha llevado a cabo una investigación con objeto de conocer los contenidos en competencia cultural y competencia comunicativa intercultural que ofrece la formación reglada de los futuros profesionales enfermeros. Los resultados de la misma informan de un déficit de estos conocimientos en los programas y en las informaciones que reciben estos futuros profesionales. Los autores del artículo haciéndose eco de la importancia de estos contenidos, hacen una propuesta para formar a los nuevos profesionales del cuidado en competencias que les permita actuar en sociedades culturalmente plurales (AU)

The role of culture is fundamental in the health- illness process. In the societies where are living together people of different cultural references, the professionals of nursing would be prepared for efficient communication with their patients; furthermore they should know, and take into account, their cultural references in relation to the health - illness process. As being essential the acquisition of this cultural knowledge by nurses, a research has been carried out in order to determine the contents of cultural and intercultural communicative competences provided by the academic curriculum to the future nurses. The results of this study show that there is a deficit of these competences in the academic programs and in the information that receive these students. The paper concludes with a proposal to train the nursing professionals on these competences (AU)

Aproximación cualitativa a la relación enfermera-paciente musulmán / Qualitative approximation to the relationship between the nurse and muslim patients

Objetivo: conocer cómo perciben los profesionales enfermeros la relación con suspacientes musulmanes, colectivo de extranjeros más numeroso en la zona dondese desarrolla el estudio: Almería.Metodología: estudio cualitativo. Para la recogida de datos se llevaron dos gruposde discusión con profesionales de Enfermería. El análisis de datos se realizó medianteanálisis de contenido, identificando categorías y construyendo un sistemafinal de metacategorías.Resultados: emergieron dos metacategorías representativas de la relación enfermera-paciente musulmán: responsabilidad enfermera: el papel de la enfermera paramantener un ambiente cordial, tranquilo y conseguir relaciones normalizadas conlos pacientes musulmanes; normalidad ante la sociedad multicultural: la incorporaciónde la nueva realidad multicultural a la cotidianeidad de los profesionales.Conclusiones: los profesionales enfermeros deben convertirse en el agente decambio que lidere el proceso conducente a que los hospitales se conviertan en lugaresde tolerancia y convivencia. Para conseguirlo será necesario formar en loscuidados culturales, la competencia intercultural, fomentando el contacto intercultural,mejorando y adaptando los cuidados enfermeros y de esta forma ganaren respeto cultural así como en calidad en los cuidados (AU)

Objective: to ascertain how nursing professionals perceive their relationships withmuslim patients, the largest alien group in the area where the study was conducted:Almería.Methodology: qualitative study. For the collection of data two discussion groupscomprised of nursing professionals were used. Data analysis was carried out bymeans of content analysis, identifying categories and constructing a final systemof metacategories.Results: two representative metacategories of the nurse-muslim patient relationshipwere identified: 1) the nurse’s responsibility, that is the role of the nurseto maintain a pleasant, friendly and relaxing environment and to achieve theestablishment of normal relationships with muslim patients and 2) to maintain normalitywithin a multicultural community, by incorporating the new multicultural realityto the routines of the healthcare professionals.Conclusions: nursing professionals must become the change agents that lead theprocess which makes hospitals places where tolerance and co-living converge. Todo this, special training should be given on aspects such as cultural care, interculturalcompetitiveness, by fostering intercultural exchange, improving and adapting nursingcare and in so doing, gaining the cultural respect as well as the quality of car (AU)

[Attitude towards immigration a study among nursing professionals]. / Actitud ante la inmigración. Estudio entre profesionales de enfermería.

Somewhat more than 5 million foreigners reside in Spain; they make up 11.3% of the total population, their presence implies an increase in the cultural diversity of the people who make use of public health services. By means of a descriptive quantitative study which used interviews, we have been able to discover the attitudes towards immigration which nursing professionals in the three public hospitals in the province of Almeria hold; and to analyze whether or not significant differences exist among them. After analyzing the results of more than 200 questionnaires collected, we can conclude that there are few clearly positive or negative attitudes while almost 75% of this sample show moderate attitudes and there are no statistically significant differences based on work place; therefore, we can suppose that the percentage of foreigners attended to does not determine the attitude toward immigration by personnel in each hospital. This research project was financed by the Andalucian Government's Health Council as part of those Biomedical and Health Sciences Research Projects subsidized in Andalucia in 2007, according to the official Andalucian Government publication "BOJA no 149 de fecha 30 de julio. Expediente: Pl 424-2007".

Visión de los profesionales de Enfermería sobre los pacientes marroquíes / Vision of Nursing professionals regarding marroccan patients

Objetivo: conocer las actitudes de profesionales enfermeros del ámbito hospitalarioante la inmigración y concretamente ante los pacientes marroquíes.Material y métodos: se realizó un estudio observacional descriptivo transversalen el Complejo Hospitalario Torrecárdenas. Se distribuyeron 200 encuestas entrelas áreas de hospitalización, dirigidas tanto a enfermeras como a auxiliares de Enfermería.El instrumento de recogida de datos fue la Escala de Actitud ante la Inmigraciónpara Enfermería (EAIE) de Antonín y Tomás modificada. La suma de laspuntuaciones de todos los ítems se agruparon en cuatro intervalos de puntuación.Resultados: respondieron la encuesta 95 personas (tasa de respuesta del 47,5%).En lo que respecta a la puntuación total obtenida en la EAIE, un 13,7% se ubicó enuna actitud claramente positiva y un 15,8% en una claramente negativa ante la inmigración.Entre las auxiliares de Enfermería se observó que las actitudes negativaseran de un 34,4% frente a un 6,3% en enfermeras. El colectivo de pacientes peorvalorado fue el de los marroquíes, seguidos por subsaharianos y europeos del este.Conclusiones: es necesario el aumento de recursos materiales y humanos en laszonas de mayor población inmigrantes para adaptar los medios disponibles al aumentode usuarios, así como la puesta en marcha de programas de formación delpersonal sanitario en la atención a pacientes extranjeros, así como profundizar enel conocimiento de las costumbres y tradiciones de salud de los marroquíes

Objective: to identify the attitudes of the nursing professionals in the hospital settingwhen treating immigrants and more specifically Moroccan patients.Material and methods: a cross-sectional observational descriptive analysis was conductedat the Torrecárdenas medical centre. 200 surveys were distributed betweenthe different hospitalisation areas, aimed at both registered nurses and nursing assistants.The tool used for data collection was the modified Attitude Scale of Nursesin cases of Immigration (Spanish acronym EAIE) by Antonín and Tomás. The additionof the scores of all the items were subgrouped in four different score intervals.Results: 95 people responded to the survey (47,5% response rate). With respectto the total score obtained in the EAIE, 13,7% showed a clearly positive attitudeand 15,8% a clearly negative attitude regarding immigration. 34,4% of nursingassistants were found to have negative attitudes vs 6,3% of nurses. The group ofpatients that obtained the lowest score was the Moroccan group, followed by subsaharanand east-europeans.Conclusions: increased material and human resources are needed in areas withthe greatest affluence of immigrants to adapt the means available to the increasednumber of users, as well as to set up training programs for health personnel in theattention to foreign patients and gain more insight into the knowledge of the customsand health traditions of moroccans