Self-identified barriers to health services among migrants 50 years of age or older: population-based survey study of Russian speakers in Finland.

BACKGROUND: The compounded effect of a migratory background and ageing increases the risk of unequal medical treatment opportunities. The aim of this article is to investigate the social determinants of barriers to health services. METHODS: The study uses population-based survey data of Russian-speaking migrants (50 + years) residing in Finland (n = 1082, 57% of men, mean age 63 years). Multiple correspondence analysis was performed as a dimension reduction procedure on six barriers to health services. Multiple ordinary least-squares linear regression was used for the predicted score of the barriers as an outcome variable. RESULTS: Most of the sociodemographic characteristics were not associated with barriers to health services, except gender, as women tended to face more disadvantages. Migration-related factors, such as the need for interpreters for health services and experienced discrimination, were associated with an increased likelihood of reporting barriers to health services. Using the internet as a primary source of health information was associated with more access barriers to health services. CONCLUSIONS: Migrants 50 years of age or older face multiple barriers to health services. Given that the healthcare needs increase with age, addressing this issue becomes crucial, necessitating improved access to health services for older migrants.

Migrants face Barriers to Obtaining Electronic Identification: A population-based Study Among Older Russian-speakers in Finland.

As digital technologies continue to transform health care and health systems, they will continue to have a lasting impact on health services. Many health and social care services have rapidly become 'digital by default'. The electronic identification (e-ID) technology is needed for secure authentication to digital services. Recent studies have shown that the 'digital divide' is prominent between ethnic minorities and the majority populations and between older and younger adults. Inequalities related to not having an e-ID, which is in many countries required to access digital health services, remain under-researched. Moreover, there is a lack of knowledge of the use of digital services among older migrants. This study analyses general socio-demographic as well as migration specific factors that may be associated with not having an e-ID among older migrants. We used the Care, Health and Ageing of Russian-speaking Minority in Finland (CHARM) study, which is a nationally representative survey of community-dwelling Russian-speaking adults aged ≥ 50 years living in Finland (N = 1082, 57% men, mean age 63.2 years, standard deviation 8.4 years, response rate 36%). Our results showed that 21% of older Russian-speakers did not have an e-ID. Our regression analysis showed that older age and poorer economic situation were associated with a lower probability of having an e-ID. In addition, we found an association between not speaking local languages and not having an e-ID. This may relate to private banks regulating the requirements for obtaining the most common e-ID method, online banking ID. We argue that for individuals who are already in vulnerable positions, current e-ID practices might pose yet another obstacle to obtaining the health services they need and are entitled to.

Neighbourhood Ethnic Density, Local Language Skills, and Loneliness among Older Migrants-A Population-Based Study on Russian Speakers in Finland.

So far, little attention has been paid to contextual factors shaping loneliness and their interaction with individual characteristics. Moreover, the few existing studies have not included older migrants, identified as a group who are vulnerable to loneliness. This study examined the association between neighbourhood ethnic density (the proportion of own-group residents and the proportion of other ethnic residents in an area) and loneliness among older migrants. Furthermore, we investigated whether local language skills moderated this association. A population-based representative survey (The CHARM study, n = 1082, 57% men, mean age 63.2 years) and postal code area statistics were used to study Russian-speaking migrants aged 50 or older in Finland. The study design and data are hierarchical, with individuals nested in postcode areas. We accounted for this by estimating corresponding mixed models. We used a linear outcome specification and conducted logistic and ordinal robustness checks. After controlling for covariates, we found that ethnic density variables (measured as the proportion of Russian speakers and the proportion of other foreign speakers) were not associated with loneliness. Our interaction results showed that increased own-group ethnic density was associated with a higher level of loneliness among those with good local language skills but not among those with weaker skills. Good local language skills may indicate a stronger orientation towards the mainstream destination society and living in a neighbourhood with a higher concentration of own-language speakers may feel alienating for those who wish to be more included in mainstream society.

On not 'being there': Making sense of the potent urge for physical proximity in transnational families at the outbreak of the COVID-19 pandemic.

This paper investigates transnational families' experiences of the COVID-19 pandemic outbreak and the accompanying sudden and unexpected travel restrictions. Our data consist of written stories collected in April-June 2020 from migrants with ageing kin living in another country. For many respondents, the situation provoked an acutely felt urge for physical proximity with their families. By analysing their experiences of 'not being there', we seek to understand what exactly made the urge to 'be there' so forceful. Bringing into dialogue literature on transnational families with Jennifer Mason's recent theoretical work on affinities, we move the focus from families' transnational caregiving practices to the potent connections between family members. We argue that this approach can open important avenues for future research on families-transnational or otherwise-because it sheds light on the multisensory and often ineffable charges between family members that serve to connect them.

Health and self-perceived barriers to internet use among older migrants: a population-based study.

BACKGROUND: In older adults, including those with a migrant background, ill health is associated with less internet use. However, it is not known what are the specific self-perceived barriers to internet use among older migrants with different health conditions. The aim of this study was to investigate the associations between different health conditions and self-perceived barriers to internet use among older migrants. METHODS: We used the Care, Health and Ageing of Russian-speaking Minority in Finland (CHARM) study, which is a nationally representative survey of community-dwelling Russian-speaking adults aged ≥50 years living in Finland (N=1082, 57% men, mean age 63.2 years, standard deviation 8.4 years, response rate 36%). Postal survey data were collected in 2019. Health indicators were self-rated health (SRH), depressive symptoms, cognitive functioning, and doctor-diagnosed conditions. Linear regression analyses were used to investigate the associations between health indicators and a summary scale consisting of the following barriers of internet use: (1) internet use is too complicated and hard to learn; (2) having concerns about safety issues; (3) internet use is too expensive; (4) physical limitations hinder the internet use; (5) memory problems hinder the internet use. In addition, the two most commonly reported barriers (the first two) were examined separately using logistic regression analyses. The analyses were adjusted for age, sex, education, marital status, local language proficiency, and income support, and the health conditions, and were performed with weights accounting for the survey design and non-response. RESULTS: After adjustments, spine/back problems (b=0.13; p=0.049), depressive symptoms (b=0.40; p=0.007), and problems in learning new things (b=0.60; p<0.0005) were associated with higher level of overall barriers to internet use. In addition, a number of health conditions were associated with individual barriers, albeit some health conditions appeared protective. CONCLUSIONS: In general, older migrants with declining health experience more barriers to internet use than their counterparts with better health. To provide better access to healthcare for older adults, including older migrants, rapidly changing devices, software and apps need to be modified and adapted for those with specific health-related needs.

Digital Information Technology Use and Transnational Healthcare: A Population-Based Study on Older Russian-Speaking Migrants in Finland.

This study examines the association between digital information technology (DIT) use and the utilization of transnational healthcare (THC) in older migrants, and investigates how this relationship depends on social integration or perceived discrimination in health services in the destination country. The data from a population-based study conducted in Finland in 2019, which targeted Russian-speaking residents aged 50 and above (n = 1082) nationwide, are analyzed. The analysis demonstrates that those who had a high level of DIT use were significantly more likely to use THC than those who had a low level of use. However, the findings do not show that the relationship depends on social integration or perceived discrimination. Older migrants can actively use transnational networks to address their health and well-being issues by using DIT and seeking healthcare abroad. Their health service use can be illustrated as an active process involving various geographical domains.

Digital Information Technology Use, Self-Rated Health, and Depression: Population-Based Analysis of a Survey Study on Older Migrants.

BACKGROUND: Previous studies have found that in general, poor health is associated with a lower likelihood of internet use in older adults, but it is not well known how different indicators of health are associated with different types of digital information technology (DIT) use. Moreover, little is known about the relationship between health and the types of DIT use in older ethnic minority and migrant populations. OBJECTIVE: The aim of this study is to examine the associations among depressive symptoms and self-rated health (SRH) with different dimensions of DIT use in older migrants. METHODS: We analyzed data from the Care, Health and Ageing of Russian-speaking Minority (CHARM) study, which is based on a nationally representative sample of community-dwelling, Russian-speaking adults aged 50 years or older residing permanently in Finland (men: 616/1082, 56.93%; age: mean 63.2 years, SD 8.4 years; response rate: 1082/3000, 36.07%). Data were collected in 2019 using a postal survey. Health was measured using depressive symptoms (measured using the Center for Epidemiologic Studies Depression Scale) and SRH. Binary logistic regression analyses were used to investigate the associations between the two health indicators and the following six outcomes: daily internet use, smartphone ownership, the use of the internet for messages and calls, social media use, the use of the internet for personal health data, and obtaining health information from the internet. A number of sociodemographic and socioeconomic factors were controlled for in the logistic regression regression analysis. Analyses were performed with weights accounting for the survey design and nonresponse. RESULTS: After adjusting for sociodemographic and socioeconomic factors, depressive symptoms (odds ratio [OR] 2.68, 95% CI 1.37-5.24; P=.004) and poor SRH (OR 7.90, 95% CI 1.88-33.11; P=.005) were associated with a higher likelihood of not using the internet daily. Depressive symptoms (OR 1.88, 95% CI 1.06-3.35; P=.03) and poor SRH (OR 5.05, 95% CI 1.58-16.19; P=.006) also increased the likelihood of smartphone nonuse. Depressive symptoms were additionally associated with a lower likelihood of social media use, and poor SRH was associated with a lower likelihood of using the internet for messaging and calling. CONCLUSIONS: Poor SRH and depressive symptoms are associated with a lower likelihood of DIT use in older adults. Longitudinal studies are required to determine the directions of these relationships.

Wie kann ein optimaler Qualifikationsmix effektiv verwirklicht werden - und warum?

Initiativen für einen optimalen Qualifikationsmix zielen direkt oder indirekt auf eine Veränderung von Berufsbildern: Direkt durch die Ausweitung von Aufgaben oder Qualifikationen, die Delegation von Verantwortung und die Einführung neuer Berufe; indirekt durch Veränderungen an den Schnittstellen zwischen Angeboten am Versorgungsort. Solche Initiativen entstehen aufgrund qualitativer Ziele (mehr Qualität, berufliche Weiterentwicklung und besseres Arbeitsleben) und quantitativer Erfordernisse (Knappheit, Verteilungsprobleme und Kostenwirksamkeit). Strategische Instrumente zur Unterstützung einer wirksamen Umsetzung der Initiativen sind u. a.: die Veränderung oder Neueinführung beruflicher Aufgaben durch organisatorische oder regulatorische Maßnahmen, hierunter dieRegelung des beruflichen Tätigkeitsbereichs und die Überwindung institutioneller Barrieren; die kollektive Finanzierung neuer oder erweiterter Berufsbilder und geänderte finanzielle Anreize; die Sicherung der Ausbildungsgrundlagen (Kompetenz und Kapazität) für neue und erweiterte Berufsbilder. Für jede dieser Initiativen ist eine Unterstützung durch die betroffenen Fachorganisationen und die Regierung unverzichtbar. Initiativen für einen optimalen Qualifikationsmix müssen vom Bedarf geleitet sein. Ein sensibles Vorgehen innerhalb des Gesundheitssystems und gegenüber dem Gesundheitspersonal ist ratsam. Das Überstülpen einer vorgefertigten Lösung hilft nicht weiter.

Профессионально-квалификационная структура: как ее оптимизировать и зачем это нужно?

Инициативы по оптимизации профессионально-квалификационной структуры направлены на изменение профессиональных ролей с помощью прямых или косвенных механизмов. В рамках этих инициатив роли изменяются либо непосредственно, например, путем расширения функций или навыков, делегирования полномочий или внедрения нового типа работников, либо косвенно, например, путем изменения структурных взаимоотношений между различными звеньями и службами здравоохранения, когда изменяются уровни или места оказания медицинской помощи. Стимулами для проведения инициатив по оптимизации профессионально-квалификационной структуры могут послужить как качественные, так и количественные факторы; первая группа включает повышение качества медицинской помощи, профессиональное развитие и улучшение сбалансированности между трудовой и личной жизнью, а вторая – нехваткуили неоптимальное распределение кадров и стремление к повышению экономической эффективности. Инструменты политики, способствующие эффективной реализации инициатив по оптимизации профессионально-квалификационной структуры, включают следующее: изменение существующих или внедрение новых профессиональных ролей с помощью различных организационных и нормативных мер, включая регулирование диапазона профессиональных функций ипреодоление институциональных барьеров; оказание поддержки новым или расширенным профессиональным ролям с помощью коллективного финансирования и измененияфинансовых стимулов; создание образовательной базы (компетентность и потенциал), необходимой для выполнения новых и расширенных профессиональных ролей. Для успеха любых инициатив такого рода крайне важно, чтобы соответствующие профессиональные организации и правительственные органы поддерживали новые профессиональные роли. Инициативы по оптимизации профессионально-квалификационной структуры должны основываться на реальных потребностях, а при их проведении следует тщательно учитывать характерные для данной страныили региона особенности системы здравоохранения и сложившихся категорий медработников, так как применение каких-то универсальных и подходящих для всех подходов не приводит к успеху.

Comment et pourquoi mettre en place un éventail de qualifications optimal ?

Les initiatives visant à optimiser l’éventail des qualifications portent surtout sur la modification des rôles professionnels, et ce de façon directe et indirecte. Elles changent les rôles directement soit en les élargissant ou en étendant les compétences exercées, soit par une délégation ou par la mise en place d’un nouveau type de travailleur ; elles peuvent les changer indirectement par des modifications à l’interface entre les services – c’est-à-dire, à l’emplacement où les soins sont dispensés. Ces initiatives peuvent être motivées à la fois par des considérations d’ordre qualitatif (amélioration de la qualité, développement professionnel, souci depréserver un équilibre entre travail et vie privée...) et quantitatif (pénuries, mauvaise répartition, rapport coût-efficacité...). Parmi les instruments stratégiques permettant la mise en oeuvre correcte de ces initiatives, citons : la modification des rôles professionnels ou l’introduction de nouveaux rôles par la prise de dispositions différentes sur le plan organisationnel et réglementaire, notamment par la réglementation des champs d’activité professionnelle, et par la levée des obstacles institutionnels ; le soutien aux rôles professionnels nouveaux ou élargis par un financement collectif et une modification des incitants financiers ; le fait de veiller aux fondements éducatifs (compétences et capacités) pour les rôles professionnels nouveaux et élargis.Pour l’ensemble des initiatives, il est essentiel que les fédérations professionnelles concernées et les pouvoirs publics soutiennent les nouveaux rôles professionnels. Ces initiatives doivent être motivées par une nécessité et tenir compte du système et des professionnels de santé ; les stratégies « à application universelle » ne sont pas utiles.

How can optimal skill mix be effectively implemented and why?

Skill-mix initiatives focus on changing professional roles – directly and indirectly. They change roles directly through extension of roles or skills, delegation, and the introduction of a new type of worker; they change them indirectly through modifications of the interface between services – that is, where care is provided. Skill-mix initiatives may be motivated both by qualitative considerations (such as quality improvement, professional development and quality of work–life concerns) and quantitative considerations (such as shortages, maldistribution and cost–effectiveness). Policy instruments that support the effective implementation of skill-mix initiatives include: modifying or introducing new professional roles through the development of different organizational and regulatory arrangements, including regulating professional scopes of practice and overcoming institutional barriers; supporting new or enhanced professional roles through collective financing and altered financial incentives; and ensuring the educational foundations (competence and capacity) for the new and expanded professional roles. Across all initiatives, it is essential that the professional organizations affected and the government support new professional roles. Skill-mix initiatives must be driven by need and must be sensitive to the health system and health professional; one-size-fits-all approaches are not helpful.

Decentred comparative research: Context sensitive analysis of maternal health care.

Cross-national comparison is an important tool for health care research, but too often those who use this method fail to consider important inter-national differences in the social organisation of health care and in the relationship between health care practices and social experience. In this article we make the case for a context-sensitive and reflexive analysis of health care that allows researchers to understand the important ways that health care systems and practices are situated in time and place. Our approach--decentred comparative research--addresses the often unacknowledged ethnocentrism of traditional comparative research. Decentred cross-national research is a method that draws on the socially situated and distributed expertise of an international research team to develop key concepts and research questions. We used the decentred method to fashion a multilevel framework that used the meso level of organisation (i.e., health care organisations, professional groups and other concrete organisations) as an analytical starting point in our international study of maternity care in eight countries. Our method departs from traditional comparative health systems research that is most often conducted at the macro level. Our approach will help researchers develop new and socially robust knowledge about health care.

Understanding the social organisation of maternity care systems: midwifery as a touchstone.

Theories of professions and healthcare organisation have difficulty in explaining variation in the organisation of maternity services across developed welfare states. Four countries - the United Kingdom, Finland, the Netherlands and Canada - serve as our case examples. While sharing several features, including political and economic systems, publicly-funded universal healthcare and favourable health outcomes, these countries nevertheless have distinct maternity care systems. We use the profession of midwifery, found in all four countries, as a 'touchstone' for exploring the sources of this diversity. Our analysis focuses on three key dimensions: (1) welfare state approaches to legalising midwifery and negotiating the role of the midwife in the division of labour; (2) professional boundaries in the maternity care domain; and (3) consumer mobilisation in support of midwifery and around maternity issues.