Dilemma in the foreign lands during COVID-19: An outlook of expat health care professionals with a take on a social perspective.

BACKGROUND: The World Health Organization (WHO) has declared novel coronavirus (COVID-19) infection a global pandemic due to the fast transmission of this disease worldwide. To prevent and slow the transmission of this contagious illness, the public health officials of many affected countries scrambled to introduce measures aimed at controlling its spread. As a result, unprecedented interventions/measures, including strict contact tracing, quarantine of entire towns/cities, closing of borders and travel restrictions, have been implemented by most of the affected countries including the Kingdom of Saudi Arabia. OBJECTIVES: The aim of this paper is to share health care professionals' perspectives who are experiencing COVID19 firsthand in a foreign land. In addition, the role of the Saudi governance to combat the current situation is also discussed. DISCUSSION: Personal and previous experiences as related to Middle East respiratory syndrome coronavirus (MERS-CoV) by the authors has been compared to the current situation and how it affected our thoughts and management. A review of the evidence-based literature was conducted to investigate the demographics of the region; and to understand the awareness of the various tools that are available and how they were utilized in the present situation of pandemic. CONCLUSIONS: Saudi Arabia has been challenged during the pandemic as are other countries.

A questionnaire study of the negative outcomes for UK health professional volunteers in low and middle income countries.

INTRODUCTION: Past research has reported considerable benefits of international health professional volunteering for British healthcare professionals; however, there are also some negative outcomes reported. Negative outcomes reportedly happen on a personal, professional and organisational level. However, there is little evidence of the frequency they might occur. METHODS: We aimed to understand what the negative outcomes of health professional volunteering in low-income and middle-income countries were, and how frequently they occurred, in an opportunistic sample of UK health professionals. We used a questionnaire developed using potential negative outcomes reported in the peer-reviewed papers. We conducted secondary analysis on cross-sectional questionnaire data from 222 healthcare professionals. RESULTS: This research provides an indication of the frequency that negative outcomes might occur. Post hoc analyses revealed that some outcomes were experienced by the majority of health professional volunteers, for example, lack of formal recognition (131/169, 78%) and financial cost (92/169, 68%). While others happened less, for example, a reliance on agency or locum work (12/169, 7%) and loss of pension (31/169, 18%). CONCLUSION: The outcomes reported in this research quantify some of the concerns that have been raised in previous literature. Negative outcomes might be associated with certain features of volunteering and further research is needed to prospectively compare different features. Organisers of volunteering opportunities should be aware of the potential negative outcomes and engage with the research into negative outcomes to generate and apply findings about minimising potential negative outcomes, carefully balancing these against the needs of the host country.

Demographic and Socioeconomic Variables Associated With Health Care-Seeking Behavior Among Foreign Workers in Malaysia.

Foreign workers in Malaysia face various barriers in accessing health care, which results in many of them being unable to obtain appropriate medical treatment in case of sickness. This study investigates the foreign workers' health care-seeking behavior and the demographic and socioeconomic variables that influence it. Data were collected from 502 foreign workers using a self-administered questionnaire. Multiple logistic regression was used to estimate the influence of demographic and socioeconomic variables on health care-seeking behavior among foreign workers. In cases of severe sickness, 20.5% of foreign workers stated that they will not go or are unlikely to go to a clinic or hospital. The multiple logistic regression revealed that foreign workers' tendency to avoid medical treatment is associated with gender, marital status, monthly income, preferred language of communication, and work classification. Nonetheless, in cases of mild sickness, demographic and socioeconomic variables do not influence foreign workers' health care-seeking behavior.

Psychosocial work environment and cross-cultural competence among native and foreign-born registered nurses.

Cross-cultural competence is an essential component of the nursing profession, but little is known about the specific psychosocial work characteristics that potentially promote or hinder such competence. In the present study, psychosocial work characteristics were based on Karasek's Job Demand-Control Model. The researchers examined whether Karasek's psychosocial work characteristics, such as high-strain jobs, high-strain isolated jobs, active jobs, and active collective jobs, are associated with cross-cultural competence (empathy, skills, positive attitudes, and motivation), and whether there are differences between native and foreign-born registered nurses (RN) in these potential associations. A random sample of 744 native RNs (91.0% women) and a total sample (n = 212) of foreign-born RNs (94.3% women) working in Finland were used. Data were collected using a questionnaire and analyzed with a series of multiple linear regression analyses. High-strain and high-strain isolated jobs were negatively associated with all four dimensions of cross-cultural competence. Active collective jobs, but not active jobs, were positively associated with cross-cultural skills. There were no differences between native and migrant nurses in these associations. The psychosocial work environment is associated with cross-cultural competence in both native and migrant nurses. Improvements in psychosocial working conditions, especially minimizing negative factors in the work environment, such as high-strain and high-strain isolated jobs, may need to be considered as a part of the efforts aimed to enhance cross-cultural competence among nursing personnel.

The motivations and aspirations of Indian physiotherapists who migrate overseas to study and work: a grounded theory study.

OBJECTIVE: To explore why Indian physiotherapists seek to migrate overseas for study and work. DESIGN: Qualitative research using Constructivist Grounded Theory (CGT) methodology. SETTING: Individual interviews and focus groups were conducted in the UK and India, at university, clinic or hotel locations convenient to the participants. PARTICIPANTS: Nineteen physiotherapists from across India. Thirteen had studied or worked in the UK, Australia or Kuwait, and six had no overseas experience. FINDINGS: The participants desired a 'better life' due to factors perceived as less favourable in India: pay levels, professional respect and professional development. These elements were inter-dependent and their importance varied between participants and according to gender. Indian societal values amplified the importance of pay for male physiotherapists, whereas females prioritised professional development. Migrant physiotherapists aspired to professional autonomy through the development of knowledge, skills and experience. Respect was important, but there were different perspectives on its achievement and the relevance of titles. For those studying overseas, work was sought to recoup the cost of that study, and, importantly to consolidate learning and experience of autonomous physiotherapy practice. They all planned to return to India and wished to transfer their knowledge and skills back into practice in India. CONCLUSION: Pay, respect and professional development are all motivators for Indian physiotherapists to study and work overseas. An ability to practise physiotherapy autonomously is a key factor underpinning the achievement of each of these elements and thus the ultimate aspiration to have a 'better life'.

Doctors on the move: a qualitative study on the driving factors in a group of Egyptian physicians migrating to Germany.

BACKGROUND: Migration of physicians has become a global phenomenon with significant implications for the healthcare delivery systems worldwide. The motivations and factors driving physician's migration are complex and continuously evolving. Purpose of this study is to explore the driving forces in a group of Egyptian physicians and final-years medical students preparing to migrate to Germany. METHODS: A qualitative study was conducted based on social constructivism epistemology. In five focus group discussions, there participated a total 12 residents and 6 final-year medical students from 7 different training and workplace locations in Egypt. The participants provided information about their motivation and planning for migration. We applied a coding framework based on the concept of push/pull factors and barriers/facilitators for migration, and used Atlas.ti software for analysis. RESULTS: The thematic analysis indicated that the migration within the study's participants results from a specific weighting of push and pull factors. Push factors are considered to be more important than pull factors. Factors related to professional development play a leading role. The route of migration towards Germany is mainly determined by the low hurdle registration and licensing requirements in this destination country compared to other countries. In some cases, Germany is regarded as a "transit country", a step on the road to other European countries. The intent, planning and preparation of migration is assisted considerably by the local formation of a community and culture of migration with multiple ways for information exchange, identity building and social support through face-to-face and online channels. CONCLUSIONS: This study specifies - in a group of Egyptian physicians and final-year medical students - the perceived push and pull factors which influenced their intent to migrate to Germany. In addition to the general wealth gap, their particular route of migration is mainly determined by the requirements in licensing and registration procedures for foreign physicians in the potential destination country. The planning and preparation of a move is substantially facilitated by their joining a social network and a community of migrating physicians.

Oppression, liberation, wellbeing, and ecology: organizing metaphors for understanding health workforce migration and other social determinants of health.

BACKGROUND: The Commission on Social Determinants of Health (CSDH) identifies the maldistribution of power, money, and resources as main drivers of health inequities. The CSDH further observes that tackling these drivers effectively requires interventions to focus at local, national, and global levels. Consistent with the CSDH's observation, this paper describes the eco-psychopolitical validity (EPV) paradigm, a multilevel and transdisciplinary model for research and action, thus far insufficiently tapped, but with the potential to systematize the exploration of the social determinants of health. RESULTS: Using the physician migration from Sub-Saharan Africa (SSA) to the United States as illustration, this paper articulates how the EPV model can be applied to the systematic analysis of a complex social problem with health inequity implications. To help explore potential determinants of physician migration, a comprehensive coding matrix is developed; with the organizing metaphors of the EPV model-namely oppression, liberation, and wellbeing-serving as analytical categories. Through the lens of the EPV model, migrating physicians are revealed as both ecological subjects enmeshed in a vast web of transnational processes linking source and destination countries, and potential change agents pursuing liberation and wellbeing. While migration may expand the opportunities of émigré physicians, it is argued that, the pursuit of wellbeing by way of migration cannot fully materialize abroad without some efforts to return home, physically or socially. CONCLUSION: Clarifying the relationship between various social determinants of health and health inequities at different levels of analysis is a more complex but essential endeavor to knowledge generation than using a one-dimensional frame. With its roots in interdisciplinary thinking and its emphasis on both individual and contextual factors, the EPV paradigm holds promise as a model for examining the social determinants of health.

Factors influencing the migration of Iranian healthcare professionals: A qualitative study.

BACKGROUND: The migration of healthcare specialists from developing countries has increased in recent years. This has caused a rapid reduction in the access to and quality of healthcare services in such countries. The aim of this study is to evaluate the factors affecting the migration of specialist human resources in Iran's healthcare system. METHODS: This is a qualitative study, which was carried out through semi-structured interviews between 2015 and 2016. For sampling, purposive sampling method with maximum variation sampling was used. Further, data saturation was observed by conducting 21 interviews, and data analysis was performed using the MAXQDA10 content analysis software. RESULTS: Factors affecting the migration of specialists were classified into five key themes, including structural, occupational, personal, socio-political and economic factors. These themes consisted of 12 categories and 50 subcategories. The most important factors affecting the migration of our study population were structural issues, occupational problems, and personal concerns. CONCLUSION: Identification of factors influencing migration is the first step to prevent the migration of specialist human resources. Implementing the recommendations proposed in this study would assist to prevent migration of medical professionals.

Employability and career experiences of international graduates of MSc Public Health: a mixed methods study.

OBJECTIVES: This article aims to describe the public health career experiences of international graduates of a Master of Science in Public Health (MSc PH) programme and to contribute to developing the evidence base on international public health workforce capacity development. STUDY DESIGN: A sequential mixed methods study was conducted between January 2017 and April 2017. METHODS: Ninety-seven international graduates of one UK university's MSc PH programme were invited to take part in an online survey followed by semistructured interviews, for respondents who consented to be interviewed. We computed the descriptive statistics of the quantitative data obtained, and qualitative data were thematically analysed. RESULTS: The response rate was 48.5%. Most respondents (63%) were employed by various agencies within 1 year after graduation. Others (15%) were at different stages of doctor of philosophy studies. Respondents reported enhanced roles after graduation in areas such as public health policy analysis (74%); planning, implementation and evaluation of public health interventions (74%); leadership roles (72%); and research (70%). The common perceived skills that were relevant to the respondents' present jobs were critical analysis (87%), multidisciplinary thinking (86%), demonstrating public health leadership skills (84%) and research (77%). Almost all respondents (90%) were confident in conducting research. Respondents recommended the provision of longer public health placement opportunities, elective courses on project management and advanced statistics, and 'internationalisation' of the programme's curriculum. CONCLUSIONS: The study has revealed the relevance of higher education in public health in developing the career prospects and skills of graduates. International graduates of this MSc PH programme were satisfied with the relevance and impact of the skills they acquired during their studies. The outcomes of this study can be used for curriculum reformation. Employers' perspectives of the capabilities of these graduates, however, need further consideration.

The Life Story Experience of "Migrant Dentists" in Australia: Potential Implications for Health Workforce Governance and International Cooperation.

BACKGROUND: The migration of dentists is a major policy challenge facing both developing and developed countries. Dentists from over 120 countries migrate to Australia, and a large proportion are from developing countries. The aim of the study was to assess the life story experience (LSE) of migrant dentists in Australia, in order to address key policy challenges facing dentist migration. METHODS: A national survey of all migrant dentists resident in Australia was conducted in 2013. Migrant experiences were assessed through a suite of LSE scales, developed through a qualitative-quantitative study. Respondents rated experiences using a five-point Likert scale. RESULTS: A total of 1022 migrant dentists responded to the survey (response rate = 54.5%). LSE1 (health system and general lifestyle concerns in home country), LSE2 (appreciation towards Australian way of life) and LSE3 (settlement concerns in Australia) scales varied by migrant dentist groups, sex, and years since arrival to Australia (chi-square, P < .05). In a logistic regression model, migrants mainly from developing countries (ie, the examination pathway group) faced greater health system and general lifestyle concerns in their home countries (9.32; 3.51-24.72) and greater settlement challenges in Australia (5.39; 3.51-8.28), compared to migrants from well-developed countries, who obtained direct recognition of qualifications. Migrants also are more appreciative towards the Australian way of life if they had lived at least ten years in Australia (1.97; 1.27-3.05), compared to migrants who have lived for less than ten years. CONCLUSION: Migrant dentists, mainly from developing countries, face challenges both in their home countries and in Australia. Our study offers evidence for multi-level health workforce governance and calls for greater consensus towards an international agenda to address dentist migration. Better integration of dentist migration with the mainstream health workforce governance is a viable and opportunistic way forward.