Coproducing a culturally sensitive storytelling video intervention to improve psychosocial well-being: a multimethods participatory study with Nepalese migrant workers.
This study aimed to coproduce a culturally adaptive storytelling video intervention to support the psychosocial well-being of Nepalese migrant workers.
A multimethods participatory study was conducted involving three different but interconnected phases: (1) formative research involving a systematic review, pilot survey and stakeholder consultations; (2) exploration and analysis of Nepalese literature relevant to contemporary migration; and (3) coproduction of a storytelling video intervention, using participatory workshops.
Convenience sample of outgoing and returnee migrant workers from the Gulf Cooperation Council (GCC) countries, their families and other relevant stakeholders in Dhading District of Bagmati Province, Nepal.
The systematic review of 33 included studies identified five key health issues: mental health; occupational hazards; sexual health; healthcare access; and infectious diseases. In the survey (n=60), workers reported various health problems including fever/common cold (42%); mental health problems (25%); and verbal abuse (35%). Twenty interviewees identified issues related to physical health (eg, pneumonia, kidney disease) as well as mental health (eg, anxiety, depression). Nepalese literary resources primarily portrayed themes of: separation; hopelessness and helplessness; and poor workplace environments. Drawing on these findings and iterative workshops with stakeholders, a culturally sensitive storytelling video intervention was coproduced to support the psychosocial well-being of Nepalese migrant workers in GCC countries. The intervention used an animated video format with audio narration and subtitles, presenting a story centred around the struggles of an archetypal male migrant worker and their use of coping strategies for dealing with adversities.
This is a feasibility study conducted in a single district of Nepal; as such, the findings should be generalised cautiously. Despite these limitations, the project is testament to the value of participatory methods in the development of culturally sensitive public health interventions for marginalised groups, and points to the utility of coproduced storytelling formats in migrant health contexts. Future research is needed to evaluate feasibility and acceptability of the intervention as well as the outcomes and experiences of migrant workers who engaged with the video.
Paudyal P
，Wasti SP
，Neupane P
，Sapkota JL
，Watts C
，Kulasabanathan K
，Silwal R
，Memon A
，Shukla P
，Pathak RS
，Michelson D
，Berry C
，Moult A
，Simkhada P
，van Teijlingen ER
，Cassell J
... -
《BMJ Open》
Gender differences in the context of interventions for improving health literacy in migrants: a qualitative evidence synthesis.
Health literacy can be defined as a person's knowledge, motivation and competence in four steps of health-related information processing - accessing, understanding, appraising and applying health-related information. Individuals with experience of migration may encounter difficulties with or barriers to these steps that may, in turn, lead to poorer health outcomes than those of the general population. Moreover, women and men have different health challenges and needs and may respond differently to interventions aimed at improving health literacy. In this review, we use 'gender' rather than 'sex' to discuss differences between men and women because gender is a broad term referring to roles, identities, behaviours and relationships associated with being male or female.
The overall objective of this qualitative evidence synthesis (QES) was to explore and explain probable gender differences in the health literacy of migrants. The findings of this QES can provide a comprehensive understanding of the role that any gender differences can play in the development, delivery and effectiveness of interventions for improving the health literacy of female and male migrants. This qualitative evidence synthesis had the following specific objectives: - to explore whether there are any gender differences in the health literacy of migrants; - to identify factors that may underlie any gender differences in the four steps of health information processing (access, understand, appraise, and apply); - to explore and explain gender differences found - or not found - in the effectiveness of health literacy interventions assessed in the effectiveness review that is linked to this QES (Baumeister 2023); - to explain - through synthesising findings from Baumeister 2023 and this QES - to what extent gender- and migration-specific factors may play a role in the development and delivery of health literacy interventions.
We conducted electronic searches in MEDLINE, CINAHL, PsycINFO and Embase until May 2021. We searched trial registries and conference proceedings. We conducted extensive handsearching and contacted study authors to identify all relevant studies. There were no restrictions in our search in terms of gender, ethnicity or geography.
We included qualitative trial-sibling studies directly associated with the interventions identified in the effectiveness review that we undertook in parallel with this QES. The studies involved adults who were first-generation migrants (i.e. had a direct migration experience) and used qualitative methods for both data collection and analysis.
We extracted data into a form that we developed specifically for this review. We assessed methodological limitations in the studies using the CASP (Critical Appraisal Skills Programme) Qualitative Studies) checklist. The data synthesis approach that we adopted was based on "best fit" framework synthesis. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our level of confidence in each finding. We followed PRISMA-E guidelines to report our findings regarding equity.
We included 27 qualitative trial-sibling studies directly associated with 24 interventions assessed in a linked effectiveness review (Baumeister 2023), which we undertook in parallel with this QES. Eleven studies included only women, one included only men and 15 included both. Most studies were conducted in the USA or Canada and primarily included people of Latino/Latina and Hispanic origin. The second most common origin was Asian (e.g. Chinese, Korean, Punjabi). Some studies lacked information about participant recruitment and consideration of ethical aspects. Reflexivity was lacking: only one study contained a reflection on the relationship between the researcher and participants and its impact on the research. None of the studies addressed our primary objective. Only three studies provided findings on gender aspects; these studies were conducted with women only. Below, we present findings from these studies, with our level of confidence in the evidence added in brackets. Accessing health information We found that 'migrant women of Korean and Afghan origin preferred access to a female doctor' (moderate confidence) for personal reasons or due to cultural norms. Our second finding was that 'Afghan migrant women considered their husbands to be gatekeepers', as women of an Afghan background stressed that, in their culture, the men were the heads of the household and the decision-makers, including in personal health matters that affected their wives (low confidence). Our third finding was 'Afghan migrant women reported limited English proficiency' (moderate confidence), which impeded their access to health information and services. Understanding health information Female migrants of Afghan background reported limited writing and reading abilities, which we termed 'Afghan migrant women reported low literacy levels' (moderate confidence). Applying health information Women of Afghan and Mexican backgrounds stated that the 'women's role in the community' (moderate confidence) prevented them from maintaining their own health and making themselves a priority; this impeded applying health information. Appraising health information We did not find any evidence related to this step in health information processing. Other findings In the full text of this QES, we report on migration-specific factors in health literacy and additional aspects related to health literacy in general, as well as how participants assessed the effectiveness of health literacy interventions in our linked effectiveness review. Moreover, we synthesised qualitative data with findings of the linked effectiveness review to report on gender- and migration-specific aspects that need to be taken into account in the development, design and delivery of health literacy interventions.
The question of whether gender differences exist in the health literacy of migrants cannot be fully answered in this qualitative evidence synthesis. Gender-specific findings were presented in only three of the 27 included studies. These findings represented only Afghan, Mexican and Korean women's views and were probably culturally-specific. We were unable to explore male migrants' perceived health literacy due to the notable lack of research involving migrant men. Research on male migrants' perceived health literacy and their health-related challenges is needed, as well as more research on potential gender roles and differences in the context of migration. Moreover, there is a need for more research in different countries and healthcare systems to create a more comprehensive picture of health literacy in the context of migration.
Aldin A
，Baumeister PhD A
，Chakraverty D
，Monsef I
，Noyes J
，Kalbe E
，Woopen C
，Skoetz N
... -
《Cochrane Database of Systematic Reviews》
ResearchGate
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钛学术
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