Evaluation of self-competency of family physicians and family health workers in providing health services to Syrian children: an example from Ankara, Türkiye

Year 2024, Volume: 22 Issue: 1, 72 - 86, 26.04.2024

Damla Özyürek , L. Hilal Özcebe

https://doi.org/10.20518/tjph.1375539

Abstract

Objective: Türkiye is an immigrant-intensive country and primary health care services are the first health institution to apply for migrant children. In this research, it is aimed to evaluate how competent family physicians and family health workers working at where high Syrian migration population live consider themselves in providing health services to Syrian children.
Methods: This descriptive research was conducted among 224 family health physician and 250 family health workers in seven districts with a high migrant population in Ankara, Türkiye. Language knowledge and abroad experience was asked to the participants. The questionnaire included the participants’ education on migrant health, their experience in providing health care to migrant people. Multinomial logistic regression analysis was used to evaluate factors associated with experiencing difficulties in serving immigrant children.
Results: Over the third-four of the family physicians (78.9%) and more than one-third of the family health workers (31.6%) knew at least one foreign language (p<0.001). Cultural competence and taking immigrant health courses before graduation are associated with low level difficulty in providing child health care (p<0.05). Higher cultural competency scale score is associated lower health service difficulty level in proving health care to immigrant children (p<0.05).
Conclusion: Health professionals have difficulties in providing health services to immigrant children due to training on migrant health and cultural differences. Development of migrant health education is important to reduce the difficulties experienced by health professionals. Supporting foreign language education will facilitate health professionals to remove barriers in communication.

Keywords

Migrant, Child Health, Health Service, Cultural Competency

References

• World Migration Report 2022. In: IOM UN Migration Publications Platform [online]. Available at: https://publications.iom.int/books/world-migration-report-2022. Accessed January 20,2024.
• Yıllara Göre Geçici Koruma Kapsamındaki Suriyeliler. In: T.C. İçişleri Bakanlığı Göç İdaresi Başkanlığı. Available at: https://www.goc.gov.tr/gecici-koruma5638. Accessed March 9, 2024.
• Ekmekci PE. Syrian Refugees, Health and Migration Legislation in Turkey. J Immigr Minor Health 2017;19(6):1434-41.
• Kadir A, Battersby A, Spencer N, Hjern A. Children on the move in Europe: a narrative review of the evidence on the health risks, health needs and health policy for asylum seeking, refugee and undocumented children. BMJ Paediatr Open 2019;3(1):e000364.
• Stevens AJ. How can we meet the health needs of child refugees, asylum seekers and undocumented migrants? Arch Dis Child 2020;105(2):191-6.
• Büyüktiryaki M, Canpolat FE, Alyamaç Dizdar E et al. Neonatal outcomes of Syrian refugees delivered in a tertiary hospital in Ankara, Turkey. Confl Health 2015; 38(9).
• Perk O, Yılmaz Candar A. Evaluation of Syrian Patients Followed in Children Intensive Care Unit: Syrian Immigrants children. Chronicles of Precision Medical Researchers 2022; 3(1), 16–20.
• Yalaki Z, Taşar M, Ünsal Saç R, Uslu Gökçeoğlu A, Şimşek Orhon F. Evaluation of Child Refugees’ Reasons for Applying to Hospital: Ankara Experience. J Contemp Med. 2020;10(4):510-515.
• Kınık K, Koçak H, Mayadağlı A. Evaluation of the National Health System Utilization Status of the Syrian Refugees in Turkey Between 2011 and 2017. Disaster Med Public Health Prep. 2022;17:e92.
• Babacan T, Yılmaz TE, Babacan MT et al. Evaluation of immigrant health services in Turkey: a single-center study. J Public Health (Berl.) 2022; 30, 2491–2498.
• Ayhan Baser D, Mıhcı Ö, Direk MT, Cankurtaran M. Views and experiences of family physicians about Syrian refugee patients in Turkey: a qualitative research. Prim Health Care Res Dev. 2021;22:e19.
• Dikmetaş YE, Coşkun UN, Yardan T. Göçmen Hastalar ile Aile Hekimliği Personeli Arasindaki İletişim . Samsun Sağlık Bilimleri Dergisi 2016;1(2):83-92.
• Savci C. Göçmen / Mülteci / Sığınmacı Hastalara Bakım Veren Hemşire ve Ebelerin Karşılaştıkları Güçlüklerin Belirlenmesi. Social Sciences Studies Journal 2019;5(43):4631-4637.
• Zengin M, Düken ME, Yayan EH, Dağ YS. Hemşirelerin Suriyeli Sığınmacı Çocuklara Bakım Verirken Yaşadığı Güçlükler. İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek Okulu Dergisi 2021;9(1):252-263.
• Tengilimoğlu D, Zekioğlu A, Budak F, Eriş H, Younis M. Refugees’ Opinions about Healthcare Services: A Case of Turkey. Healthcare (Basel) 2021;9(5):e490.
• Lars TF, Kathy Ainul M, Esperanza D. Primary healthcare usage and morbidity among immigrant children compared with non-immigrant children: a population-based study in Norway. BMJ Open 2016;6(10):e012101.
• Savran S, Sat NA. Ankara’da Suriyeli Göçmenlerin Yer Seçimi Tercihlerinin İncelenmesi ve Bir Etnik Kentsel Adacık Örneği Olarak Önder, Ulubey, Alemdağ Mahalleleri. Ankara Araştırmaları Dergisi 2019;7(2):283 - 302.
• Gözüm S, Tuzcu A, Yurt S. Developing a Cultural Competency Scale for Primary Health Care Professionals. Studies in Psychology 2020;40(2):429-450.
• Sevinç S, Kılıç SP, Ajghif M, Öztürk MH, Karadağ E. Difficulties encountered by hospitalized Syrian refugees and their expectations from nurses. Int Nurs Rev. 2016;63(3):406-414.
• Gruner D, Feinberg Y, Venables MJ, Shanza Hashmi S, Saad A, Archibald D, et al. An undergraduate medical education framework for refugee and migrant health: Curriculum development and conceptual approaches. BMC Medical Education. 2022;22(1):374.
• Yılmaz M, Kuğuoğlu S. Çocuk Kliniklerinde Çalışan Hemşirelerin Kültürel Yeterlilik Düzeyleri: Bir Devlet Hastanesi Örneği. Kırşehir Ahi Evran Üniversitesi Sağlık Bilimleri Dergisi 2023;7(3):205-213.
• Türker A. Aile sağlığı merkezinde çalışan hemşire ve ebelerin sağlık iletişimi yeterlilikleri ve kültürlerarası etkililikleri. In:ProQuest Dissertations & Theses Global. Available at: https://www.proquest.com/dissertations-theses/aile-sağlığı-merkezinde-çalışan-hemşire-ve/docview/2468382291/se-2. 2019. Accessed:January 20,2024.
• Yılmaz M, Yeni C, Avcı E, Uluk N. Aile Sağlığı Merkezlerinde Çalışan Hemşire/Ebelerin Kültürel Duyarlılık ve Kültürel Beceri Düzeylerinin İncelenmesi. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi 2019;12(3):170-8.
• Jowsey T. Three zones of cultural competency: surface competency, bias twilight, and the confronting midnight zone. BMC Med Educ 2019;19(1):e306.
• Chohan N, Arzoky Z, Khan N. Twelve tips for incorporating migrant and ethnic minorities in the medical curriculum and healthcare. Med Teach. 2021;43(10):1122-6.
• Wang C, Shakespeare-Finch J, Dunne MP, Hou XY, Khawaja NG. How much can our universities do in the development of cultural intelligence? A cross-sectional study among health care students. Nurse Educ Today 2021;103:e104956.
• Slifko SE, Vielot NA, Becker-Dreps S, Pathman DE, Myers JG, Carlough M. Students with global experiences during medical school are more likely to work in settings that focus on the underserved: an observational study from a public U.S. institution. BMC Med Educ 2021;21(1):e552.
• Nishigori H, Takahashi O, Sugimoto N, Kitamura K, McMahon GT. A national survey of international electives for medical students in Japan: 2009-2010. Med Teach 2012;34(1):71-3.
• Tamamaki K, Nishio H. Study abroad experience is related to Japanese doctors’ behavior to see foreign patients. Kobe J Med Sci 2013;59(1):e10-6.
• Artuğ CG, Beydağ KD. Mülteci Gebe ve Lohusa Kadınlara Bakım Veren Ebe ve Hemşirelerin Bakım Verme ve Bakımı Sürdürmede Yaşadığı Güçlükler. Dünya İnsan Bilimleri Dergisi 2022;2:53-72.
• Rogers HJ, Hogan L, Coates D, Homer CSE, Henry A. Responding to the health needs of women from migrant and refugee backgrounds-Models of maternity and postpartum care in high-income countries: A systematic scoping review. Health Soc Care Community 2020;28(5):1343-65.
• Winn A, Hetherington E, Tough S. Caring for pregnant refugee women in a turbulent policy landscape: perspectives of health care professionals in Calgary, Alberta. Int J Equity Health 2018;17(1):e91.
• Batista R, Pottie K, Bouchard L, Ng E, Tanuseputro P, Tugwell P. Primary Health Care Models Addressing Health Equity for Immigrants: A Systematic Scoping Review. J Immigr Minor Health 2018;20(1):214-30.
• Azad F, Rifat MA, Manir MZ, Biva NA. Breastfeeding support through wet nursing during nutritional emergency: A cross sectional study from Rohingya refugee camps in Bangladesh. PLoS One 2019;14(10):e0222980.
• Işık H, Arça G. Anne Sütü ve Emzirmeye İlişkin Ebe ve Hemşirenin Rolü. Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi 2019;1(3):221-8.
• George P, Terrion JL, Ahmed R. Reproductive health behaviour of Muslim immigrant women in Canada. International Journal of Migration, Health and Social Care 2014;10:88-101.
• Kroening AL, Moore JA, Welch TR, Halterman JS, Hyman SL. Developmental Screening of Refugees: A Qualitative Study. Pediatrics 2016;138(3): e20160234.
• Audi MN, Mwenda KM, Wei G, Lurie MN. Healthcare accessibility in preconflict Syria: a comparative spatial analysis. BMJ Open 2022;12(5):e059210.
• Aile Hekimliği Uygulama Yönetmeliği. In: T.C. Cumhurbaşkanlığı Mevzuat Bilgi Sistemi. Available at: https://www.mevzuat.gov.tr/t?MevzuatNo=17051&MevzuatTur=7&MevzuatTertip=5. Accessed January 22,2024.
• Çelebi C. Hemşirelerin Farklı Kültürden Olan Hastaya Yaklaşımları, Yüksek Lisans Tezi. In: Yükseköğretim Kurulu Başkanlığı Tez Merkezi. Available at: https://tez.yok.gov.tr/UlusalTezMerkezi/giris.jsp. Accessed January 22,2024. Accessed January 22,2024.
• Delilovic S, Kulane A, Åsbring N, Marttila A, Lönnroth K. What value for whom? – provider perspectives on health examinations for asylum seekers in Stockholm, Sweden. BMC Health Services Research 2018;18(1):e601.
• Jongen, C., J. McCalman, and R. Bainbridge, Health workforce cultural competency interventions: a systematic scoping review. BMC Health Serv Res 2018;18(1):232.
• Perng SJ, Watson R. Construct validation of the nurse cultural competence scale: A hierarchy of abilities. Journal of clinical nursing. 2012; 21(11-12): 1678-1684.