Top

International Journal for Equity in Health

Published in:

Open Access 01-12-2019 | Research

Salutogenic health promotion program for migrant women at risk of social exclusion

Authors: A. Bonmatí-Tomas, M. C. Malagón-Aguilera, S. Gelabert-Vilella, C. Bosch-Farré, L. Vaandrager, M. M. García-Gil, D. Juvinyà-Canal

Published in: International Journal for Equity in Health | Issue 1/2019

Abstract

Background

Migrant women at risk of social exclusion often experience health inequities based on gender, country of origin or socioeconomic status. Traditional health promotion programs designed for this population have focused on covering their basic needs or modifying lifestyle behaviors. The salutogenic model of health could offer a new perspective enabling health promotion programs to reduce the impact of health inequities. This study evaluated the effectiveness of a salutogenic health promotion program focused on the empowerment of migrant women at risk of social exclusion.

Methods

A four-session salutogenic health promotion program was conducted over a period of 6 months. In a quasi-experimental pre-test post-test design, an ad hoc questionnaire was administered to 26 women to collect sociodemographic data, together with 5 validated instruments: Antonovsky’s Sense of Coherence (SOC-13), Duke-UNC-11 (perceived social support), Quality of Life Short Form-36 (SF-36), Rosenberg’s Self-Esteem Scale, and the Cohen et al. Perceived Stress Scale (PSS-10). Descriptive analysis and multiple linear regression models were performed. Statistical tests were considered significant with a two-tailed p value < 0.05.

Results

Participants had a low initial SOC-13 score (60.36; SD 8.16), which did not show significant change after the health promotion program. Perceived social support (37.07; SD 6.28) and mental quality of life also remained unchanged, while physical quality of life increased from 50.84 (SD 4.60) to 53.08 (SD 5.31) (p = 0.049). Self-esteem showed an increasing trend from 30.14 (SD 4.21) to 31.92 (SD 4.38) (p = 0.120). Perceived stress decreased from 20.57 (SD 2.91) to 18.38 (SD 3.78) (p = 0.016). A greater effect was observed at the end of the program in women with lower initial scores for SOC-13 and quality of life and higher initial scores of perceived stress.

Conclusions

The health promotion program reduced perceived stress, increased physical quality of life and showed a trend toward increased self-esteem, especially among migrant women with multiple vulnerability factors. The salutogenic model of health should be considered as a good practice to apply in health promotion programs and to be included in national policies to reduce health inequity in migrant populations.

Available only for authorised users

Omidina P. Aging and family in an afghan refugee community. New York: Taylor&Francis Inc; 1996.

Nesterko Y, Braehler E, Grande G, Glaesmer H. Life satisfaction and health-related quality of life in immigrants and native-born Germans: the role of immigration-related factors. Qual Life Res. 2013;22(5):1005–13. https://doi.org/10.1007/s11136-012-0239-y.PubMedCrossRef

Bak-Klimek A, Karatzias T, Elliott L, Maclean R. The determinants of well-being among international economic immigrants: a systematic literature review and meta-analysis. Appl Res Qual Life. 2010;10(1):161–88. https://doi.org/10.1007/s11482-013-9297-8.CrossRef

Eurostat. Migration and migrant population statistics. Luxemburg: European Union; 2018. https://ec.europa.eu/eurostat/data/database. Accessed 4 Sept 2018

Idescat. Anuari estadístic de Catalunya. Barcelona: Generalitat de Catalunya; 2018. http://www.idescat.cat/pub/?id=aec&n=996. Accessed 11 Nov 2018

Bollini P, Siem H. No real progress towards equity: health of migrants and ethnic minorities on the eve of the year 2000. Soc Sci Med. 1995;41:819–28.CrossRef

Bregant T, Torosyan M, Shriwise A, Balwicki L, Tulchinsky T. Migrant and minority health in Europe: the way forward report on the Salzburg workshop on migrant and minority health, 3–9 April 2016. Public Health Rev. 2016;37:26. https://doi.org/10.1186/s40985-016-0045-0.PubMedCentralCrossRef

Bhugra D. Migration and mental health. Acta Psiquiatr Scan. 2004;109(4):243–58. https://doi.org/10.1046/j.0001-690X.2003.00246.x.CrossRef

Dow HD. An overview of stressors faced by immigrants and refugees: a guide for mental health practitioners. Home Health Care Manag Pract. 2001;23(3):210–7. https://doi.org/10.1177/1084822310390878.CrossRef

10.

Lipson J, Melies A. Issues in health care of middle eastern patients in cross culture medicine. West J Med. 1983;139(6):854–61.PubMedPubMedCentral

11.

Flaskerud JH, Winslow BJ. Conceptualizing vulnerable populations health-related research. Nurs Res. 1998;47(2):69–78.PubMedCrossRef

12.

Fernandez-Gutierrez M, Bas-Sarmiento P, Albar-Marin MJ, Paloma-Castro O, Romero-Sanchez JM. Health literacy interventions for immigrant populations a systematic review. Int Nurs Rev. 2018;65:54–64. https://doi.org/10.1111/inr.12373.PubMedCrossRef

13.

Urbanos-Garrido RM. Social inequalities in health: measuring the contribution of housing deprivation and social interactions for Spain. Int J Equity Health. 2012;11:77. https://doi.org/10.1186/1475-9276-11-77.PubMedPubMedCentralCrossRef

14.

De Vito C, Massimi A, Di Thiene D, Rosso A, D’Andrea E, Vacchio MR, Villari P, Marzuillo C. Low level of attention to health inequalities in prevention planning activities of the Italian regions. Int J Equity Health. 2016;19:15–28. https://doi.org/10.1186/s12939-016-0318-8.CrossRef

15.

Malmusi D, Borrell C, Benach J. Migration-related health inequalities: showing the complex interactions between gender, social class and place of origin. Soc Sci Med. 2010;71(9):1610–9. https://doi.org/10.1016/j.socscimed.2010.07.043.CrossRef

16.

Comisión para Reducir las Desigualdades Sociales en Salud en España. Avanzando hacia la equidad: propuesta de Políticas e intervenciones para reducir las desigualdades Sociales en salud en España. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad; 2015.

17.

Ahonen E, López-Jacob M, Vázquez M, Porthé V. Gil- González D, García a. invisible work, unseeen hazards: the health of women immigrant household service workers in Spain. Am J Ind Med. 2010;53(4):405–16.PubMedCrossRef

18.

Clark R, Anderson N, Clark V, Williams D. Racism as a stressor for African Americans: a biopsychosocial model. Am Psychol. 1999;54(10):805–16.PubMedCrossRef

19.

Miller C, Kaiser C. A theoretical perspective on coping with stigma. J Soc Issues. 2001;57(1):73–92. https://doi.org/10.1111/0022-4537.00202.CrossRef

20.

Aguadelo-Suárez A, Gil-González D, Ronda-Pérez E, Porthé V, Paramio-Pérez G, García A, Garí A. Discrimination, work and health in immigrant populations in Spain. Soc Sci Med. 2009;68(10):1866–74.CrossRef

21.

Major B, O’Brien L. The social psychlogy of stigma. Annu Rev Clin Psychol. 2005;56:393–421. https://doi.org/10.1146/annurev.psych.56.091103.070137.CrossRef

22.

Corker E, Brown J, Henderson C. How does self stigma differ across people with psychiatric diagnoses and rheumatoid arthritis, and how does it impact on self-esteem and empowerment? Psychol Health Med. 2016;85:1–13. https://doi.org/10.1080/13548506.2016.1139139.CrossRef

23.

Mann M, Hosman CMH, Schaalma HP, de Vries NK. Self-esteem in a broad-spectrum approach for mental health promotion. Health Educ Res. 2004;19(4):357–72. https://doi.org/10.1093/her/cyg041.PubMedCrossRef

24.

Brown GK, Bifuco A, Andrews B. Self esteem and depression III. Aetiological issues. Soc Psychiatry Psychiatr Epidemio. 1990;25(5):235–43.CrossRef

25.

Rutter M. Psychological resilience and protective mechanisms. In: Rolf JA, Masten D, Cichetti K, Nuechterlein SW, editors. Risk and Protective Factors in the Development of Psychopathology. Cambridge: Cambridge University Press; 1993. p. 181–214.

26.

Trickett E, Buchanan R. The role of personal relationships in transitions: contributions of an ecological perspective. In: Sarason B, Duck S, editors. Personal relationships: implications for clinical and community psychology. Chichester: Wiley; 2001. p. 141–57.

27.

Gracia E, Herrero J. Personal and situational determinants of relationship-specific perceptions of social support. Soc Behav Pers. 2004;32(5):459–76. https://doi.org/10.2224/sbp.2004.32.5.459.CrossRef

28.

UCL Institute of Health Equity. Review of social determinants and the health divide in the WHO European Region: Executive Summary. 2013. http://www.instituteofhealthequity.org/resources-reports/review-of-social-determinants-and-the-health-divide-in-the-who-european-region-final-report

29.

Maxwell AE, Young S, Crespi CM, Vega RR, Cayetano RT, Bastani R. Social determinants of health in the Mixtec and Zapotec community in Ventura County, California. Int J Equity Health. 2015;14:16. https://doi.org/10.1186/s12939-015-0148-0.PubMedPubMedCentralCrossRef

30.

Capewell S, Graham H. Will cardiovascular disease prevention widen health inequalities? PLoS Med. 2010;7:e1000320.PubMedPubMedCentralCrossRef

31.

Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Public Health Rev. 2010;64:284–91.

32.

Ministerio de Sanidad, Consumo y Bienestar Social. Estrategia de Promoción de la Salud y Prevención en el Sistema Nacional de Salud. Memoria Buenas Prácticas. 2017. http://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/Estrategia/docs/MemoriaBuenasPracticasEstrategia_2017.pdf

33.

Comisión para Reducir las Desigualdades Sociales en Salud en España. Propuesta de políticas e intervenciones para reducir las desigualdades sociales en salud en España. Gac Sanit. 2012;26(2):182–9. https://doi.org/10.1016/j.gaceta.2011.07.024.CrossRef

34.

Antonovsky A. Health, stress and coping. San Francisco: Jossey-Bass; 1979.

35.

Eriksson M, Lindström B. Validity of Antonovsky’s sense of coherence scale: a systematic review. J Epidemiol Public Health Rev. 2005;59(6):460–6. https://doi.org/10.1136/jech.2003.018085.CrossRef

36.

Antonovsky A. Unraveling the mystery of health. San Francisco: Jossey-Bass; 1987.

37.

Langeland E, Riise T, Hanestad BR, Nortvedt MW, Kristoffersen K, Wahl AK. The effect of salutogenic treatment principles on coping with mental health problems. A randomised controlled trial. Patient Educ Couns. 2006;62(2):212–9. https://doi.org/10.1016/j.pec.2005.07.004.PubMedCrossRef

38.

Van der Waerden JEB, Hoefnagels C, Hosman CH, Souren PM, Jansen MWJ. A randomized controlled trial of combined exercise and psycho-education for low-SES women: short-and long-term outcomes in the reduction of stress and depressive symptoms. Soc Sci Med. 2013;91:84–93. https://doi.org/10.1016/j.socscimed.2013.05.015.PubMedCrossRef

39.

Antonovsky A. The structure and properties of the sense of coherence scale. Soc Sci Med. 1993;36:725–33.PubMedCrossRef

40.

Virués-Ortega J, Martínez-Martín P, del Barrio JL, Lozano LM. Validación transcultural de la Escala de Sentido de Coherencia de Antonovsky (OLQ-13) en ancianos mayores de 70 años. Med Clín. 2007;128(13):486–92. https://doi.org/10.1157/13100935.CrossRef

41.

Malagón-Aguilera M, Juvinyà Canal D, Bonmatí-Tomàs A, Fernández-Peña R, Bosch-Farré C, Bertran Noguer C, Suñer-Soler R. Sentido de coherencia de las enfermeras y validación del cuestionario SOC-13. Metas Enferm. 2012;15(9):27–31.

42.

Bellon Saameno JA, Delgado SA, Luna del Castillo JD, Lardelli CP. Validez y fiabilidad del cuestionario de apoyo social funcional Duke-UNC-11. Atenc Prim. 1996;18(4):153–63.

43.

Vilagut G, Valderas J, Ferrer M, Garín O, Lopez-Garcia E, Alonso J. Interpretación de los cuestionarios de salud SF-36 y SF-12 en España: componentes físico y mental. Med Clín. 2008;130(19):726–35. https://doi.org/10.1157/13121076.CrossRef

44.

Martín-Albo J, Núñiez JL, Navarro JG, Grijalvo F. The Rosenberg self-esteem scale: translation and validation in university students. Span J Psychol. 2007;10(2):458–67. https://doi.org/10.1017/S1138741600006727.PubMedCrossRef

45.

Remor E. Psychometric properties of a European Spanish version of the perceived stress scale (PSS). Span J Psychol. 2006;9(1):86–93.CrossRef

46.

Bayram N, Thorburn D, Demirhan H, Bilgel N. Quality of life among Turkish immigrants in Sweden. Qual Health Res. 2007;16(8):1319–33. https://doi.org/10.1007/s11136-007-9249-6.CrossRef

47.

Bhugra D, Becker M. Migration, cultural bereavement and cultural identity. World Psychiatry. 2005;4(1):18–24.PubMedPubMedCentral

48.

Berjot S, Gillet N. Stress and coping with discrimination and stigmatization. Front Psychol. 2011;2(33):1–13. https://doi.org/10.3389/fpsyg.2011.00033.CrossRef

49.

Spry N, Marchant T. How a personal development program enhances social connection and mobilises women in the community. Aust J Adult Learn. 2014;54(2):32–53.

50.

Frohlich KL, Potvin L. The inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008;98:216–21.PubMedPubMedCentralCrossRef

51.

Van der Waerden JEB, Jansen M, Hoefnagels C, Hosman C. Do disavadvantaged women appreciate a synergetic exercise and psychoeducative program? Rationale process evaluation of the exercise without worries course. Int J Pers Cent Med. 2011;17:180–99.

52.

Golding J. Role occupancy and role-specific stress and social support and predictors of depression. Basic Appl Soc Psych. 1989;10(2):173–95. https://doi.org/10.1207/s15324834basp1002_7.CrossRef

53.

Gary FA. Stigma: Barrier to mental health care among ethnic minorities. Issues Ment Health Nurs. 2005;26(10):979–99. https://doi.org/10.1080/01612840500280638.PubMedCrossRef

54.

Bekhuis E, Boschloo L, Rosmalen JGM, Schoevers RA. Differential associations of specific depressive and anxiety disorders with somatic symptoms. J Psychosom Res. 2015;78:116–22. https://doi.org/10.1016/j.jpsychores.2014.11.007.PubMedCrossRef

55.

Costanza R, Fisher B, Ali S, Beer C, Bond L, Boumans R, Louis N, et al. Quality of life: an approach integrating opportunities, human needs, and subjective well-being. Ecol Econom. 2007;61(2–3):267–76. https://doi.org/10.1016/j.ecolecon.2006.02.023.CrossRef

56.

Wong W, Ho P, Liang J, Holroyd E, Lam C, Pau A. Road to better health and integration: a Delphi study on health service models for Hong Kong migrants. Int J Equity Health. 2014;13:127. https://doi.org/10.1186/s12939-014-0127-x.PubMedPubMedCentralCrossRef

Title: Salutogenic health promotion program for migrant women at risk of social exclusion
Authors: A. Bonmatí-Tomas
M. C. Malagón-Aguilera
S. Gelabert-Vilella
C. Bosch-Farré
L. Vaandrager
M. M. García-Gil
D. Juvinyà-Canal
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: International Journal for Equity in Health / Issue 1/2019
Electronic ISSN: 1475-9276
DOI: https://doi.org/10.1186/s12939-019-1032-0

At a glance: The STEP trials

Springer Medicine

Salutogenic health promotion program for migrant women at risk of social exclusion

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2019

Through health workers’ eyes: a qualitative study of health service provision for migrants at Schengen border

Understanding the experiences, perspectives and values of indigenous women around smoking cessation in pregnancy: systematic review and thematic synthesis of qualitative studies

Barriers and facilitators to the implementation of brief interventions targeting smoking, nutrition, and physical activity for indigenous populations: a narrative review

Social and cultural construction processes involved in HPV vaccine hesitancy among Chinese women: a qualitative study

Healthcare-seeking behavior among pregnant women in the Chinese hierarchical medical system: a cross-sectional study

Beyond enrolments: a systematic review exploring the factors affecting the retention of Aboriginal and Torres Strait Islander health students in the tertiary education system