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      The COVID-19 vaccination experience of non-English speaking immigrant and refugee communities of color: A community co-created study

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          Abstract

          In this community-partnered study we conducted focus groups with non-English speaking immigrant and refugee communities of color in 4 languages to understand their perspectives on COVID-19 vaccines, barriers to accessing vaccines, and recommendations for healthcare providers. We used a mixed deductive-inductive thematic analysis approach and human centered design to guide data analysis. 66 individuals participated; 85% were vaccinated. The vaccination experience was often positive; however, participants described language inaccessibility, often relying on family members for interpretation. Community-based organizations played a role in connecting participants to vaccines. Unvaccinated participants expressed fear of side effects and belief in natural immunity. Participants shared recommendations to providers around increasing vaccine access, improving language accessibility, and building trust. Results from our study show numerous barriers immigrant and refugee communities of color faced getting their COVID-19 vaccine, but also highlights opportunities to engage with community partners. Future implications for research, policy, and practice are described.

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          Most cited references64

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          The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health.

          Intersectionality is a theoretical framework that posits that multiple social categories (e.g., race, ethnicity, gender, sexual orientation, socioeconomic status) intersect at the micro level of individual experience to reflect multiple interlocking systems of privilege and oppression at the macro, social-structural level (e.g., racism, sexism, heterosexism). Public health's commitment to social justice makes it a natural fit with intersectionality's focus on multiple historically oppressed populations. Yet despite a plethora of research focused on these populations, public health studies that reflect intersectionality in their theoretical frameworks, designs, analyses, or interpretations are rare. Accordingly, I describe the history and central tenets of intersectionality, address some theoretical and methodological challenges, and highlight the benefits of intersectionality for public health theory, research, and policy.
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            More than culture: structural racism, intersectionality theory, and immigrant health.

            Explanations for immigrant health outcomes often invoke culture through the use of the concept of acculturation. The over reliance on cultural explanations for immigrant health outcomes has been the topic of growing debate, with the critics' main concern being that such explanations obscure the impact of structural factors on immigrant health disparities. In this paper, we highlight the shortcomings of cultural explanations as currently employed in the health literature, and argue for a shift from individual culture-based frameworks, to perspectives that address how multiple dimensions of inequality intersect to impact health outcomes. Based on our review of the literature, we suggest specific lines of inquiry regarding immigrants' experiences with day-to-day discrimination, as well as on the roles that place and immigration policies play in shaping immigrant health outcomes. The paper concludes with suggestions for integrating intersectionality theory in future research on immigrant health. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Is Open Access

              Barriers to health care for undocumented immigrants: a literature review

              With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations, to discrimination and fear of deportation. This paper is aimed at reviewing the literature on barriers to health care for undocumented immigrants and identifying strategies that have or could be used to address these barriers. To address study questions, we conducted a literature review of published articles from the last 10 years in PubMed using three main concepts: immigrants, undocumented, and access to health care. The search yielded 341 articles of which 66 met study criteria. With regard to barriers, we identified barriers in the policy arena focused on issues related to law and policy including limitations to access and type of health care. These varied widely across countries but ultimately impacted the type and amount of health care any undocumented immigrant could receive. Within the health system, barriers included bureaucratic obstacles including paperwork and registration systems. The alternative care available (safety net) was generally limited and overwhelmed. Finally, there was evidence of widespread discriminatory practices within the health care system itself. The individual level focused on the immigrant’s fear of deportation, stigma, and lack of capital (both social and financial) to obtain services. Recommendations identified in the papers reviewed included advocating for policy change to increase access to health care for undocumented immigrants, providing novel insurance options, expanding safety net services, training providers to better care for immigrant populations, and educating undocumented immigrants on navigating the system. There are numerous barriers to health care for undocumented immigrants. These vary by country and frequently change. Despite concerns that access to health care attracts immigrants, data demonstrates that people generally do not migrate to obtain health care. Solutions are needed that provide for noncitizens’ health care.
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                Author and article information

                Journal
                Community Health Equity Res Policy
                Community Health Equity Res Policy
                spqch
                QCH
                Community Health Equity Research & Policy
                SAGE Publications (Sage CA: Los Angeles, CA )
                2752-535X
                2752-5368
                25 October 2022
                25 October 2022
                : 2752535X221133140
                Affiliations
                [1 ]universityJewish Family Community Services; , Pittsburgh, PA, USA
                [2 ]Division of Immersive Media, Ringgold 6604, universityChatham University; , Pittsburgh, PA, USA
                [3 ]universityCasa San Jose; , Pittsburgh, PA, USA
                [4 ]universityFamilia & Comunidad Outreach; , Westmoreland, PA, USA
                [5 ]universityOCA Asian Pacific American Advocates--Pittsburgh Chapter; , Pittsburgh, PA, USA
                [6 ]universityAPALA Pittsburgh; , Pittsburgh, PA, USA
                [7 ]Division of Adolescent and Young Adult Medicine, Ringgold 6614, universityUniversity of Pittsburgh; , Pittsburgh, PA, USA
                [8 ]universityCongolese Union of Pittsburgh; , Pittsburgh, PA, USA
                [9 ]Division of General Academic Pediatrics, Ringgold 6614, universityUniversity of Pittsburgh and UPMC Pittsburgh; , PA, USA
                [10 ]universityBhutanese Community Association of Pittsburgh; , Pittsburgh, PA, USA
                [11 ]universitySomali Bantu Community Association of Pittsburgh; , Pittsburgh, PA, USA
                [12 ]Department of Medicine, Ringgold 6614, universityUniversity of Pittsburgh; , Pittsburgh, PA, USA
                [13 ]Department of Behavioral and Community Health Sciences, Ringgold 6614, universityUniversity of Pittsburgh; universitySchool of Public Health; , Pittsburgh, PA, USA
                Author notes
                [*]Maya I. Ragavan, University of Pittsburgh, 3414 Fifth Avenue, Pittsburgh, PA 15213, USA. Email: ragavanm@ 123456chp.edu
                Author information
                https://orcid.org/0000-0003-4443-6829
                Article
                10.1177_2752535X221133140
                10.1177/2752535X221133140
                9597283
                36283968
                384a4450-31a8-4a89-ac57-793b1b0afd8a
                © The Author(s) 2022

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Funding
                Funded by: CTSI Pilot Grant;
                Categories
                Applied Research
                Custom metadata
                corrected-proof
                ts10

                immigrant and refugee,language justice,structural inequities,community-partnered research,qualitative methods,covid-19 vaccines

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