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      Challenges of nursing research with immigrant and refugee populations: methodological and pragmatic considerations Translated title: Desafíos de la investigación en enfermería con poblaciones inmigrantes y refugiadas: consideraciones metodológicas y pragmáticas Translated title: Desafios da pesquisa em enfermagem com populações imigrantes e refugiadas: considerações metodológicas e pragmáticas


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          The objective of the study was to identify the main challenges in conducting research with immigrants and refugees and to provide seven methodological and pragmatic strategies. The analyses presented, based on the Theory of Culture Care Diversity and Universality, are extracted from insights of the authors’ experiences as researchers and the literature. The main challenges are related to cultural, moral, political, and educational differences between researcher and researched; identification of the universe and sampling; access to informants through the barrier of distrust; and communication and language difficulties. Strategies to make research more successful involve: developing a thorough research protocol; creatively recruiting participants; developing strategies to facilitate communication; having a sensitive look; offering a structure of reciprocity; increasing trust, and triangulating research. The main methodological and pragmatic issues in studies with immigrants and refugees were explored, providing valuable guidance for future projects. However, in different migration situations, researchers must be aware of the possibility of other challenges arising during the investigative process.


          O objetivo do estudo foi identificar os principais desafios na condução de pesquisas com imigrantes e refugiados e fornecer sete estratégias metodológicas e pragmáticas. As análises apresentadas, embasadas na Teoria da Diversidade e Universalidade do Cuidado Cultural, são extraídas de insights das experiências dos autores enquanto pesquisadores e da literatura. Os principais desafios relacionam-se a diferenças culturais, morais, políticas e educacionais entre pesquisador e pesquisado; identificação do universo e amostragem; acesso aos informantes pela barreira da desconfiança; e dificuldade de comunicação e idioma. As estratégias para tornar a pesquisa mais exitosa envolvem: desenvolver um minucioso protocolo de pesquisa; recrutar participantes de forma criativa; elaborar estratégias para facilitar a comunicação; ter olhar sensível; oferecer uma estrutura de reciprocidade; ampliar a confiança e triangular a pesquisa. Foram exploradas as principais questões metodológicas e pragmáticas nos estudos com imigrantes e refugiados, fornecendo orientações valiosas para projetos futuros. Entretanto, em diferentes situações de migração, os pesquisadores devem atentar-se para a possibilidade de surgirem outros desafios durante o processo investigativo.


          El objetivo del estudio fue identificar los principales desafíos al realizar investigaciones con inmigrantes y refugiados y proporcionar siete estrategias metodológicas y pragmáticas. Los análisis presentados, basados en la Teoría de Diversidad y Universalidad de la Atención Cultural, se extraen de insights de las experiencias de los autores como investigadores y de la literatura. Los principales desafíos están relacionados con las diferencias culturales, morales, políticas y educativas entre investigador e investigado; identificación del universo y muestreo; acceso a informantes a través de la barrera de la desconfianza; y dificultades de comunicación y lenguaje. Las estrategias para lograr que la investigación sea más exitosa implican: desarrollar un protocolo de investigación exhaustivo; reclutar participantes de forma creativa; desarrollar estrategias para facilitar la comunicación; tener una mirada sensible; ofrecer una estructura de reciprocidad; aumentar la confianza y triangular la investigación. Se exploraron las principales cuestiones metodológicas y pragmáticas en los estudios con inmigrantes y refugiados, proporcionando una valiosa orientación para proyectos futuros. Sin embargo, en diferentes situaciones migratorias, los investigadores deben ser conscientes de la posibilidad de que surjan otros desafíos durante el proceso de investigación.

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          Leininger's Theory of Culture Care Diversity and Universality: An Overview With a Historical Retrospective and a View Toward the Future.

          An historical overview of Leininger's Theory of Culture Care Diversity and Universality also known as the Culture Care Theory (CCT) and evolution of the Sunrise Enabler are presented along with descriptions of the theory purpose, goal, tenets, basic assumptions, major core constructs, and orientational definitions. Recent articles, books, and book chapters provide relevant exemplars to enhance scholarly understanding and application of theory constructs. Proposed future directions encompass using the CCT to guide research of discovery and translational research projects for evidenced-based nursing practice; develop nursing courses and curricula to prepare culturally competent nurses; guide future culturally competent administrative and leadership policies and procedures; inform public policy related to cultural diversity and underserved populations; promote grant writing initiatives to enhance cultural diversity in hiring nursing staff, supervisors, and faculty; and promote admission of nursing students from underserved and/or diverse backgrounds.
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            Cohort Analysis of Immigrant Rhetoric on Timely and Regular Access of Prenatal Care

            To assess whether recent anti-immigration rhetoric is significantly associated with inadequate prenatal care. This was a population-based cohort study (2011–2017). In their native language, patients were consented and queried regarding country of origin and time in the United States. Additional variables were collected or abstracted from the medical record, including documentation and timing of prenatal visits. Based on relevance and prevalence during the study period, publicly available Google search trends were mined for the terms “Make America Great Again,” “Mexico Wall,” and “Deportation” by geographic region. The time of first deviation from the mode Google search popularity value for each term was ascertained (mode inflection date). Perinatal data was averaged over 15 day moving windows, and the Adequacy of Prenatal Care Utilization Index (APNCU) was used to categorically define inadequate prenatal care by validated standards. Twenty-four thousand nine hundred thirty-three deliveries occurred during the study period. A mode inflection date was extrapolated from Google trend analytics and used to define the period prior to change in trends use pre (before rhetoric) and post (after rhetoric). Coincident to the rhetoric change, there was a significant increase in days until first prenatal visit, fewer prenatal visits and a decreased trend of mean hemoglobin nadir among U.S. non-native Hispanics ( p <0.001). Immigrant status was an independent predictor of inadequate prenatal care as defined by the APNCU standard with increased adjusted odds among Hispanics (aOR 1.581, 95% CI 1.407–1.7771.4–1.8) coincident with anti-immigration rhetoric. Our findings are of likely significant public health importance, and suggest that recent anti-immigrant rhetoric is associated with adequate, timely, and regular access to prenatal care among nearly 25,000 deliveries in Houston, Texas. There is a temporal association between increased anti-immigrant political rhetoric and inadequate prenatal care among U.S. native and U.S. non-native gravidae.
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              Recruiting African Immigrant Women for Community-Based Cancer Prevention Studies: Lessons Learned from the AfroPap Study

              Recruitment in research can be challenging, particularly for racial/ethnic minorities and immigrants. There remains a dearth of research identifying the health and sociocultural needs of these populations related to recruitment. To describe our experiences and lessons learned in recruiting African immigrant (AI) women for the AfroPap study, a community-based study examining correlates of cervical cancer screening behaviors. We developed several recruitment strategies in collaboration with key informants and considered published recruitment methods proven effective in immigrant populations. We also evaluated the various recruitment strategies using recruitment records and study team meeting logs. We enrolled 167 AI women in the AfroPap study. We used the following recruitment strategies: (1) Mobilizing African churches; (2) Utilizing word of mouth through family and friends; (3) Maximizing research team’s cultural competence and gender concordance; (4) Promoting altruism through health education; (5) Ensuring confidentiality through the consenting and data collection processes; and (6) Providing options for data collection. Online recruitment via WhatsApp was an effective recruitment strategy because it built on existing information sharing norms within the community. Fear of confidentiality breaches and time constraints were the most common barriers to recruitment. We were successful in recruiting a “hard-to-reach” immigrant population in a study to understand the correlates of cervical cancer screening behaviors among AI women by using a variety of recruitment strategies. For future research involving African immigrants, using the internet and social media to recruit participants is a promising strategy to consider.

                Author and article information

                Rev Esc Enferm USP
                Rev Esc Enferm USP
                Revista da Escola de Enfermagem da USP
                Universidade de São Paulo, Escola de Enfermagem
                20 May 2024
                : 58
                : e20230417
                [1 ]Universidade Estadual de Maringá, Departamento de Enfermagem, Maringá, PR, Brazil.
                [2 ]Universidade Federal de Mato Grosso do Sul, Três Lagoas, MS, Brazil.
                [3 ]Universidad de Antofagasta, Departamento de Enfermería, Antofagasta, AN, Chile.
                Author notes
                Corresponding author: Mayckel da Silva Barreto, Av. Colombo, 5790, Zona 7 87020-900 – Maringá, PR, Brazil msbarreto@ 123456uem.br

                ASSOCIATE EDITOR: Paulino Artur Ferreira de Sousa

                Author information

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 20 December 2023
                : 20 March 2024
                Page count
                Figures: 02, References: 21
                Theoretical Study

                emigrants and immigrants,refugees,nursing,nursing research,research promotion,emigrantes e inmigrantes,refugiados,enfermería,investigación en enfermería,promoción de la investigación,emigrantes e imigrantes,enfermagem,pesquisa em enfermagem,promoção da pesquisa


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