Social capital in the prevention and management of non-communicable diseases among migrants and refugees: a systematic review and meta-ethnography – World
Sok Teng Tan1, Pei Ting Amanda Low, Natasha Howard, Huso Yi
Correspondence to Dr Huso Yi; [email protected]
Globally, the burden of non-communicable diseases (NCDs) falls disproportionately on underserved populations. Migrants and refugees are particularly vulnerable due to economic instability and systemic poverty. Despite the myriad of health risks facing migrants and refugees, access to appropriate health care is hampered by structural, cultural and socio-economic barriers. We conducted a systematic review and meta-ethnography to gain critical insight into how the interplay of social capital and structural factors (eg, state policies and socio-economic disadvantage) influence prevention and treatment of NCDs in migrant and refugee populations. We included 26 studies from 14,794 identified articles, which reported qualitative results on the structure and functions of social capital in the prevention and management of NCDs among migrants and refugees. We synthesized the results, using the process described by Noblit and Hare, who indicated that migrants and refugees experienced weakened social networks in post-migration contexts. They faced multiple barriers in accessing health care and difficulties navigating health systems perceived to be complex. The family as the nucleus of social capital has emerged of mixed value in the prevention and management of NCDs, interacting with cultural dissonance and economic stress. Community organizations have played a critical role in brokering access to health care, particularly in information dissemination and logistics. Health care providers, especially general practitioners, were important gateways for training service users and ensuring a full continuum of quality care. While social capital reduced immediate barriers to accessing health care for the prevention and management of NCDs, it was insufficient to overcome structural barriers. System-level interventions appear necessary to achieve equitable access to health care in host countries. PROSPERO registration number: CCRD42020167846.
What is already known?
Social capital can develop protective networks and facilitate access to care.
It mitigates the negative impacts of socio-economic disadvantages on health.
These results were inconclusive and the effects were not systematically desirable.
What are the new discoveries?
Social capital is converted into practical resources, which were integral to improving health literacy, increasing access to appropriate health care, and adherence to prescribed treatments and disease self-management. non-communicable diseases (NCDs) among migrants and refugees.
The successful conversion of social capital into effective prevention and management of NCDs depends on the interactions of individual circumstances, community dynamics, and the broader systemic and structural issues of populations.
The cultural competence of health care providers is crucial as a linking capital to enable migrants and refugees to act on the basis of the health information received.
What do the new discoveries imply?
Social capital can alleviate some barriers to accessing health care among migrants and refugees.
Structural forces and institutional actors play an important role in building social capital among migrants and refugees.
There is a need to improve the cultural competence of health care providers and to encourage patient-centered communication between providers and migrants and refugees.