REVIEW PROTOCOL

Influence of the Covid-19 pandemic on the health of immigrant, refugee, and asylum-seeking men: a scoping review protocol

Sidiane Rodrigues Bacelo1, Sabrina Viegas Beloni Borchhardt2, João Cruz Neto3, Pricila Oliveira de Araújo1, Anderson Reis de Sousa2, Luciano Garcia Lourenção4

1Universidade Federal do Rio Grande, Rio Grande, RS, Brazil

2Universidade Federal de Pelotas, Pelotas, RS, Brazil

3Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brazil

4Ministério da Previdência Social, Esplanada dos Ministérios, Brasília, DF, Brazil

ABSTRACT

Objective: To outline the scientific evidence on the influence of the Covid-19 pandemic on the health status of immigrant, refugee, and asylum-seeking men. Method: This is a scoping review protocol developed according to the methodology established by the Joanna Briggs Institute. Publications in Portuguese, English, and Spanish addressing the influence of the Covid-19 pandemic on the health of adult immigrant, refugee, and asylum-seeking men will be included without time limit. Reviews, editorials, letters, and study protocols will be excluded. The following databases and libraries were identified for data collection: Latin American and Caribbean Health Sciences Literature via the Virtual Health Library, PubMed, Web of Science, Embase, Scopus, Brazilian Digital Library of Theses and Dissertations, Catalog of Theses and Dissertations of the Coordination of Superior Level Staff Improvement (CAPES), Digital Library of the Scientific Electronic Library Online (SciELO), and Open Access Scientific Repositories from Portugal. The selection and final evaluation of the studies will be carried out by three independent reviewers, with a fourth reviewer to resolve any disagreements. The data will be compiled in an adapted instrument, including information on the title, year of publication, country of origin, aim, type of study, identified effects, DOI, and access link. Results will be presented in tables, charts, graphs, figures, and narrative.

Descriptors: Global Health; Ethnic Minorities Health; Men Health; Emigrants and Immigrants; Refugees; Covid-19.

INTRODUCTION

The Covid-19 pandemic not only caused the spread of an unknown virus but also generated consequences and concerns in various sectors of our society; issues related to refugees and immigrants and their interface with health conditions have gained prominence. Public policies to combat the health crisis by closing borders directly affected the processes and flows of human mobility of international migrations, sometimes violating the rights of these people(1-2).

Although Brazilian legislation guarantees various rights to immigrants, refugees, and asylum seekers; access to these rights was hampered by the government’s response to the crisis, making them a forgotten population in the management of the Covid-19 pandemic(3). The pandemic exacerbated expressions of xenophobia and increased discrimination, processes to which these individuals are typically already subjected and which are motivated by the association of foreigners with the spread of the disease, an intrinsic stigma in the history of epidemics(1-2).

Immigrants, refugees, and asylum seekers are not nationals; they are individuals who are outside their country of origin for various reasons. Immigrants are characterized by economic instigation; they leave their country voluntarily to escape poverty and misery, in search of better living conditions, housing, and food(4). They are therefore free to choose their destination. Refugees, on the other hand, leave their country of origin because of insecurity, fear of persecution, and repression related to ethnicity, religion, nationality, social identity and/or political opinion, as well as severe human rights violations and armed conflicts(5). Depending on the way they apply to enter the country of destination, this population can also be called asylum seekers if the motivation for moving between countries is political. Consequently, the governments that receive them cannot return them to their countries of origin, where their lives are threatened. To become citizens, they must go through a naturalization process that requires time and financial resources(3). However, the impact of these outcomes and the characteristics of this population are reflected in their access to the health system. For global health, the pandemic scenario demanded unprecedented efforts; countries struggled to meet the demands of the healthcare system and also faced a growing number of reported deaths every day. The burden of this responsibility was projected onto healthcare professionals and caregivers, who were tasked with the majority of these efforts, but often without due recognition and/or reward(6).

The pandemic has exacerbated structural, economic, and social inequalities and has created a global health crisis. As a result, the vulnerabilities and impacts that permeate the living conditions of migrants, refugees, and asylum seekers also disproportionately affect them. This includes working conditions, housing, access to information and health services, as well as public policies and protection networks, which determine and affect the lives of the population in different ways.

The array of resources, vaccines, tests, and treatments for Covid-19, which has had a significant impact in saving lives, has been initiated worldwide; however, it is known to have further increased inequality among populations, especially in richer countries, as the same has not been demonstrated in lower-income countries(6).

In this context, one can imagine how this part of the population has been confronted with all these social, economic, cultural, and health adversities, far from their origins. The effects can be seen in mental health but have not yet been quantified(7), which justifies the importance of this study. The specific social determinants of these populations must be recognized, and their specificities must not be diminished. There is a need for practices of resistance, resilience, and solidarity, which can have an even greater impact in pandemic scenarios(5).

The identification of the specificities of these specific populations in the Covid-19 pandemic is essential for the elaboration and implementation of public health policies that allow access to rights and services that meet the real subsistence needs of this population. However, the impact on the health status of these ethnic minorities is not clear. A preliminary search was conducted in July 2023 using the descriptors “health” AND “covid-19” AND “refugees” AND “immigrants” in PubMed, Virtual Health Library (BVS), Scopus, OSF search, JBI Evidence Synthesis, and Online Brazilian Journal of Nursing (OBNJ); in the end, no scope reviews or scope review protocols were found to outline the scientific evidence regarding the impact of the Covid-19 pandemic on the health conditions of immigrants, refugees, and asylum seekers.

Therefore, the development and publication of this study is justified by the need for methodological rigor to transparently fulfill the complex stages of a systematic review(8).

Thus, this study aims to outline the scientific evidence on the impact of the Covid-19 pandemic on the health status of migrant, refugee, and asylum-seeking men.

Review question

What scientific publications are available on the impact of the Covid-19 pandemic on the health conditions of immigrant, refugee, and asylum-seeking men?

Subquestion

What are the impacts of the Covid-19 pandemic on the health conditions of immigrant, refugee, and asylum-seeking men?

Keywords

Health; Covid-19; Refugees; Immigrants.

Inclusion criteria

Participants

Participants will be adult men in immigration, refugee, and asylum situations during the Covid-19 pandemic.

Concept

This review will include studies that discuss the influence of Covid-19 pandemic on health conditions in their biological, psychological, and social dimensions.

Context

Studies will be included from the emergence and classification of the new coronavirus (SARS-CoV-2) by the World Health Organization (WHO) to the Covid-19 pandemic(9). The Covid-19 pandemic is thought to have affected the health of the population in several ways. These effects may include the actions of health services of different levels of complexity, including primary health care units, specialized centers, and hospitals as well as social aspects such as income distribution, employment, and housing.

The Covid-19 pandemic is thought to have had a cross-cultural impact on the health of immigrant, refugee, and asylum-seeking men. The literature findings may indicate adverse effects on survival, post-Covid-19 sequelae, impoverishment, difficulties in accessing health services, discrimination, stigma, xenophobia, family breakdown, loss of status, post-traumatic stress, suicide, and other adverse health phenomena.

Sources of evidence

This scoping review will consider all available scientific research in its entirety, including quantitative and qualitative studies, theses, and dissertations available in the health databases listed, that meet the inclusion criteria, depending on the research question, published in English, Portuguese, and Spanish, without temporal restriction, to retrieve the largest possible number of publications. Editorials, letters, commentaries, books, and book chapters are excluded.

METHOD

This is a scoping review protocol. A scoping review is a synthesis of knowledge from a systematic analysis to outline scientific productions and identify the main concepts, theories, sources, and knowledge gaps on a particular topic(10,11). This review will follow the methodology proposed by the Joanna Briggs Institute (JBI)(11). The protocol will be registered on the Open Science Framework platform (https://osf.io/uz937/).

Sources of information

To identify descriptors and keywords, an initial search of the PubMed portal was conducted to identify the main descriptors and keywords used in studies on the topic of interest. Descriptors were combined using the Boolean operators AND and OR to formulate the search strategy. There was no time restriction on publications.

The libraries and databases defined were PubMed, Latin American and Caribbean Health Sciences Literature (LILACS) via the Virtual Health Library, Web of Science, Scopus, Embase, and Scientific Electronic Library Online (SciELO). For theses and dissertations, searches were performed in the Brazilian Digital Library of Theses and Dissertations, the Catalog of Theses and Dissertations of the Coordination of Superior Level Staff Improvement (CAPES), and the Open Access Scientific Repositories of Portugal (RCAAP).

Search strategy

Descriptors in Health Sciences (DeCS) and Medical Subject Headings (MeSH) were used (Figure 1). According to the adopted reference(11), the search strategy was carried out in three stages. The search strategy defined with the help of a librarian is “COVID-19” OR “pandemics” AND “immigrants” OR “refugees” AND “men.” The search strategy is adapted for each database. A reference list of all sources of evidence included in the full-text search will be included for subsequent study retrieval.

Figure 1- Keywords and entry terms in PubMed. Rio Grande, RS, Brazil, 2023

Study selection

After the search, all identified citations are grouped and loaded into EndNote software (Clarivate Analytics, USA)(12) to remove duplicate studies. They are then sent to the Rayyan software(13), where they are assessed based on the titles and abstracts of all identified studies, taking into account the inclusion and exclusion criteria established. The selected studies are fully evaluated for subsequent data extraction.

This process is performed by three reviewers independently and blinded, with disagreements resolved by a fourth reviewer. Reasons for excluding full-text evidence that does not meet the inclusion criteria will be recorded. The flow of study identification and selection will be presented according to the PRISMA-ScR flowchart(10).

Data extraction

Data will be extracted independently by the three reviewers using a JBI data extraction tool(11) adapted by the authors, which includes information on study type, year of publication, country of origin, objective, identified health outcomes, DOI, and access link (Figure 2). Disagreements during data extraction are resolved by consensus or by evaluation by a fourth reviewer. This tool may be modified during the process to better serve the aim of the present scoping review.

Source: JBI Manual for Evidence Synthesis adapted from Aromataris e Munn, 2020.

Figure 2 - Data extraction tool. Rio Grande, RS, Brazil, 2023

Analysis and presentation of data

The results of this scoping review will be presented in narrative, pictorial, and tabular form. A table will be created with information on the title, authors, year of publication, study method, and interventions described using the PCC mnemonic.

Ethical considerations

The study does not require approval from a research ethics committee because it uses secondary data. However, all ethical aspects and principles have been considered and the appropriate data sources have been cited.

*Paper extracted from the dissertation “Pandemia da COVID-19: condições de saúde de homens imigrantes, refugiados e asilados no Brasil”, presented to the Federal University of Rio Grande, Rio Grande, RS, Brasil.

CONFLICT OF INTERESTS

The authors have declared that there is no conflict of interests.

REFERENCES

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2. Sousa AR de, Cerqueira SS, Santana TD, Suto CS, Aparício EC, Carvalho ES. Significados e metáforas da COVID-19 na experiência de homens adultos que tiveram a doença. Rev Baiana Enferm. 2022;36. https://doi.org/10.18471/rbe.v36.43414

3. Martuscelli PN. How are refugees affected by Brazilian responses to COVID-19? Rev Adm Pública. 2020;54(5):1446–57. https://doi.org/10.1590/0034-761220200516x   

4. Cierco T. Fluxos migratórios e refugiados na atualidade [Internet]. Rio de Janeiro: Fundação Konrad Adenauer Stiftung; 2017 [cited 2023 aug 03]. Available from: https://estudogeral.uc.pt/bitstream/10316/48147/1/Refugiados%20Africanos%20que%20tentam%20a%20Europa.pdf

5. Agência da ONU para Refugiados. Refugiados [Internet]. [place unknown]: UNHCR; c2024 [cited 2023 aug 03]. Available from: https://www.acnur.org/portugues/quem-ajudamos/refugiados/

6. World Health Organization. 10 key global health moments from 2021 [Internet]. Geneva: WHO; 2021 [cited 2023 aug 03]. Available from: https://www.who.int/news-room/spotlight/10-key-global-health-moments-from-2021

7. Aragona M, Barbato A, Cavani A, Costanzo G, Mirisola C. Negative impacts of COVID-19 lockdown on mental health service access and follow-up adherence for immigrants and individuals in socio-economic difficulties. Public Health. 2020;186:52-56. https://doi.org/10.1016/j.puhe.2020.06.055

8. Moraes EB. Review Protocols. Online Braz J Nurs. 2022;21 Suppl 1:e20226585. https://doi.org/10.17665/1676-4285.20226585  

9. Ministério da Saúde (BR). OMS classifica coronavírus como pandemia [Internet]. [place unknown]: [publisher unknown]; 2020 [cited 2023 aug 03]. Available from: https://www.gov.br/pt-br/noticias/saude-e-vigilancia-sanitaria/2020/03/oms-classifica-coronavirus-como-pandemia

10. Tricoo AC, Lillie E, Zarin W, O‘Brien KK, Colquhoun H, Levac D. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;(169):467-473. https://doi.org/10.7326/M18- 0850

11. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editores. JBI Reviewer's Manual [Internet]. Adelaide: JBI; 2020 [cited 2023 aug 03]. Available from: https://synthesismanual.jbi.global. https://doi.org/10.46658/JBIMES-20-12

12. Clarivate. Web of Science Group [Internet]. [cited 2023 jul 26]. Available from: https://access.clarivate.com/login?app=endnote

13. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5(1). https://doi.org/10.1186/s13643-016-0384-4

Submission: 15-Aug-2023

Approved: 11-Mar-2024