Background There are increasing inequalities in migrants experience in access to health care in Europe and in Italy. Websites and smartphone applications (“apps”) can represent a tools to help people improve their access to health care. To date no evaluations of apps for improving migrants access to health care exist for Italy, even fewer considering apps already available to the public at global level. The aim of this study was to evaluate an existing publically available website and its linked app, HFM-Health for Migrants – designed and implemented by SHIP a spin-off of the University of Perugia (Italy) for Umbria Region (Italy).The platforms provides map of public services in Umbria Region and explains to foreign citiziens living in Umbria their main entitlements to health care and how to get access and use public services, with a focus on maternal care. Methods We adopted a mixed-methods design, analysing both internet data and face-to-face interviews data on the website and app usage in order to explore users characteristics and patterns of usage. Face-to-face in-depth interviews were conducted with a sub-sample of 87 web and app users in a sample of Umbria Region municpalities during the period october 2015 - january 2016. Interwiews were conducted from expert interwiewers at fiscal support centres. From this, we analysed quantitative information on migrant status, socio-economic status, migrants use of health services in the past year, their acces to mobile and internet. Finally, qualitative data from interviews on migrants perceptions of acceptability, usability and perceived effectiveness, as well as recommendations on how to improve the app and web were collected alonside the interview and analysed. Results Approximately a thousand people in a 3-month period accessed the web platform. From the interviews, we found that users of the app and website were mostly people who had been in Italy since long time. Most users of the app were people regularly resident in Italy and had been in Italy for a long time. The more represented nationalities in the sample were Morocco (40%), Romania (15%) and Albania (6%). Over 90% of respondents were born in their country of origin. 12% of respondents of Moroccan nationality are second-class citizens generation, and were born in Italy and in the same municipality of residence. Women in the sample were more educated compared to men: 90% of women against 60% of men had a school diploma or diploma. 13% of males had only elementary education, against 0% of females. About 50% of respondents were working, 42% of women and 58% of men. There is a gender bias according to the type of work. Males were mainly carpenters, artisans, employed in restaurants while females carried out the work of carers and cleaners. 85% of males and 70% of women were employed, 8% are self-employed as cooperative members or temporarily employed in a small-medium enterprise. 3% of respondents were occasional workers. Most of the respondents were from low income classes. 12% reported zero income. A battery of questions on utilisation of a set of commodities was added in order to complete the picture of the conditions of life of the interviewees. Most of the respondents (91%) had a washing machine in the home and color television color television (97%), without significant gender differences. About 72% declared their health status to be good or very good (72% of women and 75% of males), while none reported to have a very bad health status. The majority (88%) registered with the NHS, 95% had accessed services at the time of the interview, with no sigificant gender differences. Among the interviewed, 35% have access to emergency services to treat their health problems during the 12 months prior to the interview, while 35% have used basic health care services. Satisfaction with public health care is quite high. However, 20% said they had unmet medical needs, with females showing the highest proportion. 48% declared to have good knowledge of the Italian NHS, while the rest declared not to be very keen on how to access public heath care. The main reason for this is a poor knowledge of the language (38%). On average, women declared to have more difficulties in relating to health workers (22% vs 11% men). Over a fifth of respondents say that in the last 12 months unmet needs for medical visits, examinations or therapies, with significant gender difference: 33% females and 13% males. The main reasons were: economic difficulties, long waiting lists, inability to be absent from work and a geographically difficult accessibility of the service. With regard to waiting lists, there is no gender difference. Instead, the prevalent reason of unmet needs for males was the distance to service and not having free time from work. The economic reason is prevalent among females (45% vs 18% males). Almost all respondents (99%) had a telephone, 100% of men and 97% of women. Access to the Internet from home was on average 71%, higher among women (76%) w.r. to men (67%). Only 65% of respondents had access to a personal computer at home. Many interviewees knew about the existence of the HFM platform through friends (29%), 25% through workers unions or other institutions/NGOs, while 21% was informed through the interview. As expected, the app is considered very useful by 49% and quite useful from 18% of the group of users aged up to 50, while a minor interest has emerged for the older population. The majority of migrants coming from high pressure migration countries declared the app to be very useful or useful (80% of the Albanians and 63% of Moroccans), while less than 50% of the Eastern european did so. Family network and community networks were the main source of diffusion of the platform among migrants. Qualitative data analysis on the open comments collected after closed questions, showed that for migrants it is very important to have a map of publicly provided services and more information on their rights to health care. Surprisingly, the latter need came from individuals who resident for a long time in Italy as many declared to not be still aware of their rights. Conclusions The HFM app revealed to be a useful tool to support individuals who are already users of the public healthcare system. This evaluation provides insight into the usability and acceptability of the app features and a number of recommendations for improving user satisfaction and the potential effectiveness of apps designed to facilitate migrants access to health care can be derived. Despite the limitations of the study due to the limited sample size and lack of data on irregular migrants, this is the first attempt to measure migrants access to mhealth in Italy and results appear encouraging.
A mixed-methods evaluation of Health For Migrants (HFM) online website and application for improving migrants access to health care in Umbria Region (Italy)
MARGHERITA GIANNONI
;VITTORIA MATTEI;ELEONORA TODINI
2018
Abstract
Background There are increasing inequalities in migrants experience in access to health care in Europe and in Italy. Websites and smartphone applications (“apps”) can represent a tools to help people improve their access to health care. To date no evaluations of apps for improving migrants access to health care exist for Italy, even fewer considering apps already available to the public at global level. The aim of this study was to evaluate an existing publically available website and its linked app, HFM-Health for Migrants – designed and implemented by SHIP a spin-off of the University of Perugia (Italy) for Umbria Region (Italy).The platforms provides map of public services in Umbria Region and explains to foreign citiziens living in Umbria their main entitlements to health care and how to get access and use public services, with a focus on maternal care. Methods We adopted a mixed-methods design, analysing both internet data and face-to-face interviews data on the website and app usage in order to explore users characteristics and patterns of usage. Face-to-face in-depth interviews were conducted with a sub-sample of 87 web and app users in a sample of Umbria Region municpalities during the period october 2015 - january 2016. Interwiews were conducted from expert interwiewers at fiscal support centres. From this, we analysed quantitative information on migrant status, socio-economic status, migrants use of health services in the past year, their acces to mobile and internet. Finally, qualitative data from interviews on migrants perceptions of acceptability, usability and perceived effectiveness, as well as recommendations on how to improve the app and web were collected alonside the interview and analysed. Results Approximately a thousand people in a 3-month period accessed the web platform. From the interviews, we found that users of the app and website were mostly people who had been in Italy since long time. Most users of the app were people regularly resident in Italy and had been in Italy for a long time. The more represented nationalities in the sample were Morocco (40%), Romania (15%) and Albania (6%). Over 90% of respondents were born in their country of origin. 12% of respondents of Moroccan nationality are second-class citizens generation, and were born in Italy and in the same municipality of residence. Women in the sample were more educated compared to men: 90% of women against 60% of men had a school diploma or diploma. 13% of males had only elementary education, against 0% of females. About 50% of respondents were working, 42% of women and 58% of men. There is a gender bias according to the type of work. Males were mainly carpenters, artisans, employed in restaurants while females carried out the work of carers and cleaners. 85% of males and 70% of women were employed, 8% are self-employed as cooperative members or temporarily employed in a small-medium enterprise. 3% of respondents were occasional workers. Most of the respondents were from low income classes. 12% reported zero income. A battery of questions on utilisation of a set of commodities was added in order to complete the picture of the conditions of life of the interviewees. Most of the respondents (91%) had a washing machine in the home and color television color television (97%), without significant gender differences. About 72% declared their health status to be good or very good (72% of women and 75% of males), while none reported to have a very bad health status. The majority (88%) registered with the NHS, 95% had accessed services at the time of the interview, with no sigificant gender differences. Among the interviewed, 35% have access to emergency services to treat their health problems during the 12 months prior to the interview, while 35% have used basic health care services. Satisfaction with public health care is quite high. However, 20% said they had unmet medical needs, with females showing the highest proportion. 48% declared to have good knowledge of the Italian NHS, while the rest declared not to be very keen on how to access public heath care. The main reason for this is a poor knowledge of the language (38%). On average, women declared to have more difficulties in relating to health workers (22% vs 11% men). Over a fifth of respondents say that in the last 12 months unmet needs for medical visits, examinations or therapies, with significant gender difference: 33% females and 13% males. The main reasons were: economic difficulties, long waiting lists, inability to be absent from work and a geographically difficult accessibility of the service. With regard to waiting lists, there is no gender difference. Instead, the prevalent reason of unmet needs for males was the distance to service and not having free time from work. The economic reason is prevalent among females (45% vs 18% males). Almost all respondents (99%) had a telephone, 100% of men and 97% of women. Access to the Internet from home was on average 71%, higher among women (76%) w.r. to men (67%). Only 65% of respondents had access to a personal computer at home. Many interviewees knew about the existence of the HFM platform through friends (29%), 25% through workers unions or other institutions/NGOs, while 21% was informed through the interview. As expected, the app is considered very useful by 49% and quite useful from 18% of the group of users aged up to 50, while a minor interest has emerged for the older population. The majority of migrants coming from high pressure migration countries declared the app to be very useful or useful (80% of the Albanians and 63% of Moroccans), while less than 50% of the Eastern european did so. Family network and community networks were the main source of diffusion of the platform among migrants. Qualitative data analysis on the open comments collected after closed questions, showed that for migrants it is very important to have a map of publicly provided services and more information on their rights to health care. Surprisingly, the latter need came from individuals who resident for a long time in Italy as many declared to not be still aware of their rights. Conclusions The HFM app revealed to be a useful tool to support individuals who are already users of the public healthcare system. This evaluation provides insight into the usability and acceptability of the app features and a number of recommendations for improving user satisfaction and the potential effectiveness of apps designed to facilitate migrants access to health care can be derived. Despite the limitations of the study due to the limited sample size and lack of data on irregular migrants, this is the first attempt to measure migrants access to mhealth in Italy and results appear encouraging.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
