Abstract
This descriptive predictive design aimed to employ quantitative and qualitative approaches. The quantitative study was designed to describe health workers’ attitude towards health services for migrants, compare the attitude between professional and supportive health workers, and examine correlation between personal and system factors and health workers’ attitude towards health services for migrants. For qualitative part, it focused on health workers’ attitude towards health services for migrants as well as their experiences regarding policy, health services, and facilitating factors. The sample was health workers with 6 month-experience and practice in 11 border provinces. The sample consisted of 1,356 health workers with additional 20 purposive subjects for the interview. The researchers developed the Knowledge of Migrant’s Culture and Context and the Health Worker’s Attitude towards Health Services for Migrants questionnaires based on the review of literature. The content was validated by 5 experts. The Content Validity Index (CVI) were 0.85 and 0.81, respectively as well as Cronbach's Alpha Coefficient also were 0.85 and 0.81, respectively. The data was analyzed by Mann-Whitney U Test and Spearman's rank-order correlation. Content analysis was done for qualitative data.
The quantitative results found that the majority of the health workers (91.22%) had positive attitude towards health services for migrants. There was no difference of attitude towards health services for migrants between professional and supportive health workers. Knowledge of migrant’s culture and context was statistically positively significant correlated to attitude towards health services for migrants among health workers (r= .152, p value=.000) (when controlling for age, sex, work status, work experiences, work experience with migrants, and trans-cultural training programs for health workers). The appropriateness of special health services, number of translators for migrants including handbooks, media, labels used in communication with migrants, and number of health workers for health services for migrants were statistically positively significant correlated to attitude towards health services for migrants among health workers (r=.120, p=.000; r=.063, p=.021; r=.060, p=.027; r=.133, p=.000). The results from Binary Logistics Regression revealed that the subjects have an increasing 1 score of Knowledge of migrant’s culture and context, they have an increased likelihood of positive attitude towards health services for migrants 1.32 times ((Exp(B)=1.32, p=.000).Furthermore, the subjects have an increasing 1 score of perceived number of health workers for health services for migrants, they have an increased likelihood of positive attitude towards health services for migrants 1.02 times ((Exp(B)=1.02, p=.000).
The qualitative findings revealed that 1) health workers’ attitude towards health services for migrants were both positive and negative. Positive attitudes were to be friendly, equal treatment like Thai citizens, legal workers, best regards for human rights and being responsible. The negative attitudes were that migrants are financial burden for Thailand, obstacle for hospital management, take the jobs of native workers, bring dangerous communicable disease to Thailand, increase the workload of health workers, not adherent to treatment, scary, and unfriendly and the minority group in Thailand. 2) Facilitating individual factors to improve health workers’ positive attitude towards health services for migrants based on the knowledge related to beliefs and cultures of migrants. Facilitating system factors were having health screening and health insurance policy for migrants and effective health service system. Supportive factors included media in health service and having translators. Facilitating individual factors health workers’ negative attitude towards health services for migrants were undesirable behaviors, increased number of migrants receiving health services and communication obstacle were system factors.
Hospitals executives and the ministry of public health can use the results from this study to promote health workers’ positive attitude towards health services for migrants. To alter their negative views or attitudes can lead to health services effectiveness and solve migrant health related services problem in the long run.
