Abstracts
Résumé
À la suite d’une demande de la part de Médecins du Monde, nous avons réalisé une recherche participative pour mieux comprendre la réalité des soignants offrant des soins aux personnes migrantes à statut précaire (PMSP). Les soignants ont été rencontrés lors de groupes de discussion (n=12) et d’entretiens en profondeur (n=8) afin d’explorer les spécificités de leur pratique et les répercussions sur leur santé mentale. Leurs propos ont été analysés sous l’angle de la phénoménologie critique, ce qui a permis de révéler : 1) les défis de cette pratique à la lumière des contraintes institutionnelles et politiques en place; 2) les réalités psychiques occasionnées par le contact avec la détresse des PMSP. Nos résultats sont analysés à la lumière de l’influence des déterminants structurels de la santé affectant la réalité quotidienne des PMSP et par ricochet celle des soignants travaillant auprès de cette population. Cet article contribue à enrichir la littérature francophone en santé publique en explorant les défis liés à la recherche qualitative auprès de populations marginalisées sujettes à vivre des inégalités sociales.
Mots-clés :
- Phénoménologie critique,
- personnes migrantes à statut précaire (pmsp),
- inégalités sociales en santé mentale,
- soignants,
- déterminants structurels de la santé
Abstract
Following a request from Médecins du Monde, we conducted a participatory research to better understand the reality of caregivers providing care to migrants with precarious status (PMSP). Caregivers were interviewed in focus groups (n = 12) and in-depth interviews (n = 8) to explore the specificities of their practice and the impact on their mental health. Their comments were analysed from a critical phenomenological perspective, which revealed: 1) the challenges of this practice in light of the institutional and political constraints in place; 2) the psychological consequences of contact with the distress of PMSP. Our results are analysed in light of the influence of structural determinants of health affecting the daily reality of PMSPs and, by extension, that of caregivers working with this population. This article contributes to the French-language literature on public health by exploring the challenges associated with qualitative research among marginalised populations subject to social inequalities.
Keywords:
- Critical phenomenology,
- migrants with precarious status (pmsp),
- social inequalities in mental health,
- caregivers,
- structural determinants of health
Appendices
Références
- Aldamman, K., Tamrakar, T., Dinesen, C., Wiedemann, N., Murphy, J., Hansen, M., Badr, E. E., Reid, T., & Vallières, F. (2019). Caring for the mental health of humanitarian volunteers in traumatic contexts: The importance of organisational support. European Journal of Psychotraumatology, 10(1). https//doi.org/10.1080/20008198.2019.1694811
- Allan, S. M., Bealey, R., Birch, J., Cushing, T., Parke, S., Sergi, G., Bloomfield, M., & Meiser-Stedman, R. (2020). The prevalence of common and stress-related mental health disorders in healthcare workers based in pandemic-affected hospitals: a rapid systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1). https//doi.org/10.1080/20008198.2020.1810903
- Armenta, A., & Sarabia, H. (2020). Receptionists, doctors, and social workers: Examining undocumented immigrant women’s perceptions of health services. Social Science & Medicine, 246. https//doi.org/10.1016/j.socscimed.2020.112788
- Aubé, T., Pisanu, S., & Merry, L. (2019). La Maison Bleue: Strengthening resilience among migrant mothers living in Montreal, Canada. PLoS One, 14(7). https//doi.org/10.1371/journal.pone.0220107
- Barkensjö, M., Greenbrook, J. T., Rosenlundh, J., Ascher, H., & Elden, H. (2018). The need for trust and safety inducing encounters: A qualitative exploration of women’s experiences of seeking perinatal care when living as undocumented migrants in Sweden. BMC Pregnancy and Childbirth, 18(1), 1-17.
- Bendixsen, S. K. (2020). Existential displacement: Health care and embodied un/belonging of irregular migrants in Norway. Culture, Medicine, and Psychiatry, 44, 479-500.
- Brabant, Z., & Raynault, M. F. (2012). Health of migrants with precarious status: Results of an exploratory study in Montreal-Part B. Social Work in Public Health, 27(5), 469-481.
- Brooks, S., Amlot, R., Rubin, G. J., & Greenberg, N. (2020). Psychological resilience and post-traumatic growth in disaster-exposed organisations: Overview of the literature. BMJ Mil Health, 166(1), 52-56.
- Carazo, S., Pelletier, M., Talbot, D., Jauvin, N., De Serres, G., & Vézina, M. (2022). Psychological distress of healthcare workers in Québec (Canada) during the second and the third pandemic waves. Journal of Occupational and Environmental Medicine, 64(6), 495-503.
- Cervantes, L., Richardson, S., Raghavan, R., Hou, N., Hasnain-Wynia, R., Wynia, M. K., Kleiner, C., Chonchol, M., & Tong, A. (2018). Clinicians’ perspectives on providing emergency-only hemodialysis to undocumented immigrants: A qualitative study. Annals of Internal Medicine, 169(2), 78-86.
- Cheong, A. R., & Massey, D. S. (2019). Undocumented and unwell: Legal status and health among Mexican migrants. International Migration Review, 53(2), 571-601.
- Cleveland, J., Hanley, J., Jaimes, A., & Wolofsky, T. (2020). Impacts de la crise de la COVID-19 sur les « communautés culturelles » montréalaises : enquête sur les facteurs socioculturels et structurels affectant les groupes vulnérables [Rapport de recherche]. Institut universitaire SHERPA. https://sherpa-recherche.com/wp-content/uploads/impact_covid19_communautes_culturelles.pdf
- Cloos, P., Ndao, E. M., Aho, J., Benoît, M., Fillol, A., Munoz-Bertrand, M., Ouimet, M.‑J., Hanley, J., & Ridde, V. (2020). The negative self-perceived health of migrants with precarious status in Montreal, Canada: A cross-sectional study. PLoS One, 15(4). https//doi.org/10.1371/journal.pone.0231327
- Commission des normes, de l’équité, de la santé et de la sécurité du travail du Québec (CNESST). (2022). Statistiques annuelles. Gouvernement du Québec. https://www.cnesst.gouv.qc.ca/fr/organisation/documentation/formulaires-publications/statistiques-annuelles
- Coutin, S. B. (2003). Legalizing moves: Salvadoran immigrants’ struggle for US residency. University of Michigan Press.
- Curling, P., & Simmons, K. B. (2010). Stress and staff support strategies for international aid work. Intervention, 8(2), 93-105.
- D’Alessandro-Lowe, A. M., Brown, A., Sullo, E., Pichtikova, M., Karram, M., Mirabelli, J., McCabe, R. E., McKinnon, M. C., & Ritchie, K. (2024). Why are healthcare providers leaving their jobs? A convergent mixed-methods investigation of turnover intention among Canadian healthcare providers during the COVID-19 pandemic. Nursing Reports, 14(3), 2030-2060.
- De Genova, N. P. (2002). Migrant “illegality” and deportability in everyday life. Annual Review of Anthropology, 31(1), 419-447.
- De Jong, L., Pavlova, M., Winters, M., & Rechel, B. (2017). A systematic literature review on the use and outcomes of maternal and child healthcare services by undocumented migrants in Europe. The European Journal of Public Health, 27(6), 990-997.
- Desjarlais, R., & Throop, J. (2011). Phenomenological approaches in anthropology. Annual Review of Anthropology, 40, 87-102.
- De Vries, N., Boone, A., Godderis, L., Bouman, J., Szemik, S., Matranga, D., & De Winter, P. (2023). The race to retain healthcare workers: A systematic review on factors that impact retention of nurses and physicians in hospitals. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 60. https//doi.org/10.1177/00469580231159318
- Fabi, R. E., & Taylor, H. A. (2019). Prenatal care for undocumented immigrants: Professional norms, ethical tensions, and practical workarounds. Journal of Law, Medicine & Ethics, 47(3), 398-408.
- Fakhoury, J., Burton-Jeangros, C., Consoli, L., Duvoisin, A., Courvoisier, D., & Jackson, Y. (2021). Mental health of undocumented migrants and migrants undergoing regularization in Switzerland: A cross-sectional study. BMC Psychiatry, 21(1), 1-10.
- Foucault, M. (1988). La gouvernementalité. Dans M. Foucault (Éd.), Dits et écrits, 1954-1988 (Vol. 3). Gallimard. https://doi.org/10.14375/NP.9782070739882
- Foucault, M. (2004). Naissance de la biopolitique : cours au Collège de France (1978-1979). Gallimard et Seuil.
- Gagnon, M., Kansal, N., Goel, R., & Gastaldo, D. (2022). Immigration status as the foundational determinant of health for people without status in Canada: A scoping review. Journal of Immigrant and Minority Health, 24(4),1-16.
- Gauthier, L., & Bentayeb, N. (2022). Recherche interventionnelle sur la santé mentale des intervenant(e)s communautaires durant la pandémie [Rapport de recherche]. Institut universitaire SHERPA. https://sherpa-recherche.com/fr/projet/recherche-interventionnelle-sur-la-sante-mentale-des-intervenant-e-s-communautaires/
- Guenther, L. (2022). Abolish the world as we know it: Notes for a praxis of phenomenology beyond critique. Puncta, 5(2), 28-44.
- Guskovict, K. L., & Potocky, M. (2018). Mitigating psychological distress among humanitarian staff working with migrants and refugees: A case example. Advances in Social Work, 18(3), 965-982.
- Hacker, K., Anies, M., Folb, B. L., & Zallman, L. (2015). Barriers to health care for undocumented immigrants: A literature review. Risk Management and Healthcare Policy. https//doi.org/10.2147/RMHP.S70173
- Hanley, J., Larios, L., Ricard-Guay, A., Meloni, F., & Rousseau, C. (2020). Pregnant and undocumented: Taking work into account as a social determinant of health. International Journal of Migration, Health and Social Care, 16(2), 189-199.
- Hill, J. E., Harris, C., Danielle L, C., Boland, P., Doherty, A. J., Benedetto, V., Bhutani, E. G., & Clegg, A. J. (2022). The prevalence of mental health conditions in healthcare workers during and after a pandemic: Systematic review and meta‐analysis. Journal of Advanced Nursing, 78(6), 1551-1573.
- Hintjens, H. M., Siegmann, K. A., & Staring, R. H. (2020). Seeking health below the radar: Undocumented people’s access to healthcare in two Dutch cities. Social Science & Medicine, 248. https//doi.org/10.1016/j.socscimed.2020.112822
- Jachens, L., Houdmont, J., & Thomas, R. (2019). Effort-reward imbalance and burnout among humanitarian aid workers. Disasters, 43(1), 67-87.
- Jawed, A., Moe, S. M., Anderson, M., Slaven, J. E., Wocial, L. D., Saeed, F., & Torke, A. M. (2021). High moral distress in clinicians involved in the care of undocumented immigrants needing dialysis in the United States. Health Equity, 5(1), 484-492.
- Lems, A. (2020). Phenomenology of exclusion: Capturing the everyday thresholds of belonging. Social Inclusion, 8(4), 116-125.
- Liang, H., Beydoun, M. A., & Eid, S. M. (2019). Health needs, utilization of services and access to care among Medicaid and uninsured patients with chronic disease in health centres. Journal of Health Services Research & Policy, 24(3), 172-181.
- Lopes Cardozo, B., Gotway Crawford, C., Eriksson, C., Zhu, J., Sabin, M., Ager, A., Foy, D., Snider, L., Scholte, W., Kaiser, R., Olff, M., Rijnen, B., & Simon, W. (2012). Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: A longitudinal study. PLoS One, 7(9). https//doi.org/10.1371/journal.pone.0044948
- Magalhaes, L., Carrasco, C., & Gastaldo, D. (2010). Undocumented migrants in Canada: A scope literature review on health, access to services, and working conditions. Journal of Immigrant and Minority Health, 12(1), 132-151.
- Mattingly, C. (2019). Critical phenomenology and mental health: Moral experience under extraordinary conditions. ETHOS, 47(1), 115-125.
- Ministère de la Santé et des Services sociaux du Québec (MSSS). (2014). Surcharge et exemptions pour certains ressortissants étrangers dans les établissements publics du réseau. https://g26.pub.msss.rtss.qc.ca/Formulaires/Circulaire/ConsCirculaire.aspx?enc=N2uaeyC6xTQ=
- Merleau-Ponty, M. (1945). Phénoménologie de la perception. Gallimard.
- Merleau-Ponty, M. (1964). Le visible et l’invisible. Gallimard.
- Nellums, L. B., Powis, J., Jones, L., Miller, A., Rustage, K., Russell, N., Friedland, J. S., & Hargreaves, S. (2021). “It’s a life you’re playing with”: A qualitative study on experiences of NHS maternity services among undocumented migrant women in England. Social Science & Medicine, 270. https://doi.org/10.1016/j.socscimed.2020.113610
- Pigeon-Gagné, É., Bourgeois-Guérin, É., & Gilbert, S. (2025). Lorsque les vécus d’oppression se propagent des patient.es aux chercheur.es : comment intégrer les données expérientielles à la recherche en santé mondiale? Santé publique, 37(1), 67-80.
- Pilabré, F. (2019). Accès aux soins de santé : expériences de migrants sans assurance maladie à Montréal, Canada [Mémoire de maîtrise inédit]. Université de Montréal, Montréal, Canada.
- Rathe, K. J. (2022). Towards a critical phenomenology of borders and migration: Introduction to the themed issue. Puncta, 5(3), 1-11.
- Ricard-Guay, A., Hanley, J., Montgomery, C., Meloni, F., & Rousseau, C. (2014). Mère et sans-papiers au Québec. Dans F. Kanouté, & G. Lafortune (Éds), L’intégration des familles d’origine immigrante (pp. 49-64). Presses de l’Université de Montréal.
- Ridde, V., Aho, J., Ndao, E. M., Benoit, M., Hanley, J., Lagrange, S., Fillol, A., Raynault, M.-F., & Cloos, P. (2020). Unmet healthcare needs among migrants without medical insurance in Montreal, Canada. Global Public Health, 15(11), 1603-1616.
- Rousseau, C., & Frounfelker, R. L. (2019). Mental health needs and services for migrants: An overview for primary care providers. Journal of Travel Medicine, 26(2). https//doi.org/10.1093/jtm/tay150
- Ruiz-Casares, M., Rousseau, C., Laurin-Lamothe, A., Rummens, J. A., Zelkowitz, P., Crépeau, F., & Steinmetz, N. (2013). Access to health care for undocumented migrant children and pregnant women: The paradox between values and attitudes of health care professionals. Maternal and Child Health Journal, 17, 292-298.
- Salamon, G. (2018). What’s critical about critical phenomenology? Puncta, 1(1), 8-17.
- Sandblom, M., & Mangrio, E. (2017). The experience of nurses working within a voluntary network: A qualitative study of health care for undocumented migrants. Scandinavian Journal of Caring Sciences, 31(2), 285-292.
- Sheekha, T. A., Rohatinsky, N., Alhassan, J. A. K., Kendel, D., Levandoski, C., Dmytrowich, J., Lafontaine, T., Cardinal, M., & Peña-Sánchez, J. N. (2024). Health care providers’ well-being indicators are associated with their intention to leave their positions: A cross-sectional study from Saskatchewan, Canada. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 61. https://doi.org/10.1177/00469580241306548
- Strohmeier, H., & Scholte, W. F. (2015). Trauma-related mental health problems among national humanitarian staff: A systematic review of the literature. European Journal of Psychotraumatology, 6(1). https//doi.org/10.3402/ejpt.v6.28541
- Suphanchaimat, R., Kantamaturapoj, K., Putthasri, W., & Prakongsai, P. (2015). Challenges in the provision of healthcare services for migrants: A systematic review through providers’ lens. BMC Health Services Research, 15, 1-14.
- Ter Kuile, S., Rousseau, C., Munoz, M., Nadeau, L., & Ouimet, M. (2007). The universality of the Canadian health care system in question: Barriers to services for immigrants and refugees. International Journal of Migration, Health and Social Care, 3(1), 15-26.
- Willen, S. S. (2007). Exploring “illegal” and “irregular” migrants’ lived experiences of law and state power. International Migration, 45(3), 2-7.
- World Health Organization (WHO). (2022). World report on the health of refugees and migrants. World Health Organization.