Immigration, Participation in Health Services and Social Occupations: A Literature Review

Document Type : Review Article


1 Occupational Therapy Program, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK

2 Occupational Therapy Department, Faculty of Allied Health, Kuwait University, Kuwait

3 Iranian Research Centre on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

4 Occupational Therapy Program, Health & Wellbeing, Sheffield Hallam University, Sheffield, UK

5 Occupational Therapy Program, Cardiff University, Cardiff, UK

6 Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK

7 Department of Clinical Psychology, Islamic Azad University, Tehran, Iran

8 Independent Clinician, Tehran, Iran


Introduction: According to the World Health Organisation ‘participation’, meaning involvement in everyday occupations, has a positive influence on health and wellbeing and lack thereof can lead to negative health consequences. Occupational therapy scholars believe this phenomenon needs exploring with attention to context. Variability is apparent in the way participation has been addressed in the context of voluntary immigration. This review aims to identify how the concept of participation and its association with the health and wellbeing of immigrants is addressed in research literature.
Methods: A literature review method was applied. The data bases searched were: PubMed, ASSIA, CINHAL, PsycINFO, AMED, CRD, EBESCO Host, Sociological Abstract, Lexis and EMBASE. Articles that fulfilled all inclusion criteria were critically appraised in order to assess their quality. Sixteen articles from major related databases were included. Qualitative analysis was used throughout.
Results: Participation was mostly identified by measuring the number of attendances or self-report of attendance in health-related services or social occupations. Four themes were identified: outlook of participation, contributing factors to participation, approaches to studying immigrants’ participation, and outcomes of participation.
Conclusion: Participation lacks a common and exclusive definition that considers both objective and subjective experiences. How immigrants’ backgrounds and future perspectives affect what ‘participation’ means to them needs further exploration. The current publication has identified several contributing factors that need considering in health and social-related policies, plans and strategies. It is significant that enabling factors such as the positive attitude of immigrants, and providing support to immigrants can facilitate their participation pattern.


  1. World Health Organization. International Classification of Functioning, Disability, and Health (ICF). Geneva, Switzerland: WHO; 2001.
  2. Hemmingsson H, Jonsson H. An occupational perspective on the concept of participation in the International Classification of Functioning, Disability and Health--some critical remarks. Am J Occup Ther. 2005;59(5):569-576. doi:10.5014/ajot.59.5.569.
  3. Atkinson JA, Vallely A, Fitzgerald L, Whittaker M, Tanner M. The architecture and effect of participation: a systematic review of community participation for communicable disease control and elimination. Implications for malaria elimination. Malar J. 2011;10:225. doi:10.1186/1475-2875-10-225.
  4. Cole MB, Donohue MV. Social Participation in Occupational Contexts: In Schools, Clinics, and Communities. Thorofare: Slack Incorporated; 2010.
  5. Murray SB, Skull SA. Hurdles to health: immigrant and refugee health care in Australia. Aust Health Rev. 2005;29(1):25-29. doi:10.1071/ AH050025.
  6. Rechel B, Mladovsky P, Ingleby D, Mackenbach JP, McKee M. Migration and health in an increasingly diverse Europe. Lancet. 2013;381(9873):1235-1245. doi:10.1016/S0140-6736(12)62086-8.
  7. Watson RM. Being before doing: The cultural identity (essence) of occupational therapy. Aust Occup Ther J. 2006;53(3):151-158. doi:10.1111/j.1440-1630.2006.00598.x.
  8. Harris N, Minniss FR, Somerset S. Refugees connecting with a new country through community food gardening. Int J Environ Res Public Health. 2014;11(9):9202-9216. doi:10.3390/ijerph110909202.
  9. Bhopal RS. Racism in health and health care in Europe: reality or mirage? Eur J Public Health. 2007;17(3):238-241. doi:10.1093/eurpub/ckm039.
  10. Mattingly C, Lawlor M. Learning from Stories: Narrative Interviewing in Cross-cultural Research. Scand J Occup Ther. 2000;7(1):4-14. doi:10.1080/110381200443571.
  11. Hudelson P, Dominice Dao M, Perneger T, Durieux-Paillard S. A “migrant friendly hospital” initiative in Geneva, Switzerland: evaluation of the effects on staff knowledge and practices. PLoS One. 2014;9(9):e106758. doi:10.1371/journal.pone.0106758.
  12. Gallagher M, Muldoon OT, Pettigrew J. An integrative review of social and occupational factors influencing health and wellbeing. Front Psychol. 2015;6:1281. doi:10.3389/fpsyg.2015.01281.
  13. Sheldon KM, Elliot AJ. Goal striving, need satisfaction, and longitudinal well-being: the self-concordance model. J Pers Soc Psychol. 1999;76(3):482-497. doi:10.1037/0022-3514.76.3.482.
  14. World Federation of Occupational Therapista. WFOT statement on occupational therapy. 2012. 300811.pdf.
  15. Hocking C, Whiteford GE. Occupational Science: Society, Inclusion, Participation. Wiley Blackwell; 2012.
  16. Kinebanian A, Stomph M. Cross-cultural occupational therapy: a critical reflection. Am J Occup Ther. 1992;46(8):751-757. doi:10.5014/ajot.46.8.751.
  17. Bennett KM, Scornaiencki JM, Brzozowski J, Denis S, Magalhaes L. Immigration and its impact on daily occupations: a scoping review. Occup Ther Int. 2012;19(4):185-203. doi:10.1002/oti.1336.
  18. Pooremamali P, Eklund M, Ostman M, Persson D. Muslim Middle Eastern clients’ reflections on their relationship with their occupational therapists in mental health care. Scand J Occup Ther. 2012;19(4):328-340. doi:10.3109/11038128.2011.600328.
  19. Pooremamali P, Persson D, Eklund M. Occupational therapists’ experience of working with immigrant clients in mental health care. Scand J Occup Ther. 2011;18(2):109-121. doi:10.3109/11038121003649789.
  20. Hart C. Doing a Literature Review: Releasing the Social Science Research Imagination. Oxford, UK: Sage Publications; 2006.
  21. Aveyard H. Doing a Literature Review in Health and Social Care. London: McGraw-Hill Education; 2014.
  22. Centre of Reviews and Dissemination. Systematic Reviews: CRD’s guidance for undertaking reviews in health care. 2009.
  23. Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inform. 2004;22(2):63-75. doi:10.3233/EFI-2004-22201.
  24. American Occupational Therapy Association. Occupational therapy practice framework: Domain and process. Am J Occup Ther. 2014;6S:S1-48.
  25. Cambridge Dictionaries Online. 2016.
  26. Sedky K, Nazir R, Parlapalli R, Lippmann S. Letter to the editor: Stages of immigration. Int J Soc Psychiatry. 2011;57(3):323-324. doi:10.1177/0020764009357491.
  27. McIntyre A. Participatory Action Research. London: Sage Publications; 2008.
  28. Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45. doi:10.1186/1471-2288-8-45.
  29. Evenson KR, Sarmiento OL, Tawney KW, Macon ML, Ammerman AS. Personal, social, and environmental correlates of physical activity in North Carolina Latina immigrants. Am J Prev Med. 2003;25(3 Suppl 1):77-85. doi:10.1016/S0749-3797(03)00168-5.
  30. Amankwah E, Ngwakongnwi E, Quan H. Why many visible minority women in Canada do not participate in cervical cancer screening. Ethn Health. 2009;14(4):337-349. doi:10.1080/13557850802699122.
  31. Knipscheer JW, Kleber RJ. Help-seeking behaviour regarding mental health problems of Mediterranean migrants in the Netherlands: familiarity with care, consultation attitude and use of services. Int J Soc Psychiatry. 2005;51(4):372-382. doi:10.1177/0020764005060853.
  32. Kwok C, White K, Roydhouse JK. Chinese-Australian women’s knowledge, facilitators and barriers related to cervical cancer screening: a qualitative study. J Immigr Minor Health. 2011;13(6):1076-1083. doi:10.1007/s10903-011-9491-4.
  33. Kawar LN. Barriers to breast cancer screening participation among Jordanian and Palestinian American women. Eur J Oncol Nurs. 2013;17(1):88-94. doi:10.1016/j.ejon.2012.02.004.
  34. Suto MJ. Leisure Participation and Well-being of Immigrant Women in Canada. J Occup Sci. 2013;20(1):48-61. doi:10.1080/14427591.2012.732914.
  35. Lai DW, Chau SB. Predictors of health service barriers for older Chinese immigrants in Canada. Health Soc Work. 2007;32(1):57- 65. doi:10.1093/hsw/32.1.57.
  36. Weltin AM, Lavin RP. The effect of a community garden on HgA1c in diabetics of Marshallese descent. J Community Health Nurs. 2012;29(1):12-24. doi:10.1080/07370016.2012.645724.
  37. Juarbe TC, Lipson JG, Turok X. Physical activity beliefs, behaviors, and cardiovascular fitness of Mexican immigrant women. J Transcult Nurs. 2003;14(2):108-116. doi:10.1177/1043659602250623.
  38. Devlin JT, Dhalac D, Suldan AA, Jacobs A, Guled K, Bankole KA. Determinants of physical activity among Somali women living in Maine. J Immigr Minor Health. 2012;14(2):300-306. doi:10.1007/s10903-011-9469-2.
  39. Walseth K. Bridging and bonding social capital in sport— experiences of young women with an immigrant background. Sport Educ Soc. 2008;13(1):1-17. doi:10.1080/13573320701780498.
  40. Hansen AR, Ekholm O, Kjoller M. Health behaviour among non- Western immigrants with Danish citizenship. Scand J Public Health. 2008;36(2):205-210. doi:10.1177/1403494807085065.
  41. Terry DR, Le Q, Hoang H. Migrants’ perceptions of health promotion messages in rural Tasmania. Health Risk Society. 2012;14(7-8):639- 653. doi:10.1080/13698575.2012.713914.
  42. McMullin JM, De Alba I, Chavez LR, Hubbell FA. Influence of beliefs about cervical cancer etiology on Pap smear use among Latina immigrants. Ethn Health. 2005;10(1):3-18. doi:10.1080/1355785052000323001.
  43. Tirodkar MA, Baker DW, Makoul GT, Khurana N, Paracha MW, Kandula NR. Explanatory models of health and disease among South Asian immigrants in Chicago. J Immigr Minor Health. 2011;13(2):385-394. doi:10.1007/s10903-009-9304-1.
  44. Hofstetter CR, Ayers JW, Irvin VL, et al. Does church participation facilitate tobacco control? A report on Korean immigrants. J Immigr Minor Health. 2010;12(2):187-197. doi:10.1007/s10903-009-9228-9.
  45. Kim SS, Son H, Nam KA. The sociocultural context of korean american men’s smoking behavior. West J Nurs Res. 2005;27(5):604-623;comment 624-607. doi:10.1177/0193945905276258.
  46. Bennett MJ. Becoming interculturally competent. In: Wurzel JS. Toward Multiculturalism: A Reader in Multicultural Education. MA: Newton; 2004:62-77.
  47. Nayar S, Hocking C, Wilson J. An Occupational Perspective of Migrant Mental Health: Indian Women’s Adjustment to Living in New Zealand. Br J Occup Ther. 2007;70(1):16-23. doi:10.1177/030802260707000106.
  48. Kielhofner G. Model of Human Occupation: Theory and Application. 4th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2008.
  49. Bennett KM, Scornaiencki JM, Brzozowski J, Denis S, Magalhaes L. Immigration and its impact on daily occupations: a scoping review. Occup Ther Int. 2012;19(4):185-203. doi:10.1002/oti.1336.
  50. Sakellariou D, Pollard N. Occupational Therapies Without Borders: Integrating Justice with Practice. London, UK: Elsevier Health Sciences; 2016.
  51. Anderson LM, Scrimshaw SC, Fullilove MT, Fielding JE, Normand J. Culturally competent healthcare systems. A systematic review. Am J Prev Med. 2003;24(3 Suppl):68-79. doi:10.1016/S0749-3797(02)00657-8.
  52. Iwama M. Culture and occupational therapy: meeting the challenge of relevance in a global world. Occup Ther Int. 2007;14(4):183-187. doi:10.1002/oti.234.
  53. Kwok C, Sullivan G. Influence of traditional Chinese beliefs on cancer screening behaviour among Chinese-Australian women. J Adv Nurs. 2006;54(6):691-699. doi:10.1111/j.1365-2648.2006.03872.x.
  54. Maroney P, Potter M, Thacore VR. Experiences in occupational therapy with Afghan clients in Australia. Aust Occup Ther J. 2014;61(1):13-19. doi:10.1111/1440-1630.12094.
  55. Talero P. Culturally responsive care in occupational therapy: learning from other worldviews. In: Sekellariou D, Pllard N, eds. Occupational Therapies Without Borders. 2nd ed. Edinburgh: Elsevier; 2017:292-301.
  56. Schultz-Krohn W, Drnek S, Powell K. Occupational therapy intervention to foster goal setting skills for homeless mothers. Occup Ther Health Care. 2006;20(3-4):149-166. doi:10.1080/J003v20n03_10.
  57. Pine F. Migration as hope: space, time, and imagining the future. Curr Anthropol. 2014;55(suppl 9):S95-104. doi:10.1086/676526.
  58. Berger R. Immigrant Women Tell Their Stories. Binghamton, NY: Taylor Francis; 2013.
  59. Taylor RR. The Intentional Relationship: Outpatient Therapy and Use of Self. Philadelphia: FA Davis; 2008.
  60. Zanchetta MS, Poureslami IM. Health literacy within the reality of immigrants’ culture and language. Can J Public Health. 2006;97 Suppl 2:S26-30.
  61. Hammell KR. Belonging, occupation, and human well-being: an exploration. Can J Occup Ther. 2014;81(1):39-50. doi:10.1177/0008417413520489.
  62. Hasselkus BR. The Meaning of Everyday Occupation. 2nd ed. NJ: Slack Incorporated; 2011.
  63. Pollard N, Sakellariou D. Politics of Occupation-Centred Practice: Reflections on Occupational Engagement Across Cultures. UK: John Wiley Sons; 2012. doi:10.1002/9781118702819.
  64. Munoz JP. Culturally responsive caring in occupational therapy. Occup Ther Int. 2007;14(4):256-280. doi:10.1002/oti.238.
  65. Lincoln YS, Guba EG. Naturalistic inquiry. Newbury Park, CA: Sage Publications; 1985.