In e na ional Jou nal o
En i onmen al Resea ch
and Public Heal h
A icle
The Occupa ional Heal h o Female Immig an
Ca egi e s: A Quali a i e App oach
Rocío de Diego-Co de o 1, Juan Vega-Escaño 2,* , Lo ena Ta iño-Conceje o 3,* and
Ma íaÁngeles Ga cía-Ca pin e o-Muñoz 3
1Resea ch G oup CTS 969 Inno a ion in Heal hCa e and Social De e minan s o Heal h, Facul y o Nu sing,
Physio he apy and Podia y, Uni e si y o Se ille, 41009 Se ille, Spain; [email p o ec ed]
2Resea ch G oup CTS 1054 In e en ions and Heal h Ca e, Red C oss, Spanish Red C oss Nu sing School,
Uni e si y o Se ille, 41009 Se illa, Spain
3Resea ch G oup PAIDI-CTS 1050 Complex Ca e, Ch onici y and Heal h Ou comes, Facul y o Nu sing,
Physio he apy and Podia y, Uni e si y o Se ille, 41009 Se ille, Spain; [email p o ec ed]
*Co espondence: [email p o ec ed] (J.V.-E.); [email p o ec ed] (L.T.-C.)
Recei ed: 14 Sep embe 2020; Accep ed: 22 Oc obe 2020; Published: 25 Oc obe 2020

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Abs ac :
In gene al, immig an s su e poo wo king condi ions. This is pa icula ly ue in he case
o women, who cons i u e 48% o in e na ional mig an s, and hese poo condi ions a e closely linked
o he sec o s hey mainly occupy, such as domes ic and ca e-gi ing se ices. The aim o he p esen
s udy was o in es iga e he wo king condi ions o he emale immig an popula ion li ing in sou he n
Spain and how hese condi ions may a ec hei heal h. A quali a i e s udy using semi-s uc u ed
in e iews and discussion g oups was conduc ed o e one yea in 2019, wi h 61 immig an women
ec ui ed. The sec o s occupied by immig an women we e ca egi ing o dependen people and
domes ic se ices. Mos o he emale immig an s in e iewed we e wo king (63.94%), al hough he
majo i y we e employed in an i egula si ua ion, wi h a e y long wo king day. Among he main
isks iden i ied we e biological isks, physical a acks, alls, wounds and musculoskele al complain s
ela ed o handling pa ien s and ca ying ou household cho es. Mos o hem had no aken an
occupa ional heal h es and did no epo acciden s occu ing in he wo kplace o ea o losing hei
jobs. The main heal h p oblems we e ela ed o physical and men al heal h (such as musculoskele al
diseases and s ess). These indings highligh he impo ance o making a majo change in ou
pe spec i e ega ding he social alue o including immig an women in he labou ma ke and he
di e en aspec s ela ed o hei heal h.
Keywo ds:
ca egi e ; immig an s; occupa ional heal h; wo king condi ions; women;
household se ices
1. In oduc ion
Mig a ion, de ined by he In e na ional O ganisa ion o Mig a ion (IOM) as “ he mo emen o a
pe son o a g oup o pe sons, ei he ac oss an in e na ional bo de , o wi hin a S a e” [
1
] is an ine i able
phenomenon which a ec s all coun ies. The goal o mig an s has usually been o imp o e hei
s anda d o li ing. In ecen yea s, he numbe o in e na ional mig an s has inc eased signi ican ly,
eaching 272 million wo ldwide in 2019. Female mig an s cons i u ed 48 pe cen o his in e na ional
mig an s ock [2].
In Spain, immig an s cons i u e 10.7% o he o al popula ion. In Andalusia, his igu e is 7%,
o which 49% a e women [
3
]. As ega ds na ional o igins, he low o immig an s om Sou h Ame ica
o Andalusia inc eased om 2003 o 2008, and has dec eased since 2009, wi h 7200 people egis e ed in
2018 [4].
In . J. En i on. Res. Public Heal h 2020,17, 7807; doi:10.3390/ije ph17217807 www.mdpi.com/jou nal/ije ph
In . J. En i on. Res. Public Heal h 2020,17, 7807 2 o 14
Immig an s a e conside ed ulne able people, due o he in e ac ion o a ious ac o s such as
hei sociodemog aphic cha ac e is ics, capaci ies (knowledge, ne wo ks, access o esou ces and
in o ma ion, e c.), loca ion and he impac o c isis-induced ac o s (sepa a ion, loss and lack o esou ces
and oppo uni ies o disc imina ion in access o assis ance) [
1
]. Se e al s udies ha e shown ha he
i egula i y o wo k is a common ea u e in he si ua ion o immig an wo ke s [
5
,
6
]. This popula ion
mos commonly wo ks in he so-called “3D jobs”: dange ous, di y and demanding/deg ading [
7
].
In compa ison wi h he na i e popula ion, immig an s usually pe o m low-skilled, empo a y jobs,
wi h low wages, g ea e physical equi emen s, in e io en i onmen al condi ions a wo k and g ea e
exposu e o occupa ional haza ds [
8
–
10
], esul ing in wo se heal h ou comes and an inc eased isk
o inju ies and occupa ional diseases. Among he mos common heal h p oblems among immig an
wo ke s in Spain a e s ess, dep ession, sleep diso de s, di use muscle pain, headaches and gas ic
complain s [11–14].
In Eu opean coun ies, he popula ion is g adually aging, and he e is a g owing demand o ca e
p o ide s. Inc easingly, ca e wo k is no p o ided by he na i e popula ion, since i is no an a ac i e
choice o wo ke s who may ha e o he wo k op ions [
15
–
17
]. Immig an women he e o e p o ide
ca e in he domes ic en i onmen , and ha e assumed he adi ional, well-de ined cha ac e is ics o he
ca egi e in e ms o in isibili y, an unheal hy o e load o wo k, de e io a ion in he quali y o li e and
social ela ionships, physical a igue and exposu e o s esso s [
18
–
20
]. To his, we mus add he na u e
o hei si ua ion as mig an s [
17
]. P e ious s udies ha e shown ha he main heal h p oblems ela ed
o wo king condi ions among emale o eign domes ic wo ke s we e physical, e bal, and sexual
abuse, musculoskele al s ain, espi a o y di icul ies, men al heal h illness and in ec ious diseases,
among o he s [
21
]. In addi ion, a ecen bibliome ic analysis o 21,457 documen s conce ning global
mig a ion heal h poin ed ou he need o in es iga e he heal h condi ions o emale mig an wo ke s
and p omo e esea ch in o mig an women’s heal h in gene al [22].
All o he abo e, he inc ease in immig an s who ha e a i ed in Andalusia, hei si ua ion o
ulne abili y, he i egula jobs hey pe o m, he nega i e heal h e ec s ha his en ails and he
inco po a ion o his popula ion in o he ca e sec o as a consequence o he aging popula ion o
Eu opean coun ies jus i y ou esea ch, whose objec i e has been o s udy he wo king condi ions
o he emale immig an popula ion li ing in sou he n Spain and how hese condi ions may a ec
hei heal h.
2. Ma e ials and Me hods
2.1. Design
The s udy had a quali a i e desc ip i e design, an e hnog aphic app oach. Au ho s such as C eswell
(1998) [
23
], Al
á
ez-Gayou (2003) [
24
] and Me ens (2005) [
25
] indica ed ha his app oach seeks o
desc ibe and unde s and phenomena om he pe spec i e o each pa icipan and collec i ely, based on
he analysis o speci ic discou ses and hemes, as well as on he analysis o hei possible meanings.
2.2. Sample
The s udy was ca ied ou in i e Non-Go e nmen al O ganisa ions (NGOs) in Andalusia which
o e social and p o essional assis ance o immig an s. The o al numbe o in o man s was 61.
The sample o he in e iews (I) was made up o 43 women and he sample o he Focus G oups
(FGs) consis ed o 18 women.
In o man s we e included p o ided hey we e adul immig an women li ing in Spain; we e able
o communica e (in luen Spanish o English); we e en olled in NGOs; we e wo king o had been
wo king in companies ha p o ide home help se ices.
The sampling was pu posi e and sa u a ion c i e ia was used, and i was unlikely ha new da a,
i.e., new ca ego ies o concep s, would be ob ained in subsequen in e iews [26].
In . J. En i on. Res. Public Heal h 2020,17, 7807 3 o 14
2.3. Da a Collec ion
Bo h in e iews and FGs we e ca ied ou . The aim o he FGs was o deepen ou knowledge
o he aspec s ha eme ged inc easingly a e he in e iews ouched on mo e p o ound opics and
he mo i a ing ac o s ha we e exp essed only in he g oup dialogue, which allowed us o es ablish
con ex ual in e p e a ions o he egis e ed esponses [27].
Due o he pa icipan s’ lack o a ailabili y, he du a ion o bo h he in e iews and he FGs anged
om 45 o 60 min. The in e iews we e ca ied ou ace- o- ace on he NGOs’ p emises (n=38) and by
phone (n=5) in 2019, las ing 50 min. The FGs (n=2) we e ca ied ou on he NGOs’ p emises o
45–60 min. Bo h we e audio aped and ansc ibed e ba im.
The in o man s we e selec ed a he NGOs whe e hey ecei ed job ad ice. A he s a o he
aining session, hey we e in o med o he objec i es o he s udy and in i ed o pa icipa e olun a ily.
Those who ag eed o ake pa we e in e iewed a he end o a aining session abou Occupa ional
Heal h and Sa e y (OHS). The da a collec ion p ocess was comple ed ollowing he p inciple o
heo e ical sa u a ion [28].
A summa i e con en analysis was ca ied ou . A e codi ica ion, he mos signi ican uni s
o analysis we e ex ac ed and he in e ela ionships be ween he di e en hemes we e iden i ied.
A inal epo was p epa ed wi h he s a emen s om he in e iews o FDs in o man s, indica ed by
“I-numbe ” and yea s. The whole analy ical p ocess was ca ied ou using he NVi o so wa e.
2.4. Ins umen s
In 2006, he p ojec called “Immig a ion, Wo k and Heal h” (ITSAL) began in Spain, om he
collabo a ion o occupa ional heal h esea ch g oups loca ed in di e en ci ies, whose gene al objec i e
is o analyse he employmen condi ions and wo k o immig an wo ke s and hei ela ionship
wi h heal h. As speci ic objec i es, he ITSAL p ojec includes desc ibing he pe sonal and labou
cha ac e is ics o mig an wo ke s, knowing hei pe cep ions abou heal h, wo k and he ela ionships
be ween hem, desc ibing hei employmen and wo k condi ions, hei knowledge abou occupa ional
isks and hei heal h p o ec ion igh s a wo k, and analyse he ela ionships o all hese elemen s
wi h indica o s o physical, men al and social heal h [
8
]. The opic guide was based on his p ojec .
Ano he opic guide was w i en o he FGs.
A g oup o expe s in occupa ional heal h (n =7), mig a ion (n =6) and women’s heal h (
n=5
)
ca ied ou an analysis o he con en o hese sc ip s o assess hei sui abili y be ween May and
July 2018. Two emale use s o he NGO we e also consul ed o show hei deg ee o ag eemen
wi h, and unde s anding o , he opic guide, and hei con ibu ions we e also aken in o accoun .
Expe inpu on he opic guides was ecei ed and amendmen s we e made acco dingly (Table 1).
Table 1. Topic guide.
In e iew Topic Guide
Sociodemog aphic cha ac e is ics
Age, coun y o o igin, le el o educa ion
Reason o Mig a ion: Why did you decide o come o Spain?
Time and cha ac e is ics o esidence in Spain (Who do you li e wi h? Numbe o child en/ ela i es).
Semi-s uc u ed hemes
Socio-labou cha ac e is ics
Since a i ing in Spain, which sec o s ha e you wo ked in? Wha asks ha e you been doing?
Wo king condi ions
Cu en employmen
1
si ua ion (in sea ch o employmen , unemployed, employed, social insu ance and egula wo k, ype
o wo k and unc ions pe o med).
Daily wo king condi ions (weekly schedule, o e ime, wo k o day: comple e/pa ial o o he wise).
I unemployed, p e ious wo k his o y (in Spain).
Exposu e o occupa ional isk (iden i ica ion, a ibu ed se e i y).
Types o isks (handling o ehicles, machine y o o he dange ous ools, use o chemical p oduc s).
T aining in OHS by he company (cha ac e is ics, ype o aining, du a ion).
In . J. En i on. Res. Public Heal h 2020,17, 7807 4 o 14
Table 1. Con .
Occupa ional heal h
Occupa ional acciden s h oughou wo king li e in Spain (desc ip ion, ype o acciden , se e i y, equi ed heal h ca e,
sequelae o inju ies, impac on job).
Occupa ional Heal h Exam ( equency, cha ac e is ics and es s pe o med).
Sick lea e ( eason, du a ion, impac on job).
Cu en heal h s a us (pe cep ion o heal h, p esence o ch onic p oblems).
Associa ion o heal h p oblems wi h wo k ac i i y (new symp oms, wo sening disease)
Vaccina ion a he wo kplace.
FGs opic guide
Sociodemog aphic cha ac e is ics
Age, coun y o o igin, le el o educa ion
Mig a o y aspec s:
Why did you decide o come o Spain?
Is Spain he inal des ina ion o only a ansi be o e mo ing o ano he Eu opean coun y?
Reason o coming o o s aying in Spain (language, suppo ne wo k o ela i es o o he compa io s). Reason o choosing Andalusia
Expec a ions o p e ious knowledge abou Spain
Time and cha ac e is ics o esidence in Spain
Who do you li e wi h? (Numbe o child en / ela i es).
Family income.
Co- esponsibili y be ween men and women in domes ic asks
Family ca e: child en in coun y o o igin, pe cen age o sala y sen o help wi h hei main enance
Wo king condi ions
Cu en employmen 2si ua ion (in sea ch o employmen , unemployed, employed, social insu ance and egula wo k,
ype o wo k and unc ions pe o med).
Wo king daily condi ions (weekly schedule, o e ime, shi wo k, wo king day: ull-/pa - ime o o he ).
Occupa ional heal h
Occupa ional acciden s h oughou wo king li e in Spain (desc ip ion, ype o acciden , se e i y, equi ed heal h ca e,
sequelae o inju ies, labou impac ).
Occupa ional Heal h Exam ( equency, cha ac e is ics and es s pe o med).
Labou lea e ( eason, du a ion, labou impac ).
Cu en heal h s a us (pe cep ion o heal h, p esence o ch onic p oblems).
Associa ion o heal h p oblems wi h wo k ac i i y (new symp oms, wo sening disease)
Vaccina ion a he wo kplace.
Ac ions aken when hey become ill (sel -medica ion, help om iends o neighbou s, al e na i e medicine, e c.)
No e: 1,2 wo k o business; occupa ion.
2.5. Da a Analysis
The s udy ook a phenomenological pe spec i e, conside ing and ela ing o human beings
in connec ion wi h hei wo ld [
24
]. To achie e his, wo esea che s ead h ough all he ield
no es and in e iew ansc ip ions se e al imes, o gain an o e all unde s anding o he con en .
Likewise, he o he wo au ho s ead samples o he ield no es and in e iews. The analysis was
ca ied ou by o ganizing desc ip i e labels, ocusing on eme ging o pe sis en concep s and
simila i ies/di e ences in he pa icipan s’ beha iou and s a emen s. Th ee main hemes e lec ed
he ca ego ies: “Reasons/mo i a ing ac o s o mig a ion”, “Wo king women” and “Occupa ional
heal h sa e y”.
2.6. Validi y
This esea ch ollowed he c i e ia o he Consolida ed C i e ia o Repo ing Quali a i e S udies
(COREQ) [
29
]. Aguila -Ga i a and Ba oso-Osuna (2015) [
30
] p oposed ha s udies should use i e
di e en me hods o iangula ion: sou ces, esea che s, heo e ical, me hodological and mul iple.
In ou s udy, we used me hodological iangula ion, which enabled us o es he le el o consis ency
and o esol e disc epancies (see he Supplemen a y Ma e ial, Table S1).
The me hods used o imp o e he alidi y o his quali a i e s udy included da a iangula ion
(including pa icipan s wi h di e en sociodemog aphic cha ac e is ics) and iangula ion o da a
analysis ia di e en esea che s (belonging o he g oup o expe s who analysed he con en o he
opic guides).
In . J. En i on. Res. Public Heal h 2020,17, 7807 5 o 14
2.7. E hical Conside a ions
All he women included in he p ojec olun a ily ag eed o pa icipa e. They ecei ed e bal
and w i en in o ma ion abou he s udy, as well as a le e o con iden iali y signed by he esea ch
eam be o e he in e iews and FGs. The in o ma ion included he po en ial isks o he s udy,
olun a y pa icipa ion, and explana ions abou he igh o e use o answe ques ions o e mina e
in e iews a any poin . In addi ion, he pa icipan s we e in o med abou he in e iews and
FGs, ha hey would be eco ded on audio and quo ed anonymously in publica ions, and ha
all pe sonal iden i ying in o ma ion would emain blinded. In addi ion, e bal consen was
ob ained om pa icipan s. The s udy was app o ed by he Andalusian Resea ch E hics Commi ee,
Spain (Code: 0731-N-19).
2.8. Re lexi i y
The in e iews we e conduc ed by academic esea che s, who collabo a e wi h NGOs as olun a y
s a . To a oid powe imbalances, he in e iews and FGs we e ca ied ou on he NGOs’ p emises,
as hese we e amilia e i o ies o he pa icipan s and whe e hey el ee o exp ess hemsel es.
3. Resul s
3.1. In o man s
The o al sample consis ed o 61 emale La in-Ame ican immig an s (43 in e iewees and 18 FGs
pa icipan s), wi h an a e age age o 41.30 (SD =10.36), who had li ed in Spain o 5.52 (SD =6.33)
yea s. The educa ional le el o he pa icipan s was 32.78% wi h high school s udies and 27.86% wi h
uni e si y s udies (Table 2).
Table 2. Sociodemog aphic cha ac e is ics and employmen s a us.
Va iable
Pa icipan s (n=61) Mean (SD)/[%]
In e iews (n=43) Focus G oups (n=18) To al Pa icipan s (n=61)
Age (yea s) 38.2 (12.45) 44.4 (13.18) 41.3 (10.36)
Coun y o O igin
A gen ina [0] [5.75] [1.64]
Boli ia [9.3] [11.1] [9.84]
Chile [2.3] [0] [1.64]
Colombia [11.62] [11.1] [11.48]
Ecuado [2.3] [0] [1.64]
El Sal ado [4.5] [0] [3.27]
Gua emala [2.3] [0] [1.64]
Hondu as [11.62] [11.1] [9.84]
Nica agua [37.5] [22.4] [32.78]
Pe u [6.9] [22.4] [13.11]
Dominican Republic [9.3] [0] [6.56]
Venezuela [2.3] [16.7] [6.56]
Residence in Spain (yea s) 4.26 (5.52) 6.78 (14.12) 5.52 (6.33)
Numbe o child en 1.97 (1.2) 1.27 (0.78) 1.62 (1.41)
G adua e Cou se
P ima y school [18.6] [16.7] [18.03]
Seconda y school [25.7] [11.1] [21.33]
Bachelo [41.8] [16.7] [32.78]
Uni e si y s udies [13.9] [55.5] [27.86]
Employmen
Yes [72.38] [55.5] [63.94]
No [27.62] [44.5] [36.06]
3.2. Reasons/Mo i a ing Fac o s o Mig a ion
The main mo i a ing ac o behind mig a ion was o escape om p eca ious socioeconomic
condi ions e ging on po e y and o ind a job o be able o enjoy a be e s anda d o li ing,

In . J. En i on. Res. Public Heal h 2020,17, 7807 6 o 14
p incipally o hei amilies. Nea ly all he pa icipan s ha e child en back home o whom hey send
paymen s o hei upkeep and o help hem ou : his, in ac , was hei p incipal eason o mig a ing.
In o al, 95% o he pa icipan s commen ed:
“In my coun y, po e y is e e ywhe e, and he e a e no oppo uni ies o anyone o achie e
some hing in li e” I7 (49 yea s).
“I do i o ge a be e quali y o li e and help my son who is in my coun y (Ecuado ).” I42
(50 yea s).
“To ensu e o my daugh e and mysel a be e u u e wi h economic s abili y” I43 (37 yea s).
“The e (home coun y) i was di icul o ind wo k, and he elde ly a e no ca ed o as much
as he e” I19 (41 yea s).
“I came he e o make a new li e and I ha e a daugh e in Colombia who I’m suppo ing” I25
(58 yea s).
“(...) because i I
´
m he e I can gi e my amily a be e quali y o li e han I can gi e in my
coun y” I7, FG1 (35 yea s).
Ano he majo eason was public sa e y and he ac ha c ime he e was p ac ically non-exis en
compa ed wi h hei coun ies o o igin. Some mo i es o poli ical asylum desc ibed by 50% o he
pa icipan s we e also de ec ed.
“I ’s no he same he e-he e, you a e comple ely sa e” I1, FG2 (50 yea s).
“I came because o he di icul si ua ion in my coun y: he e’s a ci il wa ” I2 (37 yea s).
In addi ion, he Spanish language and he cul u al simila i ies wi h Andalusia we e seen as
a p ime eason o choosing hei des ina ion, in compa ison wi h o he ac o s such as economic
de elopmen and job oppo uni ies in o he pa s o Spain o weal hie Eu opean coun ies. In o al,
90% o he pa icipan s ema ked.
“Wha ’s mo e, mos people come he e because o he language, because you can mo e
a ound, bu language is also a p oblem o us, because none o us can speak English o
F ench” I2, FG2 (62 yea s).
“The Andalusian people a e e y like us” [...] “chee ul and home-lo ing” [...] “we can ge
on be e wi h an Andalusian han wi h a Ca alan” I1, FG1 (24 yea s).
3.3. Wo king Female Immig an s
Mos o ou in e iewees we e employed (63.94%), bu hei con ac ual si ua ion was uns able,
and hey wo ked long hou s.
“I wo k pa - ime” [...] “once a week, bu hey don’ gi e me a con ac ” I2, FG2 (62 yea s).
“I wo ked as a child-minde in a house, bu I wasn’ egis e ed wi h he social secu i y” I38
(43 yea s).
“I (wo k) 24 h a day 7 days a week, and don’ ask o one weekend a mon h like o he gi ls
because he e’s no-one else who’ll s ay he e. So, i you wan o ea n you mon hly sala y,
you ha e o accep he condi ions, which a e 24/7” I7, FG1 (35 yea s old).
The main p o essional sec o was domes ic se ice and ca egi ing o dependen people, such as
child en, and he elde ly wi h i e e sible cogni i e diso de s such as demen ia. All o he pa icipan s
old us:
In . J. En i on. Res. Public Heal h 2020,17, 7807 7 o 14
“I look a e a senio ci izen, o help he do he hings like cooking, cleaning” [...] “e e y hing”
I5 (37 yea s).
“I’ e wo ked as a li e-in assis an aking ca e o elde ly people wi h Alzheime ’s, senile
demen ia, diabe es” I8, FG1 (50 yea s).
“I’ e wo ked wi h an olde pe son wi h Alzheime ’s disease” I4, FG1 (27 yea s).
“I’ e wo ked as a ca egi e ” I8 (51 yea s).
“I’ e had wo jobs since I a i ed he e - I ‘ e ca ed o olde people” I7, FG1 (35 yea s).
As ega ds he asks pe o med, 55 pa icipan s did a mo e wo k han was equi ed o hem and
mo e han hey we e p o essionally ained o do, o en ca ying ou he oles o heal h ca e s o nu ses.
In o al, 30% o he pa icipan s li ed in u al a eas, he domes ic asks e en included looking a e
c ops and li es ock: hese jobs usually equi e a huge physical e o and in ol e long wo king hou s.
They commen ed:
“When I look a e he elde ly, I do he ki chen, he oile , he house, all he gene al cleaning,
as well as changing he d essings on hei so es” I10 (55 yea s).
“I cooked, i oned, cleaned, wen shopping, con olled all he medica ion o he pe son I was
looking a e , such as injec ing insulin, pu ing on pa ches and measu ing blood p essu e,
as well as looking a e hei die , mo emen and pe sonal hygiene” I41 (43 yea s).
“Doing he domes ic cho es, cleaning, washing (...) I also helped hem o pick o anges and
ook ca e o he animals” I7 (49 yea s).
“(
. . .
) o ca e o he , help he o do he housewo k such as cooking o cleaning, among o he s”
I5 (37 yea s).
“To ake ca e o he elde ly and child en” I17 (29 yea s).
“I did all he housewo k and I also ook ca e o an olde pe son” I22 (46 yea s).
“E e y hing ela ed o wo k a home (...) in addi ion, I looked a e olde people wi h educed
mobili y” I20 (48 yea s).
“P ac ically all housewo k asks” I39 (48 yea s).
As o he occupa ional isks ha hey el hey we e exposed o, one o he mos dange ous
biological isks ha was men ioned by 85% o he pa icipan s was he isk o in ec ious disease
due o con ac wi h he pe son hey we e looking a e . Howe e , ano he isk was iden i ied by
24 pa icipan s. They men ioned:
“When ca ing o elde ly people, showe ing hem wi hou glo es” I4 (45 yea s).
“E e y yea I ge he lu” [...] “i ’s ine i able when you wo k looking a e dependen people”
I30 (48 yea s).
“O he s a e he sp ead o he pa ien ’s diseases, such as he lu” I23 (49 yea s).
“Risks o slipping o e ” I12 (34 yea s).
“I can cu mysel a home wi h a kni e o slip” I10 (55 yea s)
In . J. En i on. Res. Public Heal h 2020,17, 7807 8 o 14
“I hi my knee on he pa ien ’s winch. These kinds o blows a e no mal when aking ca e o
him” I21 (54 yea s).
Nine een pa icipan s also men ioned he isk o being exposed o chemicals in he cleaning
p oduc s hey wo k wi h.
“I used ammonia and had p oblems wi h i because i ga e me a headache” I19 (41 yea s).
“The e’s a deg ease ha is e y s ong” I17 (29 yea s).
“In he ki chen wi h chemical cleaning p oduc s” I25 (58 yea s).
O he isks de ec ed included inju ies a e being assaul ed by pa ien s wi h men al diso de s,
as well as b uises and inju ies om acciden s and alls. Os eoa icula inju ies caused by mo ing he
pa ien s we e also equen , and in all cases, hey s essed he lack o pe sonal p o ec i e equipmen
and he wo kplace no being e gonomically adap ed.
“Some Alzheime ’s pa ien s ha e hi me— he e’s he isk o being a acked” I6 (49 yea s).
“I ell ou o he window on he i s loo in he home o a pe son I was looking a e .
. . .
”
I26 (43 yea s).
“I wo ked 25 mon hs wi hou a con ac and was exposed o oo many isks because I ook
ca e o a woman who weighed o e 150 kg. E e y day, I had o li he ou o bed and ha
was e ible o my back” I27 (42 yea s).
In o al, 87% o he pa icipan s had ecei ed no aining in Occupa ional Heal h and Sa e y (OHS)
and se en pa icipan s who admi ed hey had had some aining said ha i was insu icien .
“The only aining, I had was o b owse and ead hings online” I8 (51 yea s).
“They ne e ain you; hey’ e ne e done i wi h anyone I know” I16 (49 yea s).
“Once I wan ed o pa icipa e in a aining p og amme ha las ed wo days, bu I had o
a el and inally I wasn’ able o do i ” I12 (34 yea s).
3.4. Occupa ional Heal h Sa e y
O e hal he women had ne e had an occupa ional heal h examina ion. In addi ion, hey mis ook
he occupa ional heal h examina ion o a gene al medical check-up.
“As I ha e my own insu ance, I was going o ha e he check-up done on my own”
I15 (59 yea s).
“I had a ull heal h es and hey asked me abou diseases” I2 (37 yea s).
“I ake ca e o my heal h mysel , because I ha e my public heal h insu ance, and I usually go
when necessa y. I had my las check-up a yea ago” I8 (51 yea s).
The main heal h p oblems de ec ed ela e o bo h physical and men al heal h.
“(
. . .
) when you a e wo king wi h olde people, i a ec s you physical and men al heal h”
I8, DG1 (50 yea s).
Among hem, he mos common p oblems among hose in e iewed we e ela ed o s ess, as well
as os eoa icula and muscula pain in bo h hal es o he body (uppe and lowe ). In men al heal h,
s ess p oblems due o wo k o e load we e he common.
In . J. En i on. Res. Public Heal h 2020,17, 7807 9 o 14
“I as well as ca ing o an elde ly pe son, he amily also ells you ha you ha e o clean he
house and look a e pe s, hen you s ess le els inc ease” I13 (49 yea s).
“(...) he a igue is physical, bu you also ge men al a igue a nigh ” I1, FG1 (24 yea s).
“(
. . .
) e y i ed since i was ha d o bend down o do he cleaning and my ee and back
hu a lo .” I12 (34 yea s).
In physical heal h, he in e iewees commen ed on os eoa icula and musculoskele al pain,
also ela ed o wo k o e load.
“My bones and join s ache (...) i doesn’ ma e who you wo k o , you always wo k long
hou s” I25 (58 yea s).
“In my case, my back is he wo s bi , I don’ s op (...) and when I ge o he end o he day,
my ee eel so e” I10, FG1, (49 yea s).
Many known cases o occupa ional acciden s we e no epo ed o no iden i ied:
“I ell and had a b uise on my oo and in lamma ion o 20 days, bu I didn’ go o he doc o ”
I20 (48 yea s).
“I’ e su e ed supe icial wounds, bu hey we en’ se ious, and I’ e also banged my leg
agains he co ne o he able o cu mysel wi h kni e when cooking.” I10 (55 yea s).
“I had a con ac , bu I didn’ phone he child en—which was s upid o me” [...] “she had a
all a ou o’clock in he mo ning and I li ed he up mysel and ca ied he o bed—and
hen I go he he nia” I2, FG2 (62 yea s).
“I cu my inge s wi h he mea slice ” I31 (30 yea s).
“I climbed a ee o pick some o anges and ell and sc a ched my eye” I24 (27 yea s).
When hey had a heal h p oblem, mos o he women in e iewed u ned o he adi ional na u al
medicine hey used in hei home coun y and/o sel -medica e. Ele en pa icipan s isi ed he heal h
se ices when hey needed medical a en ion o we e e y ill.
“I s a ed o make my ea, which was cele y ea, by he way, and I made ano he cup o
pa sley ea o ease he pain” I7, FG1 (35 yea s).
“I sel -medica e. My ecipe is ginge wi h lemon and cinnamon, in e y ho ea, wice a day,
oge he wi h pa ace amol . . . and well, I’m be e now” I10, FG1 (49 yea s).
“Algae, ea o educe s omach pain” I1, FG1 (24 yea s).
“Fo he cold I usually d ink ho milk wi h honey, ho milk wi h hyme, honey and lemon (...)
he na u al ecipes o my coun y. (
. . .
) I only isi o he doc o when I’m e y ill” I2, FG2
(62 yea s).
4. Discussion
Ou indings show ha he main easons o immig an s o mig a e o Spain and, in pa icula ,
o Andalusia a e o look o a job o imp o e hei s anda d o li ing, o send o eign cu ency home o
suppo hei amilies, and linguis ic and cul u al p oximi y. Immig an wo king women a e employed
i egula ly, and unde wo king condi ions which demand long hou s, as well as a lack o indi idual
p o ec ion equipmen and no in o ma ion on occupa ional isk p e en ion. The main isks iden i ied