“Looking for better (job) opportunities”: a qualitative analysis of the occupational health of immigrants in southern Spain

1 “Looking for better (job) opportunities”:- A qualitative analysis of the occupational health of immigrants in Southern Spain Abstract Background: Spain hosts the fourth largest number of immigrants in Europe, resulting in a large proportion of migrant workers. To date, few studies have examined the working conditions of immigrants in Southern Spain who are known to be at risk for adverse working conditions. This study aimed to investigate the patterns of work and working conditions of immigrants living in southern Spain and to understand how these factors may affect their health. Methods: A qualitative study using semi-structured interviews was conducted throughout 2019 and included 93 immigrants. Transcription, literal reading, and theoretical categorization were performed and a narrative content analysis was carried out. Findings: Three themes emerged on working conditions of this study population including social and labor-related characteristics, working conditions and occupational health issues. Four employment sectors were most commonly occupied by these immigrants including, caregiving and food service for women and, agriculture and construction for men. Most immigrants were from Latin America, unemployed or working part-time jobs, not hired under an employment contract, working in low qualified jobs and exposed to occupational hazards such as falls from heights, and manual handling of loads.materials, and psychological strain. The lack of training on occupational risk prevention and labor rights were related to a low identification of work situations having a negative impact on the health of immigrants. Conclusions/Application to Practice: These findings should be taken into account by the government and public health managers in order to provide better assistance to immigrant workers in Europe. Keywords: health surveillance; immigrants; occupational health; occupational health nursing; qualitative research; working conditions. Comentado [WHS01]: Is this correct? 2 Background Since the global economic crisis in 2007, the economic insecurity and the lack of job opportunities have led to an increase in international migration to countries with higher income levels (Valero et al., 2014) resulting in countries from the European Union have received a large number of immigrants. Within this context, Spain hosts the fourth largest number of immigrants in Europe, representing 7% of its population (Eurostat Statistics Explained, 2019). The Spanish regions with the highest foreign population are Catalonia (20%), Madrid (16%), Andalusia (14%) and Valencia (14%) (Economic and Social Council Spain, 2019). In recent years, some changes have been noted concerning migration characteristics in Spain. The use of the Strait of Gibraltar is still one of the most important routes for “forced” migrations due to conflict situations (e.g. Syrian refugees) (CEAR Spanish Refugee Assistance Commission, 2016). Conversely, middle and high-income individuals, aiming to live in a country with better socioeconomic situations, are attracted by investment migration programs in Spain (Hombrados et al., 2019). Immigrants tend to contribute positively to the labor force of Spain, since with 80% are in the active working -age range (i.e. 16 to 65 years oldof age), and help mitigate the aging population and the low birth rate in Spain. Likewise, concerning the economic role of immigrants in Spain, it is important to note that only 0.6% of the Spanish Gross Domestic Product (GDP) is directed to foreign currency remittances, and, for this reasontherefore,, its negative impact on the Spanish economy is minimal (Economic and Social Council Spain, 2019). Different studies have reported that the working conditions of immigrants are characterized by precariousness, low qualification, and more hours of work than the native population (Akhlaq, 2020; Arici et al., 2019; Moyce & Schenker, 2018). This is a result of a policy requiring immigrants to seek employment in order to obtain a residence permit 3 (Agudelo et al., 2009; Rosemberg et al., 2019). Immigrants usually are selected for the toughest and most difficult jobs for certain sectors such as agriculture, eating establishments, small businesses and construction and domestic services, without proper economic compensation (García et al., 2009). In addition to an insufficient salary (Agudelo et al., 2009), immigrant populations are exposed to workplace hazards, experience higher rates of workplace injuries, illnesses, and fatalities, and are more prone to suffer from vacation deprivation (Agudelo et al., 2009; Ministry of Labor Migration and Social Security, 2019). Despite these workplace challenges, previous research has reported high rates of job satisfaction among immigrant populations. These findings could be the result of an improved quality of life improvement through employment, the main goal of migrating for most immigrant individuals (Rinken, 2005). In the past five years, few studies have investigated the association between working conditions and occupational health (Agudelo et al., 2019; Arici et al., 2019; Benazizi et al., 2018; Cayuela et al., 2018; Conway et al., 2016) and, even fewer studies have addressed this literature gap with qualitative methods (Ronda et al., 2016; Zapata et al., 2018). To our knowledge, this is the first study with among a Spanish immigrant working population that also examines occupational health and safety (OHS) training, since it is a factor that influences the perception of occupational risks and better health care for workers. Aiming to bridge this gap, the objective of this study was to employ qualitative methods to investigate the association of work patterns and work conditions with the health of the immigrant population living in southern Spain. Methods A qualitative, exploratory and descriptive design was adopted employed and data were analyzed using a phenomenological approach. This approach seeks to describe and understand experiences (i.e. the study phenomenon) from each participant based on the analysis of specific discourses and themes, aiming to build a collective perspective 4 (Hernández et al., 2010). Data collection consisted of semi-structured interviews with immigrants living in southern Spain in the year of 2019. This research followed the criteria of The Consolidated Criteria for Reporting Qualitative Studies - COREQ (Tong et al., 2007). Setting and Sample The study was conducted in Andalusia, the southernmost region of Spain and Europe, where according to the Spanish National Institute Statistics (National Institute Statistics, 2019), there is a population ofare 8,427,000 inhabitants and 653,146 immigrants. Participants were recruited through contacts with five non-governmental organizations (NGOs) from five Andalusian cities (Seville, Cádiz, Málaga, Huelva and Córdoba). These NGOs offer social and labor support to immigrants of different nationalities, such as orientation to employability, the advice in getting the appropriate documentation, English as a Second Language course, and OHS training. However, training in the care sector is the course most attended by the immigrant population, ensuring better job interviews in the future. Eligibility criteria for participants included being adult immigrantsadults (i.e. at least 18 years old)of age, who migrated to Spain, being and were able to communicate (in fluent Spanish or English), and received or participated ; receiving or participating in any of the NGOs services, and who were already trained in occupational health and safety. Sampling was intentional, and the number of informants was completed when the interviews did not provide any new information. A series of sociodemographic variables of the selected sample were established (gender, age, job, country of origin and years living in Spain) in order to ensure heterogeneity of profiles and perspectives. The intention was to increase the relevance of our findings within the Andalusia areas and their generalizability to other Spanish areas. Based on these inclusion criteria, our study sample included 93 participants. Data collection 5 The interviews allowed participants to report their concerns and were carried out face-toface by two qualified researchers inside the NGOs (n = 80) or by phone (n = 13) during the year 2019. They Interviews lasted approximately 50 minutes and were audiotaped and transcribed verbatim. Data collection continued until data saturation was reached as previously mentioned. Participants were recruited in the NGOs where they received job guidance and were interviewed after they had completed a 20-hours of occupational health and safety OHS training. At the beginning of the training, they were informed of the objectives of the study and were invited to participate voluntarily. The interviews were carried out at the end of the training in the NGO facilities or other locations, according to the participants’ preferences or by telephone. Those who agreed to participate, signed a consent term or gave verbal consent when the interview was carried out by phone. The study was approved by the Andalusian Research Ethics Committee in, Spain. All participants received written and oral information about the study, including the right to withdraw and the guarantee of anonymity.confidentiality. At the request of the entities, all personal identifying information will remain blinded. The interview script was based on the project called “Immigration, Work and Health,” a nation-wide study collecting information on the working conditions of immigrant workers and their relationship with health. This project was funded by the Spanish Ministry of Health and Consumption (2006). A group of experts in occupational health (n = 9), and migrations (n = 6) and two NGO users carried out an analysis of the content of this script to assess its adequacy. (this phase was conducted between May and July 2018). Finally, the script was improved and expanded, incorporating issues such as driving or handling of dangerous vehicles, machines or tools, use of chemical products, healthcare received due to work activity, and occupational vaccination status. Comentado [WHS02]: Anonymity cannot be provided in an interview based Study because you know who the participant is. Comentado [WHS03]: This doesn’t go here 6 The interview script was made up of two parts: including questions about sociodemographic characteristics and details about workers’ labor characteristics. Details for the interview script are outlined in Table 1. In brief, workers were asked about work characteristics, daily work conditions and schedules, types of occupational hazards, occupational training, as well as occupational health events and issues (injury and/or illness) and need for work leave. Data Analysis The data obtainedData were captured through audio recording. Transcription, literal reading, and thematic categorization were performed. Data analyses started with individual repeated readings in order to get an overview of respondents’ experiences. The research staff read all field notes and interview transcriptions several times, to gain an overall understanding of the content. The analysis continued by organizing descriptive labels, focusing on emerging or persistent concepts and similarities/differences in participant’s behaviors and statements. The coded data from each participant were examined and compared with the data from all the other participants to develop categories of meanings. A narrative analysis of the transcript content of the transcripts was carried out, following methods proposed by Taylor and Bogdan (Taylor & Bogdan, 1998). To ensure the quality of the data, triangulation with the research staff and informants was conducted. The data were analyzed using NVivo software. (NVivo version 12; 2018; QSR International, Doncaster, Australia owned by the University of Seville, Seville, Spain). A final report was prepared with the statements of each immigrant in the following way: “I, number, sex, age”. Descriptive analysis of the background information was carried out using numbers and percentages, as well as mean, and standard deviation. Results 7 The study sample included 93 participants (77.4% females and 22.6% males), with a mean age of 41.3 (SD=10.3) years and 37.63% had at least hHigh sSchool level of education. Participants were from Seville (32% of the sample), Malaga (23%), Cádiz (19.5%), Huelva (14%) and Córdoba (11.5%). The NGOs included a wide number of nationalities with most immigrants from Latin America (25.8% from Nicaragua, followed by 10.7% from Peru, 10.7% from Colombia and 10.7% from Bolivia) and their average length of stay in Spain was 5.5 years (Table 2). A total of 73.1% of participants did not have a job during the interview. The lack of job opportunities in the country of origin was pointed out as the most common reason for migration, followed by political asylum. In general, migrations were based on individual reasons and had a strong desire to return to the home country. However, this desire remaineds in the background, since one of the main objectives to be fulfilled by immigrant workers is sending remittances to relatives outside Spain. Three main themes emerged from the discussions including, socio-labor characteristics, working conditions and occupational health. Three main themes emerged from the discussions including, and reflected all of the categories: Socio-labor characteristics, Working conditions and Occupational health. Social and labor related characteristics Four employment sectors were the most commonly occupied by the study participants immigrants in this study and and differed by gender including: informal/formal caregivers and food and beverage establishments (for females) and, agriculture and construction (for males). Females reported an overload of functions during their work, usually assigning tasks not specifically outlined in their job description and exceeding working hours. For example, “although I was hired to accompany an older person, I could rarely be with her because I also had to cook for the whole family and clean the house” (I42 female, 45 years). It was common for women to carry out housework and care for both children and the elderly, some of them 8 with chronic diseases, as described by one participant, “Caregiving for diabetes patients…also dependent with Alzheimer, dementia, cerebrovascular accident (...) besides cleaning the house, cooking, ironing, shopping, accompanying the doctor, going to the pharmacy ...” (I62 female, 50 years). In most of the cases, a clear difference was noted between the job qualifications in Spain (i.e. lower qualification) as compared to their country of origin (i.e. higher qualification). A female said “I have worked as a waitress and saleswoman in Nicaragua, but here in Spain, I was working only picking oranges, and they call me to work from time to time, whenever they want” (I2 female, 37 years). Another Colombian participant has switched from working in a bank offering loans, to occupying a waiter position in a bar in Spain (I22 male, 32 years). The participants reported that this lower job qualification was justified by the bureaucracy and the challenges needed to validate academic degrees. However, the need to send remittances to the country of origin and the desire to quickly occupy a job that allows economic maintenance were also important reasons for this low qualification. As a participant refers, “I have some validated documents, but they are not enough. Some of them have to be sent by our universities, so we are caught between the slow bureaucracy of our country and the demands of the Spanish law” (I14 male, 28 years old). Working conditions Even though almost three quarters of the immigrants interviewed were currently unemployed (72.37%), most of them had worked in Spain in the past. Nevertheless, among those employed, most were recruited for part-time or seasonal jobs. It was also frequent to find people who work without a work permit (e.g. picking olives in the field, I66 male, 23 years), and situations in which the employer failed to formalize the situation of the employee like not paying governmental social security taxes: “In my previous job, I have worked 25 months giving care to a dependent person without contributing to social security” (I27 female, 42 years); “I have worked in an air conditioning installation company from 2005 to 2007, and he [the boss] told me he would hire me but he didn't. Since he didn't pay me for a week, I quit 9 my job and I'm currently looking for a regulated job (i.e. to be hired under an employment contract)” (I4 male, 51 years). Other common complaints related to the working conditions including the duration of the working day, which usually surpassed 8 hours. Some respondents reported a 12-hour workday (I69 male, 42 years; I70 female, 48 years) or even living with the person they care for, working as internal staff: “My workday is [never] complete as an internal worker, there is no rest. I have to take care of her [dependent person] day and night” (I11 female, 40 years). They also mention having no expectation of ongoing work or guaranteed hours of work per week, working, according to demand, which does not allow for having a fixed salary. It is clear from the pParticipants’ quotes tindicated exposure to hat these occupations have health and safety hazardshealth hazards at work, such as falls from heights, patient handling and lifting, manual handling of loads, and psychosocial risksstrain. A female participant said: I worked 25 months without a contract and was exposed too many risks because I took care of a woman over 150 kg. I lifted her daily from the bed and it was terrible for my back. They demanded a lot of me and that was also a constant stress (I27 female, 42 years). Another said: “some Alzheimer's patients have hit me, there is that risk of being attacked. I have also been infected with the flu” (I6 male, 49 years). Participants verbalized that they have not had been received training: “They never train you, they have never done it with anyone I know” (I91 female, 49 years). “I was never trained in safety or occupational risk prevention” (I11 male, 44 years); “The company was never interested in offering me training” (I14 male, 28 years). Nevertheless, they pointed out that the identification of labor risks has been possible thanks to the OHS training received. “After the course, I knew what a work accident was and that if we suffered one, we could take a day off … but then, we had to continue working” (I14 male, 28 years). 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