Developing Socio-Epidemiological Indicators of Sexual Health among Migrant Population in Chile

Developing Socio-Epidemiological Indicators of Sexual Health among Migrant Population in Chile | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Developing Socio-Epidemiological Indicators of Sexual Health among Migrant Population in Chile Constanza Adrian Parra, Valeria Stuardo Ávila, Cristian Lisboa Donoso, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5328464/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Apr, 2025 Read the published version in Archives of Public Health → Version 1 posted 12 You are reading this latest preprint version Abstract Background Monitoring and responding to the sexual health needs of migrants is crucial, given their vulnerability during migration. Therefore, this study aimed to develop socio-epidemiological indicators related to sexual health and communicable diseases among the migrant population in Chile, including dimensions of the contexts of vulnerability and migratory trajectories. Method We used a mixed methodology within the framework of implementation research and community-based research based on qualitative data, secondary sources, and expert judgment to construct socio-epidemiological indicators related to sexual health among the migrant population in Chile, including vulnerability and migration trajectories. Preliminary indicators were defined. First, qualitative data were collected through semi-structured interviews with individuals of migrant origin and focus groups with members of community-based organizations, primary healthcare providers, and experts. These instruments were then complemented with indicators from secondary sources. The set of indicators was subjected to content validation and ranking through Delphi Groups and expert judgment, ending with validation through a field pilot test. Results The result was a definitive instrument that included 94 indicators, distributed into 73 questions that correspond to the following dimensions: sociodemographic background, migratory history, and contexts of vulnerability, violence, connection with the Chilean health system, sexual practices, sex work, sexual health (including HIV and STIs) and access to sexual health services, and sexual health needs. Conclusion Participation of the target population and key actors allowed for consensus on a highly sensitive data collection instrument since its indicators account for the contexts of vulnerability and key structural aspects to address sexual health among migrants from an intersectional perspective. Migrants Sexual health Epidemiological surveillance STIs Figures Figure 1 Figure 2 Contributions To The Literature This study shows that the development of indicators with the participation of the target population and key stakeholders allows for the creation of a highly sensitive data collection instrument that integrates a diversity of knowledge and experiences. The importance of addressing migrants' sexual health from an intersectional perspective is emphasized, enriching the analysis of structural inequalities and vulnerabilities for better understanding. A monitoring instrument for migrant ' sexual health in Chile is presented, facilitating continuous data collection and overcoming the limitations of cross-sectional surveys through an updatable and adaptable data system. Background In 2020, there were 281 million migrants between nations, representing 3.6% of the world’s population [ 1 ], with an increase of 0.8% between 2000 and 2020 [ 2 ]. Migration is considered a social determinant of health (SDH) [ 3 ] because it can exert considerable effects on the health of those who migrate. This is due to vulnerability situations during migration, arrival, and settlement in the destination country [ 4 ]. Although the health status of migrants is heterogeneous and difficult to compare globally, there is evidence of persistent inequities in access to health services has been reported in various regions [ 5 ], [ 6 ], [ 7 ]. Furthermore, mortality from infectious diseases and external causes is higher among migrants [ 8 ]. These causes are preventable and demonstrate how SDH influences this population. Sexual health (SH) is essential for comprehensive well-being, including the physical, psychological, and sociocultural aspects related to sexuality [ 9 ]. Addressing the SH needs of individuals of migrants is a crucial challenge for public health because of the vulnerability they face during migration, where they are exposed to sexual abuse and exploitation, especially women, girls, boys, and adolescents [ 10 ]. During transit, women have limited access to SH and reproductive services is limited, increasing the risk —especially in irregular migration [ 11 ]. Lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) migrants, and particularly transgender people, face additional barriers [ 10 ], [ 12 ] and double marginalization due to stigma, violence, and discrimination [ 12 ], [ 13 ], [ 14 ]. In the international context, studies have found that the incidence and prevalence rates of HIV, hepatitis B, C, and syphilis are higher among migrant populations than in local populations[ 15 ]. Although migration does not directly increase the risk of HIV, associated social, economic, and political factors do [ 16 ]— including barriers to accessing health services, lack of knowledge [ 10 ], [ 15 ], [ 17 ], low participation in preventive programs [ 18 ], and experiences of stigma and discrimination [ 15 ]. In Chile, migration has increased considerably over the last decade, reaching 1,625,074 foreigners in 2022: 8.45% of the total population [ 19 ]. This represents a 25.0% increase compared to the same period in 2018. Concurrently, a re-emergence of the HIV epidemic has been observed, with an incidence of 0.25 cases per 1,000 inhabitants in 2022 [ 20 ], and an increase in cases of syphilis and gonorrhea [ 21 ]. New cases of HIV among migrants have increased from 20.2–33.8% between 2017 and 2021[ 22 ]. The 2020 Global Migration Report [ 23 ] highlights the urgency of standardizing and comparing health data for migrants to better understand trends and results. According to this report, it is recommended to monitor care-seeking behaviors, access to services. In addition, health inequities are explained by social class, gender, and ethnicity [ 24 ]. Monitoring such inequities is crucial for guiding policies and programs that promote health equity [ 23 ]. Considering the SH needs associated with migration phenomena at a global level, the development of a community-based surveillance system (CBSS) [ 25 ] focused on the SH of migrants in Chile may be a relevant strategy to link these populations with the health system and prevent disease. This investigation, framed within the study “Community-based surveillance of socio-epidemiological aspects linked to sexual health and related communicable diseases among the migrant population in Chile” (FONDECYT Regular N° 1220371) - COSMIC, aimed to develop socio-epidemiological indicators related to sexual health and communicable diseases among the migrant population in Chile, including dimensions of the contexts of vulnerability and migratory trajectories. Methodology Study design This study was a mixed methodology within the framework of implementation [26] and community-based research [27], [28]. Study population and setting The target population was international migrants living in Chile in the cities of Antofagasta and Santiago, selected due to the high percentage of migrants. Techniques for collecting information and content validation Table 1 Process of developing ting socio-epidemiological indicators. Process Stage Method Outcome Creation of indicators Stage 1 Construction of indicators by a primary qualitative survey Preliminary indicator matrix Complementation with secondary data sources Extensive indicator matrix Content validation Stage 2 Modified Delphi Group Version 1 Expert judgment Version 2 Stage 3 Pilot testing Final version 1. Stage 1: Creation of socio-epidemiological indicators Two complementary stages were conducted to construct and define the list of indicators: A. Construction of indicators from a qualitative data survey A total of 18 semi-structured interviews were conducted with individuals of migrant origin from Bolivia (n = 6), Colombia (n = 6), and Venezuela (n = 6) in the city of Antofagasta, using convenience sampling. Furthermore, 3 focus groups (FG) were conducted with community-based organizations (CBOs) workers (n = 4) and primary health care (PHC) workers (n = 2) from Antofagasta, academic experts (n = 2) in migration, and workers (n = 5) from the Ministry of Health (MINSAL) of Chile. The aim of this study was to explore SH, migration trajectories, and the contexts of migrants’ vulnerability . All interviews and GFs were conducted by expert personnel, recorded, and transcribed. A group of five experts in SH and migration was established to construct indicators from the qualitative survey, and review and agree on the indicators. The Atlas.ti 23 software was used to code and categorize according to common themes. The list of indicators also underwent an individual content review by nine experts in SH, gender, and migration to form preliminary matrix of socio-epidemiological indicators . B. Complementation with secondary sources: The preliminary indicator matrix was complemented with 3 secondary sources: 1. Questionnaire for the study “Contexts of vulnerability, sexual practices, and institutional barriers to addressing sexual health, HIV, and other STIs in migrant populations” (MIRADASS). It was also used in the previous phase of indicator construction. 2. National Survey of Health, Sexuality, and Gender (ENSSEX) of Chile 2022 – 2023 [29]. 3. “Structural and intermediary determinants in access to sexual health care among migrant populations: A scoping review ”[30]. The first version of the “Extensive Matrix of Indicators” was prepared using an Excel spreadsheet after triangulating with the elements provided by these three sources. The model included dimensions, categories, subcategories, and indicators. Additionally, an "Instrument" type document was prepared with the questions and response categories derived from each indicator. 2. Stage 2: Content prioritization and validation A. Delphi Group The modified Delphi method was used to build consensus on the set of socio-epidemiological indicators to be included for monitoring SH and related communicable diseases in a CBSS of migrants in Chile. This participatory process involves expert consensus without direct confrontation of opinions [31], [32]. A panel of 9 experts in migration, gender, and SH was formed, and they were invited to participate via email with information about the Project and the Delphi process. A web form (Google forms) was designed. The form contained a complete matrix of questions and response categories, but is divided into four parts due to the large number of indicators. It was planned in such way to reduce the workload of the experts. Participants were asked to evaluate each question and response category (indicator) and make the decision to “keep,” “modify,” or “delete” the questions based on their pertinence and relevance in the context of developing a CBSS to monitor the SH of migrants in Chile. After each question, the form contains a space to provide suggestions and modifications to the question being asked. Three rounds of review were performed over 3 weeks. At the end of each round, the information was systematized in Microsoft Excel, and the aggregated and anonymized results were sent. Reminders were sent to reduce the dropout rate, and a 1-week flexibility was granted for sending responses. B. Validation by expert judgment Since the modified Delphi Group technique did not sufficiently reduce the indicators, validation by less structured expert judgment was used as a complementary strategy, with the purpose of prioritizing and reducing the number of indicators. To this end, a panel of 11 experts in migration and SH in clinical, academic, and community environments was formed, of which 10 confirmed their participation. Invitations and information were sent via email. The panel includes: · MINSAL representatives: One from the intercultural health area and three from the HIV/AIDS and STI Program. · Representatives from the two PHC establishments linked to the project. · Representatives of the four CBOs linked to the project. The validation process by expert judgment consisted of an individual review using a web form (Google forms), which divided the indicator matrix into 2 parts (A and B). The MINSAL representatives reviewed Part A or B, according to their area of expertise, whereas the CBO and PHC workers reviewed the entire matrix (see Figure 1). The form contained the following question for each indicator: “ Is it necessary (relevant and pertinent) to include the question in a monitoring system aimed at identifying greater vulnerability linked to sexual health (and related communicable diseases) of migrants in Chile?” Dichotomous response alternatives: yes or no . The result of round 1 was systematized in Excel, and a report was generated. Since Round 1 did not reach the consensus necessary to significantly reduce the number of indicators, a second round of group review was carried out by 2 of the Delphi Group experts. 3. Stage 3: Piloting of the instrument Once the latest version of the instrument was ready, it was validated through a field pilot test to assess migrants over 18 years old’ understanding of the indicator questions. Four trained interviewers applied the instrument for 3 weeks at the CBOs and PHC facilities linked to the project in Santiago and Antofagasta, establishing a sample of 100 people. The instrument was reviewed and adjusted on the third day of piloting. During the piloting, the interviewers recorded aspects of wording, structure, and personal sensitivities. This information was analyzed to facilitate the modifications that led to the final instrument. Results 1. Stage 1: A. Construction of indicators from a qualitative data survey To construct the indicators, a team of 5 experts coded and categorized the information from 13 interviews, including proposing preliminary dimensions, categories, and subcategories. Information from the interviews was triangulated using the three FGs. After the preliminary indicators were defined, questions and response categories were developed based on the coded information. The list of indicators and the instrument with questions and response categories were reviewed by the team during telematic sessions, resulting in 168 indicators distributed into 130 questions. Then, an individual content review was conducted by nine experts , who provided feedback via email. This modified the indicators, questions, and response categories, and adjustments to the organization of dimensions and categories. Finally, a preliminary matrix of socio-epidemiological indicators was created with 170 indicators contained in 132 questions, distributed in 5 dimensions and 26 categories (see in supplementary material): migration trajectory and contexts of vulnerability, violence, SH imagination, SH and access to health, and connection with the health system. B. Complementation with secondary sources: From secondary sources, 39 indicators (17 questions) to the preliminary matrix, totaling 203 indicators (149 questions) (see supplementary material). The dimensions and categories were reorganized, adding 2 new dimensions: “Sociodemographic Background” and “Sex Work”. In addition, new categories such as “Sexual Practices” were included, which did not emerge in the initial qualitative approach. This caused the Extended Matrix of Indicators (see Table 2). Table 2: Dimensions and categories of the Extended Matrix of Indicators resulting for Stage 1. Dimensions Categories Sociodemographic Background Sex assigned at birth, sexual identity, country of birth, language, religion or creed, and educational level. Migratory trajectory and contexts of vulnerability Context of departure, networks, context of migratory journey, capacity for agency on the way to Chile, and capacity for agency since settling in Chile. Violence Gender violence, sexual violence, and discrimination. Sexual health as an imaginary Sexual initiation, sexual socialization (sex-diverse community), family planning, sexual practices, and prevention methods. Sex work Sexual health and access to health Gynecological check-up, Pap smear, breast examination, menstrual health, sexual satisfaction, and/or dysfunction, HIV, STI (non-HIV), pregnancy, abortion, childbirth, sexual health needs. Linkage with the health system 2. Stage 2: A. Modified Delphi Group Round 1: The established consensus criteria were: · Agreement greater than 50% to eliminate a question/indicator. · Agreement greater than 50% to keep a question/indicator (with no expert selecting the option to eliminate). · Questions/indicators without consensus will be subject to a second round of consensus. In round 1, 9 experts sent their responses, and 18 indicators and questions were eliminated. There was no consensus among the 88 questions (129 indicators), so a second round of individual review was conducted. See results in Figure 2. Round 2: The 9 experts were asked to review the indicators that did not achieve consensus and 8 of 9 responded. The criterion of an agreement greater than 50% was applied to “keep” or “eliminate” an indicator. Therefore, 63 questions were retained, 15 were eliminated, and 10 did not reach a consensus. Round 3: Two experts reviewed and discussed questions/indicators that did not lead to consensus in round 2. A review of the entire instrument was conducted to ensure the harmony and coherence of the prioritized indicators. As a result, 2 questions (5 indicators) without prior consensus were kept and 18 were eliminated (8 without prior consensus and 10 that were included but affected the coherence of the instrument). These rounds allowed for constructing a prioritized indicator matrix; however, the expected reduction was not achieved. Version 1 of the instrument contained 98 questions (140 indicators) distributed into 8 dimensions (see supplementary material), including “Sexual Practices.” B. Validation by expert judgment Round 1: in round 1, 22 questions reached a consensus above 20% for elimination. No consensus was reached to prioritize the indicators. Therefore, it was decided to carry out a second round to reduce the extent of the instrument. Round 2: Two experts reviewed all the indicators as a group. Priority was given to eliminating indicators with a consensus greater than 20% (2 experts or more) in round 1, requiring 100% consensus in round 2. Table 3: Results of the expert judgment validation Round 1 Round 2 Yes No Questions Eliminated questions 100% 0% 43 6 87.5% 12.5% 32 6 75% 25% 16 12 62.5% 37.5% 6 5 29 questions were eliminated: 17 questions were agreed upon in Round 1, and 12 questions were agreed upon in Round 2. The question “Age” was added and two questions from the item “SH needs” were divided. As a result, “ Version 2” of the final matrix had 71 questions and 102 indicators after eliminating the “Sexual Imagery” dimension and redistributing its questions into “Violence” and “SH and Access to SH.” 3. Phase 3: Piloting and final version: The instrument was adjusted once the piloting began by adding a new question and indicator to “Time in Chile” and modifying six questions by complementing their response categories. The application was completed in 100 individuals, with an application duration of between 10 and 15 minutes. Final adjustments were made and indications for the instrument manual were identified after analyzing qualitative records. The dimensions and categories of the set of indicators are presented in Table 4, and the subcategories are discussed in more detail in the Supplementary material. Table 4: Dimensions and categories of the set of indicators Dimension Category Sociodemographic Background Sex assigned at birth, sexual identity, age, country of birth, and educational level. Migratory trajectory and contexts of vulnerability Context of departure, migration, and of settling in Chile. Violence Discrimination, gender violence, sexual violence. Connection with the health system Contact with the health system and access barriers. Sexual practices Sexual initiation, sexual partners, condom use, CHEMSEX, and last sexual relationship. Sex work. Sexual health and access to sexual health Gynecological or urological check-up, Pap smear, methods for preventing pregnancy, STIs (not HIV) or other genital infections, HIV, pregnancy, childbirth, and abortion. Sexual health needs Need for sexual healthcare access in Chile and unmet needs. The final instrument had 73 questions and 94 indicators . Table 5 shows the organization of the instrument: Table 5: Organization and instrument question before and after the pilot Sections Version 1 questions (Before the pilot) Questions after the pilot Sociodemographic background. 6 6 Migratory trajectory and contexts of vulnerability 11 11 a. Migratory journey 6 6 b. Context of settlement in Chile and its socioeconomic situation 5 5 Violence 5 5 Connection with the Chilean health system 4 4 Sexual practices 8 10 Sex work 4 3 Sexual health and access to sexual health 31 31 a. Gynecological/urological care 7 7 b. Pregnancy prevention 3 3 c. STIs (and other genital infections) 5 5 d. HIV 8 8 e. Obstetric history (pregnancy, abortion, and childbirth) 8 8 Sexual health needs 2 3 Total 71 73 Discussion This research was framed according to a community-based research methodology that involves the active participation of the community in all its phases. This allows the quality and validity of the research to be improved through the incorporation of the knowledge of the individuals involved and a co-learning process [27], [28]. Consistent with this approach, the methodology involved the incorporation of adaptation and iteration processes in its different phases, which developed capacities through problem solving and conferred legitimacy to the procedures [33]. A set of indicators for monitoring the SH of migrants in Chile was developed and defined, resulting in an instrument composed of 73 questions and 94 indicators selected based on their relevance. The development of a monitoring instrument of this type is valuable not only in Chile but also worldwide. This is because it exceeds the potential of a cross-sectional survey—by configuring a continuous data collection system that constitutes a source of information for action—with the potential to be permanently updated and adapted to different contexts. An innovative and relevant aspect was the construction phase of measurable indicators from the primary qualitative data. The interviews collected information from the target population, thus incorporating key dimensions reported by them. Moreover, triangulation with secondary data sources allowed for the incorporation of previously validated indicators for both the general population and the migrant population, as well as diversification of the whole matrix, adding structural and specific indicators from the SH field. This allows for future data comparability to understand differences in key indicators’ behavior in populations with vulnerable contexts. The participation of experts in migration and health issues, health professionals, and community workers, who contributed with their extensive knowledge and experience of working with migrant populations—both in the construction phase and in the validation of content—facilitated the achievement of a broad consensus to be achieved. The participation of experts is essential when constructing instruments because it allows for the incorporation of rigor into the process based on knowledge and learning from accumulated experience. The set of proposed indicators reflects the complexity of migration, which includes structural barriers and cross-cutting axes of inequality. The SH of migrants cannot be studied in isolation because of their vulnerabilities and the associated impact [10]. Migration processes should be analyzed from a gender perspective because they are influenced by the intersection of various associated dimensions, such as race, class, sexuality, sexual orientation, and identity [34], [35], and marked by intersectional violence [36]. Therefore, it is essential to approach studies and interventions on migration and social security from an intersectional perspective to understand how power systems affect individuals and groups [37], [38]. Therefore, in the development of the instrument for monitoring the social security of migrants, priority was given to indicators of dimensions that address structural inequities from an intersectional perspective in its different phases—such as “Migratory Trajectories and Contexts of Vulnerability” and “Violence.” These indicators included in the instrument will allow us to reduce the knowledge gap and expand the analysis by including social security variables, structural factors, and contexts of migrant population vulnerability. Among the indicators of violence, “Discrimination” and “Sexual Violence” were included. The literature shows that the gender diversity/LGBTI+ population and women are groups in which these inequities are intensified. Examples of this in Chile are the high percentage of LGBT individuals who report discrimination (64% in the last year) and homophobic harassment (45%) [39]. Women report more sexual assaults and abuse than men (5.6% versus 7%) [40]. This study has some limitations. The instrument was developed in Spanish because the objective is to implement a CBSS, and community devices do not have intercultural facilitators for its application in other languages. Therefore, in the future, considering that migration processes include individuals who speak other languages, it is essential that versions be adapted and translated to these populations. Furthermore, it was not possible to prioritize enough indicators using only the Delphi method, which led to the need to complement it with a less structured methodology, such as consulting experts. Conclusion The construction of indicators with the participation of the target population and key actors made it possible to reach a consensus on an information collection instrument that aims to be highly sensitive, since it incorporates the diversity of knowledge and experiences, as well as an intersectional perspective, contexts of vulnerability, and fundamental structural aspects for addressing sexual health in migrants. Abbreviations CBSS Community-based surveillance system CBOs Community-based organizations PHC Primary health care SH Sexual Health FG Focus Group LGBTI+ Lesbian, gay, bisexual, transgender, queer, and intersex Declarations Ethics approval and consent to participate. This project was approved through Act No. 017/2022, of May 10, by the Bioethics Committee, the Vice-Rectorate for Research and Doctorate of the Andrés Bello University, and the Scientific Ethics Committees of the North (No. 022/2023) and Antofagasta (No. 038-23/2024) Metropolitan Health Services. Informed consent was obtained from all subjects involved in the study. Consent for publication Not Applicable. Availability of data and materials No datasets were generated or analysed during the current study. Competing interests The authors report no conflicts of interest. Funding This research was conducted as part of the project “Community-based surveillance of socio-epidemiological aspects linked to sexual health and related communicable diseases among the migrant population in Chile” – COSMIC, funded by the National Agency for Research and Development of Chile and the National Fund for Scientific and Technological Development (Fondecyt Regular 1220371). Authors' contributions Conceptualization: VSA, JBP, JBD, MCP, CBI, CAP, CLD Methodology: CAP, VSA, JBP, PCH, KLA. Formal analysis and investigation: CAP, KLA, CLD, VSA, Support in data collection for research: EC, DD, DS, CNH, CLV, VUH. Writing - original draft preparation: CAP. Writing - review and editing: All Authors Funding acquisition: VSA. Acknowledgements The authors would like to thank all those who contributed to the development of this monitoring instrument, especially community workers and migrants who generously shared their life stories. References McAuliffe M, Triandafyllidou A, editors. World Migration Report 2022 . Geneva: International Organization of Migration (IOM), 2021. Accedido: 28 de abril de 2024. [En línea]. Disponible en: https://publications.iom.int/books/world-migration-report-2022 United Nations. «International Migrant Stock | Population Division». Accedido: 28 de abril de 2024. [En línea]. Disponible en: https://www.un.org/development/desa/pd/content/international-migrant-stock Castañeda H, Holmes SM, Madrigal DS, Young M-ED, Beyeler N, y, Quesada J. «Immigration as a social determinant of health», Annu. Rev. Public Health , vol. 36, pp. 375–392, mar. 2015, 10.1146/annurev-publhealth-032013-182419 OIM, «Health of Migrants: Resetting the Agenda - Report of the 2nd Global Consultation on Migrant Health - World», International Organization for Migration (IOM), Sri Lanka. oct. 2017. Accedido: 28 de abril de 2024. [En línea]. Disponible en: https://reliefweb.int/report/world/health-migrants-resetting-agenda-report-2nd-global-consultation-migrant-health Lebano A, et al. «Migrants’ and refugees’ health status and healthcare in Europe: a scoping literature review». BMC Public Health. jun. 2020;20. 10.1186/s12889-020-08749-8 . n. o 1. Logie CH et al. «Sexual and reproductive health among forcibly displaced persons in urban environments in low and middle-income countries: scoping review findings», Reprod. Health , vol. 21, n. o 1, p. 51, abr. 2024, 10.1186/s12978-024-01780-7 Chawhanda C, Levin J, Ibisomi yL. «Factors associated with sexual and reproductive health service utilisation in high migration communities in six Southern African countries». BMC Public Health. may 2022;22:876. 10.1186/s12889-022-13308-4 . Aldridge R et al. «Global Patterns of Mortality in International Migrants: A Systematic Review and Meta-Analysis», 7 de junio de., 2018, Rochester, NY : 3210901. 10.2139/ssrn.3210901 WHO, «Defining sexual health: Report of a technical consultation on sexual health 28–31 January 2002, Geneva.», Geneva. 2006. Accedido: 28 de abril de 2024. [En línea]. Disponible en: http://salutsexual.sidastudi.org/es/registro/d25f08043443ca12013443cd25b000a6 Abubakar I et al. «The UCL–Lancet Commission on Migration and Health: the health of a world on the move», The Lancet , vol. 392, n. o 10164, pp. 2606–2654, dic. 2018, 10.1016/S0140-6736(18)32114-7 Letona P, Felker-Kantor E, Wheeler yJ. «Sexual and reproductive health of migrant women and girls from the Northern Triangle of Central America». Rev Panam Salud Pública. mar. 2023;47:e59. 10.26633/RPSP.2023.59 . Yarwood V, Checchi F, Lau K, Zimmerman yC. «LGBTQI + Migrants: A Systematic Review and Conceptual Framework of Health, Safety and Wellbeing during Migration», Int. J. Environ. Res. Public. Health , vol. 19, n. o 2, Art. n. o 2, ene. 2022, 10.3390/ijerph19020869 Meyer IH. «Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence». Psychol Sex Orientat Gend Divers. 2013;1:3–26. 10.1037/2329-0382.1.S.3 . n. o S. Testa RJ, Habarth J, Peta J, Balsam K, Bockting yW. «Development of the Gender Minority Stress and Resilience Measure». Psychol Sex Orientat Gend Divers. 2015;2:65–77. 10.1037/sgd0000081 . n. o 1. Panchenko S, Gabster A, Mayaud P, y, Erausquin JT. «Sexual health challenges in migrant, immigrant, and displaced populations 2022–2023», Curr. Opin. Infect. Dis. , vol. 37, n. o 1, p. 46, feb. 2024, 10.1097/QCO.0000000000000990 UNAIDS, The gap report. Geneva: UNAIDS. 2014. Accedido: 28 de abril de 2024. [En línea]. Disponible en: https://digitallibrary.un.org/record/775321 Sawadogo PM et al. sep., «Barriers and facilitators of access to sexual and reproductive health services among migrant, internally displaced, asylum seeking and refugee women: A scoping review», PLOS ONE , vol. 18, n. o 9, p. e0291486, 2023, 10.1371/journal.pone.0291486 UNAIDS, «Confronting inequalities — Lessons for pandemic responses from 40 years of AIDS», Geneva. 2021. Accedido: 28 de abril de 2024. [En línea]. Disponible en: https://www.unaids.org/en/resources/documents/2021/2021-global-aids-update INE, «Informe de resultados de la estimación de personas extranjeras residentes en Chile 2022». 2023. Accedido: 28 de abril de 2024. [En línea]. Disponible en: http://www.ine.gob.cl/estadisticas/sociales/demografia-y-vitales/demografia-y-migracion/2023/12/29/población-extranjera-residente-en-chile-superó-los-1-6-millones-de-personas-en-2022-con-un-6-6-de-ellas-en-situación-irregular ONUSIDA, «Chile/2022». Accedido: 28 de abril de 2024. [En línea]. Disponible en: https://www.unaids.org/es/regionscountries/countries/chile Ministerio de Salud de Chile. «Informe de situación epidemiológica de gonorrea y sífilis Chile, 2018.», 2019. Ministerio de Salud de Chile. «Informe Epidemiológico Anual. Enfermedad por el Virus de la Inmunodeficiencia Humana(VIH).2021», 2021. OIM, «Informe sobre las Migraciones en el Mundo 2020», nov. 2019. Accedido: 21 de julio de 2024. [En línea]. Disponible en: https://publications.iom.int/es/books/informe-sobre-las-migraciones-en-el-mundo-2020 Solar O y, Irwin A. «A Conceptual Framework for Action on the Social Determinants of Health», WHO Document Production Services, 2010. Accedido: 21 de julio de 2024. [En línea]. Disponible en: http://hdl.handle.net/1903/23135 Technical Contributors to the June 2018 WHO meeting, «A definition for community-based surveillance and a way forward: results of the WHO global technical meeting, France, 26 to 28 June 2018», Eurosurveillance, vol. 24, n.o 2, p. 1800681, ene. 2019, 10.2807/1560-7917.ES.2019.24.2.1800681 David H, Peters, Nhan T, Tran T, Adam. «Implementation Research in Health: A Practical Guide.», Alliance for Health Policy and Systems Research, World Health Organization, 2013. Accedido: 4 de mayo de 2024. [En línea]. Disponible en: https://ahpsr.who.int/publications/i/item/9789241506212 Israel BA, Schulz AJ, Parker EA, Becker yAB. «Review of community-based research: assessing partnership approaches to improve public health». Annu Rev Public Health. 1998;19:173–202. 10.1146/annurev.publhealth.19.1.173 . Israel BA, Schulz AJ, Parker EP, y, Becker AB. «Community-based participatory research: policy recommendations for promoting a partnership approach in health research», Educ. Health Change Learn. Pract. , vol. 14, n. o 2, pp. 182–197, jul. 2001, 10.1080/13576280110051055 Ministerio de Salud de Chile, «ENCUESTA NACIONAL DE SALUD, SEXUALIDAD Y GÉNERO (ENSSEX.) 2022–2023», EPI – Departamento de Epidemiologia. Accedido: 4 de mayo de 2024. [En línea]. Disponible en: https://epi.minsal.cl/ensex-que-es-la-encuesta/ Adrian Parra C, et al. «Structural and intermediary determinants in sexual health care access in migrant populations: a scoping review». Public Health. feb. 2024;227:54–62. 10.1016/j.puhe.2023.11.031 . Varela-Ruiz M, Díaz-Bravo L, García-Durán yR. «Descripción y usos del método Delphi en investigaciones del área de la salud», Investig. En Educ. Médica , vol. 1, n. o 2, pp. 90–95, jun. 2012. García Valdés M. y M. Suárez Marín, «El método Delphi para la consulta a expertos en la investigación científica», Rev. Cuba. Salud Pública , vol. 39, n. o 2, pp. 253–267, jun. 2013. Andrews M, Pritchett L, Woolcock yM. Building State Capability: Evidence, Analysis, Action . Oxford University Press, 2017. Accedido: 21 de julio de 2024. [En línea]. Disponible en: https://bsc.hks.harvard.edu/publications/building-state-capability-evidence-analysis-action/ M. Domínguez Amorós y P. Contreras Hernández, «Agencia femenina en los procesos migratorios internacionales: una aproximación epistemológica», Empiria Rev. Metodol. Cienc. Soc. , n. o 37, pp. 75–99, 2017. Parella Rubio S, Reyes yL. «Identidades interseccionales: Mujeres migrantes poblanas con estatus migratorio indocumentado en Nueva York», en Migración con ojos de mujer: Una mirada interseccional , 2019, ISBN 978-958-5533-97-4, págs. 85–118, Universidad Simón Bolívar Colombia, 2019, pp. 85–118. Accedido: 8 de junio de 2024. [En línea]. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=7793368 Contreras-Hernández P. y M. Trujillo-Cristoffanini, «Matriz de violencia interseccional: experiencias y trayectorias de mujeres latinoamericanas en Barcelona», Antípoda Rev. Antropol. Arqueol. , n. o 51, Art. n. o 51, abr. 2023, 10.7440/antipoda51.2023.08 Crenshaw K. «Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics», U Chi Leg. F , vol. 1989, p. 139, ene. 1989. Shannon G et al. «Intersectional insights into racism and health: not just a question of identity», Lancet Lond. Engl. , vol. 400, n. o 10368, pp. 2125–2136, dic. 2022, 10.1016/S0140-6736(22)02304-2 Lisboa Donoso C. y V. Stuardo Ávila, «Aspects associated with sexualised drug use among gay men and other men who have sex with men: a cross-sectional study from the Latin America MSM Internet Survey 2018 - Chile», Sex. Health , vol. 17, n. o 6, pp. 493–502, dic. 2020, 10.1071/SH20089 Ministerio de Salud de Chile. «Preliminary results national health, sexuality and gender (ENSSEX)», Chile. [En línea]. Disponible en: http://epi.minsal.cl/primera-presentacion-de-resultados-encuesta-nacional-de-salud-sexualidad-y-genero-enssex-2022-2023/ Additional Declarations No competing interests reported. Supplementary Files Copiadeplanillasmaterialcomplementario.xlsx InstrumentoCOSMICDefinitivo.pdf Cite Share Download PDF Status: Published Journal Publication published 09 Apr, 2025 Read the published version in Archives of Public Health → Version 1 posted Editorial decision: Revision requested 08 Dec, 2024 Reviews received at journal 07 Dec, 2024 Reviews received at journal 26 Nov, 2024 Reviewers agreed at journal 15 Nov, 2024 Reviewers agreed at journal 11 Nov, 2024 Reviewers agreed at journal 11 Nov, 2024 Reviewers agreed at journal 05 Nov, 2024 Reviewers agreed at journal 04 Nov, 2024 Reviewers invited by journal 04 Nov, 2024 Editor assigned by journal 31 Oct, 2024 Submission checks completed at journal 31 Oct, 2024 First submitted to journal 24 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5328464","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":376803319,"identity":"b04cfa7d-40e5-4dd8-b872-c97970f100a2","order_by":0,"name":"Constanza Adrian Parra","email":"","orcid":"","institution":"PhD in Biomedical Research Methodology and Public Health. Department of Pediatrics, Obstetrics, and Gynecology and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona","correspondingAuthor":false,"prefix":"","firstName":"Constanza","middleName":"Adrian","lastName":"Parra","suffix":""},{"id":376803320,"identity":"e17e43e4-9408-4161-9fdb-10c102d4aef5","order_by":1,"name":"Valeria Stuardo Ávila","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYFAC5gYGBgMYh41BDkwyMFjg0cII1cIG0WIMZUoQ0MKA0JLYQEiLwfGDjY8rCuwY5Of3GH6uKLNJ33C7+dkDhho8Ws4kNhueMUhmMDjGYyx55lxa7oY7x8wNGI7h1iLZkNgm2WDAzGDAxmMg2dh2OHfDjQQzCcYGPFr6H7b/bDCoZ5Bv4zH+CdSSbnAj/RteLfwSiW2MDQaHGRiO8ZiBbEkwuJGD3xZ+iYfNQIcd5zE4llZm2XAuzXDmjZxygwQ8fmHjTz74seFPtZx88+HNNxvKbOT5bqRve/ChxganFhjgQeUmENQwCkbBKBgFowAfAAArbk7NOOEnAQAAAABJRU5ErkJggg==","orcid":"","institution":"Institute of Public Health, Universidad Andrés Bello","correspondingAuthor":true,"prefix":"","firstName":"Valeria","middleName":"Stuardo","lastName":"Ávila","suffix":""},{"id":376803321,"identity":"82f39643-4696-4abc-b3bd-d2ae3d32e231","order_by":2,"name":"Cristian Lisboa Donoso","email":"","orcid":"","institution":"School of Dentistry, Department of Health Sciences, Universidad Autonoma de Chile.","correspondingAuthor":false,"prefix":"","firstName":"Cristian","middleName":"Lisboa","lastName":"Donoso","suffix":""},{"id":376803322,"identity":"85d944bd-cb0f-4ea8-8805-b292ca932728","order_by":3,"name":"Kenny Low Andrade","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Kenny","middleName":"Low","lastName":"Andrade","suffix":""},{"id":376803323,"identity":"1d1aada5-5386-4333-ae95-7a70d3cae9e1","order_by":4,"name":"Débora Solís","email":"","orcid":"","institution":"Chilean Association for Family Protection, APROFA","correspondingAuthor":false,"prefix":"","firstName":"Débora","middleName":"","lastName":"Solís","suffix":""},{"id":376803324,"identity":"0bd745f6-01ea-4766-ae2d-8178f0c802c2","order_by":5,"name":"Danilo Gómez","email":"","orcid":"","institution":"Chilean Red Cross, Antofagasta Branch","correspondingAuthor":false,"prefix":"","firstName":"Danilo","middleName":"","lastName":"Gómez","suffix":""},{"id":376803325,"identity":"b45ff521-0c5b-4af0-8419-b7d1825a4c15","order_by":6,"name":"Evelyn Cortés","email":"","orcid":"","institution":"Crealuz Cultural and Personal Development Center","correspondingAuthor":false,"prefix":"","firstName":"Evelyn","middleName":"","lastName":"Cortés","suffix":""},{"id":376803326,"identity":"0a72794f-df5b-475f-a537-38d72b8432f8","order_by":7,"name":"Carolina Nuñez Hernandez","email":"","orcid":"","institution":"AIDS Healthcare Foundation","correspondingAuthor":false,"prefix":"","firstName":"Carolina","middleName":"Nuñez","lastName":"Hernandez","suffix":""},{"id":376803327,"identity":"5ed8f2c1-5d8e-4672-a9f2-218aa08351fd","order_by":8,"name":"Victor Parra Hidalgo","email":"","orcid":"","institution":"Savia Foundation","correspondingAuthor":false,"prefix":"","firstName":"Victor","middleName":"Parra","lastName":"Hidalgo","suffix":""},{"id":376803328,"identity":"65a79dbf-0d47-442f-9fc8-30c8b95045d8","order_by":9,"name":"Carlos Lobos Vega","email":"","orcid":"","institution":"Chile Positivo Foundation","correspondingAuthor":false,"prefix":"","firstName":"Carlos","middleName":"Lobos","lastName":"Vega","suffix":""},{"id":376803329,"identity":"b3acb8e0-73b8-481a-af69-2dcb730d61de","order_by":10,"name":"Julieta Belmar Prieto","email":"","orcid":"","institution":"School of Public Health. School of Medicine. University of Chile","correspondingAuthor":false,"prefix":"","firstName":"Julieta","middleName":"Belmar","lastName":"Prieto","suffix":""},{"id":376803330,"identity":"312883a8-52e2-4977-ae92-4c894c3d81c1","order_by":11,"name":"Paola Contreras Hernández","email":"","orcid":"","institution":"Department of Education . University of Tarapacá.","correspondingAuthor":false,"prefix":"","firstName":"Paola","middleName":"Contreras","lastName":"Hernández","suffix":""},{"id":376803331,"identity":"6836a08b-7856-4833-a96d-691cbe789ef0","order_by":12,"name":"Mercedes Carrasco Portiño","email":"","orcid":"","institution":"Department of Obstetrics and Childcare, School of Medicine, Universidad de Concepción","correspondingAuthor":false,"prefix":"","firstName":"Mercedes","middleName":"Carrasco","lastName":"Portiño","suffix":""},{"id":376803332,"identity":"1e2fece6-04ad-42cc-903c-31d40a949f2f","order_by":13,"name":"Cecilia Bustos Ibarra","email":"","orcid":"","institution":"Department of Social Work, School of Social Sciences, Universidad de Concepción","correspondingAuthor":false,"prefix":"","firstName":"Cecilia","middleName":"Bustos","lastName":"Ibarra","suffix":""},{"id":376803333,"identity":"22c7fa8b-af2a-43b9-afaa-fafdfcc1b0e4","order_by":14,"name":"Jaime Barrientos Delgado","email":"","orcid":"","institution":"Universidad Alberto Hurtado","correspondingAuthor":false,"prefix":"","firstName":"Jaime","middleName":"Barrientos","lastName":"Delgado","suffix":""}],"badges":[],"createdAt":"2024-10-24 22:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5328464/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5328464/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13690-025-01587-3","type":"published","date":"2025-04-09T16:05:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":68817211,"identity":"065db6d5-078e-4f1c-87b9-edc38eb23326","added_by":"auto","created_at":"2024-11-12 10:13:14","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":93247,"visible":true,"origin":"","legend":"\u003cp\u003eValidation process of expert judgment\u003c/p\u003e","description":"","filename":"Figure1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5328464/v1/70131e5a514d9faf7d9591d1.jpeg"},{"id":68816075,"identity":"8e16176d-edd5-47ac-93b3-d2df7bc20355","added_by":"auto","created_at":"2024-11-12 10:05:14","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":121687,"visible":true,"origin":"","legend":"\u003cp\u003eProcess and results of initial ranking of indicators\u003c/p\u003e","description":"","filename":"Figure2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5328464/v1/5056a51b202bafb830dd20f4.jpeg"},{"id":80558747,"identity":"a5e48eda-29f7-4597-9d8d-b99c35169053","added_by":"auto","created_at":"2025-04-14 16:16:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1568974,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5328464/v1/8fd2409f-fb01-46e7-97a6-312fb787f5be.pdf"},{"id":68817212,"identity":"40d0f5eb-4753-4210-bb65-d90f3a1f553f","added_by":"auto","created_at":"2024-11-12 10:13:14","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":62876,"visible":true,"origin":"","legend":"","description":"","filename":"Copiadeplanillasmaterialcomplementario.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5328464/v1/60ff9c189048323fdf9b2a6d.xlsx"},{"id":68816077,"identity":"508b7b53-42e4-448f-a21a-34b49059c92f","added_by":"auto","created_at":"2024-11-12 10:05:14","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":548016,"visible":true,"origin":"","legend":"","description":"","filename":"InstrumentoCOSMICDefinitivo.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5328464/v1/cb8771ac45d1cb96e267d40d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Developing Socio-Epidemiological Indicators of Sexual Health among Migrant Population in Chile","fulltext":[{"header":"Contributions To The Literature","content":"\u003cul\u003e\n \u003cli\u003eThis study shows that the development of indicators with the participation of the target population and key stakeholders allows for the creation of a highly sensitive data collection instrument that integrates a diversity of knowledge and experiences.\u003c/li\u003e\n \u003cli\u003eThe importance of addressing migrants\u0026apos; sexual health from an intersectional perspective is emphasized, enriching the analysis of structural inequalities and vulnerabilities for better understanding.\u003c/li\u003e\n \u003cli\u003eA monitoring instrument for migrant \u0026apos; sexual health in Chile is presented, facilitating continuous data collection and overcoming the limitations of cross-sectional surveys through an updatable and adaptable data system.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Background","content":"\u003cp\u003eIn 2020, there were 281\u0026nbsp;million migrants between nations, representing 3.6% of the world\u0026rsquo;s population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], with an increase of 0.8% between 2000 and 2020 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMigration is considered a social determinant of health (SDH) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] because it can exert considerable effects on the health of those who migrate. This is due to vulnerability situations during migration, arrival, and settlement in the destination country [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough the health status of migrants is heterogeneous and difficult to compare globally, there is evidence of persistent inequities in access to health services has been reported in various regions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Furthermore, mortality from infectious diseases and external causes is higher among migrants [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These causes are preventable and demonstrate how SDH influences this population.\u003c/p\u003e \u003cp\u003eSexual health (SH) is essential for comprehensive well-being, including the physical, psychological, and sociocultural aspects related to sexuality [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Addressing the SH needs of individuals of migrants is a crucial challenge for public health because of the vulnerability they face during migration, where they are exposed to sexual abuse and exploitation, especially women, girls, boys, and adolescents [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. During transit, women have limited access to SH and reproductive services is limited, increasing the risk \u0026mdash;especially in irregular migration [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) migrants, and particularly transgender people, face additional barriers [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and double marginalization due to stigma, violence, and discrimination [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the international context, studies have found that the incidence and prevalence rates of HIV, hepatitis B, C, and syphilis are higher among migrant populations than in local populations[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Although migration does not directly increase the risk of HIV, associated social, economic, and political factors do [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026mdash; including barriers to accessing health services, lack of knowledge [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], low participation in preventive programs [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and experiences of stigma and discrimination [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Chile, migration has increased considerably over the last decade, reaching 1,625,074 foreigners in 2022: 8.45% of the total population [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This represents a 25.0% increase compared to the same period in 2018. Concurrently, a re-emergence of the HIV epidemic has been observed, with an incidence of 0.25 cases per 1,000 inhabitants in 2022 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and an increase in cases of syphilis and gonorrhea [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. New cases of HIV among migrants have increased from 20.2\u0026ndash;33.8% between 2017 and 2021[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe 2020 Global Migration Report [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] highlights the urgency of standardizing and comparing health data for migrants to better understand trends and results. According to this report, it is recommended to monitor care-seeking behaviors, access to services. In addition, health inequities are explained by social class, gender, and ethnicity [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Monitoring such inequities is crucial for guiding policies and programs that promote health equity [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Considering the SH needs associated with migration phenomena at a global level, the development of a community-based surveillance system (CBSS) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] focused on the SH of migrants in Chile may be a relevant strategy to link these populations with the health system and prevent disease.\u003c/p\u003e \u003cp\u003eThis investigation, framed within the study \u0026ldquo;Community-based surveillance of socio-epidemiological aspects linked to sexual health and related communicable diseases among the migrant population in Chile\u0026rdquo; (FONDECYT Regular N\u0026deg; 1220371) - COSMIC, aimed to develop socio-epidemiological indicators related to sexual health and communicable diseases among the migrant population in Chile, including dimensions of the contexts of vulnerability and migratory trajectories.\u003c/p\u003e "},{"header":"Methodology","content":"\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eThis study was a mixed methodology within the framework of implementation\u0026nbsp;[26]\u0026nbsp;and community-based research\u0026nbsp;[27], [28].\u003c/p\u003e\n\u003ch3\u003eStudy population and setting\u003c/h3\u003e\n\u003cp\u003eThe target population was international migrants living in Chile in the cities of Antofagasta and Santiago, selected due to the high percentage of migrants.\u003c/p\u003e\n\u003ch3\u003eTechniques for collecting information and content validation\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;1\u0026nbsp;Process of developing ting socio-epidemiological indicators.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"517\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProcess\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCreation of indicators\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eStage 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConstruction of indicators by a primary qualitative survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePreliminary indicator matrix\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComplementation with secondary data sources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eExtensive indicator matrix\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eContent validation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eStage 2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eModified Delphi Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVersion 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eExpert judgment\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVersion 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStage 3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePilot testing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFinal version \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch3\u003e1.\u0026nbsp; \u0026nbsp;Stage 1: Creation of socio-epidemiological indicators\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eTwo complementary stages were conducted to construct and define the list of indicators:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA.\u0026nbsp;\u0026nbsp;Construction of indicators from a qualitative data survey\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA total of 18 semi-structured interviews\u003c/strong\u003e were conducted with individuals of migrant origin from Bolivia (n = 6), Colombia (n = 6), and Venezuela (n = 6) in the city of Antofagasta, using convenience sampling. Furthermore, \u003cstrong\u003e3 focus groups\u003c/strong\u003e (FG) were conducted with community-based organizations (CBOs) workers (n = 4) and primary health care (PHC) workers (n = 2) from Antofagasta, academic experts (n = 2) in migration, and workers (n = 5) from the Ministry of Health (MINSAL) of Chile. The aim\u003cstrong\u003e\u0026nbsp;of this study was to explore SH, migration trajectories, and the contexts of migrants\u0026rsquo; vulnerability\u003c/strong\u003e. All interviews and GFs were conducted by expert personnel, recorded, and transcribed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA group of five experts in SH and migration was established to construct indicators from the qualitative survey, and review and agree on the indicators. The Atlas.ti 23 software was used to code and categorize according to common themes.\u0026nbsp;The list of indicators also underwent \u003cstrong\u003ean individual content review by nine experts\u003c/strong\u003e in SH, gender, and migration to form \u003cstrong\u003epreliminary matrix of socio-epidemiological indicators\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eB.\u0026nbsp; \u0026nbsp;Complementation with secondary sources:\u003c/p\u003e\n\u003cp\u003eThe preliminary indicator matrix was complemented with 3 secondary sources:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Questionnaire for the study\u003c/strong\u003e \u0026ldquo;Contexts of vulnerability, sexual practices, and institutional barriers to addressing sexual health, HIV, and other STIs in migrant populations\u0026rdquo; (MIRADASS). It was also used in the previous phase of indicator construction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. National Survey of Health, Sexuality, and Gender (ENSSEX) of Chile 2022\u003c/strong\u003e\u0026ndash;\u003cstrong\u003e2023\u003c/strong\u003e[29].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.\u003c/strong\u003e \u0026ldquo;Structural and intermediary determinants in access to sexual health care among migrant populations: \u003cstrong\u003eA scoping review\u003c/strong\u003e\u0026rdquo;[30].\u003c/p\u003e\n\u003cp\u003eThe first version of the \u0026ldquo;Extensive Matrix of Indicators\u0026rdquo; was prepared using an Excel spreadsheet after triangulating with the elements provided by these three sources. The model included dimensions, categories, subcategories, and indicators. Additionally, an \u0026quot;Instrument\u0026quot; type document was prepared with the questions and response categories derived from each indicator.\u003c/p\u003e\n\u003ch3\u003e2.\u0026nbsp; \u0026nbsp;Stage 2: Content prioritization and validation\u003c/h3\u003e\n\u003cp\u003eA.\u0026nbsp; \u0026nbsp;Delphi Group\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe modified Delphi method was used to build consensus on the set of socio-epidemiological indicators to be included for monitoring SH and related communicable diseases in a CBSS of migrants in Chile. This participatory process involves expert consensus without direct confrontation of opinions\u0026nbsp;[31], [32].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA panel of 9 experts in migration, gender, and SH was formed, and they were invited to participate via email with information about the Project and the Delphi process.\u003c/p\u003e\n\u003cp\u003eA web form (Google forms) was designed. The form contained a\u0026nbsp;complete matrix of questions and response categories, but is divided into four parts due to the large number of indicators.\u0026nbsp;It was planned in such way to reduce the workload of the experts.\u003c/p\u003e\n\u003cp\u003eParticipants were asked to \u003cem\u003eevaluate each question and response category (indicator) and make the decision to \u0026ldquo;keep,\u0026rdquo; \u0026ldquo;modify,\u0026rdquo; or \u0026ldquo;delete\u0026rdquo; the questions based on their pertinence and relevance in the context of developing a CBSS to monitor the SH of migrants in Chile.\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAfter each question, the form contains a space to provide suggestions and modifications to the question being asked.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThree rounds of review were performed over 3 weeks. At the end of each round, the information was systematized in Microsoft Excel, and the aggregated and anonymized results were sent. Reminders were sent to reduce the dropout rate, and a 1-week flexibility was granted for sending responses.\u003c/p\u003e\n\u003cp\u003eB.\u0026nbsp; \u0026nbsp;Validation by expert judgment\u003c/p\u003e\n\u003cp\u003eSince the modified Delphi Group technique did not sufficiently reduce the indicators, validation by less structured expert judgment was used as a complementary strategy, with the purpose of prioritizing and reducing the number of indicators.\u003c/p\u003e\n\u003cp\u003eTo this end, a panel of 11 experts in migration and SH in clinical, academic, and community environments was formed, of which 10 confirmed their participation. Invitations and information were sent via email.\u003c/p\u003e\n\u003cp\u003eThe panel includes:\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;MINSAL representatives: One from the intercultural health area and three from the HIV/AIDS and STI Program.\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Representatives from the two PHC establishments linked to the project.\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Representatives of the four CBOs linked to the project.\u003c/p\u003e\n\u003cp\u003eThe validation process by expert judgment consisted of an individual review using a web form (Google forms), which divided the indicator matrix into 2 parts (A and B). The MINSAL representatives reviewed Part A\u0026nbsp;or B, according to their area of expertise, whereas the CBO and PHC workers reviewed the entire matrix (see Figure 1).\u003c/p\u003e\n\u003cp\u003eThe form contained the following question\u0026nbsp;for each indicator:\u003cstrong\u003e\u0026nbsp;\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eIs it necessary (relevant and pertinent) to include the question in a monitoring system aimed at identifying greater vulnerability linked to sexual health (and related communicable diseases) of migrants in Chile?\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDichotomous response alternatives: \u003cem\u003eyes or no\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eThe result of round 1 was systematized in Excel, and a report was generated. Since Round 1 did not reach the consensus necessary to significantly reduce the number of indicators, a second round of group review was carried out by 2 of the Delphi Group experts.\u003c/p\u003e\n\u003ch3\u003e3. \u0026nbsp; Stage 3: Piloting of the instrument\u003c/h3\u003e\n\u003cp\u003eOnce the latest version of the instrument was ready, it was validated through a field pilot test to assess migrants over 18 years old\u0026rsquo; understanding of the indicator questions.\u003c/p\u003e\n\u003cp\u003eFour trained interviewers applied the instrument for 3 weeks at the CBOs and PHC facilities linked to the project in Santiago and Antofagasta, establishing a sample of 100 people.\u003c/p\u003e\n\u003cp\u003eThe instrument was reviewed and adjusted on the third day of piloting. During the piloting, the interviewers recorded aspects of wording, structure, and personal sensitivities. This information was analyzed to facilitate the modifications that led to the final instrument.\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003e1. \u0026nbsp; Stage 1:\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eA. \u0026nbsp;Construction of indicators from a qualitative data survey\u003c/p\u003e\n\u003cp\u003eTo construct the indicators, a team of 5\u003cstrong\u003e\u0026nbsp;experts\u003c/strong\u003e coded and categorized the information from 13 interviews, including proposing preliminary dimensions, categories, and subcategories. Information from the interviews was triangulated using the three FGs. After the preliminary indicators were defined, questions and response categories were developed based on the coded information.\u003c/p\u003e\n\u003cp\u003eThe list of indicators and the instrument with questions and response categories were reviewed by the team during telematic sessions, resulting in 168 indicators distributed into 130 questions. Then, an \u003cstrong\u003eindividual content review was conducted by nine experts\u003c/strong\u003e, who provided feedback via email. This modified the indicators, questions, and response categories, and adjustments to the organization of dimensions and categories.\u003c/p\u003e\n\u003cp\u003eFinally, a preliminary \u003cstrong\u003ematrix of socio-epidemiological indicators\u003c/strong\u003e was created with 170 indicators contained in 132 questions, distributed in 5 dimensions and 26 categories (see in supplementary material): migration trajectory and contexts of vulnerability, violence, SH imagination, SH and access to health, and connection with the health system.\u003c/p\u003e\n\u003cp\u003eB. \u0026nbsp; Complementation with secondary sources:\u003c/p\u003e\n\u003cp\u003eFrom secondary sources, 39 indicators (17 questions) to the preliminary matrix, totaling 203 indicators (149 questions) (see supplementary material). The dimensions and categories were reorganized, adding 2 new dimensions: \u0026ldquo;Sociodemographic Background\u0026rdquo; and \u0026ldquo;Sex Work\u0026rdquo;. In addition, new categories such as \u0026ldquo;Sexual Practices\u0026rdquo; were included, which did not emerge in the initial qualitative approach. This caused the Extended Matrix of Indicators (see Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2: Dimensions and categories of the Extended Matrix of Indicators resulting for Stage 1.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.1667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDimensions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.8333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.1667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSociodemographic Background\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.8333%;\"\u003e\n \u003cp\u003eSex assigned at birth, sexual identity, country of birth, language, religion or creed, and educational level.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.1667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMigratory trajectory and contexts of vulnerability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.8333%;\"\u003e\n \u003cp\u003eContext of departure, networks, context of migratory journey, capacity for agency on the way to Chile, and capacity for agency since settling in Chile.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.1667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eViolence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.8333%;\"\u003e\n \u003cp\u003eGender violence, sexual violence, and discrimination.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.1667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual health as an imaginary\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.8333%;\"\u003e\n \u003cp\u003eSexual initiation, sexual socialization (sex-diverse community), family planning, sexual practices, and prevention methods.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.1667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex work\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.8333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.1667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual health and access to health\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.8333%;\"\u003e\n \u003cp\u003eGynecological check-up, Pap smear, breast examination, menstrual health, sexual satisfaction, and/or dysfunction, HIV, STI (non-HIV), pregnancy, abortion, childbirth, sexual health needs.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.1667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLinkage with the health system\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.8333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch3\u003e\u003cbr\u003e\u003c/h3\u003e\n\u003ch3\u003e2. \u0026nbsp; Stage 2:\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eA. \u0026nbsp;Modified Delphi Group\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRound 1:\u003c/strong\u003e The established consensus criteria were:\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u0026nbsp; \u0026nbsp; \u0026nbsp;Agreement greater than 50% to eliminate a question/indicator.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u0026nbsp; \u0026nbsp; \u0026nbsp;Agreement greater than 50% to keep a question/indicator (with no expert selecting the option to eliminate).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u0026nbsp; \u0026nbsp; \u0026nbsp;Questions/indicators without consensus will be subject to a second round of consensus.\u003c/p\u003e\n\u003cp\u003eIn round 1, 9 experts sent their responses, and 18 indicators and questions were eliminated. There was no consensus among the 88 questions (129 indicators), so a second round of individual review was conducted. See results in Figure 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRound 2:\u003c/strong\u003e The 9 experts were asked to review the indicators that did not achieve consensus and 8 of 9 responded. The criterion of an agreement greater than 50% was applied to \u0026ldquo;keep\u0026rdquo; or \u0026ldquo;eliminate\u0026rdquo; an indicator. Therefore, 63 questions were retained, 15 were eliminated, and 10 did not reach a consensus.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRound 3:\u003c/strong\u003e Two experts reviewed and discussed questions/indicators that did not lead to consensus in round 2. A review of the entire instrument was conducted to ensure the harmony and coherence of the prioritized indicators. As a result, 2 questions (5 indicators) without prior consensus were kept and 18 were eliminated (8 without prior consensus and 10 that were included but affected the coherence of the instrument).\u003c/p\u003e\n\u003cp\u003eThese rounds allowed for constructing a prioritized indicator matrix; however, the expected reduction was not achieved. Version 1 of the instrument contained 98 questions (140 indicators) distributed into 8 dimensions (see supplementary material), including \u0026ldquo;Sexual Practices.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eB. \u0026nbsp; Validation by expert judgment\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRound 1:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ein round 1, 22 questions reached a consensus above 20% for elimination. No consensus was reached to prioritize the indicators. Therefore, it was decided to carry out a second round to reduce the extent of the instrument.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRound 2:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo experts reviewed all the indicators as a group. Priority was given to eliminating indicators with a consensus greater than 20% (2 experts or more) in round 1, requiring 100% consensus in round 2.\u003c/p\u003e\n\u003cp\u003eTable 3: Results of the expert judgment validation\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 65.5714%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRound 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5714%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRound 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.7143%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.2857%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5714%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5714%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEliminated questions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.7143%;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.2857%;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5714%;\"\u003e\n \u003cp\u003e43\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5714%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.7143%;\"\u003e\n \u003cp\u003e87.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.2857%;\"\u003e\n \u003cp\u003e12.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5714%;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5714%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.7143%;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.2857%;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5714%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5714%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.7143%;\"\u003e\n \u003cp\u003e62.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.2857%;\"\u003e\n \u003cp\u003e37.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5714%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5714%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e29 questions were eliminated: 17 questions were agreed upon in Round 1, and 12 questions were agreed upon in Round 2. The question \u0026ldquo;Age\u0026rdquo; was added and two questions from the item \u0026ldquo;SH needs\u0026rdquo; were divided. As a result, \u0026ldquo;\u003cstrong\u003eVersion 2\u0026rdquo;\u003c/strong\u003e of the final matrix had 71 questions and 102 indicators after eliminating the \u0026ldquo;Sexual Imagery\u0026rdquo; dimension and redistributing its questions into \u0026ldquo;Violence\u0026rdquo; and \u0026ldquo;SH and Access to SH.\u0026rdquo;\u003c/p\u003e\n\u003ch3\u003e3. \u0026nbsp; Phase 3: Piloting and final version:\u003c/h3\u003e\n\u003cp\u003eThe instrument was adjusted once the piloting began by adding a new question and indicator to \u0026ldquo;Time in Chile\u0026rdquo; and modifying six questions by complementing their response categories.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe application was completed in 100 individuals, with an application duration of between 10 and 15 minutes. Final adjustments were made and indications for the instrument manual were identified after analyzing qualitative records.\u003c/p\u003e\n\u003cp\u003eThe dimensions and categories of the set of indicators are presented in Table 4, and the subcategories are discussed in more detail in the Supplementary material.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;4: Dimensions and categories of the set of indicators\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.2934%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63.7066%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.2934%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSociodemographic Background\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63.7066%;\"\u003e\n \u003cp\u003eSex assigned at birth, sexual identity, age, country of birth, and educational level.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.2934%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMigratory trajectory and contexts of vulnerability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63.7066%;\"\u003e\n \u003cp\u003eContext of departure, migration, and of settling in Chile.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.2934%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eViolence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63.7066%;\"\u003e\n \u003cp\u003eDiscrimination, gender violence, sexual violence.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.2934%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConnection with the health system\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63.7066%;\"\u003e\n \u003cp\u003eContact with the health system and access barriers.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.2934%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual practices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63.7066%;\"\u003e\n \u003cp\u003eSexual initiation, sexual partners, condom use, CHEMSEX, and last sexual relationship.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.2934%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex work.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63.7066%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.2934%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual health and access to sexual health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63.7066%;\"\u003e\n \u003cp\u003eGynecological or urological check-up, Pap smear, methods for preventing pregnancy, STIs (not HIV) or other genital infections, HIV, pregnancy, childbirth, and abortion.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.2934%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual health needs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63.7066%;\"\u003e\n \u003cp\u003eNeed for sexual healthcare access in Chile and unmet needs.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe final instrument had \u003cstrong\u003e73 questions and 94 indicators\u003c/strong\u003e. Table 5 shows the organization of the instrument:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;5: Organization and instrument question before and after the pilot\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"444\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSections\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVersion 1 questions (Before the pilot)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestions after the pilot\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003eSociodemographic background.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003eMigratory trajectory and contexts of vulnerability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003ea. \u0026nbsp; Migratory journey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003eb. \u0026nbsp; Context of settlement in Chile and its socioeconomic situation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003eViolence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003eConnection with the Chilean health system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003eSexual practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003eSex work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003eSexual health and access to sexual health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e31\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e31\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003ea. \u0026nbsp; \u0026nbsp;Gynecological/urological care\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003eb. \u0026nbsp; Pregnancy prevention\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003ec. \u0026nbsp; STIs (and other genital infections)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003ed. \u0026nbsp; HIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003ee. \u0026nbsp; Obstetric history (pregnancy, abortion, and childbirth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003eSexual health needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65.8427%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e71\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0787%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e73\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis research was framed according to a community-based research methodology that involves the active participation of the community in all its phases. This allows the quality and validity of the research to be improved through the incorporation of the knowledge of the individuals involved and a co-learning process\u0026nbsp;[27], [28]. Consistent with this approach, the methodology involved the incorporation of adaptation and iteration processes in its different phases, which developed capacities through problem solving and conferred legitimacy to the procedures\u0026nbsp;[33].\u003c/p\u003e\n\u003cp\u003eA set of indicators for monitoring the SH of migrants in Chile was developed and defined, resulting in an instrument composed of 73 questions and 94 indicators selected based on their relevance. The development of a monitoring instrument of this type is valuable not only in Chile but also worldwide. This is because it exceeds the potential of a cross-sectional survey—by configuring a continuous data collection system that constitutes a source of information for action—with the potential to be permanently updated and adapted to different contexts.\u003c/p\u003e\n\u003cp\u003eAn innovative and relevant aspect was the construction phase of measurable indicators from the primary qualitative data. The interviews collected information from the target population, thus incorporating key dimensions reported by them. Moreover, triangulation with secondary data sources allowed for the incorporation of previously validated indicators for both the general population and the migrant population, as well as diversification of the whole matrix, adding structural and specific indicators from the SH field. This allows for future data comparability to understand differences in key indicators’ behavior in populations with vulnerable contexts.\u003c/p\u003e\n\u003cp\u003eThe participation of experts in migration and health issues, health professionals, and community workers, who contributed with their extensive knowledge and experience of working with migrant populations—both in the construction phase and in the validation of content—facilitated the achievement of a broad consensus to be achieved. The participation of experts is essential when constructing instruments because it allows for the incorporation of rigor into the process based on knowledge and learning from accumulated experience.\u003c/p\u003e\n\u003cp\u003eThe set of proposed indicators reflects the complexity of migration, which includes structural barriers and cross-cutting axes of inequality. The SH of migrants cannot be studied in isolation because of their vulnerabilities and the associated impact\u0026nbsp;[10]. Migration processes should be analyzed from a gender perspective because they are influenced by the intersection of various associated dimensions, such as race, class, sexuality, sexual orientation, and identity\u0026nbsp;[34], [35], and marked by intersectional violence\u0026nbsp;[36]. Therefore, it is essential to approach studies and interventions on migration and social security from an intersectional perspective to understand how power systems affect individuals and groups\u0026nbsp;[37], [38].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherefore, in the development of the instrument for monitoring the social security of migrants, priority was given to indicators of dimensions that address structural inequities from an intersectional perspective in its different phases—such as “Migratory Trajectories and Contexts of Vulnerability” and “Violence.” These indicators included in the instrument will allow us to reduce the knowledge gap and expand the analysis by including social security variables, structural factors, and contexts of migrant population vulnerability. Among the indicators of violence, “Discrimination” and “Sexual Violence” were included. The literature shows that the gender diversity/LGBTI+ population and women are groups in which these inequities are intensified. Examples of this in Chile are the high percentage of LGBT individuals who report discrimination (64% in the last year) and homophobic harassment (45%)\u0026nbsp;[39]. Women report more sexual assaults and abuse than men (5.6% versus 7%)\u0026nbsp;[40].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study has some limitations. The instrument was developed in Spanish because the objective is to implement a CBSS, and community devices do not have intercultural facilitators for its application in other languages. Therefore, in the future, considering that migration processes include individuals who speak other languages, it is essential that versions be adapted and translated to these populations. Furthermore, it was not possible to prioritize enough indicators using only the Delphi method, which led to the need to complement it with a less structured methodology, such as consulting experts.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe construction of indicators with the participation of the target population and key actors made it possible to reach a consensus on an information collection instrument that aims to be highly sensitive, since it incorporates the diversity of knowledge and experiences, as well as an intersectional perspective, contexts of vulnerability, and fundamental structural aspects for addressing sexual health in migrants.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity-based surveillance system\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBOs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity-based organizations\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePHC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePrimary health care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexual Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFocus Group\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLGBTI+\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLesbian, gay, bisexual, transgender, queer, and intersex\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch3\u003eEthics approval and consent to participate.\u003c/h3\u003e\n\u003cp\u003eThis project was approved through Act No. 017/2022, of May 10, by the Bioethics Committee, the Vice-Rectorate for Research and Doctorate of the Andr\u0026eacute;s Bello University, and the Scientific Ethics Committees of the North (No. 022/2023) and Antofagasta (No. 038-23/2024) Metropolitan Health Services. Informed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003ch3\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003ch3\u003eAvailability of data and materials\u003c/h3\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003ch3\u003eCompeting interests\u003c/h3\u003e\n\u003cp\u003eThe authors report no conflicts of interest.\u003c/p\u003e\n\u003ch3\u003eFunding\u003c/h3\u003e\n\u003cp\u003eThis research was conducted as part of the project \u0026ldquo;Community-based surveillance of socio-epidemiological aspects linked to sexual health and related communicable diseases among the migrant population in Chile\u0026rdquo; \u0026ndash; COSMIC, funded by the National Agency for Research and Development of Chile and the National Fund for Scientific and Technological Development (Fondecyt Regular 1220371).\u003c/p\u003e\n\u003ch3\u003eAuthors\u0026apos; contributions\u003c/h3\u003e\n\u003cp\u003eConceptualization: VSA, JBP, JBD, MCP, CBI, CAP, CLD\u003c/p\u003e\n\u003cp\u003eMethodology: CAP, VSA, JBP, PCH, KLA.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFormal analysis and investigation: CAP, KLA, CLD, VSA,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSupport in data collection for research: EC, DD, DS, CNH, CLV, VUH.\u003c/p\u003e\n\u003cp\u003eWriting - original draft preparation: CAP.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWriting - review and editing: All Authors\u003c/p\u003e\n\u003cp\u003eFunding acquisition: VSA.\u003c/p\u003e\n\u003ch3\u003eAcknowledgements\u003c/h3\u003e\n\u003cp\u003eThe authors would like to thank all those who contributed to the development of this monitoring instrument, especially community workers and migrants who generously shared their life stories.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMcAuliffe M, Triandafyllidou A, editors. \u003cem\u003eWorld Migration Report 2022\u003c/em\u003e. Geneva: International Organization of Migration (IOM), 2021. Accedido: 28 de abril de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://publications.iom.int/books/world-migration-report-2022\u003c/span\u003e\u003cspan address=\"https://publications.iom.int/books/world-migration-report-2022\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnited Nations. \u0026laquo;International Migrant Stock | Population Division\u0026raquo;. Accedido: 28 de abril de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.un.org/development/desa/pd/content/international-migrant-stock\u003c/span\u003e\u003cspan address=\"https://www.un.org/development/desa/pd/content/international-migrant-stock\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCasta\u0026ntilde;eda H, Holmes SM, Madrigal DS, Young M-ED, Beyeler N, y, Quesada J. \u0026laquo;Immigration as a social determinant of health\u0026raquo;, \u003cem\u003eAnnu. Rev. Public Health\u003c/em\u003e, vol. 36, pp. 375\u0026ndash;392, mar. 2015, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1146/annurev-publhealth-032013-182419\u003c/span\u003e\u003cspan address=\"10.1146/annurev-publhealth-032013-182419\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOIM, \u0026laquo;Health of Migrants: Resetting the Agenda - Report of the 2nd Global Consultation on Migrant Health - World\u0026raquo;, International Organization for Migration (IOM), Sri Lanka. oct. 2017. Accedido: 28 de abril de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://reliefweb.int/report/world/health-migrants-resetting-agenda-report-2nd-global-consultation-migrant-health\u003c/span\u003e\u003cspan address=\"https://reliefweb.int/report/world/health-migrants-resetting-agenda-report-2nd-global-consultation-migrant-health\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLebano A, et al. \u0026laquo;Migrants\u0026rsquo; and refugees\u0026rsquo; health status and healthcare in Europe: a scoping literature review\u0026raquo;. BMC Public Health. jun. 2020;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-020-08749-8\u003c/span\u003e\u003cspan address=\"10.1186/s12889-020-08749-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. n.\u003csup\u003eo\u003c/sup\u003e 1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLogie CH et al. \u0026laquo;Sexual and reproductive health among forcibly displaced persons in urban environments in low and middle-income countries: scoping review findings\u0026raquo;, \u003cem\u003eReprod. Health\u003c/em\u003e, vol. 21, n.\u003csup\u003eo\u003c/sup\u003e 1, p. 51, abr. 2024, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12978-024-01780-7\u003c/span\u003e\u003cspan address=\"10.1186/s12978-024-01780-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChawhanda C, Levin J, Ibisomi yL. \u0026laquo;Factors associated with sexual and reproductive health service utilisation in high migration communities in six Southern African countries\u0026raquo;. BMC Public Health. may 2022;22:876. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-022-13308-4\u003c/span\u003e\u003cspan address=\"10.1186/s12889-022-13308-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAldridge R et al. \u0026laquo;Global Patterns of Mortality in International Migrants: A Systematic Review and Meta-Analysis\u0026raquo;, 7 de junio de., 2018, \u003cem\u003eRochester, NY\u003c/em\u003e: 3210901. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2139/ssrn.3210901\u003c/span\u003e\u003cspan address=\"10.2139/ssrn.3210901\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO, \u0026laquo;Defining sexual health: Report of a technical consultation on sexual health 28\u0026ndash;31 January 2002, Geneva.\u0026raquo;, Geneva. 2006. Accedido: 28 de abril de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://salutsexual.sidastudi.org/es/registro/d25f08043443ca12013443cd25b000a6\u003c/span\u003e\u003cspan address=\"http://salutsexual.sidastudi.org/es/registro/d25f08043443ca12013443cd25b000a6\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbubakar I et al. \u0026laquo;The UCL\u0026ndash;Lancet Commission on Migration and Health: the health of a world on the move\u0026raquo;, \u003cem\u003eThe Lancet\u003c/em\u003e, vol. 392, n.\u003csup\u003eo\u003c/sup\u003e 10164, pp. 2606\u0026ndash;2654, dic. 2018, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(18)32114-7\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(18)32114-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLetona P, Felker-Kantor E, Wheeler yJ. \u0026laquo;Sexual and reproductive health of migrant women and girls from the Northern Triangle of Central America\u0026raquo;. Rev Panam Salud P\u0026uacute;blica. mar. 2023;47:e59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.26633/RPSP.2023.59\u003c/span\u003e\u003cspan address=\"10.26633/RPSP.2023.59\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYarwood V, Checchi F, Lau K, Zimmerman yC. \u0026laquo;LGBTQI\u0026thinsp;+\u0026thinsp;Migrants: A Systematic Review and Conceptual Framework of Health, Safety and Wellbeing during Migration\u0026raquo;, \u003cem\u003eInt. J. Environ. Res. Public. Health\u003c/em\u003e, vol. 19, n.\u003csup\u003eo\u003c/sup\u003e 2, Art. n.\u003csup\u003eo\u003c/sup\u003e 2, ene. 2022, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph19020869\u003c/span\u003e\u003cspan address=\"10.3390/ijerph19020869\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeyer IH. \u0026laquo;Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence\u0026raquo;. Psychol Sex Orientat Gend Divers. 2013;1:3\u0026ndash;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/2329-0382.1.S.3\u003c/span\u003e\u003cspan address=\"10.1037/2329-0382.1.S.3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. n.\u003csup\u003eo\u003c/sup\u003e S.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTesta RJ, Habarth J, Peta J, Balsam K, Bockting yW. \u0026laquo;Development of the Gender Minority Stress and Resilience Measure\u0026raquo;. Psychol Sex Orientat Gend Divers. 2015;2:65\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/sgd0000081\u003c/span\u003e\u003cspan address=\"10.1037/sgd0000081\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. n.\u003csup\u003eo\u003c/sup\u003e 1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePanchenko S, Gabster A, Mayaud P, y, Erausquin JT. \u0026laquo;Sexual health challenges in migrant, immigrant, and displaced populations 2022\u0026ndash;2023\u0026raquo;, \u003cem\u003eCurr. Opin. Infect. Dis.\u003c/em\u003e, vol. 37, n.\u003csup\u003eo\u003c/sup\u003e 1, p. 46, feb. 2024, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/QCO.0000000000000990\u003c/span\u003e\u003cspan address=\"10.1097/QCO.0000000000000990\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNAIDS, The gap report. Geneva: UNAIDS. 2014. Accedido: 28 de abril de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://digitallibrary.un.org/record/775321\u003c/span\u003e\u003cspan address=\"https://digitallibrary.un.org/record/775321\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSawadogo PM et al. sep., \u0026laquo;Barriers and facilitators of access to sexual and reproductive health services among migrant, internally displaced, asylum seeking and refugee women: A scoping review\u0026raquo;, \u003cem\u003ePLOS ONE\u003c/em\u003e, vol. 18, n.\u003csup\u003eo\u003c/sup\u003e 9, p. e0291486, 2023, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0291486\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0291486\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNAIDS, \u0026laquo;Confronting inequalities \u0026mdash; Lessons for pandemic responses from 40 years of AIDS\u0026raquo;, Geneva. 2021. Accedido: 28 de abril de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unaids.org/en/resources/documents/2021/2021-global-aids-update\u003c/span\u003e\u003cspan address=\"https://www.unaids.org/en/resources/documents/2021/2021-global-aids-update\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eINE, \u0026laquo;Informe de resultados de la estimaci\u0026oacute;n de personas extranjeras residentes en Chile 2022\u0026raquo;. 2023. Accedido: 28 de abril de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ine.gob.cl/estadisticas/sociales/demografia-y-vitales/demografia-y-migracion/2023/12/29/poblaci\u0026oacute;n-extranjera-residente-en-chile-super\u0026oacute;-los-1-6-millones-de-personas-en-2022-con-un-6-6-de-ellas-en-situaci\u0026oacute;n-irregular\u003c/span\u003e\u003cspan address=\"http://www.ine.gob.cl/estadisticas/sociales/demografia-y-vitales/demografia-y-migracion/2023/12/29/poblaci\u0026oacute;n-extranjera-residente-en-chile-super\u0026oacute;-los-1-6-millones-de-personas-en-2022-con-un-6-6-de-ellas-en-situaci\u0026oacute;n-irregular\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eONUSIDA, \u0026laquo;Chile/2022\u0026raquo;. Accedido: 28 de abril de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unaids.org/es/regionscountries/countries/chile\u003c/span\u003e\u003cspan address=\"https://www.unaids.org/es/regionscountries/countries/chile\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinisterio de Salud de Chile. \u0026laquo;Informe de situaci\u0026oacute;n epidemiol\u0026oacute;gica de gonorrea y s\u0026iacute;filis Chile, 2018.\u0026raquo;, 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinisterio de Salud de Chile. \u0026laquo;Informe Epidemiol\u0026oacute;gico Anual. Enfermedad por el Virus de la Inmunodeficiencia Humana(VIH).2021\u0026raquo;, 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOIM, \u0026laquo;Informe sobre las Migraciones en el Mundo 2020\u0026raquo;, nov. 2019. Accedido: 21 de julio de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://publications.iom.int/es/books/informe-sobre-las-migraciones-en-el-mundo-2020\u003c/span\u003e\u003cspan address=\"https://publications.iom.int/es/books/informe-sobre-las-migraciones-en-el-mundo-2020\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSolar O y, Irwin A. \u0026laquo;A Conceptual Framework for Action on the Social Determinants of Health\u0026raquo;, WHO Document Production Services, 2010. Accedido: 21 de julio de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://hdl.handle.net/1903/23135\u003c/span\u003e\u003cspan address=\"http://hdl.handle.net/1903/23135\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTechnical Contributors to the June 2018 WHO meeting, \u0026laquo;A definition for community-based surveillance and a way forward: results of the WHO global technical meeting, France, 26 to 28 June 2018\u0026raquo;, Eurosurveillance, vol. 24, n.o 2, p. 1800681, ene. 2019, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2807/1560-7917.ES.2019.24.2.1800681\u003c/span\u003e\u003cspan address=\"10.2807/1560-7917.ES.2019.24.2.1800681\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavid H, Peters, Nhan T, Tran T, Adam. \u0026laquo;Implementation Research in Health: A Practical Guide.\u0026raquo;, Alliance for Health Policy and Systems Research, World Health Organization, 2013. Accedido: 4 de mayo de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ahpsr.who.int/publications/i/item/9789241506212\u003c/span\u003e\u003cspan address=\"https://ahpsr.who.int/publications/i/item/9789241506212\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsrael BA, Schulz AJ, Parker EA, Becker yAB. \u0026laquo;Review of community-based research: assessing partnership approaches to improve public health\u0026raquo;. Annu Rev Public Health. 1998;19:173\u0026ndash;202. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1146/annurev.publhealth.19.1.173\u003c/span\u003e\u003cspan address=\"10.1146/annurev.publhealth.19.1.173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsrael BA, Schulz AJ, Parker EP, y, Becker AB. \u0026laquo;Community-based participatory research: policy recommendations for promoting a partnership approach in health research\u0026raquo;, \u003cem\u003eEduc. Health Change Learn. Pract.\u003c/em\u003e, vol. 14, n.\u003csup\u003eo\u003c/sup\u003e 2, pp. 182\u0026ndash;197, jul. 2001, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/13576280110051055\u003c/span\u003e\u003cspan address=\"10.1080/13576280110051055\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinisterio de Salud de Chile, \u0026laquo;ENCUESTA NACIONAL DE SALUD, SEXUALIDAD Y G\u0026Eacute;NERO (ENSSEX.) 2022\u0026ndash;2023\u0026raquo;, EPI \u0026ndash; Departamento de Epidemiologia. Accedido: 4 de mayo de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://epi.minsal.cl/ensex-que-es-la-encuesta/\u003c/span\u003e\u003cspan address=\"https://epi.minsal.cl/ensex-que-es-la-encuesta/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdrian Parra C, et al. \u0026laquo;Structural and intermediary determinants in sexual health care access in migrant populations: a scoping review\u0026raquo;. Public Health. feb. 2024;227:54\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.puhe.2023.11.031\u003c/span\u003e\u003cspan address=\"10.1016/j.puhe.2023.11.031\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVarela-Ruiz M, D\u0026iacute;az-Bravo L, Garc\u0026iacute;a-Dur\u0026aacute;n yR. \u0026laquo;Descripci\u0026oacute;n y usos del m\u0026eacute;todo Delphi en investigaciones del \u0026aacute;rea de la salud\u0026raquo;, \u003cem\u003eInvestig. En Educ. M\u0026eacute;dica\u003c/em\u003e, vol. 1, n.\u003csup\u003eo\u003c/sup\u003e 2, pp. 90\u0026ndash;95, jun. 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarc\u0026iacute;a Vald\u0026eacute;s M. y M. Su\u0026aacute;rez Mar\u0026iacute;n, \u0026laquo;El m\u0026eacute;todo Delphi para la consulta a expertos en la investigaci\u0026oacute;n cient\u0026iacute;fica\u0026raquo;, \u003cem\u003eRev. Cuba. Salud P\u0026uacute;blica\u003c/em\u003e, vol. 39, n.\u003csup\u003eo\u003c/sup\u003e 2, pp. 253\u0026ndash;267, jun. 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndrews M, Pritchett L, Woolcock yM. \u003cem\u003eBuilding State Capability: Evidence, Analysis, Action\u003c/em\u003e. Oxford University Press, 2017. Accedido: 21 de julio de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bsc.hks.harvard.edu/publications/building-state-capability-evidence-analysis-action/\u003c/span\u003e\u003cspan address=\"https://bsc.hks.harvard.edu/publications/building-state-capability-evidence-analysis-action/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM. Dom\u0026iacute;nguez Amor\u0026oacute;s y P. Contreras Hern\u0026aacute;ndez, \u0026laquo;Agencia femenina en los procesos migratorios internacionales: una aproximaci\u0026oacute;n epistemol\u0026oacute;gica\u0026raquo;, \u003cem\u003eEmpiria Rev. Metodol. Cienc. Soc.\u003c/em\u003e, n.\u003csup\u003eo\u003c/sup\u003e 37, pp. 75\u0026ndash;99, 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParella Rubio S, Reyes yL. \u0026laquo;Identidades interseccionales: Mujeres migrantes poblanas con estatus migratorio indocumentado en Nueva York\u0026raquo;, en \u003cem\u003eMigraci\u0026oacute;n con ojos de mujer: Una mirada interseccional\u003c/em\u003e, 2019, ISBN 978-958-5533-97-4, p\u0026aacute;gs. 85\u0026ndash;118, Universidad Sim\u0026oacute;n Bol\u0026iacute;var Colombia, 2019, pp. 85\u0026ndash;118. Accedido: 8 de junio de 2024. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dialnet.unirioja.es/servlet/articulo?codigo=7793368\u003c/span\u003e\u003cspan address=\"https://dialnet.unirioja.es/servlet/articulo?codigo=7793368\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eContreras-Hern\u0026aacute;ndez P. y M. Trujillo-Cristoffanini, \u0026laquo;Matriz de violencia interseccional: experiencias y trayectorias de mujeres latinoamericanas en Barcelona\u0026raquo;, \u003cem\u003eAnt\u0026iacute;poda Rev. Antropol. Arqueol.\u003c/em\u003e, n.\u003csup\u003eo\u003c/sup\u003e 51, Art. n.\u003csup\u003eo\u003c/sup\u003e 51, abr. 2023, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7440/antipoda51.2023.08\u003c/span\u003e\u003cspan address=\"10.7440/antipoda51.2023.08\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrenshaw K. \u0026laquo;Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics\u0026raquo;, \u003cem\u003eU Chi Leg. F\u003c/em\u003e, vol. 1989, p. 139, ene. 1989.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShannon G et al. \u0026laquo;Intersectional insights into racism and health: not just a question of identity\u0026raquo;, \u003cem\u003eLancet Lond. Engl.\u003c/em\u003e, vol. 400, n.\u003csup\u003eo\u003c/sup\u003e 10368, pp. 2125\u0026ndash;2136, dic. 2022, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(22)02304-2\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(22)02304-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLisboa Donoso C. y V. Stuardo \u0026Aacute;vila, \u0026laquo;Aspects associated with sexualised drug use among gay men and other men who have sex with men: a cross-sectional study from the Latin America MSM Internet Survey 2018 - Chile\u0026raquo;, \u003cem\u003eSex. Health\u003c/em\u003e, vol. 17, n.\u003csup\u003eo\u003c/sup\u003e 6, pp. 493\u0026ndash;502, dic. 2020, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1071/SH20089\u003c/span\u003e\u003cspan address=\"10.1071/SH20089\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinisterio de Salud de Chile. \u0026laquo;Preliminary results national health, sexuality and gender (ENSSEX)\u0026raquo;, Chile. [En l\u0026iacute;nea]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://epi.minsal.cl/primera-presentacion-de-resultados-encuesta-nacional-de-salud-sexualidad-y-genero-enssex-2022-2023/\u003c/span\u003e\u003cspan address=\"http://epi.minsal.cl/primera-presentacion-de-resultados-encuesta-nacional-de-salud-sexualidad-y-genero-enssex-2022-2023/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Migrants, Sexual health, Epidemiological surveillance, STIs","lastPublishedDoi":"10.21203/rs.3.rs-5328464/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5328464/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMonitoring and responding to the sexual health needs of migrants is crucial, given their vulnerability during migration. Therefore, this study aimed to develop socio-epidemiological indicators related to sexual health and communicable diseases among the migrant population in Chile, including dimensions of the contexts of vulnerability and migratory trajectories.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eWe used a mixed methodology within the framework of implementation research and community-based research based on qualitative data, secondary sources, and expert judgment to construct socio-epidemiological indicators related to sexual health among the migrant population in Chile, including vulnerability and migration trajectories. Preliminary indicators were defined. First, qualitative data were collected through semi-structured interviews with individuals of migrant origin and focus groups with members of community-based organizations, primary healthcare providers, and experts. These instruments were then complemented with indicators from secondary sources. The set of indicators was subjected to content validation and ranking through Delphi Groups and expert judgment, ending with validation through a field pilot test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe result was a definitive instrument that included 94 indicators, distributed into 73 questions that correspond to the following dimensions: sociodemographic background, migratory history, and contexts of vulnerability, violence, connection with the Chilean health system, sexual practices, sex work, sexual health (including HIV and STIs) and access to sexual health services, and sexual health needs.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eParticipation of the target population and key actors allowed for consensus on a highly sensitive data collection instrument since its indicators account for the contexts of vulnerability and key structural aspects to address sexual health among migrants from an intersectional perspective.\u003c/p\u003e","manuscriptTitle":"Developing Socio-Epidemiological Indicators of Sexual Health among Migrant Population in Chile","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-12 10:05:09","doi":"10.21203/rs.3.rs-5328464/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-09T02:31:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-07T18:22:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-26T09:20:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148940926597056729255754929242191961327","date":"2024-11-15T14:42:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181678727341676633196018986292764570414","date":"2024-11-12T01:53:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122104379381950773928768286155354405062","date":"2024-11-11T18:04:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"223850022525168643448929966257725700552","date":"2024-11-05T16:00:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19875653623785074213526785149070537065","date":"2024-11-04T06:39:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-04T05:01:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-31T06:32:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-31T06:31:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Public Health","date":"2024-10-24T22:41:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"db7e30cd-84cc-4be4-a152-ced38aea041e","owner":[],"postedDate":"November 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-14T16:10:51+00:00","versionOfRecord":{"articleIdentity":"rs-5328464","link":"https://doi.org/10.1186/s13690-025-01587-3","journal":{"identity":"archives-of-public-health","isVorOnly":false,"title":"Archives of Public Health"},"publishedOn":"2025-04-09 16:05:43","publishedOnDateReadable":"April 9th, 2025"},"versionCreatedAt":"2024-11-12 10:05:09","video":"","vorDoi":"10.1186/s13690-025-01587-3","vorDoiUrl":"https://doi.org/10.1186/s13690-025-01587-3","workflowStages":[]},"version":"v1","identity":"rs-5328464","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5328464","identity":"rs-5328464","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}