“Health as Work”, Structural Vulnerability Shaping Migrant Health in Non-Metropolitan Spain: A Qualitative Study

Abstract

Highlights What are the main findings? Health as Work emerged as the central concept explaining migrants’ health experiences. Administrative precarity and occupational insecurity influenced health more than healthcare access alone. What are the implications of the main findings? Nurses can reduce structural vulnerability by strengthening cultural competence, facilitating healthcare navigation, and advocating for equitable access to care. Integrated health and social policies are needed to improve migrant health in smaller communities. Abstract Background/Objectives: Migrants often experience health inequities resulting from administrative insecurity, precarious employment, and barriers to healthcare access. Although non-metropolitan areas are increasingly important destinations for migrant populations, evidence on their health experiences in these settings remains limited. This study aimed to examine how migrants living in non-metropolitan areas of Spain experience health throughout the migration process and to identify implications for nursing practice and health policy. Methods: A qualitative phenomenological design was used to explore migrants’ lived experiences. Twenty-two adult migrants living in the Spanish provinces of Zamora and León participated in semi-structured, in-depth interviews. Data were analyzed using thematic analysis following Braun and Clarke, and the study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Five interconnected themes emerged: migration process, health perceptions, social networks, work conditions, and adaptation and integration. The central finding, “Health as Work”, revealed that participants primarily understood health as the ability to work and maintain economic stability rather than as a state of physical or mental well-being. This perspective reflected broader structural vulnerability arising from administrative insecurity, precarious employment, and limited social support. Nurses and third-sector organizations were identified as essential in facilitating healthcare navigation, promoting health literacy, and providing psychosocial support. Conclusions: Migrants’ health experiences in non-metropolitan Spain are shaped by structural vulnerability, with employment and legal status strongly influencing health and access to care. Nursing practice should integrate culturally responsive and structurally informed care, while health policies should reduce administrative and employment barriers and strengthen collaboration between healthcare services and community organizations to promote health equity.