Self-Care Among Vulnerable Migrants Along Mediterranean and Western Balkan Migration Routes: Protocol for a Theory-Informed Mixed-Methods Systematic Review

Introduction. Vulnerable migrants may experience legal insecurity, socioeconomic precarity, disrupted social networks, language barriers, discrimination, and restricted or fragmented access to healthcare and social protection. Under these conditions, maintaining health may depend not only on formal healthcare but also on everyday actions undertaken to preserve health, recognize changes in health status, and respond to health problems. In this context, self-care, conceptualized within Riegel’s Middle-Range Theory of Self-Care of Chronic Illness as a process of maintaining health with practices of health promotion, provides a relevant framework for examining these actions. According to this theory, self-care includes self-care maintenance, defined as daily behaviors to maintain health stability; self-care monitoring, defined as actions aimed at monitoring one’s physical and emotional conditions; and self-care management, defined as individual responses to changes in physical and emotional aspects. However, self-care is rarely examined explicitly as an overarching construct in migrant populations. Relevant health behaviors are often embedded within studies of health, illness, healthcare use, treatment adherence, coping, lifestyle behavior, healthcare utilization, or help-seeking. Consequently, self-care behaviors among vulnerable migrants and the contextual factors reported to influence them remain insufficiently synthesized within a common theoretical framework. Objectives. The review has two objectives: (1) to identify and synthesize self-care behaviors reported among vulnerable migrants living in Europe and associated with Mediterranean and Western Balkan migration routes, and to classify these behaviors within self-care maintenance, monitoring, and management; and (2) to identify and synthesize contextual factors reported to influence these self-care behaviors. Study Design. A mixed-methods systematic review using a convergent integrated approach in accordance with Joanna Briggs Institute methodology and a theory-informed synthesis based on Riegel's Middle-Range Theory of Self-Care. Participants and setting. Studies involving first-generation adults aged ≥18 years who are vulnerable migrants residing in European host countries and whose migration circumstances are consistent with Mediterranean and/or Western Balkan migration pathways. Intervention or Exposure. Migration-related and structural vulnerability. Conclusions. The review will synthesize evidence on self-care behaviors among vulnerable migrants and the contextual factors reported to influence these behaviors. Their integration is expected to clarify both the health actions reported across heterogeneous health contexts and the conditions under which these actions are enabled, constrained, modified, interrupted, or supported, informing nursing and healthcare research, context-sensitive practice, and intervention development.