Barriers and facilitators in providing care for patients with a migration background

Abstract

Aims and objectives The aim of this study was to identify the barriers and facilitators experienced by healthcare professionals while caring for patients with a migration background. Background People with a migration background often face several structural inequalities and barriers in terms of accessibility to, and affordability of, healthcare. In order to provide quality care for patients with a migration background, it is important to understand which barriers healthcare professionals experience that prevent them from providing care and which factors can facilitate this. Design and methods Qualitative research following the COREQ criteria. A total of six focus groups (n = 37) and 12 individual interviews were conducted with a multidisciplinary sample: doctors, nurses, social workers, and occupational therapists. Nursing and medical students were also included. Thematic content analysis was used. Results Key findings suggest that the main barrier is that healthcare professionals regard people with a migration background as “the other”. Healthcare professionals do not feel secure or competent to provide care for these “others.” According to the healthcare professionals, the hospital structures—and, particularly, the managerial instances—appear to be only slightly supportive. Structural barriers at the level of the healthcare system, such as limited implementation of care coordination and austerity measures (time pressure or economic restrictions), were also perceived as barriers. Facilitators can be the healthcare professionals' attitude or the flexibility of the management. Conclusions Healthcare professionals experience barriers in caring for people with a migration background. Othering plays a key role in building or maintaining several barriers. A multilevel approach is necessary to tackle these barriers and enable facilitators. Relevance to clinical practice Raising awareness about “othering” in the educational programs of students and healthcare professionals is essential. Also, deploying support mechanisms and valuing the competences of multicultural and multi‐lingual healthcare professionals can help facilitate quality care for patients with a migrant background. Patient or Public Contribution Patients, informal and formal caregivers participated in the study at several stages (e.g.: by involving them during the research design phase or providing feedback and input at specific moments across the study). In addition, community participants played a key role also during the research design and data analysis phases as well as by facilitating patients' recruitment.

Evaluation of the impact of “speak out” and “human libraries” educational methodologies on nursing students' attitudes toward immigration

“…In general, the results obtained conclude that students' attitudes and acceptability toward caring for immigrants are positive, with little questioning of the personal/professional relationship with immigrants in need (or not in need) of professional care (12). The conclusions of a study (13) state that one of the issues that may explain the problem is that health professionals conceive immigrants as "others, " not feeling safe or competent to provide care; although it's considered that the attitudes of professionals are a fortunate factor in the problem. This study also proposes that the assessment and improvement of competence in culturally, and the promotion of training in multilanguage is interesting to improve attitudes toward immigration.…”

“…Thus, although the attitudes analyzed were, as in our study, acceptable and positive, the implementation of exchange and mobility programs for students (12) has been proposed as measures that have also shown positive results. Other studies recommend that nursing programs integrate educative sessions on transcultural nursing into the curricula of nursing education, assessing the multicultural competence of health professionals and also motivating students in language learning (13,39). Other suggested interventions including the use of role play as a teaching-learning activity (as creating inclusive environments helps students better understand the vulnerabilities of at-risk groups) (40).…”

Different senses of one’s place: Exploring social adjustment to home-based care services among family caregivers from minority ethnic backgrounds who have relatives living with dementia

“…Minority ethnic groups, often defined as groups with ethnic, cultural, religious or linguistic characteristics that differ from the majority population (International Organization for Migration, 2019), have in recent years become an area of increasing interest in dementia research (Berdai Chaouni & De Donder, 2019; Berdai Chaouni et al, 2020; Claeys et al, 2022; Parveen et al, 2017; Sagbakken, Spilker, & Ingebretsen, 2018). In Norway, there are approximately 1,025,000 immigrants and Norwegian-born children to immigrants, constituting 18.9% of the total population (Statistics Norway, 2022a).…”

“…A recently published Belgian study examining dementia care for minority ethnic groups revealed several obstacles to receiving healthcare services at the structural healthcare system level (Claeys et al, 2022). Furthermore, a study conducted in Norway suggested that a lower degree of service use among families from minority ethnic backgrounds may be due to inadequate care provision and caution against assuming that the decision to use less healthcare services is always rooted in cultural norms and traditions (Moholt et al, 2020).…”

“…Furthermore, a study conducted in Norway suggested that a lower degree of service use among families from minority ethnic backgrounds may be due to inadequate care provision and caution against assuming that the decision to use less healthcare services is always rooted in cultural norms and traditions (Moholt et al, 2020). In their study, Claeys et al (2022) demonstrated how austerity measures, such as economic restrictions, staff shortage and limited time, are major restraining factors to the adoption of healthcare services and receiving appropriate care services among all family caregivers, irrespective of ethnicity. These concerns might also apply to the Norwegian context.…”