Communication Experiences in Primary Healthcare with Refugees and Asylum Seekers: A Literature Review and Narrative Synthesis

Patel, Pinika; Bernays, Sarah; Dolan, Hankiz; Muscat, Danielle M; Trevena, Lyndal

doi:10.3390/ijerph18041469

Cited by 19 publications

(21 citation statements)

References 46 publications

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“…The results of the study revealed that the translation service shifted from being on site to a phone service during the pandemic. There were complaints about the quality of translation and a risk that health information was lost in communication where translators' lack of physical presence meant that they were not able to follow the non-verbal communication in the rooms at the health service centers, which could be confirmed by recent research that shows that following non-verbal communication could be a challenge for refugees during encounters within healthcare settings ( 46 ). Furthermore, there were different ways that refugees chose to protect their own health, but that social distancing was challenging due to crowded living and being isolated, which was challenging because there was a lack of physical space in crowded apartments.…”

Section: Discussionmentioning

confidence: 99%

Working With Refugees' Health During COVID-19—The Experience of Health- and Social Care Workers in Sweden

Mangrio

Zdravkovic

Michael

2022

Front. Public Health

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IntroductionIn Sweden, often seen as one of the most egalitarian countries, the COVID-19 pandemic exposed high levels of health inequality, especially harming people with a refugee background. This is also despite Sweden's image as a refugee-friendly country. In this context, the aim of this paper is to better understand how Swedish health- and social workers have reacted to the health- and social needs of refugees during the pandemic. The Swedish case is particularly interesting because, as seen in the paper, health- and social workers had the task of communicating health guidance to refugees who were sometimes more reliant on information from abroad where the consensus on COVID-19 restrictions ran contrary to the approach recommended by the Swedish public health authority.MethodThe study utilizes a qualitative content analysis of 13 in-depth interviews with health- and social workers in Sweden, active in the care of refugees within different kinds of health- and social care settings.ResultsThe analysis showed that healthcare services have remained open during the pandemic but with new precautions at reception areas impacting how refugees access healthcare. As discussed in the article, the shift to digital tools has particularly impacted refugees, worsening already existing barriers to healthcare services faced by those with refugee status. Public health recommendations were poorly designed to the needs of refugees whose living conditions often prevented them from self-isolation and social distancing. Furthermore, Sweden's initially non-restrictive approach to the pandemic instructed health- and social-workers to encourage refugees to take far fewer precautions (e.g., self-isolation, home-schooling, pregnant women to avoid virus hotspots) compared both with European neighbors and the international media typically used by refugees. When Sweden shifted toward a more restrictive approach, health- and social-workers had to revise their guidance in relation to the new recommendations around precautions.ConclusionRefugees have faced increased barriers to maintaining their health and wellbeing during the pandemic that exceed those experienced by the rest of the Swedish population. Refugees have, in general, taken precautions in regard to social distancing and followed recommendations but faced challenges with social distancing due to isolation and crowded living. Public health authorities have often failed to acknowledge that individuals use increasingly diverse sources of knowledge when trying to protect their health, and that not everyone has access to the knowledge needed to access healthcare and social systems. At the same time, there is a need to acknowledge that refugees are sometimes a source of expertise that was ignored by the Swedish health and social system during the pandemic. There is a need for urgent efforts to halt the worsening health conditions for this specific group, but also to counter knock-on societal effects and rising health inequity.

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Section: Discussionmentioning

confidence: 99%

Working With Refugees' Health During COVID-19—The Experience of Health- and Social Care Workers in Sweden

Mangrio

Zdravkovic

Michael

2022

Front. Public Health

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“…Inadequate communication can negatively impact on patient trust of healthcare services, it can also result in delayed and more costly health care (Migrant & Refugee Women's Health Partnership, 2019). While it is widely acknowledged that interpreter utilization in healthcare settings can be challenging for a variety of reasons, including inadequate funding, workforce shortages and time constraintshe finds this humiliating and a (Patel et al, 2021), it is best clinical practice to use interpreter services (Guzys et al, 2021). The use of appropriate language services and the right of a patient to access healthcare are inextricably linked.…”

Section: Nursing and Midwifery Contextmentioning

confidence: 99%

Racism, healthcare access and health equity for people seeking asylum

2021

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People seeking asylum are at risk of receiving poorer quality healthcare due, in part, to racist and discriminatory attitudes, behaviours and policies in the health system. Despite fleeing war and conflict; exposure to torture and traumatic events and living with uncertainty; people seeking asylum are at high‐risk of experiencing long‐term poor physical and mental health outcomes in their host country. This article aims to raise awareness and bring attention to some common issues people seeking asylum face when seeking healthcare in high‐income countries where the health system is dominated by a Western biomedical view of health. Clinical case scenarios are used to highlight instances of racist healthcare policies and practices that create and maintain ongoing health disparities; limited access to culturally and linguistically appropriate health services, and lack of trauma‐informed approaches to care. Nurses and midwives can play an important role in countering racism in healthcare settings; by identifying and calling out discriminatory practice and modelling tolerance, respect and empathy in daily practice. We present recommendations for individuals, organisations and governments that can inform changes to policies and practices that will reduce racism and improve health equity for people seeking asylum.

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“…How this is experienced is shaped in part by patients' cultural views, language proficiency and patient's perceptions of the quality of care 11 . To support the accurate and accessible translation of key messages within the clinical consultation professional interpreters have been recommended to improve patient health outcomes 12,13 . However, even interpreters when taken up concerns have been reported about availability, access, confidentiality, and the accuracy of translation 5,14 …”

Section: Introductionmentioning

confidence: 99%

“…12,13 However, even interpreters when taken up concerns have been reported about availability, access, confidentiality, and the accuracy of translation. 5,14 Some of these concerns with professional interpreter use could be negated through language concordant care between the healthcare provider and patient. Language concordant care is defined as situations where both the patient and healthcare provider speak to each other in their shared language.…”

Section: Introductionmentioning

confidence: 99%

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Exploring the expectations, experiences and tensions of refugee patients and general practitioners in the quality of care in general practice

Patel

Muscat

Trevena

et al. 2021

Health Expectations

Self Cite

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Background Refugees and asylum seekers arrive in the Australian community with complex health needs and expectations of healthcare systems formed from elsewhere. Navigating the primary healthcare system can be challenging with communication and language barriers. In multicultural societies, this obstacle may be removed by accessing language‐concordant care. Emerging evidence suggests language‐concordance is associated with more positive reports of patient experience. Whether this is true for refugees and asylum seekers and their expectation of markers of quality patient‐centred care (PCC) remains to be explored. This study aimed to explore the expectations around the markers of PCC and the impacts of having language‐concordant care in Australian primary healthcare. Methods We conducted semi‐structured individual in‐language (Arabic, Dari, and Tamil) remote interviews with 22 refugee and asylum seekers and 9 general practitioners (GPs). Interview transcripts were coded inductively and deductively, based on the research questions, using Thematic Analysis. Extensive debriefing and discussion took place within the research team throughout data collection and analysis. Results Community member expectations of markers of PCC are constantly evolving and adapting based on invisible and visible actions during clinical encounters. Challenges can occur in the clinical encounter when expectations are ‘unsaid’ or unarticulated by both community members and GPs due to the assumption of shared understanding with language concordant care. Expectations of what constitutes satisfactory, quality PCC are dynamic outcomes, which are influenced by prior and current experiences of healthcare. Conclusion This study highlights the importance of understanding that language concordant care does not always support aligned expectations of the markers of quality PCC between community members and their GP. We recommend that GPs encourage community members to provide explicit descriptions about how their prior experiences have framed their expectations of what characterizes quality PCC. In addition, GPs could develop a collaborative approach, in which they explain their own decision‐making processes in providing PCC to refugees and asylum seekers. Patient or Public Contribution Bilingual researchers from multicultural backgrounds and experience working with people from refugee backgrounds were consulted on study design and analysis. This study included individuals with lived experiences as refugees and asylum seekers and clinicians as participants.

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Communication Experiences in Primary Healthcare with Refugees and Asylum Seekers: A Literature Review and Narrative Synthesis

Cited by 19 publications

References 46 publications

Working With Refugees' Health During COVID-19—The Experience of Health- and Social Care Workers in Sweden

Working With Refugees' Health During COVID-19—The Experience of Health- and Social Care Workers in Sweden

Racism, healthcare access and health equity for people seeking asylum

Exploring the expectations, experiences and tensions of refugee patients and general practitioners in the quality of care in general practice

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