Impact of COVID-19 on migrants’ access to primary care and implications for vaccine roll-out: a national qualitative study

Abstract

Background: The COVID-19 pandemic has prompted considerable changes in delivery of UK primary care, including rapid digitalisation, yet the impact upon marginalised migrant groups is unknown. Aim: To understand the impact of the COVID-19 pandemic on migrants and their access to primary healthcare, and implications for COVID-19 vaccine roll out. Design and Setting: Primary care professionals, administrative staff, and migrants (foreign born; >18 years; <10 years in UK), were recruited in three phases using purposive, convenience and snowball sampling from urban, suburban and rural settings. Methods: In-depth semi-structured interviews were conducted by telephone. Data were analysed iteratively, informed by thematic analysis. Results: 64 clinicians were recruited in Phase 1 (25 GPs, 15 nurses, 7 HCAs, 1 Pharmacist); Phase 2 comprised 16 administrative staff; and Phase 3, 17 migrants (88% asylum seekers; 65% female; mean time in UK 4 years). Digitalisation has amplified existing inequalities in access to healthcare for many migrants due to lack of digital literacy and access to technology, compounded by language barriers and challenges building trust. Participants highlighted challenges registering and accessing healthcare due to physical closure of surgeries. Migrants reported specific beliefs around COVID-19 and COVID-19 vaccines, from acceptance to mistrust, often influenced by misinformation. Innovative opportunities suggested included translated digital health advice using text templates and YouTube. Conclusion: Migrants risk digital exclusion and may need targeted support to access services. Solutions are urgently needed to address vaccine hesitancy and barriers to vaccination in marginalised groups (including migrants) to ensure equitable uptake of the COVID-19 vaccine.

Inequalities in coverage of COVID-19 vaccination: A population register based cross-sectional study in Wales, UK

“…The use of a population register alongside data linkage enables representative analysis of vaccination inequalities in the population who have registered for health care. Consideration also needs to be taken to identify minority groups such as asylum seekers, refugees, the homeless and travelling population who may face barriers in accessing health care or registering with services which would ensure they are invited for vaccination [27] , [28] , [29] . This study has identified significant inequality in coverage of vaccination, which is the first step in tailoring services to address underlying causative factors.…”

A Rapid Systematic Review of Factors Influencing COVID-19 Vaccination Uptake in Minority Ethnic Groups in the UK

“…Barriers to COVID-19 vaccination acceptance were reported across the following domains: psychosocial factors, communications, and practical challenges (see Figure 2). Heightened vaccine hesitancy was attributed to mistrust including pre-existing lower scientific or medical trust, conspiracy suspicions and attitudes [13,20,21,23,25,30]. Mistrust that results in hesitancy to take the vaccine was reportedly the consequence of negative past experiences that individuals, their family and friends have experienced with formal services [31].…”

“…Communications: Source, Content and Access Misinformation, complex information, conflicting and changing guidance, overwhelming amounts of material, and contradiction of information between different information sources contributed to a lack of trust, confusion, and ultimately vaccine hesitancy [20,[30][31][32]. Positively framed vaccine information accessed via mainstream media, Government or National Health Service (NHS) sources fuelled suspicions and contributed to mistrust due to concerns of lack of transparency of risks [20].…”

Face-to-face GP consultations: avoiding digital exclusion of marginalised groups

“…Nonetheless, the rapid shift to physical closure of surgeries, digital appointments, and virtual or form-based online triage presented challenges for marginalised patient groups, who already face major barriers to accessing primary care 34. Our national UK study (June-November 2020), which explored the views of primary care teams and migrants on the impact of the pandemic on migrants’ access to primary care, found that virtual consultations and online forms exacerbated existing language barriers, posed challenges building rapport and identifying safeguarding cues, and risked technological exclusion due to lack of technology and digital literacy 5. Participants were concerned about loss of practical support from receptionists in registering and accessing appointments, signposting, screening services, and new patient health checks—interventions particularly important in these marginalised communities.…”

“…This challenge has been insufficiently emphasised to date, and practices need to ensure that the systems they introduce do not widen inequity in the context of stretched capacity. We need a flexible and patient centred approach, underpinned by effective clinical decision making about choice of modality, supported by Royal College of General Practitioners’ guidance,6 and combined with harnessing the opportunities of digitalisation (through, for example, virtual group consultations, YouTube based health advice, and engagement through multiple modalities to provide targeted, translated advice as identified in our study5). Such an approach will ensure effective and equitable access and balance of need and demand across practice population groups, throughout the pandemic and beyond.…”