Usefulness and practicality of a multidisease screening programme targeting migrant patients in primary care in Spain: a qualitative study of general practitioners

Abstract

ObjectivesSome migrant groups are disproportionately affected by key infectious diseases in European countries. These pose a challenge for healthcare systems providing care to these groups. We aimed to explore the views of general practitioners (GPs) on the acceptability, adaptability and feasibility of a multidisease screening programme based on an innovative clinical decision-support system for migrants (the ISMiHealth tool), by examining the current gaps in healthcare provision and areas of good practice and the usefulness and limitations of training in the health needs of migrants.MethodsWe undertook a qualitative descriptive study and carried out a series of focus groups (FGs) taking a pragmatic utilitarian approach. Participants were GPs from the four primary healthcare (PHC) centres in Catalonia, Spain, that piloted an intervention of the ISMiHealth tool. GPs were recruited using purposive and convenience sampling. FG discussions were transcribed and analysed using thematic content analysis.ResultsA total of 29 GPs participated in four FGs. Key themes identified were: (1) GPs found the ISMiHealth tool to be very useful for helping to identify specific health problems in migrants, although there are several additional barriers to screening as part of PHC, (2) the importance of considering cultural perspectives when caring for migrants, and of the impact of migration on mental health, (3) the important role of PHC in healthcare provision for migrants and (4) key proposals to improve screening of migrant populations. GPs also highlighted the urgent need, to shift to a more holistic and adequately resourced approach to healthcare in PHC.ConclusionsGPs supported a multidisease screening programme for migrant populations using the ISMiHealth tool, which aided clinical decision-making. However, intercultural participatory approaches will need to be adopted to address linguistic and cultural barriers to healthcare access that exist in migrant communities.

Tuberculosis screening in the European migrant population: a scoping review of current practices

“…A study comparing the interview strategy with CXR screening proved the former to be equally as effective as and more cost-effective than CXR, with the disadvantage of delaying diagnosis and treatment by a few weeks [ 27 ]. Screening based solely on a symptom questionnaire has the disadvantage of missing asymptomatic cases, and there are also cultural and linguistic differences that can compromise communication [ 11 , 13 , 27 ]. There are countries, such as Norway, the UK, Finland and the Netherlands, where screening includes both methods [ 12 , 26 , 29 ], though the choice of methodology and its cost-effectiveness will depend on the population and screening timing in each country [ 27 ].…”

“…According to the ECDC [ 8 ], and having been demonstrated in several studies, there are important barriers that prevent migrants from correctly benefiting from TB and LTBI screening [ 3 , 6 , 7 , 9 – 13 , 20 , 24 , 33 ].…”

“…Although most migrants have a favourable opinion of screening, other frequently reported barriers are the lack of explanation of the screening process by healthcare professionals and the lack of communication of negative results [ 11 , 12 ]. Some obstacles are also linked to the lack of training of professionals and staff in migrant health, leading them to have negative attitudes towards these people [ 10 , 11 ], and the lack of guidelines on which they can base their activity or the use of different guidelines between countries and healthcare professionals [ 6 , 7 , 13 , 25 ]. In a survey of doctors involved in migrant health in France, the majority felt that screening was not their responsibility [ 6 ].…”

“…Some cultural beliefs and values hinder the ability to establish a trusting relationship between the person and the care provider [ 13 ]. This is particularly true in cultures where, for instance, women are obliged to be accompanied by a man responsible for communicating with healthcare professionals [ 13 ].…”

“…To overcome these barriers, countries have developed several strategies. These include call letters that are more understandable with a better explanation regarding the screening location [ 12 ], rethinking the screening location [ 34 , 38 ], trying to bring screening to communities [ 10 , 34 , 38 ], and involvement of cultural mediators and community organisations bridging the gap between the patient and health services [ 7 , 9 , 10 , 13 , 20 , 23 , 33 , 34 ]. Some community places can be used for education and screening, such as churches, sports clubs, group housing and schools [ 20 , 38 , 34 ].…”