Barriers to and facilitators of health services utilisation by refugees in resettlement countries: an overview of systematic reviews
Jamuna Parajuli A C and Dell Horey A BA Department of Public Health, La Trobe University, Bundoora, Vic. 3086, Australia.
B College of Science, Health and Engineering, La Trobe University, Bundoora, Vic. 3086, Australia. Email: d.horey@latrobe.edu.au
C Corresponding author. Email: 17985075@students.latrobe.edu.au
Australian Health Review 44(1) 132-142 https://doi.org/10.1071/AH18108
Submitted: 28 May 2018 Accepted: 11 October 2018 Published: 18 January 2019
Abstract
Objective The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries.
Methods An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool.
Results Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals.
Conclusions Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups.
What is known about the topic? Refugee health after resettlement is poor, yet health service use is low.
What does this paper add? Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals’ knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified.
What are the implications for practitioners? The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees.
Additional keywords: access to care, developed countries, health-seeking behaviour, service access.
References
[1] United Nations High Commissioner for Refugees (UNHCR). World at war. UNHCR global trends. Forced displacement in 2014. Geneva, Switzerland: UNHCR; 2015.[2] United Nations High Commissioner for Refugees (UNHCR). Global trends: forced displacement in 2015. Geneva, Switzerland: UNHCR; 2016. Available at: https://www.unhcr.org/576408cd7.pdf [verified 13 February 2018].
[3] Lui RN. Such a long journey: protracted refugee situations in Asia. Glob Change Peace Secur 2007; 19 185–203.
| Such a long journey: protracted refugee situations in Asia.Crossref | GoogleScholarGoogle Scholar |
[4] Bonney C. Is resettlement in a Western country the most viable solution for protracted refugee situations? POLIS Journal 2013; 9 88–125.
[5] Milosevic D, Cheng IH, Smith MM. The NSW Refugee Health Service– improving refugee access to primary care. Aust Fam Physician 2012; 41 147–9.
| 22396929PubMed |
[6] Hadgkiss EJ, Renzaho AM. The physical health status, service utilisation and barriers to accessing care for asylum seekers residing in the community: a systematic review of the literature. Aust Health Rev 2014; 38 142–59.
| The physical health status, service utilisation and barriers to accessing care for asylum seekers residing in the community: a systematic review of the literature.Crossref | GoogleScholarGoogle Scholar | 24679338PubMed |
[7] Riggs E, Davis E, Gibbs L, Block K, Szwarc J, Casey S, Duell-Piening P, Waters E. Accessing maternal and child health services in Melbourne, Australia: reflections from refugee families and service providers. BMC Health Serv Res 2012; 12 117
| Accessing maternal and child health services in Melbourne, Australia: reflections from refugee families and service providers.Crossref | GoogleScholarGoogle Scholar | 22587587PubMed |
[8] Smith MM. Refugees in Australia: changing faces, changing needs. Med J Aust 2006; 185 587–8.
| 17181495PubMed |
[9] Davidson N, Skull S, Burgner D, Kelly P, Raman S, Silove D, Steel Z, Vora R, Smith M. An issue of access: delivering equitable health care for newly arrived refugee children in Australia. J Paediatr Child Health 2004; 40 569–75.
| An issue of access: delivering equitable health care for newly arrived refugee children in Australia.Crossref | GoogleScholarGoogle Scholar | 15367155PubMed |
[10] O’Donnell CA, Higgins M, Chauhan R, Mullen K. ‘They think we’re OK and we know we’re not’. A qualitative study of asylum seekers’ access, knowledge and views to health care in the UK. BMC Health Serv Res 2007; 7 75
| ‘They think we’re OK and we know we’re not’. A qualitative study of asylum seekers’ access, knowledge and views to health care in the UK.Crossref | GoogleScholarGoogle Scholar | 17537258PubMed |
[11] Taylor J, Lamaro Haintz G. Influence of the social determinants of health on access to healthcare services among refugees in Australia. Aust J Prim Health 2018; 24 14–28.
| Influence of the social determinants of health on access to healthcare services among refugees in Australia.Crossref | GoogleScholarGoogle Scholar | 29232545PubMed |
[12] Davidson N, Skull S, Chaney G, Frydenberg A, Isaacs D, Kelly P, Lampropoulos B, Raman S, Silove D, Buttery J, Smith M, Steel Z, Burgner D. Comprehensive health assessment for newly arrived refugee children in Australia. J Paediatr Child Health 2004; 40 562–8.
| Comprehensive health assessment for newly arrived refugee children in Australia.Crossref | GoogleScholarGoogle Scholar | 15367154PubMed |
[13] Lamb CF, Smith M. Problems refugees face when accessing health services. NSW Public Health Bull 2002; 13 161–3.
| Problems refugees face when accessing health services.Crossref | GoogleScholarGoogle Scholar |
[14] Shishehgar S, Gholizadeh L, DiGiacomo M, Davidson PM. The impact of migration on the health status of Iranians: an integrative literature review. BMC Int Health Hum Rights 2015; 15 20
| The impact of migration on the health status of Iranians: an integrative literature review.Crossref | GoogleScholarGoogle Scholar | 26275716PubMed |
[15] Colucci E, Szwarc J, Minas H, Paxton G, Guerra C. The utilisation of mental health services by children and young people from a refugee background: a systematic literature review. Int J Cult Ment Health 2014; 7 86–108.
| The utilisation of mental health services by children and young people from a refugee background: a systematic literature review.Crossref | GoogleScholarGoogle Scholar |
[16] Robertshaw L, Dhesi S, Jones LL. Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research. BMJ Open 2017; 7 e015981
| 28780549PubMed |
[17] Hoffman SJ, Robertson CL. A systematic review of Karen refugee health. Int J Migr Health Soc Care 2016; 12 1–15.
| A systematic review of Karen refugee health.Crossref | GoogleScholarGoogle Scholar |
[18] O’Mahony J, Donnelly T. Immigrant and refugee women’s post-partum depression help-seeking experiences and access to care: a review and analysis of the literature. J Psychiatr Ment Health Nurs 2010; 17 917–28.
| Immigrant and refugee women’s post-partum depression help-seeking experiences and access to care: a review and analysis of the literature.Crossref | GoogleScholarGoogle Scholar | 21078007PubMed |
[19] Cheng IH, Drillich A, Schattner P. Refugee experiences of general practice in countries of resettlement: a literature review. Br J Gen Pract 2015; 65 e171–6.
| Refugee experiences of general practice in countries of resettlement: a literature review.Crossref | GoogleScholarGoogle Scholar | 25733438PubMed |
[20] Booth A. ‘Brimful of STARLITE’: toward standards for reporting literature searches. J Med Libr Assoc 2006; 94 421–429, e205.
| 17082834PubMed |
[21] Moher D, Liberati A, Tetzlaff J, Altmane DG, The PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8 336–41.
| Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Crossref | GoogleScholarGoogle Scholar | 20171303PubMed |
[22] Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15 1277–88.
| Three approaches to qualitative content analysis.Crossref | GoogleScholarGoogle Scholar | 16204405PubMed |
[23] Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 2007; 7 10
| Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews.Crossref | GoogleScholarGoogle Scholar | 17302989PubMed |
[24] Bellamy K, Ostini R, Martini N, Kairuz T. Access to medication and pharmacy services for resettled refugees: a systematic review. Aust J Prim Health 2015; 21 273–8.
| Access to medication and pharmacy services for resettled refugees: a systematic review.Crossref | GoogleScholarGoogle Scholar | 25577397PubMed |
[25] Szajna A, Ward J. Access to health care by refugees: a dimensional analysis. Nurs Forum 2015; 50 83–9.
| Access to health care by refugees: a dimensional analysis.Crossref | GoogleScholarGoogle Scholar | 24383538PubMed |
[26] Hossain LN, Fernandez-Llimos F, Luckett T, Moullin JC, Durks D, Franco-Trigo L, Benrimoj SI, Sabater-Hernández D. Qualitative meta-synthesis of barriers and facilitators that influence the implementation of community pharmacy services: perspectives of patients, nurses and general medical practitioners. BMJ Open 2017; 7 e015471
| Qualitative meta-synthesis of barriers and facilitators that influence the implementation of community pharmacy services: perspectives of patients, nurses and general medical practitioners.Crossref | GoogleScholarGoogle Scholar | 28877940PubMed |
[27] Olaussen SJ, Renzaho AM. Establishing components of cultural competence healthcare models to better cater for the needs of migrants with disability: a systematic review. Aust J Prim Health 2016; 22 100–12.
| Establishing components of cultural competence healthcare models to better cater for the needs of migrants with disability: a systematic review.Crossref | GoogleScholarGoogle Scholar | 26752498PubMed |
[28] Akresh IR, Massey DS, Frank R. Beyond English proficiency: rethinking immigrant integration. Soc Sci Res 2014; 45 200–10.
| Beyond English proficiency: rethinking immigrant integration.Crossref | GoogleScholarGoogle Scholar | 24576636PubMed |
[29] Colic-Peisker V, Tilbury F. Integration into the Australian labour market: the experience of three ‘visibly different’ groups of recently arrived refugees. Int Migr 2007; 45 59–85.
| Integration into the Australian labour market: the experience of three ‘visibly different’ groups of recently arrived refugees.Crossref | GoogleScholarGoogle Scholar |
[30] Marlowe JM. ‘Walking the line’: Southern Sudanese masculinities and reconciling one’s past with the present. Ethnicities 2012; 12 50–66.
| ‘Walking the line’: Southern Sudanese masculinities and reconciling one’s past with the present.Crossref | GoogleScholarGoogle Scholar |
