Insights from the coalface: barriers to accessing medicines and pharmacy services for resettled refugees from Africa
Kim Bellamy A E , Remo Ostini B , Nataly Martini C and Therese Kairuz DA School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, Qld 4102, Australia.
B Rural Clinical School, The University of Queensland, Toowoomba, Qld 4350, Australia.
C School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Grafton, Auckland 1023, New Zealand.
D School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW 2308, Australia.
E Corresponding author. Email: k.bellamy@uq.edu.au
Australian Journal of Primary Health 25(2) 118-124 https://doi.org/10.1071/PY18092
Submitted: 19 June 2018 Accepted: 3 December 2018 Published: 6 February 2019
Abstract
Resettled refugees in Australia have been shown to exhibit a high prevalence of limited health literacy and are at greater risk of mismanaging their medication and not being able to access the healthcare services they need. The aim of the current study is to explore the barriers to accessing medicines and pharmacy services in Queensland, Australia, among resettled refugees from Africa; this research was conducted from the perspectives of healthcare professionals and people who help the refugees to resettle in their adopted country (resettlement workers). A ‘generic qualitative’ approach was used in this study. In-depth interviews were conducted among healthcare professionals (two GPs, nine pharmacists and three nurse practitioners) and resettlement workers. Participants were recruited via a purposive snowball sampling method in the cities of Brisbane and Townsville, Queensland, Australia. Twenty-four in-depth interviews were conducted; 14 with healthcare professionals. Three key themes emerged from the data: (1) Communication Barriers; (2) Navigating the Health System; and (3) Belief Systems and Culture. Perceptions of those ‘at the coalface’ – healthcare professionals and people who are responsible for assisting refugees to resettle in Australia – provide insight into the language and cultural challenges experienced by resettled refugees from Africa regarding access to the Australian health system, including medicines and pharmacy services.
Additional keyword: primary health care.
References
Australian Government: Department of Home Affairs (2018a) About the free interpreting service. (TIS National: Melbourne, Vic., Australia) Available at https://www.tisnational.gov.au/Agencies/Charges-and-free-services/About-the-Free-Interpreting-Service.aspx [Verified 24 April 2018]Australian Government: Department of Home Affairs (2018b) Interpreter recruitment. (TIS National: Melbourne, Vic., Australia) Available at https://www.tisnational.gov.au/en/About-TIS-National/News/Check-out-Talking-TIS-Summer-2018-newsletter [Verified 20 October 2018]
Australian Government: Department of Human Services (2016) Refugee servicing network. (Department of Human Services: Canberra, ACT, Australia) Available at https://www.humanservices.gov.au/customer/services/centrelink/refugee-servicing-network [Verified 24 April 2018]
Australian Government: Department of Social Services (2018a) Settlement services for humanitarian entrants. (Department of Social Services: Canberra, ACT, Australia) Available at https://www.dss.gov.au/settlement-and-multicultural-affairs/publications/settlement-services-for-humanitarian-entrants [Verified 24 April 2018]
Australian Government: Department of Social Services (2018b) Humanitarian settlement program. (Department of Social Services: Canberra, ACT, Australia) Available at https://www.dss.gov.au/sites/default/files/documents/09_2018/hsp-factsheet-august-2018.pdf [Verified 10 August 2018]
Bellamy K, Ostini R, Martini N, Kahlke R (2015) Access to medication and pharmacy services for resettled refugees: a systematic review. Australian Journal of Primary Health 21, 273–278.
| Access to medication and pharmacy services for resettled refugees: a systematic review.Crossref | GoogleScholarGoogle Scholar | 25577397PubMed |
Bellamy K, Ostini R, Martini N, Kairuz T (2016) Seeking to understand: using generic qualitative research to explore access to medicines and pharmacy services among resettled refugees. International Journal of Clinical Pharmacy 38, 671–675.
Bellamy K, Ostini R, Martini N, Kairuz T (2017) Perspectives of resettled African refugees on accessing medicines and pharmacy services in Queensland, Australia. International Journal of Pharmacy Practice 25, 358–364.
| Perspectives of resettled African refugees on accessing medicines and pharmacy services in Queensland, Australia.Crossref | GoogleScholarGoogle Scholar | 27896894PubMed |
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.
| Using thematic analysis in psychology.Crossref | GoogleScholarGoogle Scholar |
Department of Immigration and Citizenship (2008) Review of the Adult Migrant English Program. (AMES Research and Policy: Canberra, ACT, Australia) Available at https://www.ames.net.au/-/media/files/policy/12_ames_response_amep_discussion_paper_15aug08.pdf?la=en [Verified 1 May 2018]
Edwards A (2017) Forced displacement worldwide at its highest in decades. (The UN Refugee Agency, Geneva, Switzerland) Available at http://www.unhcr.org/en-au/news/stories/2017/6/5941561f4/forced-displacement-worldwide-its-highest-decades.html [Verified 18 March 2018]
Ethnic Communities Council of Victoria (2012) An investment not an expense: enhancing health literacy in culturally and linguistically diverse communities. (Ethnic Communities Council of Victoria: Melbourne, Vic., Australia) Available at http://eccv.org.au/library/An_Investment_Not_an_Expense_ECCV_Health_Literacy_Paper_FINAL.pdf [Verified 24 April 2018]
Foundation House (2007) Promoting refugee health: a guide for doctors and other health care providers caring for people from refugee backgrounds. (Foundation House – The Victorian Foundation for Survivors of Torture Inc: Melbourne, Vic., Australia) Available at http://refugeehealthnetwork.org.au/promoting-refugee-health-a-guide-for-doctors-nurses-and-other-health-care-providers-caring-for-people-from-refugee-backgrounds-3rd-ed/ [Verified 24 April 2018]
Fozdar F, Hartley L (2013) Refugee resettlement in Australia: what we know and need to know. Refugee Survey Quarterly 32, 23–51.
| Refugee resettlement in Australia: what we know and need to know.Crossref | GoogleScholarGoogle Scholar |
Kahlke RM (2014) Generic qualitative approaches: pitfalls and benefits of methodological mixology. International Journal of Qualitative Methods 13, 37–52.
Kanj M, Mitic W (2009) Health literacy and health promotion. 7th Global Conference on Health Promotion; 26–30 October 2009; Nairobi, Kenya. (World Health Organization: Geneva, Switzerland)
Kpozehouen E, Heywood A, Kay M, Smith M, Paudel P, Sheikh M, MacIntyre CR (2017) Improving access to immunisation for migrants and refugees: recommendations from a stakeholder workshop. Australian and New Zealand Journal of Public Health 41, 118–120.
| Improving access to immunisation for migrants and refugees: recommendations from a stakeholder workshop.Crossref | GoogleScholarGoogle Scholar | 27868296PubMed |
Li WW (2016) Comparative study on social-economic status, trauma and mental health disorders among older and younger refugees in Australia. Journal of Tropical Pyschology 6, E3
Merriam S (1998) ‘Qualitative Research and Case Study Applications in Education.’ 2nd edn. (Jossey-Bass Publishers: San Francisco, CA, USA)
Milosevic D, Cheng I, Smith M (2012) The NSW Refugee Health Service: improving refugee access to primary care. Australian Family Physician 41, 147–149.
Morony S, Lamph E, Muscat D, Nutbeam D, Dhillon H, Shepherd H, Smith S, Khan A, Osborne J, Meshreky W, Luxford K, Hayen A, McCaffery KJ (2018) Improving health literacy through adult basic education in Australia. Health Promotion International 33, 867–877.
| Improving health literacy through adult basic education in Australia.Crossref | GoogleScholarGoogle Scholar | 28541513PubMed |
Percy W, Kostere K, Kostere K (2015) Generic qualitative research in psychology. Qualitative Report 20, 76–85.
Renzaho AMN, Bilal P, Marks GC (2014) Obesity, type 2 diabetes and high blood pressure amongst recently arrived Sudanese refugees in Queensland, Australia. Journal of Immigrant and Minority Health 16, 86–94.
| Obesity, type 2 diabetes and high blood pressure amongst recently arrived Sudanese refugees in Queensland, Australia.Crossref | GoogleScholarGoogle Scholar |
Riggs E, Yelland J, Duell-Piening P, Brown S (2016) Improving health literacy in refugee populations. The Medical Journal of Australia 204, 9–10.
| Improving health literacy in refugee populations.Crossref | GoogleScholarGoogle Scholar | 26763805PubMed |
Robertshaw L, Dhesi S, Jones LL (2017) 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 7, e015981
Rowse J, Anderson K, Phillips C, Chan B (2014) Critical case analysis of adverse events associated with failure to use interpreters for non-English speaking patients. The RACGP Conference for General Practice; 9–11 October 2014; Adelaide, SA, Australia. (Australian National University: Melbourne, Vic., Australia)
