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An estimated 10,000 Burmese migrants are currently living in London. No studies have been conducted on their access to health services. Furthermore, most studies on migrants in the United Kingdom (UK) have been conducted at the point of service provision, carrying the risk of selection bias. Our cross-sectional study explored access to and utilisat...
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Citations
... Low levels of GP registration and barriers to service engagement have been reported within other UK migrant and marginalised groups. (116)(117)(118)(119) While some barriers such as inadequate documentation are shared with these groups, (123) the current review finding of a lack of desire to register or engage with GP services seems more specific to the UK-CEEs. Unofficial employment and accommodation increases the likelihood of registration rejection for UK-CEE nationals, including homeless, trafficked or Roma individuals. ...
... Low levels of GP registration and barriers to service engagement have been reported within other UK migrant and marginalised groups. (116)(117)(118)(119) While some barriers such as inadequate documentation are shared with these groups, (123) the current review finding of a lack of desire to register or engage with GP services seems more specific to the UK-CEEs. Unofficial employment and accommodation increases the likelihood of registration rejection for UK-CEE nationals, including homeless, trafficked or Roma individuals. ...
Background:
Around 2 million people have migrated from Central and Eastern Europe to the UK since 2004. The UK Central and Eastern European Community (UK-CEE) are disproportionately exposed to the social determinants of poor physical and mental health. Their health and healthcare beliefs remain under-researched, particularly regarding primary care.
Objective:
This review explores UK-CEE community members' use and perceptions of UK general practice.
Methods:
A systematic search of nine bibliographic databases identified 2094 publications that fulfilled the search criteria. Grey literature searches identified 16 additional relevant publications. Screening by title and abstract identified 201 publications of relevance, decreasing to 65 after full-text screening. Publications were critically appraised, with data extracted and coded. Thematic analysis using constant comparison allowed generation of higher-order thematic constructs.
Results:
Full UK-CEE national representation was achieved. Comparatively low levels of GP registration were described, with ability, desire and need to engage with GP services shaped by the interconnected nature of individual community members' cultural and sociodemographic factors. Difficulties overcoming access and in-consultation barriers are common, with health expectations frequently unmet. Distrust and dissatisfaction with general practice often persist, promoting alternative health-seeking approaches including transnational healthcare. Marginalized UK-CEE community subgroups including Roma, trafficked and homeless individuals have particularly poor GP engagement and outcomes. Limited data on the impact of Brexit and COVID-19 could be identified.
Conclusions:
Review findings demonstrate the need for codesigned approaches to remove barriers to engagement, culturally adapt and develop trust in GP care for UK-CEE individuals.
Community involvement:
Community members and stakeholders shaped the conceptualisation of the review question and validation of emergent themes.
... In this study, a higher proportion of our respondents self-medicated to treat their ailments and this was particularly prevalent among those who attained secondary education compared with their counterparts with no formal education, basic education and other educational studies (Arabic). These observations from our study conform to findings by Aung, Rechel, and Odermatt (2010) in the UK where self-medication was dominantly practised among migrant workers who were more educated than their counterparts with no or lower education. Nonetheless, the above evidence is incongruent with the consensus in the literature where self-medication practices of many migrants are largely linked to uneducated migrant or settler populations (Sawalha, 2008;GSS, 2012;S anchez, 2014). ...
Purpose
This study aims to investigate the health-care-seeking behaviour and practices of West African migrants who reside and operate in Wa, Ghana, as itinerant retailers.
Design/methodology/approach
The study was cross-sectional and used the quantitative research approach. The analysis was done on a target population comprising 122 itinerant immigrant retail traders in Wa, Ghana. Fisher’s exact test and logistic regression were used to analyse the data.
Findings
Malaria was the commonest disease among them. Five in ten of the migrants preferred to report malaria episodes to a private health facility than to a government facility. Significant associations were identified between four dimensions (health facility, self-medication, home remedy and consult others) of health-seeking behaviour, and some background characteristics. The main reason why migrants prefer government health facilities was because of their better health personnel. They self-medicated because of easy accessibility of over-the-counter medicine shops. Also, when ill, the migrants usually consulted family members who would be in a position to take them home when their ailment worsens.
Research limitations/implications
Snowball sampling was used to select the respondents which could potentially lead to a sample that is not fully representative of the population in general.
Originality/value
Studies concerning migration and health in Ghana have been focused on internal migrants. Yet, minority immigrant traders equally encounter adverse health conditions but limited studies have been conducted to espouse their health-seeking behaviour. This study imperatively contributes to the subject matter that has limited literature in the country.
... This was consistent with the previous studies, which showed that self-medication was an option for primary health care when medical costs were high. 23,24 Therefore, this finding was a reminding to the need for a multi-faceted approach to mitigate the older patients' financial burdens caused by medical costs, especially for public health care facilities. ...
Background
The rapidly growing aging population poses major challenges for health systems in Vietnam. This study was therefore aimed to examine factors influencing the choices of healthcare facilities among older patients in Vietnam, using a national survey on older people.
Methods
We applied multinomial logistic regression models based on Andersen’s Behavioral Model with various predisposing factors, enabling factors and healthcare-needs factors associated with different types of healthcare facilities where older patients utilized services.
Data
We used data from the Vietnam Aging Survey (VNAS) in 2011. This was the first-ever nationally representative survey on older persons in Vietnam.
Results
Among those who used healthcare services, 15.1% visited central hospitals; 23.6% visited provincial hospitals; 28.0% visited district hospitals; 8.8% visited commune heath centres; 18.3% visited private hospitals/clinics; and 6.2% visited other facilities. The results showed that “having to pay cost” and “having sufficient income” were strong predictors for using commune health centres, district hospitals, and private facilities, while “having health insurance” was not a significant predictor for using these facilities. Also, we showed that apart from enabling factors (such as age, gender, educational levels, employment status, living regionand place of residence), predisposing factor (such as health insurance, perceived sufficient income, household wealth and having to pay medical cost) as well as need factors (such as self-rated health and chronic disease) were also associated with the choice of healthcare facilities.
Conclusions
Based on the findings, we discussed the implications of the results for organizing healthcare finance and delivery to achieve efficiency and equity for older people in Vietnam.
... Unlike some previous research (Phillimore, 2016), all participants were aware of the role of the GP as the gateway to more specialised services. One Eastern European parent encountered difficulties in registering with a GP, a problem replicated in several UK studies of a variety of migrant groups (Hargreaves et al., 2006;Aung et al., 2010;Stagg et al., 2012;Sime, 2014;Gazard et al., 2015). Existing research also indicates that Eastern European adults and children may perceive UK doctors as less skilful and thorough than doctors in their country of origin (Sime, 2014;Bell et al., 2019). ...
Aim
To explore parents’ experiences of using child health services for their pre-school children post-migration.
Background
Migrating between countries necessitates movement and adjustment between systems of healthcare. Children of migrants are known to have poorer health than local children on some measures and are less likely to access primary care. In the United Kingdom (UK), children are offered a preventive Healthy Child programme in addition to reactive services; this programme consists of health reviews and immunisations with some contacts delivered in the home by public health nurses.
Methods
Five focus groups were held in a city in South West England. Participants were parents of pre-school children (n = 28) who had migrated to the UK from Romania, Poland, Pakistan or Somalia within the last 10 years. Groups selected included both ‘new migrants’ (from countries which acceded to the European Union in the 2000s) and those from communities long-established in the UK (Somali and Pakistani). One focus group consisted of parents of Roma ethnicity. Interpreters co-facilitated focus groups.
Findings
Participants described profound differences between child health services in the UK and in their country of origin, with the extent of difference varying according to nationality and ethnic group. All appreciated services free at the point of delivery and an equitable service offered to all children. Primary care services such as treatment of minor illness and immunisation were familiar, but most parents expected doctors rather than nurses to deliver these. Proactive child health promotion was unfamiliar, and some perceived this service as intruding on parental autonomy. Migrants are not a homogenous group, but there are commonalities in migrant parents’ experiences of UK child health services. When adjusting to a new healthcare system, migrants negotiate differences in service provision and also a changing relationship between family and state.
... Factors related to access and acceptance, such as language and literacy barriers, navigating and registering with primary care, and trust in health services, were considered the main barriers to vaccination. Many of these barriers are also shared by other migrant and minority groups, across different countries [27][28][29]. The funding within the Romanian health system is concentrated in secondary care, and focused on treatment rather than prevention, which may help to explain the reported lower primary healthcare use amongst Romanian communities [30]. ...
Background:
Since 2016, large scale measles outbreaks have heavily affected countries across Europe. In England, laboratory confirmed measles cases increased almost four-fold between 2017 and 2018, from 259 to 966 cases. Several of the 2017-18 measles outbreaks in England particularly affected Romanian and Roma Romanian communities, with the first outbreaks in these communities occurring in Birmingham, Leeds and Liverpool. This study explored factors influencing vaccination behaviours amongst Romanian and Roma Romanian communities in these three cities.
Methods:
Across Birmingham, Leeds and Liverpool, we conducted semi-structured interviews with 33 key providers to explore their experience in delivering vaccinations and managing the outbreak response. We also interviewed 9 Romanian women in one of the cities to explore their vaccination attitudes and behaviours. To categorise factors affecting vaccination we applied the 5As Taxonomy for Determinants of Vaccine Uptake (Access, Affordability, Awareness, Acceptance and Activation) during data analysis.
Results:
Factors related to access and acceptance, such as language and literacy, ease of registering with a general practice, and trust in health services, were reported as the main barriers to vaccination amongst the communities. Concerns around vaccination safety and importance were reported but these appeared to be less dominant contributing factors to vaccination uptake. The active decline of vaccinations amongst interviewed community members was linked to distrust in healthcare services, which were partly rooted in negative experiences of healthcare in Romania and the UK.
Conclusion:
Access and acceptance, dominant barriers to vaccination, can be improved through the building of trust with communities. To establish trust providers must find ways to connect with and develop a greater understanding of the communities they serve. To achieve this, cultural and linguistic barriers need to be addressed. Better provider-service user relationships are crucial to reducing vaccination inequalities and tackling broader disparities in health service access.
... Factors related to access and acceptance, such as language and literacy barriers, navigating and registering with primary care, and trust in health services, were considered the main barriers to vaccination. Many of these barriers are also shared by other migrant and minority groups, across different countries [27][28][29]. The funding within the Romanian health system is concentrated in secondary care, and focused on treatment rather than prevention, which may help to explain the reported lower primary healthcare use amongst Romanian communities [30]. ...
Background: Since 2016, large scale measles outbreaks have heavily affected countries across Europe. In England, laboratory confirmed measles cases increased almost four-fold between 2017 and 2018, from 259 to 966 cases. Several of the 2017-18 measles outbreaks in England particularly affected Romanian and Roma Romanian communities, with the first outbreaks in these communities occurring in Birmingham, Leeds and Liverpool. This study explored factors influencing vaccination behaviours amongst Romanian and Roma Romanian communities in these three cities.
Methods: Across Birmingham, Leeds and Liverpool, we conducted semi-structured interviews with 33 key providers to explore their experience in delivering vaccinations and managing the outbreak response. We also interviewed 9 Romanian women in one of the cities to explore their vaccination attitudes and behaviours. To categorise factors affecting vaccination we applied the 5As Taxonomy for Determinants of Vaccine Uptake (Access, Affordability, Awareness, Acceptance and Activation) during data analysis.
Findings: Factors related to access and acceptance, such as language and literacy, ease of registering with a general practice, and trust in health services, were reported as the main barriers to vaccination amongst the communities. Concerns around vaccination safety and importance were reported but these appeared to be less dominant contributing factors to vaccination uptake. The active decline of vaccinations amongst interviewed community members was linked to distrust in healthcare services, which were partly rooted in negative experiences of healthcare in Romania and the UK.
Conclusion: Access and acceptance, dominant barriers to vaccination, can be improved through the building of trust with communities. To establish trust providers must find ways to connect with and develop a greater understanding of the communities they serve. To achieve this, cultural and linguistic barriers need to be addressed. Better provider-service user relationships are crucial to reducing vaccination inequalities and tackling broader disparities in health service access.
... Likewise, just as revealed by other studies (Aung, Rechel, & Odermatt, 2010;Horton & Stewart, 2012) migrant workers tended to avoid health-care providers and self-medicated (57.7%) for the aforementioned common and minor health conditions; emergencies and serious health conditions were the only exceptions. With regard to the other barriers to health-care access, similar findings were reported by this and previous studies. ...
... With regard to the other barriers to health-care access, similar findings were reported by this and previous studies. Bangladeshi migrant workers encountered problems traveling to medical facilities (49%), which was also the case in the studies of Pithara et al. (2012) and Wee and Jomo (2007); they also experienced linguistic differences and communication problem with their health-care providers (45.7%), as did the participants in the studies conducted by Aung et al. (2010), Djafar (2012), Karim and Diah (2015), and Pithara et al. (2012). In addition, similar to Karim & Diah (2015), difficulties were created by the lack of any medical allowance from their employers (44.7%), as well time constraints (41.7%). ...
... Healthcare Access for Vulnerable Migrants Under Austerity Vulnerable migrant experiences of NHS services are affected by ambiguities surrounding access entitlements and planned reforms. 29,32,41,62 Results were consistent with studies by Mladovsky and others that migrants are confused about host country health systems and entitlements. 29,40,62 Several issues warrant improvement, including accessibility, communication, and clarity on migrant entitlements and GP responsibilities. ...
Background: Recent British National Health Service (NHS) reforms, in response to austerity and alleged ‘health tourism,’ could impose additional barriers to healthcare access for non-European Economic Area (EEA) migrants. This study explores policy reform challenges and implications, using excerpts from the perspectives of non-EEA migrants and health advocates in London.
Methods: A qualitative study design was selected. Data were collected through document review and 22 in-depth interviews with non-EEA migrants and civil-society organisation representatives. Data were analysed thematically using the NHS principles.
Results: The experiences of those ‘vulnerable migrants’ (ie, defined as adult non-EEA asylum-seekers, refugees, undocumented, low-skilled, and trafficked migrants susceptible to marginalised healthcare access) able to access health services were positive, with healthcare professionals generally demonstrating caring attitudes. However, general confusion existed about entitlements due to recent NHS changes, controversy over ‘health tourism,’ and challenges registering for health services or accessing secondary facilities. Factors requiring greater clarity or improvement included accessibility, communication, and clarity on general practitioner (GP) responsibilities and migrant entitlements.
Conclusion: Legislation to restrict access to healthcare based on immigration status could further compromise the health of vulnerable individuals in Britain. This study highlights current challenges in health services policy and practice and the role of non-governmental organizations (NGOs) in healthcare advocacy (eg, helping the voices of the most vulnerable reach policy-makers). Thus, it contributes to broadening national discussions and enabling more nuanced interpretation of ongoing global debates on immigration and health.
... About one-third of the participants in the study (31.7 %) were dissatisfied with the health-care services used and the most important reasons were long waiting times for access to health-care services and for examinations results, findings also confirmed by other studies (Arnold et al. 2014;Aung et al. 2010;Galanis et al. 2013). The main reasons for dissatisfaction seem to be similar to those expressed by native citizens. ...
Objectives:
The study aims were focused on acquiring information about access to health-care services and to investigate the potential barriers affecting full access to health-care services.
Methods:
The study population consisted of immigrants and refugees aged 18 or more living in Italy for at least 12 months recruited through non-profit organizations.
Results:
961 immigrants took part in the study, with a response rate of 98.9 %. Of the participants, 85 % had access to a general practitioner (GP) at least once, and 46.6 and 22.4 % mentioned a minimum one emergency visit and hospital stay, respectively. Diagnostic procedures and/or drug prescriptions (49.7 %), chronic disease control (15.8 %), and preventive interventions (13 %) were the most reported reasons for GP access.
Conclusions:
This study yielded current and broader insight into the model of health-care utilization among immigrants. The findings adds to our understanding of the third-sector organizations' role in facilitating immigrants' access to services offered by the Italian National Health Service, contributing to the extensive discussion on how to best manage migrant health care in Italy.
