A model explaining refugee experiences of the Australian healthcare system: a systematic review of refugee perceptions

Abstract

Background: Refugees have significant unmet health needs. Delivering services to refugees continues to be problematic in the Australian healthcare system. A systematic review and thematic synthesis of the literature exploring refugee perceptions of the Australian healthcare system was performed. Methods: Titles and abstracts of 1610 articles published between 2006 and 2019 were screened, and 147 articles were read in full text. Depending on the type of study, articles were appraised using the Modified Critical Appraisal Tool (developed by authors), the Mixed Methods Appraisal Tool, or the JBI Appraisal Checklist for Systematic Reviews. Using QSR NVivo 11, articles were coded into descriptive themes and synthesised into analytical themes. An explanatory model was used to synthesise these findings. Confidence in the review findings were assessed with GRADE-CERQual approach. Results: The final synthesis included 35 articles consisting of one systematic review, 7 mixed methods studies, and 27 qualitative studies. Only one study was from a regional or rural area. A model incorporating aspects of engagement, access, trust, and privacy can be used to explain the experiences of refugees in using the Australian healthcare system. Refugees struggled to engage with health services due to their unfamiliarity with the health system. Information sharing is needed but this is not always delivered effectively, resulting in disempowerment and loss of autonomy. In response, refugees resorted to familiar means, such as family members and their pre-existing cultural knowledge. At times, this perpetuated their unfamiliarity with the broader health system. Access barriers were also encountered. Trust and privacy are pervasive issues that influenced access and engagement. Conclusions: Refugees face significant barriers in accessing and engaging with healthcare services and often resorted to familiar means to overcome what is unfamiliar. This has implications across all areas of service provision. Health administrators and educators need to consider improving the cultural competency of staff and students. Policymakers need to consider engaging communities and upscale the availability and accessibility of professional language and cultural supports. Research is needed on how these measures can be effectively delivered. There is limited research in remote areas and further evidence is needed in these settings.

Barriers and facilitators to dental care access among asylum seekers and refugees in highly developed countries: a systematic review

“…A strength of synthesis of qualitative data, is that themes may be more transferable to other contexts and have greater potential to inform policy and practice, in comparison to individual qualitative studies [6,40]. Our findings may also be transferable to other healthcare settings, as indicated by other systematic reviews which explored experiences of this population in the host countries [4,17]. In addition, the methodology used provides a transparent link between the primary studies and the conclusions drawn in this review.…”

“…The majority of the global refugee population are hosted in poorly resourced countries. However, inequalities in health outcomes and healthcare among this group across a number of services also exist in high-income countries [4][5][6]. This raises the importance of addressing this group's health needs in highly-developed countries.…”

Integration and social determinants of health and wellbeing for people from refugee backgrounds resettled in a rural town in South Australia: a qualitative study

“…Research investigating the broad resettlement experiences for people from refugee backgrounds in high income countries has proliferated in recent years [54], however less research has focused on the experiences of refugees in regional or rural areas, particularly regarding health in those environments [55], and there is very limited research outside Australia on the experiences of refugees in regional or rural areas. The research that has been conducted has indicated that successful settlement is dependent on a number of factors [11,47,56,57] such as attitudes of the host community [41]; rural employment opportunities [58]; and size and connections of the incoming community [59], and highlights the importance of local contexts for refugee resettlement [15,60].…”

Reconceptualising specialisation: integrating refugee health in primary care

“…Building both clinical and administrative capacity is essential and underpins sustainable practice utilising the available MBS rebate. It has been established that the initial 6 months' post arrival can be challenging (Au et al 2019) and the additional time the MIRHS nurse is able to provide support in terms of both health system navigation (access) and health literacy (management) is critical to positive patient outcomes in a time-poor general practice context.…”