Impact of COVID-19 on Migrants’ Access to Primary Care: A National Qualitative Study

Abstract

BackgroundThe COVID-19 pandemic has led to considerable changes in the delivery of primary care in the UK, including rapid digitalisation, yet the extent to which these have impacted on marginalised migrant groups – already facing existing barriers to NHS care – is unknown. Understanding the perspectives and experiences of health professionals and migrants will support initiatives to deliver more effective health services, including delivery of the COVID-19 vaccine, to marginalised groups.AimTo understand the impact of the COVID-19 pandemic on migrants and their access to primary healthcare, and implications for COVID-19 vaccine roll out.Design and SettingPrimary care professionals, administrative staff, and migrants (foreign born; >18 years; <10 years in UK), were recruited in three phases using purposive, convenience and snowball sampling from urban, suburban and rural settings.MethodsIn-depth semi-structured interviews were conducted by telephone. Data were analysed iteratively, informed by thematic analysis.Results64 clinicians were recruited in Phase 1 (25 GPs, 15 nurses, 7 HCAs, 1 Pharmacists); Phase 2 comprised administrative staff (11 PMs and 5 receptionists); and in Phase 3 we recruited 17 migrants (88% asylum seekers; 65% female; mean time in UK 4 years). We found that digitalisation and virtual consultations (telephone, video, and online form-based) have amplified existing inequalities in access to healthcare for many migrants due to lack of digital literacy and access to technology, compounded by language barriers. Use of virtual consultations has resulted in concerns around building trust and the risk of missing safeguarding cues. Participants highlighted challenges around registering and accessing healthcare due to the physical closure of surgeries. Participants reported indirect discrimination, language and communication barriers, and lack of access to targeted and tailored COVID-19 information or interventions. In addition, migrants reported a range of specific beliefs around COVID-19 and on potential COVID-19 vaccines, from acceptance to mistrust, often influenced by misinformation. PCPs raised concerns that migrants may have increased risk factors for poor general health and to severe illness from COVID-19, in part due to their social and economic situation. Innovative opportunities were suggested to engage migrant groups through translated digital health advice using text templates and YouTube which merit further exploration.ConclusionPandemic-related changes in primary care delivery may be here to stay, and some migrant groups are at risk of digital exclusion and may need targeted additional support to access services. As primary care networks operationalise the delivery of the COVID-19 vaccine, these findings provide critical information on specific strategies required to support migrant population to access primary care and overcome misinformation around COVID-19 and the COVID-19 vaccine.How this fits inThe impact of pandemic-related shifts in primary care delivery on marginalised migrant groups, who may already face major disparities in accessing primary care, is poorly elucidated. We found that the rapid digitalisation of primary care services and physical closure of surgeries during the pandemic have amplified disparities in access to healthcare for specific migrant groups, with many lacking access to and capacity to use technology, compounded by language barriers. Migrants may be at increased risk of misinformation about COVID-19, which merits further consideration as COVID-19 vaccine roll out begins. Improved outreach to local migrant community organisations and places of worship, alongside co-designing with migrants more inclusive delivery approaches and creative integration of migrant ambassadors into information-sharing campaigns are needed. Primary care can maximise the opportunities of digitalisation for migrants through flexible engagement by multiple modalities (e.g. text, email, letter and YouTube videos) to provide targeted, translated advice and information, virtual group consultations for patients with a specific condition, and working with local leaders and NGOs to access and disseminate information through informal communication channels.

Migration and Outbreaks of Vaccine-Preventable Disease in Europe: A Systematic Review

“…It is crucial going forward that interventions are developed and tailored towards at-risk migrant communities to build trust and reduce disparities in access to vaccination systems (83). Migrants should have access to key vaccines regardless of their immigration status: the IOM has specifically called for governments to ensure an adequate COVID-19 vaccine stock be reserved for non-nationals and forcibly displaced migrants, regardless of their immigrations status (84).…”

Strategies and action points to ensure equitable uptake of COVID-19 vaccinations: A national qualitative interview study to explore the views of undocumented migrants, asylum seekers, and refugees

“…These include perceived or true lack of entitlement to access healthcare, fear around charging or links to immigration services and poor understanding of the system, often compounded by language barriers (15, 16). These barriers have been exacerbated in many cases by increasing digitalisation of healthcare services during the pandemic (17, 18). Adult migrants are widely excluded from vaccination services on arrival to the UK and Europe, due to structural and policy shortfalls in engaging them in catch-up vaccination campaigns (19, 20), even though ensuring high levels of coverage and equitable access are key priorities of the European Vaccine Action Plan and the Sustainable Development Goals (SDGs) (21).…”

“…This has resulted in precarious migrants only accessing services when in urgent need and avoiding preventative health services such as vaccination (16), with calls for immigration data sharing and immigration checks at health services to be suspended during the pandemic. Increased social exclusion during the pandemic may have exacerbated long-running issues of mistrust and mutual lack of understanding between public health services and migrants, impacting on their willingness to present to health services to get vaccinated (18, 27). Precarious migrants have been reported to be avoiding hospitals for fear of charging if they are negative for COVID-19 (28), despite Public Health England specifically stating that COVID-19 vaccines are free of charge and no immigration checks will be carried out (29).…”

Migration and outbreaks of vaccine-preventable disease in Europe: a systematic review

“…Robust scientific messaging to address community-specific trust issues has been highlighted as a key component of COVID-19 vaccine roll-out (13,90). It is crucial going forward that interventions are developed and tailored towards migrant communities coming from countries with known low coverage rate for key VPDs, taking into account cultural factors, to build trust and reduce disparities in access to vaccination systems (14).…”

“…Data suggest that low confidence in vaccination could also contribute to low immunisation coverage of some migrant groups (11,12), yet it is unclear to what extent or specific migrant groups are vaccine hesitant (13). These factors hold immediate relevance to current COVID-19 vaccination roll-out, with some migrant groups in one study expressing specific fears or concerns around being vaccinated for COVID-19 in the UK (14).…”