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

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101088678 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-698X (Electronic) Linking ISSN: 1472698X NLM ISO Abbreviation: BMC Int Health Hum Rights Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2001-
    • Subject Terms:
      Communication Barriers* ; Cultural Competency* ; Health Services Accessibility*; Delivery of Health Care/*ethnology ; Refugees/*psychology; Australia ; Hospitals ; Humans ; Privacy ; Trust
    • 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.
    • References:
      BMJ. 2000 Jan 1;320(7226):50-2. (PMID: 10617534)
      Fam Med. 2003 Oct;35(9):649-54. (PMID: 14523663)
      Qual Saf Health Care. 2004 Jun;13(3):223-5. (PMID: 15175495)
      J Transcult Nurs. 2006 Jan;17(1):30-9. (PMID: 16410434)
      Women Health. 2006;43(3):63-82. (PMID: 17194678)
      Aust N Z J Public Health. 2007 Aug;31(4):333-5. (PMID: 17725011)
      J Cross Cult Gerontol. 2007 Dec;22(4):405-19. (PMID: 17846877)
      BMC Med Res Methodol. 2008 Jul 10;8:45. (PMID: 18616818)
      Midwifery. 2010 Apr;26(2):189-201. (PMID: 18653262)
      Aust J Rural Health. 2008 Dec;16(6):349-54. (PMID: 19032207)
      BMC Med Educ. 2009 Apr 09;9:15. (PMID: 19358713)
      PLoS Med. 2009 Jul 21;6(7):e1000100. (PMID: 19621070)
      Soc Sci Med. 2010 Jun;70(12):2070-2079. (PMID: 20378223)
      Health Care Women Int. 2010 May;31(5):458-72. (PMID: 20390666)
      Women Birth. 2012 Mar;25(1):13-22. (PMID: 21315675)
      Aust J Prim Health. 2011;17(2):195-201. (PMID: 21645477)
      Med J Aust. 2011 Jul 18;195(2):74-6. (PMID: 21770874)
      Med J Aust. 2011 Sep 19;195(6):310-1. (PMID: 21929480)
      Aust Health Rev. 2011 Nov;35(4):475-9. (PMID: 22126952)
      Aust Fam Physician. 2012 Mar;41(3):147-9. (PMID: 22396929)
      BMC Health Serv Res. 2012 May 15;12:117. (PMID: 22587587)
      Aust J Prim Health. 2012;18(3):242-7. (PMID: 23069368)
      BMC Med Res Methodol. 2012 Nov 27;12:181. (PMID: 23185978)
      Aust J Prim Health. 2014;20(1):85-91. (PMID: 23257393)
      Med Educ. 2013 Mar;47(3):252-60. (PMID: 23398011)
      Aust J Prim Health. 2014;20(1):92-7. (PMID: 23482062)
      Australas Psychiatry. 2013 Aug;21(4):315-20. (PMID: 23804113)
      Women Birth. 2013 Dec;26(4):260-6. (PMID: 23988383)
      Med Anthropol. 2013;32(6):535-51. (PMID: 24010537)
      BMC Health Serv Res. 2014 Mar 03;14:99. (PMID: 24589335)
      BMC Oral Health. 2014 Jun 13;14:69. (PMID: 24923308)
      BMC Med Res Methodol. 2014 Jun 21;14:80. (PMID: 24951054)
      BMC Pregnancy Childbirth. 2014 Oct 06;14:348. (PMID: 25284336)
      Br J Gen Pract. 2015 Mar;65(632):e171-6. (PMID: 25733438)
      BMC Health Serv Res. 2015 Apr 23;15:123. (PMID: 25903779)
      BMJ Qual Saf. 2016 Apr;25(4):e1. (PMID: 26089208)
      J Family Med Prim Care. 2015 Jul-Sep;4(3):324-7. (PMID: 26288766)
      BMC Pregnancy Childbirth. 2015 Aug 29;15:197. (PMID: 26319482)
      Women Birth. 2016 Apr;29(2):128-37. (PMID: 26410632)
      Aust Fam Physician. 2015 Jul;44(7):503-7. (PMID: 26590497)
      Birth. 2016 Mar;43(1):86-92. (PMID: 26616739)
      Worldviews Evid Based Nurs. 2016 Jun;13(3):241-9. (PMID: 26790142)
      BMC Pregnancy Childbirth. 2016 Jan 21;16:12. (PMID: 26794243)
      J Immigr Minor Health. 2017 Jun;19(3):697-701. (PMID: 27002625)
      Br J Gen Pract. 2016 Jun;66(647):e397-409. (PMID: 27162206)
      BMC Psychiatry. 2016 Aug 02;16:275. (PMID: 27484391)
      Transcult Psychiatry. 2017 Feb;54(1):23-45. (PMID: 27550374)
      Contemp Nurse. 2016 Dec;52(6):710-721. (PMID: 27681564)
      Int J Pharm Pract. 2017 Oct;25(5):358-364. (PMID: 27896894)
      Birth. 2017 Jun;44(2):145-152. (PMID: 28110517)
      J Immigr Minor Health. 2018 Feb;20(1):140-146. (PMID: 28120131)
      BMC Psychiatry. 2017 Feb 21;17(1):76. (PMID: 28222713)
      Aust N Z J Public Health. 2017 Aug;41(4):335-337. (PMID: 28370847)
      J Clin Nurs. 2018 Sep;27(17-18):3335-3344. (PMID: 28426892)
      Aust J Prim Health. 2017 Sep;23(4):323-328. (PMID: 28756817)
      BMJ Open. 2017 Aug 4;7(8):e015981. (PMID: 28780549)
      Aust J Prim Health. 2018 Mar;24(1):90-97. (PMID: 29183565)
      Can J Psychiatry. 2018 May;63(5):297-303. (PMID: 29202665)
      BMC Health Serv Res. 2017 Dec 8;17(1):814. (PMID: 29216876)
      Implement Sci. 2018 Jan 25;13(Suppl 1):12. (PMID: 29384076)
      Aust J Gen Pract. 2018 May;47(5):305-310. (PMID: 29779299)
      Int J Equity Health. 2019 Mar 4;18(1):41. (PMID: 30832651)
      Med Care. 1981 Feb;19(2):127-40. (PMID: 7206846)
    • Contributed Indexing:
      Keywords: Access; Autonomy; Cultural competency; Engagement; Health information; Health services; Perception; Power; Public health; Qualitative; Refugees; Trust
    • Publication Date:
      Date Created: 20190720 Date Completed: 20200206 Latest Revision: 20200225
    • Publication Date:
      20231215
    • Accession Number:
      PMC6637597
    • Accession Number:
      10.1186/s12914-019-0206-6
    • Accession Number:
      31319819