Worldwide, more than 214 million people have left their country of origin (World Health Organization 2014, United Nations 2016). This unprecedented mass migration impacts on health care in host countries. This paper explores and synthesizes literature on the health care experiences of migrants.
Methods:
Design: A meta- ethnography review of qualitative research regarding migrant health care. Eight databases (MEDLINE, CINAHL, PsychInfo, EMBASE, Web of Science, Migration Observatory (United Kingdom), National Health System Scotland Knowledge Network, and ASSIA) and the Cochrane Library were searched for relevant full text articles in English, published between January 2006 and June 2016. Articles were screened against inclusion criteria for eligibility. Search terms used included ‘migrant’, ‘migrant patient’ ‘immigrants’, ‘quality of care’, ‘nursing care’, ‘satisfaction with nursing care’, ‘experiences of care’ ‘expectations’. Google and Google Scholar were used to identify studies not published in indexed journals. Included articles were assessed for quality using the Critical Appraisal Skills Programme (CASP) Oxford (Critical Appraisal Skills Programme, 2013,Critical Appraisal Skills Programme (Producer) 2017) and analysed using Noblit and Hare’s seven step meta ethnography process.
Results:
27 studies were included in the study. Five key contextualization dimensions were identified: Personal factors; The healthcare system; Accessing healthcare; The encounter and healthcare experiences. These five areas all underlined the uniqueness of each individual migrant emphasizing the need to treat a person rather than a population.
Personal factors
This dimension comprises a number of constructs that define a migrant patient's personality and inform about their health-seeking behaviours, such as a person's enculturation or society of origin with its religious or value system, but also life experiences. In some cases, exceptionally traumatic experiences such as becoming a refugee because of war and being forced to migrate
Healthcare system
The healthcare system and legal framework of the host country determines the care provision available for natives as well as for migrant patients. Depending on the healthcare model, service provision and the quality of care might differ between a migrants' home country and their host. This can result in a mismatch between the care provided and the individual’s expectations from the health care system.
Access to healthcare
This dimension addressed the barriers or enablers to healthcare in the host country. When a need for services is identified by migrants, their socio-economic and legal status would appear to affect their access to services. To even access the correct service, the individual migrant and/or their families need to know how to go about such access. Language difficulties and lack of information can serve to adversely affect their rights. An additional issue is that service providers can prove to be gatekeepers to the required services. These issues can have a detrimental effect on the individual migrant’s health and they may seek alternative health-seeking strategies.
The Encounter
When an individual migrant does access the services, the way they are treated as a person and as a patient is determined by the staff they encounter. This juncture has huge implications for the trajectory of a person’s care. Yet the encounter can prove problematic due to language difficulties and a lack of mutual knowledge of how to act in a culturally appropriately way. This also covers the misunderstandings of what an individual migrant wants from service providers, what they are used to in their own countries and what the service provider states that the person with migrant status needs. It is therefore important for service providers to treat the individual in an holistic manner, ascertaining their expectations and perceived need. Such care is at the heart of person-centeredness. Within a true person-centred approach, the individual’s cultural background is fundamental to effective care.
The healthcare experiences
This dimension comprises the constructs of healthcare needs as being ‘met’ or ‘unmet’. Healthcare needs need to be satisfied in terms of emotional support or information. (Lindemeyer et al 2016) The overall positive or negative evaluation of a healthcare experience depends on whether a migrant patient feels their care and information needs and expectations have been met or not. Migrant patients use the familiar healthcare system of their home country as a template to compare and evaluate the care they received in the host country.
Conclusion:
From the findings, a model has been designed using the five dimensions and grounded in a person-centred care approach. This model is in the form of a flow diagram that illustrates the antecedents and succedents of the migrants' healthcare experience. These include lack of linguistic abilities, clashing cultures or social or cultural taboos that may inhibit them from seeking health care and, when found, of making the best use of it. This model may help healthcare providers to identify and address antecedents to poor quality migrant healthcare, identify weak points, improve the organisation and help health care professionals to provide person-centred care to migrant patients. For the nurse in her encounter with a migrant the flow diagram shows the personal factors and healthcare system factors that ante cede and shape the encounter. It also shows the factors of the encounter itself which matter and the factors which determine how the migrant experiences the encounter subsequently. Clinical relevance: The proposed model facilitates identification of points of weakness in the care for migrant patients. Employing a person- centred care approach, may contribute to improve health outcomes for migrant patients.
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