The road to equitable healthcare: A conceptual model developed from a qualitative study of Syrian refugees in Norway

Jasmin Haj-Younes; Eirik Abildsnes; Bernadette Kumar; Esperanza Diaz

doi:10.1016/j.socscimed.2021.114540

The road to equitable healthcare: A conceptual model developed from a qualitative study of Syrian refugees in Norway

Soc Sci Med. 2022 Jan:292:114540. doi: 10.1016/j.socscimed.2021.114540. Epub 2021 Nov 6.

Authors

Jasmin Haj-Younes¹, Eirik Abildsnes², Bernadette Kumar³, Esperanza Diaz⁴

Affiliations

¹ Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway. Electronic address: jasmin.haj-younes@uib.no.
² Department of Psychosocial Health, University of Agder, PO Box 422, 4604, Kristiansand, Norway.
³ Unit for Migration and Health. Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway.
⁴ Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway; Unit for Migration and Health. Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway.

PMID: 34763966
DOI: 10.1016/j.socscimed.2021.114540

Abstract

Background: Refugees in high-income countries face barriers to healthcare access even when they have the same rights and entitlements as the host population. Disadvantages in healthcare access contribute to differences in health outcomes and impact acculturation. This study explores perceived changes in health status and experiences with the Norwegian healthcare system of Syrian refugees living in Norway, using a trajectory perspective.

Methods: We conducted 15 semi-structured interviews in April 2020 among purposefully recruited adult refugees from Syria resettled in Norway. Interviews were carried out in Arabic and analysed with Systematic Text Condensation using NVivo software. We used Lévesque's access model and Edberg's migration trajectory perspective as theoretical frameworks. A conceptual model was developed - The Migrant Sensitive Access Model - that highlights the factors contributing to a positive versus negative healthcare journey.

Results: Findings were summarized under three main themes: changes in health and well-being, expectations, and trust. Perceived changes in health status and attributed causes for change were related to the resettlement phase, gender, and were highly informed by pre-migration and migration experiences. The users' perception of the caregiver, communication, and time were identified as key factors in the care-access journey in inspiring trust or distrust in the caregiver.

Conclusion: Syrian refugees in Norway appreciate the Norwegian healthcare system but are impeded in their access to care. Many of the barriers can be bridged during the doctor-patient interaction with a diversity sensitive caregiver. The model we propose gives a comprehensive overview of key areas determining the healthcare experience of this population. The results of this study can be useful to policymakers and healthcare providers when addressing disparities in healthcare access for forced migrants.

Keywords: Access to healthcare; Health equity; Health status; Migrants and transients; Public health; Qualitative research; Refugees.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Adult
Health Services Accessibility
Humans
Norway / epidemiology
Qualitative Research
Refugees*
Syria