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Table 3 Major themes in the 16 country-specific, final factor lists

From: Health care for immigrants in Europe: Is there still consensus among country experts about principles of good practice? A Delphi study

Theme Description Details Countries mentioning theme Countries not mentioning theme in first 10
Easy and equal access A health care system that is easy to access for migrants • Accessibility on the same terms as the general population: 16  
      ◦ In health care systems with free access, free access to care for migrants.   
      ◦ In insurance-based health care systems, migrants should have the right to be insured.   
   • Remove barriers to accessing secondary care.   
  Special health services should be made available in areas with high migrant populations   
  Service hours should adapt to the needs of their users, including migrants.   
   • Services should be affordable: governments should provide the necessary resources and adapt legislation to achieve this.   
  Inform health professionals about the legislation related to the rights to health care for migrants in their country.   
Empowerment Empower migrants with regard to health & health determinants • Provision of information for migrants in their own language 15 DK
      ◦ about their rights and the functioning of the health care system and social care system.   
      ◦ about health, illness and prevention   
      ◦ Provide a special consultation the first time people access the health care system.   
   • Outside the health care sector:   
      ◦ improving access to work as well as work and living conditions empowers migrants and may consequently   
      ◦ improve their health. providing opportunities to learn the language of the host country will facilitate integration into the host country and consequently also access to health care.   
  Participation of migrants and non-governmental organisations (NGOs) dealing with migrants in the organisation of health care services.   
Culturally sensitive care Adjust care provision to cultural differences • Health care providers should receive specific training on cultural competencies and communication skills. 14 FI, UK
   • Employ cultural mediators or health care providers of migrant descent,   
   • Develop specialised services in case of added value to regular services can be demonstrated.   
  Health education and health promotion messages should take into account cultural diversity.   
Quality care Guarantee quality of care • Services should consider the patient as an individual and not stereotype them with the characteristics of the cultural group they are perceived of as belonging to. 12 DE, LT, PT, UK
   • Quality care means taking into account the individual's specific medical history and social background and giving individualised psychological support and empathy.   
   • Health care professionals should take the time to listen to patients and check that both parties have understood each other.   
   • Other factors mentioned:   
      ◦ establishing trust,   
      ◦ seeking truly informed consent,   
      ◦ guaranteeing continuity of care   
      ◦ adapting care to the person's lifestyle and their capacity to receive and self-manage care   
Patient-health care provider communication Provide interpreting and translation • High quality interpreter services, either in person or by telephone, should be easily accessible. 11 BE, HU, IT, NL, PT
   • Services should take into account varying levels of both health literacy and mastery of the local language.   
Respect towards migrants Fight discrimination & prejudice, respect differences Practitioners should show respect, create trust, be interested and address patients without prejudice and with an open mind. 9 AT, BE, DE, EL, IT, PT, UK
  Health care services should be delivered without xenophobia or any sign of racism.   
  Health care providers should be motivated to deliver care for migrants with attention to their specific needs and priorities.   
   • A policy against acts of discrimination in health care facilities should be established and implemented.   
Networking in and outside health care services Effective networking, integrated care Networking within health care services and between health and social services 8 AT, BE, DE, EL, FR, HU, LT, SE
  Interdisciplinarity is a priority within health care services.   
  Coordination between primary care services, or between primary care and refugee-specific health care services.   
  Supporting migrants to develop their social networks   
  Supporting migrants or persons of migrant descent who care for other migrants.   
Targeted outreach activities Targeted outreach programmes in prevention and care Outreach activities in health education, screening, prevention and promotion with difficult to reach migrant groups. 8 AT, BE, DK, FI, LT, NL, PL, SE
Availability of data Data on migrants, epidemiology, research Health care services should be provided with relevant knowledge on health and risk factors concerning the populations they are dealing with. 6 DK, EL, FR, HU, IT, LT, PL, PT, SE, UK
  Health registries   
      ◦ should record and monitor migrant health to facilitate migrant health research.   
      ◦ should be able to integrate patient mobility with full respect of human rights.