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

Easy and equal access

A health care system that is easy to access for migrants

• Accessibility on the same terms as the general population:

   ◦ 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

   ◦ 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.

• 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.

• 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.

• 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.

• 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

• 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.

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.

• 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.