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Table 2 Barriers of PCC for immigrants and refugees

From: Barriers and facilitators of patient centered care for immigrant and refugee women: a scoping review

LevelArticulated by (occurrences across included studies if > 1)
PatientAll patients
• Feel vulnerable when they need help
• Reluctant to “bother” nurse to ask for help
Women patients
All patients
• Culture influences expectations of healthcare provider or system and views about illness, i.e. shame about condition (4)
• Acceptance of procedures or treatment/adherence (4)
• Diversity of cultures/languages requiring some familiarity
• Lack of familiarity with healthcare system
Women patients
• Little knowledge about disease processes
• Little knowledge about female anatomy, menstrual cycle, reproduction, contraceptives
• Culture/religion influences contraceptive decisions, leading to unplanned pregnancy/abortion
• Fear of violence if families learn about contraceptive use, pregnancy or abortion
All patients
• Language (5)
Women patients
• Decisions made by family rather than the individual woman (2)
• Economic constraints or lack of health insurance (2)
• Lack of trust in health care system; sometimes due to past negative experience (2)
ClinicianAll patients
• Busy and rushed, so little communication (2)
• Delayed diagnosis (2)
• Treated like a lab rat rather than a person; wanted clinicians to get to know them, listen, care, help them understand
• Judgmental behavior or tone
• Treated differently due to culture, race, gender
Women patients
• Ignored/dismissed concerns
• Provided little information about possible complications or about actual adverse outcomes
• Disrespectful behavior or disparaging remarks
All patients
• Lack of training in cultural competency or how culture influences communication or health (seeking) behavior (4)
• How to achieve cultural competency without stereotyping (2)
• How to deliver care while accommodating culture (2)
• Unaccustomed to managing certain diseases/health care issues (i.e. trauma, mental health, tuberculosis)
• Anxiety due to lack of knowledge or experience with migrants
• Burnout
• Perceived that patients wanted doctor to lead the conversation
Women patients
All patients
• Consultations require longer time due to language, culture, knowledge barriers; relationships took longer to establish (5)
Women patients
• Lack of knowledge about culture/religion
Organization or systemAll patients
• Red tape/paperwork
• System difficult to navigate
Women patients
All patients
• Lack of language services; reliance on family (2)
• Interpreters are time-consuming and inaccurate (2)
• Using family interpreters raises privacy and ethics issues (2)
• Remuneration insufficient for time required (2)
• Lack of support/community services
• Western healthcare model inflexible
Women patients
• No protocols or guidelines to help care for migrant women
All patients
Women patients