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
Level | Articulated by (occurrences across included studies if > 1) | ||
|---|---|---|---|
Patient | Clinician | Both | |
Patient | All patients • Feel vulnerable when they need help • Reluctant to “bother” nurse to ask for help Women patients none | 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) |
Clinician | All 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 none | 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 system | All patients • Red tape/paperwork • System difficult to navigate Women patients none | 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 none Women patients none |