Table 3 Common barriers of utilizing physical rehabilitation services by Afghan immigrants and refugees in Iran
Themes | Sub-themes | Barriers | Participants |
|---|---|---|---|
Resources | Financial resources | Inadequacy of insurance coverage | S1, S2, S3, S4, S5, S6, S7, S11, S12, S14, S15, S17, S18 |
High cost of services | SP4, S3, S4, S7, S10, S18, S19 | ||
High cost of transportation and accommodation | SP1, SP2, SP3, S2, S5, S6, S8, S11, S15, S17, S19 | ||
Social resources | Lack of social networks | SP2 | |
Informational resources | Lack of knowledge about Iran’s health system | S12, S15, S17 | |
Lack of awareness about immigration-related laws | S15 | ||
Lack of awareness about available supports | SP3, S12, S15, S17 | ||
Lack of awareness regarding the benefits of PRS | SP5, SP8 | ||
Language barriers | SP4 | ||
Access to healthcare | Lack of access to PRS in remote areas | SP1, SP4, S18 | |
Shortage of rehabilitation workforces, especially in remote regions | SP1 | ||
Low quality of services | SP1 | ||
Delayed referral or failure to follow up on treatment | S2, S15 | ||
Lack of patience among providers | S8, S13, S14, S15 | ||
Predisposing factors (General factors) | Demographic factors | Reluctance of females to be examined by male practitioners | SP2 |
High household size, which limits the incapacity to pay for the health needs of each member | S7 | ||
Socioeconomic status | High rate of poverty among immigrants | SP1 | |
Low education level | SP3, SP6 | ||
Living in remote and deprived areas | SP5, S19, | ||
Dispersion of immigrants | SP2 | ||
Lack of cultural competence | SP7, SP9 | ||
Health beliefs | Poor health literacy | SP2 | |
Lack of knowledge about the responsibilities of service providers | S5 | ||
Willingness to receive services from physicians | S6, S7, S8 | ||
Predisposing factors (Immigrant-specific factors) | Immigration status | Inability to stay in accommodation centers for undocumented immigrants | SP1 |
Fear of arrest and deportation | SP1, SP4, SP5, S5 | ||
Inability to use public facilities | S3 | ||
Assimilation | Cultural mismatch | SP2 | |
Immigrant ethnic culture | Lack of trust in modern treatments | S4, S6, S8 | |
Macro-structural/contextual factors | Government Policy | Lack of a comprehensive policy for providing PRS | SP2, S4 |
Existence of strict rules regarding immigrants’ residence | S14, S15, S16 | ||
Lack of detailed information about existing health-related laws | S2, S4 | ||
Healthcare system | Low priority of PRS in the Iranian health system | SP2, SP5 | |
Major provision of PRS by the private sector | SP6 | ||
High out-of-pocket for PRS | SP2 | ||
Inadequacy of insurance coverage | SP2 | ||
Lack of interdisciplinary teamwork | SP2 | ||
Inadequate physical rehabilitation infrastructure in smaller towns | S19 | ||
Long waiting lists in public physical rehabilitation centers | S6 | ||
High workload of PRS providers | S7 | ||
Social, economic, and political conditions | High inflation rate, which limits the ability to pay for PRS | SP5, S1, S3, S4, S6, S8, S10, S14, S15, S16, S19 | |
Lack of job opportunities, which limits access to insurance | S5 | ||
Lack of job security and access to permanent insurance for immigrants | SP4 | ||
Low income and low capacity to pay | S13, S9 | ||
Low social support | S2, S3, S15 | ||
Unsuitability of urban environments | S3 |