Good practice in health care for migrants: views and experiences of care professionals in 16 European countries
1 Unit for Social and Community Psychiatry, London and the Barts School of Medicine and Dentistry, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, UK
2 Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Rua da Junqueira, 96, 1349-008 Lisbon, Portugal
3 Public Health Agency for the Lazio Region, Via S. Costanza 53, 00185 Rome, Italy
4 Etablissement public de santé Maison Blanche, 3-5 rue Lespagnol, 75020 Paris, France
5 Department of Sociology, National School of Public Health, 196 Alexandras avenue, Athens 11521, Greece
6 Clinic for Psychiatry and Psychotherapy, Charité - University Medicine Berlin, CCM, Charitéplatz 1, 10117 Berlin, Germany
7 Danish Research Centre for Migration, Ethnicity and Health (MESU), Unit of Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark
8 International and Migrant Health, NIVEL (Netherlands Institute for Health Services Research), Otterstraat 118-124, PO Box 1568, 3500 BN Utrecht, The Netherlands
9 Institute of Health and Society, Catholic University of Louvain, Clos Chapelle aux Champs 30.05., 1200 Brussels, Belgium
10 Agency of Public Health of Barcelona, Pça. Lesseps, 1, 08023 Barcelona, Spain
11 Faculty of Health Sciences at Nyíregyháza, University of Debrecen, Sóstói út 31/B, 4400 Nyíregyháza, Hungary
12 Department of Public Health Sciences, Section of Social Medicine, Karolinska Institutet, SE- 171 76 Stockholm, Sweden
13 Department of Health Management, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT 44307, Kaunas, Lithuania
14 Ludwig Boltzmann Institute for Social Psychiatry, Lazarettgasse 14A-912, 1090 Vienna, Austria
15 National Institute for Health and Welfare (THL), Department for Mental Health and Substance Abuse Services, P.O.B. 30, FIN-00271 Helsinki, Finland
16 Institute of Psychiatry and Neurology, Ul. Sobieskiego 9, 02-957 Warsaw, Poland
BMC Public Health 2011, 11:187 doi:10.1186/1471-2458-11-187Published: 25 March 2011
Health services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals experience in their service when providing such care and what they consider constitutes good practice to overcome these problems or limit their negative impact on the quality of care.
Structured interviews with open questions and case vignettes were conducted with health care professionals working in areas with high proportion of migrant populations in 16 countries. In each country, professionals in nine primary care practices, three accident and emergency hospital departments, and three community mental health services (total sample = 240) were interviewed about their views and experiences in providing care for migrant patients, i.e. from first generation immigrant populations. Answers were analysed using thematic content analysis.
Eight types of problems and seven components of good practice were identified representing all statements in the interviews. The eight problems were: language barriers, difficulties in arranging care for migrants without health care coverage, social deprivation and traumatic experiences, lack of familiarity with the health care system, cultural differences, different understandings of illness and treatment, negative attitudes among staff and patients, and lack of access to medical history. The components of good practice to overcome these problems or limit their impact were: organisational flexibility with sufficient time and resources, good interpreting services, working with families and social services, cultural awareness of staff, educational programmes and information material for migrants, positive and stable relationships with staff, and clear guidelines on the care entitlements of different migrant groups. Problems and good care components were similar across the three types of services.
Health care professionals in different services experience similar difficulties when providing care to migrants. They also have relatively consistent views on what constitutes good practice. The degree to which these components already are part of routine practice varies. Implementing good practice requires sufficient resources and organisational flexibility, positive attitudes, training for staff and the provision of information.