Open Access Highly Accessed Research article

Health care for immigrants in Europe: Is there still consensus among country experts about principles of good practice? A Delphi study

Walter Devillé1*, Tim Greacen2, Marija Bogic3, Marie Dauvrin4, Sónia Dias5, Andrea Gaddini6, Natasja Koitzsch Jensen7, Christina Karamanidou8, Ulrike Kluge9, Ritva Mertaniemi10, Rosa Puigpinós i Riera11, Attila Sárváry12, Joaquim JF Soares13, Mindaugas Stankunas14, Christa Straßmayr15, Marta Welbel16 and Stefan Priebe3

Author Affiliations

1 International and Migrant Health, NIVEL (Netherlands Institute for Health Services Research), Otterstraat 118-124, PO Box 1568, 3500 BN Utrecht & University of Amsterdam, Amsterdam Institute of Social Sciences Research, Amsterdam, the Netherlands

2 Etablissement public de santé Maison Blanche, 18 rue Rémy de Gourmont, 75019 Paris, France

3 Unit for Social and Community Psychiatry, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, UK

4 Institute of Health and Society, Université Catholique de Louvain, Clos Chapelle aux Champs 30.05., 1200 Brussels, Belgium

5 Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 96, 1349-008 Lisbon, Portugal

6 Laziosanità ASP-Public Health Agency for the Lazio Region, Via S. Costanza 53, 00198 Rome, Italy

7 Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark

8 Department of Sociology, National School of Public Health, 196 Alexandras Avenue, Athens 11521, Greece

9 Clinic for Psychiatry and Psychotherapy, Charité-University Medicine Berlin, CCM, Charitéplatz 1, 10117 Berlin, Germany

10 National Institute for Health and Welfare (THL), Department for Mental Health and Substance Abuse Services, P.O.B. 30, FIN-00271 Helsinki, Finland

11 Agency of Public Health of Barcelona, Pça. Lesseps, 1, 08023 Barcelona, Spain

12 Faculty of Health Sciences at Nyíregyháza, University of Debrecen, Sóstói út 31/B, 4400 Nyíregyháza, Hungary

13 Department of Public Health Sciences, Section of Social Medicine, Karolinska Institutet, SE-171 76 Stockholm, and Department of Public Health Sciences, Mid Sweden University, SE-851 70 Sundsvall, Sweden

14 Department of Health Management, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT 44307, Kaunas, Lithuania

15 Ludwig Boltzmann Institute for Social Psychiatry, Lazarettgasse 14A-912, 1090 Vienna, Austria

16 Institute of Psychiatry and Neurology, Ul. Sobieskiego 9, 02-957 Warsaw, Poland

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BMC Public Health 2011, 11:699  doi:10.1186/1471-2458-11-699

Published: 13 September 2011



European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants.


A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants.


The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e.g. on the need for prioritising cultural differences, and between countries, e.g. on the need for more consistent governance of health care services for immigrants.


Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some disagreement both within and between countries on specific issues that require further research and debate.