Open Access Research article

A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services’ accessibility in economic migrants

Andrés A Agudelo-Suárez12*, Diana Gil-González234, Carmen Vives-Cases24, John G Love5, Peter Wimpenny6 and Elena Ronda-Pérez24

Author Affiliations

1 Faculty of Dentistry, University of Antioquia, Calle 64 N° 52-59, Medellín, Antioquia, Colombia

2 Public Health Research Group, University of Alicante, Campus de San Vicente del Raspeig s/n, Alicante, 03690, Spain

3 Observatory of Health Policies and Health (OPPS), University of Alicante, Campus de San Vicente del Raspeig s/n, Alicante, 03690, Spain

4 CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain

5 School of Applied Social Studies. Faculty of Health & Social Care Aberdeen, The Robert Gordon University, Aberdeen, United Kingdom

6 Joanna Briggs Collaborating Centre. Faculty of Health and Social Care. School of Nursing and Midwifery, The Robert Gordon University, Aberdeen, United Kingdom

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BMC Health Services Research 2012, 12:461  doi:10.1186/1472-6963-12-461

Published: 17 December 2012



Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011).


A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories.


We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability.


Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed.

Health care; Health services accessibility; Emigrants and immigrants; Systematic review; Qualitative research; Metasynthesis