CONTEXT: Currently, Wisconsin is home to over 14,000 refugees, with more than half residing in Milwaukee. Refugees often resettle with preexistent chronic and mental health problems due to previous limited access to healthcare and exposure to traumatic events. During clinical interactions, refugee families and primary care providers (PCPs) face many challenges. PCPs are a first point of contact for refugee patients, but most lack basic knowledge about the backgrounds, expectations, and specific healthcare-related needs.
OBJECTIVE: This study sought to explore barriers and opportunities to healthcare access and navigation from the perspective of refugee patients. DESIGN: Semi-structured interviews were performed with adult refugee patients at two academic primary care clinics in Milwaukee, WI. Transcribed interviews were reviewed using qualitative software Dedoose by two different investigators who independently coded them using inductive methods. Codes generated were integrated into a single codebook from which main themes were extracted.
RESULTS: Four overarching themes were identified: (1) distinct healthcare experiences in countries of origin and the U.S. (i.e., seeking services only in crisis moments, very limited access to preventative care; out-of-pocket payments vs. Medicaid coverage; walk-in clinics vs. appointment visits; relative experiences of discrimination); (2) communication barriers and power dynamics in clinical interactions (i.e., some patients expect medical paternalism, others shared decision-making); (3) trust – in interactions with interpreters, PCPs and the health system in general; and (4) patients’ strategies for navigating the health care system including reliance on familial and community networks and accessing affordable transportation.
CONCLUSION: Refugee patients face many barriers when navigating the U.S. healthcare systems including poor English proficiency and limited health literacy. Primary care providers can benefit from better understanding these barriers to become more responsive to refugees’ complex and distinct needs.
Rusu C, Sorenson N, Shnayderman K, Kotovicz F (presenter). Challenges and opportunities of refugee healthcare in Milwaukee. Presented at North American Primary Care Research Group 46th Annual Meeting; November 9-13, 2018; Chicago, IL.