Parajuli Jamuna, Horey Dell
Department of Public Health, La Trobe University, Bundoora, Vic. 3086, Australia; and Corresponding author. Email:
Department of Public Health, La Trobe University, Bundoora, Vic. 3086, Australia; and College of Science, Health and Engineering, La Trobe University, Bundoora, Vic. 3086, Australia. Email:
Aust Health Rev. 2020 Feb;44(1):132-142. doi: 10.1071/AH18108.
Objective The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic? Refugee health after resettlement is poor, yet health service use is low. What does this paper add? Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals' knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners? The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees.
目的 本研究旨在综述先前已审阅的研究文献，以确定难民在重新安置国家利用卫生服务的障碍和促进因素。方法 开展系统综述概述。检索了七个电子数据库（医学索引数据库（Medline）、护理及相关健康文献累积索引数据库（CINAHL）、心理学文摘数据库（PsycINFO）、ProQuest Central数据库、Scopus数据库、EBSCO数据库和谷歌学术），以查找关于难民重新安置后寻求医疗行为和利用卫生服务的障碍及促进因素的系统综述。两位作者使用经过验证的工具独立进行数据选择、数据提取和质量评估。结果 九项系统综述涵盖了一系列研究领域和难民群体。卫生服务利用的障碍可分为三大类：（1）与难民相关的问题，包括难民特征、社会文化因素及既往经历的影响；（2）与卫生服务相关的问题，包括实践问题以及卫生专业人员的知识和技能；（3）与重新安置背景相关的问题，包括政策和实际问题。已确定或评估的促进因素较少，但包括护理方法、卫生服务应对措施以及卫生专业人员的行为。结论 获得医疗保健的障碍包括难民特征、卫生服务中的实践问题（包括卫生专业人员的知识和技能）以及重新安置背景。卫生服务需要识别文化敏感护理的障碍。需要改进服务提供，以满足难民的需求。需要开展更多研究来评估促进因素，以改善这些弱势群体获得医疗保健的机会。关于该主题已知的信息是什么？重新安置后的难民健康状况不佳，但卫生服务利用率较低。本文补充了什么内容？重新安置国家获得卫生服务的障碍不仅与难民有关，还与卫生服务实践问题、卫生专业人员的知识和技能以及重新安置背景有关。已确定的促进难民获得卫生服务的因素较少。对从业者有何启示？与卫生专业人员和卫生服务相关的障碍与建立信任有关，需要解决这些问题以改善难民获得护理的机会。
