Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
BMJ Open. 2021 Sep 16;11(9):e045923. doi: 10.1136/bmjopen-2020-045923.
To develop conceptual understanding of perceived barriers to seeking care for migrant children and young people (aged 0-25 years) with mental health problems and/or neurodevelopmental differences in high-income countries.
Qualitative evidence synthesis using meta-ethnography methodology. We searched four electronic databases (Medline, PsycINFO, Global Health and Web of Science) from inception to July 2019 for qualitative studies exploring barriers to care (as perceived by migrant communities and service providers) for migrant children and young people in high-income countries with neurodevelopmental differences and/or mental health problems. The quality of included studies was explored systematically using a quality assessment tool.
We screened 753 unique citations and 101 full texts, and 30 studies met our inclusion criteria. We developed 16 themes representing perceived barriers to care on the supply and demand side of the care-seeking process. Barriers included: stigma; fear and mistrust of services; lack of information on mental health and service providers lacking cultural responsiveness. Themes were incorporated into Levesque 's conceptual framework of patient-centred access to healthcare, creating a version of the framework specific to migrant children and young people's mental health and neurodevelopmental differences.
This is the first qualitative evidence synthesis on barriers to care for mental health problems and/or neurodevelopmental differences in migrant children and young people in high-income countries. We present an adapted conceptual framework that will help professionals and policy-makers to visualise the complex nature of barriers to care, and assist in improving practice and designing interventions to overcome them. Similar barriers were identified across study participants and migrant populations. While many barriers were also similar to those for children and young people in general populations, migrant families faced further, specific barriers to care. Interventions targeting multiple barriers may be required to ensure migrant families reach care.
深入了解高收入国家中，有心理健康问题和/或神经发育差异的移民儿童和青年（0-25 岁）寻求医疗服务的障碍的概念理解。
使用元民族志方法进行定性证据综合。我们从 2019 年 7 月开始在四个电子数据库（Medline、PsycINFO、全球卫生和 Web of Science）中搜索，以探索高收入国家中，有神经发育差异和/或心理健康问题的移民儿童和青年的医疗服务障碍（由移民社区和服务提供者感知）的定性研究。我们使用质量评估工具系统地探索了纳入研究的质量。
我们筛选了 753 条独特引文和 101 篇全文，其中 30 项研究符合纳入标准。我们制定了 16 个主题，代表了在医疗服务寻求过程中供应和需求方面的医疗服务障碍。这些障碍包括：污名化、对服务的恐惧和不信任、缺乏心理健康信息和服务提供者缺乏文化敏感性。这些主题被纳入了莱韦斯克的以患者为中心的医疗保健获取概念框架中，为移民儿童和青年的心理健康和神经发育差异创建了一个特定版本的框架。
这是第一个关于高收入国家移民儿童和青年心理健康问题和/或神经发育差异的医疗服务障碍的定性证据综合。我们提出了一个适应性的概念框架，这将有助于专业人员和政策制定者了解医疗服务障碍的复杂性，并有助于改善实践和设计干预措施以克服这些障碍。研究参与者和移民群体都存在类似的障碍。虽然许多障碍与一般人群中的儿童和青年相似，但移民家庭还面临着更多的特定的医疗服务障碍。可能需要针对多种障碍的干预措施，以确保移民家庭获得医疗服务。
