Department of General Practice and Health Service Research, Section Health Equity Studies & Migration, University Hospital Heidelberg, Heidelberg, Germany.
Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany.
PLoS One. 2022 Jun 24;17(6):e0270419. doi: 10.1371/journal.pone.0270419. eCollection 2022.
Research on health and healthcare for asylum seekers and refugees (ASR) has focused strongly on accessibility and legal entitlements, with quality of care receiving little attention. This study aimed to assess responsiveness, as non-medical quality of care, in the narratives of ASR patients recently arrived in Germany.
31 ASR with existing medical conditions were recruited in six refugee reception centres and three psychosocial centres. Semi-structured, qualitative interviews were conducted which reconstructed their patient journey after arrival in Germany. Interviews were recorded, transcribed verbatim and evaluated using thematic analysis.
The experiences of participants throughout the patient journey provided a rich and varied description of the responsiveness of health services. Some dimensions of responsiveness, including respectful treatment, clear communication and trust, resurfaced throughout the narratives. These factors were prominent reasons for positive evaluations of the health system, and negative experiences were reported in their absence. Other dimensions, including cleanliness of facilities, autonomy of decision-making and choice of provider were raised seldomly. Positive experiences in Germany were often set in contrast to negative experiences in the participants' countries of origin or during transit. Furthermore, many participants evaluated their experience with healthcare services in terms of the perceived technical quality of medical care rather than with reference to responsiveness.
This qualitative study among ASR analysed patient experiences to better understand responsiveness of care for this population. While our results show high overall satisfaction with health services in Germany, using the lens of responsiveness allowed us to identify particular policy areas where care can be strengthened further. These include in particular the expansion of high-quality interpreting services, provision of professional training to increase the competency of healthcare staff in caring for a diverse patient population, as well as an alignment between healthcare and asylum processes to promote continuity of care.
针对寻求庇护者和难民（ASR）的健康和医疗保健研究主要集中在可及性和法律权利上，而对护理质量关注甚少。本研究旨在评估最近抵达德国的 ASR 患者叙述中的反应性，即非医疗护理质量。
在六个难民收容中心和三个心理社会中心招募了 31 名有现有医疗条件的 ASR。进行了半结构化的定性访谈，重建了他们抵达德国后的就医历程。访谈进行了录音、逐字记录，并使用主题分析进行了评估。
参与者在整个就医历程中的经历提供了对卫生服务反应性的丰富而多样的描述。一些反应性的维度，包括尊重对待、清晰的沟通和信任，在整个叙述中反复出现。这些因素是对卫生系统积极评价的主要原因，而缺乏这些因素则会导致负面体验。其他维度，包括设施的清洁度、决策的自主性和提供者的选择，很少被提及。德国的积极体验往往与参与者原籍国或过境期间的负面体验形成鲜明对比。此外，许多参与者根据医疗服务的感知技术质量来评估他们的就医体验，而不是参考反应性。
这项针对 ASR 的定性研究分析了患者的就医体验，以更好地了解这一人群的护理反应性。虽然我们的研究结果显示，德国的卫生服务总体满意度较高，但通过反应性视角，我们可以确定在某些特定政策领域可以进一步加强护理。这些措施包括扩大高质量口译服务、提供专业培训以提高医疗保健人员照顾多样化患者群体的能力，以及使医疗保健和庇护程序保持一致，以促进护理的连续性。
