中低收入国家移民和难民利用初级卫生保健的障碍和促进因素:范围综述。

Barriers and facilitators to primary healthcare utilization among immigrants and refugees of low and middle-income countries: a scoping review.

机构信息

Health Policy Research Center, Institute of Health, School of Medicine, Shiraz University of Medical Sciences, Building No 2, Eighth Floor, Zand Avenue, Shiraz, 71348-45794, Iran.

NIHR Applied Research Collaboration (ARC) West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.

出版信息

Global Health. 2024 Oct 24;20(1):75. doi: 10.1186/s12992-024-01079-z.

Abstract

INTRODUCTION

Primary health care (PHC) is the most common model for providing primary care, and PHC services are the most common points of care that immigrants and refugees attend as a first step. Most immigrants travel to low- and middle-income countries (LMICs), yet only a few studies have examined their health conditions and their access to PHC in these countries. We have attempted to identify the barriers and facilitators that immigrants and refugees encounter when using PHC in these countries.

METHODS

We searched PubMed, Scopus, Web of Science, Embase, ProQuest, Google Scholar, Microsoft Academic, and OpenGrey in this scoping review from its inception to the end of October 2023. Moreover, we manually searched key journals, reference lists, and citations from included studies to identify any missed studies. We extracted data from each selected study using a predefined form. Finally, a thematic analysis approach was utilized to synthesize the collected data from the included qualitative studies.

RESULTS

17 qualitative studies were included in this review, which were from Iran (n = 3), Brazil (n = 3), Kenya (n = 2), Jordan (n = 2), Eastern Sudan (n = 1), Lebanon (n = 1), Bangladesh (n = 1), India (n = 1), Turkey (n = 1), Thailand (n = 1), and Malaysia (n = 1). Among the most common and important reported barriers are language differences, insufficiency of trained carers, unemployment, inability to pay the costs of hospital and medicines, no insurance coverage for immigrants, no clear referral and care system for immigrants, discrimination against women, and improper residence locations. Insurance coverage, awareness programs, and the study of immigrants' needs, along with their social and financial support from family, are among the most essential facilitators.

CONCLUSION

For LMICs, funding is always a limitation, and increasing PHC utilization is the best choice for improving health. Knowing the challenges and facilitators of PHC utilization from the point of view of each stakeholder is a promising way to decide and make policies that can improve the health of both immigrants and refugees, as well as society as a whole.

摘要

简介

初级卫生保健(PHC)是提供初级保健的最常见模式,PHC 服务是移民和难民作为第一步就诊的最常见医疗点。大多数移民前往中低收入国家(LMICs),但只有少数研究考察了他们在这些国家的健康状况和获得 PHC 的情况。我们试图确定移民和难民在这些国家使用 PHC 时遇到的障碍和促进因素。

方法

我们在这个范围综述中从其开始到 2023 年 10 月底在 PubMed、Scopus、Web of Science、Embase、ProQuest、Google Scholar、Microsoft Academic 和 OpenGrey 中进行了搜索。此外,我们还手动搜索了纳入研究的主要期刊、参考文献和引文,以确定任何遗漏的研究。我们使用预定义的表格从每个选定的研究中提取数据。最后,采用主题分析方法对纳入的定性研究中的收集数据进行综合。

结果

本综述纳入了 17 项定性研究,分别来自伊朗(n=3)、巴西(n=3)、肯尼亚(n=2)、约旦(n=2)、东苏丹(n=1)、黎巴嫩(n=1)、孟加拉国(n=1)、印度(n=1)、土耳其(n=1)、泰国(n=1)和马来西亚(n=1)。报告的最常见和最重要障碍包括语言差异、合格护理人员不足、失业、无力支付医院和药品费用、移民无保险覆盖、移民无明确转诊和护理系统、对妇女的歧视以及不当的居住地点。保险覆盖、宣传计划以及研究移民的需求,以及他们在家庭中的社会和经济支持,是最重要的促进因素之一。

结论

对于 LMICs,资金始终是一个限制因素,而增加 PHC 的利用率是改善健康的最佳选择。从每个利益相关者的角度了解 PHC 利用的挑战和促进因素,是制定可以改善移民和难民以及整个社会健康的政策的有前途的方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/01b1/11515291/378fb07d6d8d/12992_2024_1079_Fig1_HTML.jpg

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