Asylum seekers' and refugees' experiences of accessing health care: a qualitative study

Background: Asylum seekers and refugees (ASRs) often experience poor health in host countries. The United Nations High Commissioner for Refugees (UNHCR) requires hosts to ensure these sanctuary seekers have access to basic health care.

Aim: To identify barriers and facilitators that affect access to health care by ASRs in Wales.

Design & setting: Participatory research approach using qualitative focus groups across Wales, which hosts 10 000 refugees.

Method: Eight focus groups were undertaken with ASRs, support workers, and volunteers (n = 57).

Results: Specialist NHS-funded services and grant-aided non-governmental organisations (NGOs) facilitated access to health care, including primary care. Most ASRs understood the role of general practice in providing and coordinating care, but were unaware of out-of-hours services. Reported barriers included: language difficulties, health literacy, unrecognised needs, and the cost of travel to appointments. Participants recognised the importance of mental health, but were disappointed by the state of mental health care. Some feared seeking support for mental health from their GP, and few were aware they had the right to move practice if they were unhappy. Written information about health care was not as accessible to refugees as to asylum seekers (ASs). While some participants read such material before consulting, others struggled to access information when in need. Few participants were aware of health prevention services. Even when they knew about services, such as smoking cessation, these services' difficulty in accommodating ASRs was a barrier.

Conclusion: The main barriers identified were: availability of interpreters; knowledge about entitlements; and access to specialist services.