Barriers to primary care access for asylum seekers and refugees in the UK: a systematic review

Abstract Background Recent armed conflicts, in addition to the deterioration of humanitarian conditions across the world, has led to the biggest increase in civilian displacement since World War II. Exploration of the barriers and facilitators to primary healthcare access amongst asylum seekers and refugees (ASRs), from the perspective of both service users and service providers, is important for improving policy and practice to ensure more equitable health care. Methods Systematic searches of PubMed, EMBASE, MEDLINE, and CINHL databases were conducted to identify articles until May 2021 using a combination of relevant search terms. Studies were eligible if they were published in English and conducted in ASR populations in primary care settings the UK using qualitative approaches. Literature was thematically analysed using Braun and Clarke’s 6-step process. Quality assessment of included studies was conducted using the Mixed Methods Appraisal Tool. Results Nine studies were included in the review. Key themes identified included: accommodation within services; awareness of service navigation, negotiation and eligibility of care; accessibility; availability of appointments; acceptance; complexity within health needs; and cultural appropriateness. Healthcare professionals encounter barriers and facilitators within the healthcare setting, the overall healthcare system, and with regards to their understanding of migration policy. ASRs experience barriers and facilitators with regards to accessing and understanding the health system, cultural appropriateness of care, cost, stigma and prejudice, and availability of specialist services. Conclusions This study highlights the difficulties ASRs and healthcare professionals face in primary care settings, the need for consistent and unambiguous guidance that supports the cultural competence of the heath service, and the need for further research into the efforts made to eliminate health discrimination within primary care. Key messages • Barriers exist to primary healthcare amongst asylum seekers and refugees. • Specialised and incorporated healthcare and support is needed due to unique social, cultural, and demographical differences of this population.

Though familiarity with trans Ã personś needs has increased in the new millennium, still, addressing their specific health issues is challenging. In and outside of complex interdisciplinary settings with trans Ã persons and health care workers, ICT solutions are used to remind trans Ã persons of their hormone injection or to conduct voice training. Hence, we reviewed the pertinent literature to shed light on what kind of eHealth solutions are investigated, what diagnosis and treatment are eHealth solutions related to, and how are trans Ã persons enacted within these eHealth solutions. We conducted a systematic literature review analyzing peer reviewed articles presenting all kind of studies except literature reviews. Using the electronic databases PubMed and Scopus, we analyzed data from 1 January 2000 to 31 December 2021. For screening purposes we used the PRISMA checklist and, data extraction followed the PICO (Population, Intervention, Control, Outcome, and Improvement) model. We also analyzed studies covering aspects of the impact on the COVID-19 pandemic. Overall, we identified 322 records, 187 from Scopus and 135 from PubMed. Removing 117 duplicated and 47 records for other reasons, 158 reports were assessed for eligibility. Our results show that trans Ã persons were often presented as subsamples in larger samples of non-binary populations. Also, eHealth solutions related to very different technological solutions and to a wide range of treatment models, with the vast majority relating to sexual health. Hence, we could also see that trans Ã women were the more interesting group in the research included in this review. We found 23 studies relating to COVID-19. eHealth solutions have great potential to contribute to a better healthcare for trans Ã persons but the needs of different groups during healthcare have to be taken into account in further research. During the COVID-19 pandemic, the need for research on eHealth solutions for trans Ã persons came into focus.

Key messages:
Our analyzes showed that research on eHealth solutions for trans Ã persons takes place in complex interdisciplinary settings which need to be taken into account in further research.
The COVID-19 pandemic crisis lead to an uptake of eHealth interventions in mental, endocrinological, and sexual health care, especially in younger groups and in the frame of routine clinical care.
Abstract citation ID: ckac131.509 Barriers to primary care access for asylum seekers and refugees in the UK: a systematic review

Background:
Recent armed conflicts, in addition to the deterioration of humanitarian conditions across the world, has led to the biggest increase in civilian displacement since World War II. Exploration of the barriers and facilitators to primary healthcare access amongst asylum seekers and refugees (ASRs), from the perspective of both service users and service providers, is important for improving policy and practice to ensure more equitable health care.

Methods:
Systematic searches of PubMed, EMBASE, MEDLINE, and CINHL databases were conducted to identify articles until May 2021 using a combination of relevant search terms. Studies were eligible if they were published in English and conducted in ASR populations in primary care settings the UK using qualitative approaches. Literature was thematically analysed using Braun and Clarke's 6-step process. Quality assessment of included studies was conducted using the Mixed Methods Appraisal Tool.

Results:
Nine studies were included in the review. Key themes identified included: accommodation within services; awareness of service navigation, negotiation and eligibility of care; accessibility; availability of appointments; acceptance; complexity within health needs; and cultural appropriateness. Healthcare professionals encounter barriers and facilitators within the healthcare setting, the overall healthcare system, and with regards to their understanding of migration policy. ASRs experience barriers and facilitators with regards to accessing and understanding the health system, cultural appropriateness of care, cost, stigma and prejudice, and availability of specialist services.

Conclusions:
This study highlights the difficulties ASRs and healthcare professionals face in primary care settings, the need for consistent and unambiguous guidance that supports the cultural competence of the heath service, and the need for further research into the efforts made to eliminate health discrimination within primary care. Key messages: Barriers exist to primary healthcare amongst asylum seekers and refugees. Specialised and incorporated healthcare and support is needed due to unique social, cultural, and demographical differences of this population.
iii616 European Journal of Public Health, Volume 32 Supplement 3, 2022