Title: Health care moments of opportunity: a review of evidence and community dialogue to explore responsive health care for refugees and people seeking asylum in the UK
Funder: Department of Health and Social Care

Abstract: Research question. What are the ‘moments of opportunity’ to support better health care for forced migrant communities and how can these be used to support better health outcomes and experiences for this population?_x000D_ Background. A forced migrant is a person who has been forced to leave their country of birth (because of war, violence, conflict, fear of being persecuted for reasons of race, religion, nationality, membership of a social group, or political opinion, or natural disaster) and cannot return home safely; they are often called asylum seekers or refugees. Forced migrants often have poor health; they may have diseases, more than one health condition, and poor mental health. Forced migrants face substantial difficulties accessing health care in the UK because of language and cultural differences, poor doctor-patient relationships, fear and lack of trust, and limited knowledge of services. This can lead to illnesses being treated too late and a greater risk of poor health outcomes than those born in the UK. There are many opportunities to engage with forced migrants and support their health. Some of these ‘moments of opportunity’ may be outside of the usual healthcare settings. It is possible that finding the best time and place to support the health care of forced migrants, and doing so in a way that considers their needs and experiences, may improve their access to health care and support better long term health. However, there is not enough information about the best ways to do this._x000D_ Aims. We aim to find out about methods to help support better health care and better health outcomes for forced migrants. We will hold a workshop with forced migrants and people who come into contact with forced migrants in communities; this will include people in the NHS, social care services, community groups and advocacy services. We will use this workshop to find out what are possible ‘moments of opportunity’. We will complete a review of published and unpublished studies about methods to support better health care and better health outcomes for forced migrants. We will visit people (or talk to them on the phone or through video calls) who have used different methods to support better health care or who engage with forced migrants about their health. Finally, we will run workshops to share our findings and to work with forced migrants, and the people who can support better health care outcomes for forced migrants, to agree methods to improve forced migrants health care experiences and health outcomes, in the UK._x000D_ Patient and public involvement. We will involve forced migrants during all of our research project, so that our findings make sense to them and will work for their needs. One of our lead co-applicants has experience of seeking asylum in the UK, and has faced challenges accessing health care for a number of health conditions; she is experienced in representing local forced migrant communities. We will recruit two further representatives and ensure they have support from an experienced patient representative, and other support (such as interpreters) if needed._x000D_ Results. We will produce a guide for how to improve the health and the health care experiences of forced migrants who are living in the UK. We will write reports at each stage of our work and share our findings with the relevant people including health care decision-makers, health care workers and other people who are likely to support forced migrants living in a new country.

Lay abstract: Research question. What are the health care 'moments of opportunity' for forced migrant communities and can these be used to facilitate responsive health care and greater health agency amongst this population?_x000D_ Background. Forced migrants (asylum seekers and refugees) face substantial difficulties accessing healthcare in the UK and have been shown to be at increased risk of poor health outcomes including communicable and non-communicable disease, comorbid conditions and poor mental health. Studies have identified key barriers to care, including difficulties with communication, poor doctor–patient relationships, fear and lack of trust, and limited knowledge of services. Health care 'moments of opportunity' occur within, but crucially also beyond, the traditional health practitioner exchange; considering this, as well as the interconnected and interdependent factors and characteristics of good health and of the forced migrant experience, could help improve responsive health care for this population. However, the activities, initiatives and behaviours which promote this are largely unexplored. _x000D_ Aims and objectives. We aim to integrate evidence and knowledge on interventions and practices that support responsive health care and improved health agency for forced migrants across different health care moments of opportunity, putting representatives of the migrant community at the heart of the research. Specifically, we will: 1) systematically review existing evidence; 2) identify current exemplar practice; and 3) synthesise evidence and knowledge through a detailed and inclusive process of cross-cultural action-orientated dialogue. _x000D_ Methods. 1) We will engage with migrant communities, and practitioners, in a workshop to identify possible health care 'moments of opportunity' for forced migrants; 2) we will carry out a systematic review and meta-synthesis of available peer-reviewed and ‘grey’ literature to identify existing evidence on effective approaches to supporting responsive health care and health agency for forced migrants. We will identify studies that articulate outcomes relating to, for example, experiences of and realised access to health care for forced migrants, as well as outcomes relating to the experiences or attitudes of practitioners in these contexts; 3) we will identify examples in practice across the UK and internationally, collecting data from interviews, focus group discussions, ethnographic research (where appropriate), and written materials. We will be guided by the capabilities framework in considering how far approaches in the literature and in practice go in addressing someone’s capacity to access and engage in health care opportunities, bringing this together as a narrative synthesis. These findings will be presented as part of a series of participatory cross-community events, bringing together all those deemed relevant to health care 'moments of opportunity' for forced migrants. They will facilitate cross-cultural inquiry, and situate and further construct, the evidence gathered within the lived experience of forced migrant communities and the key actors relevant to their health care opportunities. _x000D_ Delivery. 18 months. _x000D_ Anticipated impact. The work will provide an understanding of approaches to addressing barriers to health care for forced migrant communities, and to ensuring responsive attitudes across different health care moments of opportunity, and for improving health agency amongst this population.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE