Mechanisms and attitudes in responsive health care for forced migrant communities. A qualitative study of transnational practice
Authors: Robinson Amy , Khan Ziaur Rahman A. , Broadhurst Kofi , Nellums Laura , Renolds Gisela , Payman Bayan , Smith Andrew 
Published: December 2024

Objectives

To understand the opportunities and practices that can support responsive health care for forced migrant communities.

Design

Qualitative study of five transnational case examples of services actively working to improve access and experiences of care for forced migrant communities. One strand of the MORRA Study.

Setting

Five services (Australia, Belgium, UK) providing a range of care (primary care, health advocacy, education and support, holistic health screening, care planning/coordination, transcultural mental health care). Delivered through state and not-for-profit structures in initial and contingency accommodation sites, health clinics, and community spaces. Data collection took place between July and October 2022.

Participants

47 participants including forced migrants using or having used one of the five services, service leads, clinical and non-clinical workers (paid and volunteer), interpreters, and service partners. Services supported recruitment of a crude representative sample of worker roles and service users/clients. Participants were required to speak one of nine languages for which we had translated study materials.

Main outcome measures

Experiences, practices, knowledges, skills and attributes of workers; experiences of forced migrants engaging in services.

Results

Services showed a willingness to innovate and work outside existing practice and organisational structures, including a ‘micro-flexibility’ in their interactions with patients, and through the creation of safe spaces that encouraged trust in providers. Other positive behaviours included: engaging in intercultural exchange; facilitating the connection of people with their cultural sphere (e.g. nationality, language); and a reflexive attitude to the individual and their broader circumstances. Social and political structures can diminish these efforts.

Conclusions

Environments that enable good health and support forced migrants to live lives of meaning are vital components of responsive care. This requires flexibility and reflexivity in practice, intercultural exchange, humility, and a commitment to communication. A broader range of caring practitioners can, and should, through intentional and interconnected communities of care, contribute to the health care of forced migrants. Opening up health care systems to include other state actors such as teachers and settlement workers and a range of non-state actors that should include community leaders and peers and private players is a key step in this process. Future work should focus on the health and health service implications of immigration practices; the inclusion of peers in a range of health care roles; alliance-building across unlikely collaborators and the embedding of intercultural exchange in practice. Findings of this study are supported by our systematic review (publication forthcoming).

Strengths and limitations of this study

We engaged with critical perceptions of care from across a range of international jurisdictions, community and health service contexts, and clinical and non-clinical professionalisms.

A diverse and contrasting research team, including a multilingual community researcher, NHS clinicians, voluntary sector advocacy services, and academics, brought contrasting perspectives and backgrounds and broadened reflections.

Unexpected restrictions (predominantly service pressures and restrictions placed by service hosts – accommodation providers) meant we engaged only a small number of service users and only with service users from some services.