| Abstract | Background
Immigrant communities, like refugees, asylum seekers, and irregular immigrants, encounter unique health challenges, contributing to their suboptimal well-being. Accessing primary care services (PCS) is particularly challenging and exacerbated by homelessness. Research on homeless immigrants' access to PCS in the UK is a notable knowledge gap. Aim
To investigate the perspectives and experiences of immigrants facing homelessness, along with stakeholders who provide and facilitate access to PCS. The research also identified priority strategies for enhancing access to PCS. Methods
A sequential exploratory mixed-methods research design with two phases was used. The qualitative phase, guided by the Levesque framework of healthcare access and an intersectionality lens, preceded the quantitative phase (Delphi surveys). In-depth, semi-structured interviews were conducted with 30 homeless immigrants and 30 stakeholders. Data were organized in Nvivo 12 software and thematic analysis was conducted. The quantitative phase utilized a two-round Delphi approach to identify priority strategies for improving access to PCS. The top ten strategies were determined through participant rankings using a 5-point Likert scale. Twelve stakeholders participated in the Delphi surveys. Data analysis was conducted using STATA-15 software. Findings
Dominant themes included low health literacy, language barriers, cultural norms, mistrust, fear of deportation, healthcare-related costs, long waiting times, partner violence, digital exclusion, inadequate culturally sensitive healthcare, competing priorities, and discrimination. The impact of the COVID-19 pandemic and accommodation instability were also identified. Alternative health-seeking approaches like self-medication and the use of emergency services were common. The three most prioritized strategies from the Delphi surveys were fighting discrimination and prejudice, improving mental health services, and empowering homeless immigrants on their rights to healthcare. Conclusion
This study highlighted significant inequalities in access to PCS among homeless immigrants in the UK. This stresses the need to address systemic inequalities and their drivers in this sub-population. The top strategies identified may offer initial solutions to address healthcare inequalities. This study expands the understanding of immigrant experiences in accessing PCS by including a focus on homelessness. |
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