Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jun 14;19(1):755.
doi: 10.1186/s12889-019-7049-x.

A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries - the 3C model

Julia Brandenberger  1   2   3   4 , Thorkild Tylleskär  5 , Katrin Sontag  6   7 , Bernadette Peterhans  8   6 , Nicole Ritz  9   6   10   11
Affiliations

A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries - the 3C model

Julia Brandenberger et al. BMC Public Health. .

Abstract

Background: Migrants and refugees have important health needs and face inequalities in their health status. Health care delivery to this patient group has become a challenging public health focus in high income countries. This paper summarizes current knowledge on health care delivery to migrants and refugees in high-income countries from multiple perspectives.

Methods: We performed a systematic literature review including primary source qualitative and quantitative studies between 2000 and 2017. Articles were excluded if the study setting was in low- or middle-income countries or focused on skilled migration. Quality assessment was done for qualitative and quantitative studies separately. Predefined variables were extracted in a standardized form. Authors were approached to provide missing information.

Results: Of 185 identified articles, 35 were included in the final analysis. We identified three main topics of challenges in health care delivery: communication, continuity of care and confidence. All but one study included at least one of the three main topics and in 21/35 (60%) all three topics were mentioned. We further developed the 3C model and elaborated the interrelatedness of the three topics. Additional topics identified showed that the specific regional context with legal, financial, geographical and cultural aspects is important and further influences the 3C model.

Conclusions: The 3C model gives a simple and comprehensive, patient-centered summary of key challenges in health care delivery for refugees and migrants. This concept is relevant to support clinicians in their day to day practice and in guiding stakeholders in priority setting for refugee and migrant health policies.

Keywords: Asylum; Communication; Confidence; Continuity of care; Immigrant; Interpreter; Quality of care; Refugee; Translator; Trust.

PubMed Disclaimer

Conflict of interest statement

We declare no competing interests. The authors alone are responsible for the views summarized in this article and they do not necessarily represent perspectives of the institutions with which they are affiliated.

Figures

Fig. 1
Fig. 1
Flow diagram showing the process of study selection (adapted from [11])
Fig. 2
Fig. 2
Venn-Diagram depicting the main categories discussed in the included studies. Of note only 34 studies are depicted as one study included did not mention any of the three main categories
Fig. 3
Fig. 3
The 3C model summarizing the results of the analytical assessment. The three main categories influencing health care service delivery in refugees and migrants and are depicted, including their interrelation and the importance of a patient-centered perspective
Fig. 4
Fig. 4
Extension of the 3C model, summarizing the main context challenges
See this image and copyright information in PMC

References

    1. United Nations DoEaSA, Population Division: International Migration Report 2017. 2017, ST/ESA/SER.A/403.
    1. UNHCR: global trends - forced displacement in 2017. In: UNHCR. 2017: 72.
    1. The Lancet Public Health No public health without migrant health. Lancet Public Health. 2018;3(6):e259. doi: 10.1016/S2468-2667(18)30101-4. - DOI - PubMed
    1. WHO: Transforming our world: the 2030 agenda for sustainable development. In: World Health Assembly 2015; Geneva United Nations; 2015.
    1. WHO. Promoting migrant health – striving for peace and decent life for all. In: Promoting migrant health – striving for peace and decent life for all. Geneva: WHO. p. 2017.

Publication types