Healthcare providers' advocacy approaches and ethical challenges in delivering healthcare to undocumented migrants: a scoping review

Abstract

Delivering healthcare to undocumented migrants presents a complex challenge for healthcare providers. Integrating advocacy efforts into their daily practices can be ambiguous in practical terms, stemming from the intricate task of addressing the health needs of this population while simultaneously advocating for their health rights within the constraints imposed on them. This study seeks to consolidate findings from literature regarding the advocacy approaches employed by healthcare providers and the correlated ethical challenges. We conducted a scoping review of qualitative literature by systematically searching four databases-PubMed/Medline, Embase, Cinahl, and Cochrane Library. For developing our search strategy, we employed the PICO (Population, Intervention, Comparison, Outcome) scheme. Our analysis followed the qualitative content analysis approach proposed by Graneheim and Lundman. 30 studies were included, revealing a cumulative total of 915 healthcare providers who were interviewed. A total of 30 themes emerged comprising 14 advocacy approaches and 16 ethical challenges. Healthcare providers made a deliberate choice to engage in advocacy, responding to injustices experienced by undocumented migrants. The spectrum of advocacy initiatives varied, encompassing voluntary participation in healthcare provision, empathetic understanding, and healthcare-focused strategies. We also identified numerous correlated ethical challenges, necessitating healthcare providers to strike a balance between their eagerness to assist and their professional competence, respect the autonomy of undocumented migrants, and establish trust with them. These findings not only offer practical guidance for healthcare providers to enhance accessibility to healthcare services for undocumented migrant patients but also foster awareness of the ethical challenges that may arise in their advocacy roles.

Keywords: Ethical challenges; Health advocacy; Healthcare providers; Undocumented migrants.

Fig. 1

PRISMA flow chart demonstrating the process of identifying relevant articles across four electronic databases

Fig. 2

Classification of healthcare providers (accumulative total = 915) based on their professions

Fig. 3

The frequency and proportionate breakdown of the main health fields across the 30 studies included

Fig. 4

Concept map for categorizing and distinguishing advocacy approaches employed by healthcare providers in delivering care to undocumented migrants