Experiences, perceptions and expectations of health services amongst marginalized populations in urban Australia: A meta-ethnographic review of the literature.

backgroundPoor health outcomes amongst marginalized groups result in part from health inequities related to social and structural determinants of health. Marginalized people report higher incidences of comorbidities, chronic disease and adverse health behaviours than their nondisadvantaged peers. The objective of this review is to examine marginalized Australians' experiences of and access to community-based primary health services in urban locations.

methodsA systematic search incorporating related MeSH terms and synonyms pertaining to marginalized Australian populations and their health-seeking was conducted across seven databases. We included qualitative studies that reported experiences of health-seeking within community-based primary health care in metropolitan Australia. Participant populations experiencing marginalization due to social stigma and isolation, early-life disadvantage, poor health and/or financial hardship were included. A meta-ethnographic framework was used to synthesize themes across selected studies and researcher triangulation was employed to develop higher-order themes.

resultsSearch results revealed 26 studies included for critical appraisal and synthesis. Seven higher-order themes were developed describing experiences of health service engagement amongst marginalized groups: (1) Understanding the patient within the context of family and community, (2) Health and cultural beliefs influence health-seeking, (3) Lack of information and poor cultural competence limit utilization of services, (4) Motivation for treatment influences health service engagement, (5) Accessing services, a spectrum of experience-from discrimination to validation, (6) Navigating a complex system in a complex society, (7) Preferences for health care and expectations for systemic change.

conclusionMarginalized Australians experience health disadvantage across micro, meso and macro levels of health system navigation and commonalities in health-seeking were identified across each of the distinct marginalized groups in our analysis. This review outlines important areas of consideration for health care provision and policy development essential to helping address health inequities for a diversity of marginalized populations. PATIENT OR PUBLIC CONTRIBUTION: Whilst patient voices were reported across all studies included within this review, no further patient or public contribution applies to this study.