What Happens to Refugees when Accessing Primary Care in the United States?: A Qualitative Meta-synthesis.

Refugees in the United States (US) face complex barriers to access healthcare. Sustainable access to primary care is critical for refugees' health and quality of life in the US. Synthesizing existing literature on refugees' experiences in accessing primary care will enhance understanding of how the healthcare system can better support this population. We applied the qualitative meta-synthesis method developed by Sandelowski and Barroso (Handbook for synthesizing qualitative research, Springer Pub. Co., New York, 2007) to integrate the literature on refugees' experiences accessing primary care in the US. We searched PubMED, CINAHL, Web of Science, and Google Scholar for published literature using the PRISMA guideline (2020). 14 of 1,053 articles met inclusion criteria and were included in our analysis. Each selected article underwent critical appraisal using the Critical Review Form - Qualitative Studies (version 2.0) developed by Letts et al. (Guidelines for critical review form: Qualitative studies (Version 2.0). McMaster university occupational therapy evidence-based practice research group 1-12, 2007). Using inductive approach through a reciprocal translation process, findings of the 14 articles were synthesized into three themes highlighting refugees' experiences accessing primary care in the US: (1) differences in medical practices and the healthcare system between the home country and the US; (2) complexity in navigating access to primary care in the US; and (3) diverse experiences from person to person include both positive and negative moments. Primary care professionals need to recognize that refugees may view the US healthcare system, primary care services, and non-verbal communication differently than the non-refugee population. Interventions and policies for improving the quality of interpretation and community resources could encourage refugees' access to primary care in the US.