Barriers and Facilitators to Asylum Seekers and Refugees Accessing Non-Hospital-Based Care: A Mixed-Methods Systematic Review.

Asylum seekers and refugees face complex healthcare challenges that are often compounded by the limitations of health and social care systems. While much attention has been directed toward access to emergency departments, the significant barriers these individuals encounter in obtaining non-hospital-based care has received less attention. This mixed-methods systematic review aims to identify barriers and facilitators to asylum seekers and refugees accessing non-hospital-based care. In January 2023, a search strategy for Medline, PubMed, EMBASE, PsycINFO, and the Cochrane Library identified qualitative, quantitative, and mixed methods studies on this topic, utilising the Joanna Briggs Institute methodology for synthesis. No time filter was applied to the search. 25 European based studies were included (19 qualitative, 4 quantitative, 2 mixed methods). Findings were organised into four themes: (i) health system structure, (ii) healthcare diversity and discrimination, (iii) pre-migration experiences, and (iv) language and communication. Key barriers identified included language difficulties, challenges in navigating the healthcare system, and a lack of cross-cultural sensitivity. Key facilitators involved the utilisation of refugee centres and social support. The findings illustrate the interconnected roles of language, cultural sensitivity, and the healthcare system structure on migrants' access to non-hospital-based care. Qualitative studies suggest that healthcare systems could improve to better serve this diverse population, however there is a limited number of quantitative studies to support this idea.