Cultural differences in healthcare: An investigation using cognitive-affective mapping.

Refugees in Germany often do not receive the necessary mental healthcare. Understanding refugees' healthcare needs, that is factors that support or hinder their health, can foster the development of effective, culturally appropriate and accessible health services. The present exploratory study investigated these needs using cognitive-affective maps (CAM), a recently developed mind map-like measurement technique enabling participants to visualise their thoughts and emotions as networks. Thirty refugees from diverse regions of origin (West Africa, Middle East and Ukraine) were asked to indicate factors supporting and hindering their health by drawing a CAM using a digital tool. We analysed the drawn CAM concepts qualitatively according to a five-step procedure, including deductive and inductive category formation. Drawn CAM concepts concerning supporting factors were grouped along the categories 'resources' and 'possibilities for explicit treatments of healthcare needs', suggesting an openness to promote well-being among refugees. Yet, various concepts were grouped along the categories 'psychological challenges', 'specific living conditions in Germany' and 'access to healthcare', focusing on factors hindering well-being. Frequency analyses of these categories suggested differences between the subsamples, which should be further investigated in future studies in order to integrate a possible heterogeneity within refugee populations in offered healthcare.