Negotiating Change:

Migrants’ experiences of accessing primary care in the UK

(Very much a work in progress!)

Migration and health – background• Though many migrants are young and

relatively healthy, many suffer poor health due to poor living and working conditions

• Although (still) free at the point of use, there are recognised problems with access to primary care

• Research often focuses on asylum seekers and migrants in immediate crisis; while this is very important, there are also long term issues

The project’s approach

• Qualitative research in this area has often been on distinct ethnic groups—differences within groups have been neglected

• On the other hand, we were interested in similar experiences /approaches from people from very different backgrounds

• Looking at experiences of health and illness & health service use in country of origin and the UK with a ‘lifecourse’ framework

Collecting narratives

• Narratives from recent migrants to the UK exploring their ‘health histories’

• Knowledge about health gained ‘at home’ and since their arrival in the UK

• Experiences of navigating health sectors and how they make sense of and respond to daily complexities.

• This presentation focuses on experiences related to primary care in the UK

How to access these narratives?

• Community Researchers as ‘cultural brokers’– Developed and trained by the Institute of

Research into Superdiversity (IRiS) at Birmingham– Links with relevant communities– Language skills (technical and conceptual):

language the participant feels ‘at home’ in– Research skills: qualitative interviewing,

translating, transcribing

What has happened so far

• 6 CRs interviewed 4 people from their (wider) community (West Africa, Iran, Poland, China, Pakistan)

• Just over half of interviews have been transcribed and returned (though none yet from Pakistan)

• Preliminary analysis of these interviews to inform a proposal for SWSAPC

Notes of caution

• Even though some of the interviewees had difficulties with health services, none was totally disengaged or unable to access them

• We are dependent on the CR’s translation and interpretation

• Some are better interviewers than others and some participants more or less articulate

• Participants can’t be seen as ‘representative’ for their country of origin

Negotiating changes

• Eliciting comparison between health systems etc. enables narratives of negotiating change

• Emerging so far are three main ‘approaches’ to accessing primary care: Gratitude; Bewilderment; and ‘Mix-and-Match’ (most people have several of these approaches

• These in turn link to different experiences and issues

Broader Context

• Most participants moved from a health system where access to good/ fast health care needs to be paid for/ no or rudimentary primary care

• However, private access to specialists, tests etc. can be easy if one can afford it (or has connections to the health care system)

• Much wider availability of medications• Huge differences within countries, e.g. rural vs.

urban China

Gratitude

• Most strongly expressed by asylum seekers from Africa, but also by other participants

• Free access to healthcare can be very precious• Also aspects of primary care being ‘well

organised’: close to home, access to prevention, vaccinations, screening

• More widely a feeling of ‘being cared for’; continuity of care

Bewilderment

• GP system can be very different from those in participants’ countries of origin

• Unclear what is included (optician, dentist, community gynaecologist)?

• Losing access to taken-for-granted services• Losing access to ‘strong’ medicine (antibiotics,

injections, invasive interventions) which can lead to feeling fobbed off

Medical Pluralism / Mix-and-match• Most participants have a pragmatic approach

mixing different elements of health care• Mix of formal healthcare and home remedies• Using elements from both countries of origin

and the UK, e.g.– Going privately to a Polish doctor who will

prescribe stronger medication– Having medication sent by relatives in Iran– Use of Chinese herbal teas and health giving soup