CARE PERCEPTIONS OF REFUGEES ACCESSING SERVICES AT THE REACH CLINIC AND THEIR EXPERIENCES TRANSITIONING TO MAINSTREAM HEALTHCARE AFTER ONE YEAR

Abstract

Background: Globally, the health needs and status of refugees are still poorly understood post-migration. Responding to the increasing numbers of refugees in Saskatoon, Saskatchewan, the Refugee Engagement and Community Health (REACH) clinic was established to optimize health-care for refugees. Using a multi-disciplinary approach, the clinic provides primary, specialized, and urgent care needs within the first year of re-settlement before supporting the transition to a family physician. Therefore it is important to determine how the clinic is impacting the health of its service users. The purpose of this mixed-methods convergent parallel design was to understand how refugees’ perceptions of care and access influence their perceived health status while attending the clinic and their transition experiences to a family physician within the community. Method: Using a cross-sectional design, data collection took place from May 2018 to April 2019. Seventy-five Government Assisted Refugees (GARs) completed a survey questionnaire at the time of transition. Questions included demographic characteristics, accessibility of care, perception of the visit with the provider, and health status. Following descriptive statistics of the sample, regression analysis measured the relationship between “perceived health status at one year” and several key independent variables as determined by multivariate analysis. At the same time, interviews conducted with a subset of 16 participants provided a deeper understanding of refugees’ perceptions of care and their transition experiences. Thematic analysis was done. Results: Statistical analysis revealed a significant relationship between perceived health status and frequency of visits (p=0.042) and “doctors’ advice” (p=0.039). Analysis of the qualitative interviews corroborated survey findings that services offered at the clinic were appropriate and tailored to refugees’ needs. Though some participants spoke of barriers related to transportation and culture, some prominent enablers included their ability to communicate and understand information through interpreters, access to child and maternity services, trusting the clinic environment, clinic partnerships, and appropriate patient-physician interactions. At transition, refugees felt unprepared to engage with their new physicians citing lack of awareness and health literacy issues. Once transitioned, language and cultural discordance, lack of understanding of the fee-for-service delivery model, and trust were some of the challenges affecting their abilities to access care. This fostered dependency in some participants and resilience in others. Conclusion: Findings indicated that GARs perceived health status and perceptions were highly influenced by their expectations of health-care delivery. Findings also underscore the importance and the effectiveness of the existing comprehensive, integrated service delivery model that is both linguistic and culturally competent and built on strong partnerships between the REACH Clinic, settlement agencies, and other community partners. On the other hand, there is a need for a more robust transition component within this integrated service delivery model; however, without new resources and up-stream funding to ensure a successful transition, poor health seeking behaviours may develop post transitioned. Providing appropriate support to mainstream physicians could also be emphasized. This study has contributed to affirm the current provision of clinic services and highlighted the urgent need for additional training, resources and policies guidelines to help reduce barriers faced by refugees and better address the transition to mainstream care. A further study could be conducted to gain more insight into how the existing barriers such as the fee-for-service model can be addressed to better accommodate refugees and to continue improving the transition of refugees as they move from refugee-specific clinics to the mainstream health care system.