Navigating challenges and workarounds: A qualitative study of healthcare and support workers' perceptions on providing care to people seeking sanctuary

• Published in: Health expectations : an international journal of public participation in health care and health policy Vol. 27; no. 3; pp. e14061 - n/a
• Main Authors: Khanom, Ashrafunnesa, Evans, Bridie A., Alanazy, Wdad, Couzens, Lauren, Fagan, Lucy, Fogarty, Rebecca, John, Ann, Khan, Talha, Kingston, Mark R., Moyo, Samuel, Porter, Alison, Richardson, Gillian, Rungua, Grace, Williams, Victoria, Snooks, Helen
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.06.2024; John Wiley and Sons Inc
• Subjects: Access; Accessibility; Adult; Applicants; asylum seekers; Attitude of Health Personnel; Barriers; Best practice; Challenges; Citizen participation; Communication; Community health; Critical junctures; Data analysis; Data collection; Decision making; delivery of healthcare; Dentists; Dissemination; Emergency medical care; Employment; Female; Health care; Health care access; Health care delivery; health personnel; Health Personnel - psychology; Health services; Health status; Humans; Infectious diseases; Informed consent; Interviews; Interviews as Topic; Male; Medical personnel; Medical referrals; Mental health; Original; Political asylum; Population studies; Primary care; primary healthcare; Psychological trauma; Public involvement; Public participation; Qualitative Research; qualitative research refugees; Recruitment; Refugees; Relocation; Research management; State Medicine; Support services; Sympathy; Teams; Wales; Wales; United Kingdom > UK; primary healthcare; asylum seekers; qualitative research refugees; delivery of healthcare; health personnel
• ISSN: 1369-6513; 1369-7625; 1369-7625
• DOI: 10.1111/hex.14061

Background Healthcare and support workers play a pivotal role in delivering quality services and support to people seeking sanctuary who have experienced poor physical and mental health linked to previous trauma, relocation and loss of freedoms. However, they often encounter various challenges in their daily work, ranging from communication barriers to resource constraints. This qualitative study seeks to delve into the perspectives of healthcare and support workers' experience of workarounds, employed to overcome barriers to providing care. Aim This study aims to describe healthcare providers', practitioners' and health and third sector support workers' views on barriers and workarounds to providing care for people seeking sanctuary, to inform policy and practice. Design A qualitative study was carried out using semi‐structured telephone interviews. Setting This study focused on primary, secondary, community and specialist National Health Service (NHS) support services for people seeking sanctuary in Wales, United Kingdom (2018). Method We interviewed 32 healthcare providers, practitioners and support workers employed by primary care and third sector organisations. Our approach involved obtaining verbal informed consent before digitally recording and transcribing all interviews. To analyse the data, we used the Four Levels of Change for Improving Quality model as a guiding framework for interpretation. Results Our study findings reveal that certain respondents expressed challenges in meeting the needs of people seeking sanctuary; notably, their experience of delivering care differed by care settings. Specifically, those involved in providing specialist NHS care believed that there was room for improvement. Mainstream primary, secondary and community health practitioners faced limitations due to resource constraints and lacked tailored information to address the unique circumstances and needs of sanctuary seekers. To address these gaps, workarounds emerged at both individual and local levels (team/departmental and organisational level). These included establishing informal communication channels between providers, fostering cross service collaboration to fill gaps and adapting existing services to enhance accessibility. Conclusion Understanding healthcare providers', practitioners' and support workers' perspectives offers invaluable insights into ways to enhance healthcare delivery to sanctuary seekers. Acknowledging challenges and harnessing innovative workarounds can foster a more effective and compassionate service for this vulnerable population. Patient or Public Contribution The HEAR study actively involved public contributors in the design, delivery and dissemination of the research. Two public contributors (S. M. and G. R.) who had personal experience of seeking asylum served as study co‐applicants. They played pivotal roles in shaping the research by participating in its development and securing funding. Alongside other co‐applicants, S. M. and G. R. formed the Research Management Group, overseeing study delivery. Their contributions extended to strategic decision‐making and specific feedback at critical junctures, including participant recruitment, data collection, analysis and reporting. Additionally, S. M. and G. R. were instrumental in recruiting and supporting a team of peer researchers, enhancing respondent participation among people seeking sanctuary. To facilitate effective public involvement, we provided named contacts for support (A. K. and R. F.), research training, honoraria, reimbursement of expenses and accessible information in line with best practice.