Digital barriers to healthcare access among long-term migrants in Europe: a systematic review

Background

Access to healthcare is a multidimensional concept shaped by health systems and individuals’ ability to engage with services. As European health systems increasingly digitalise, it remains insufficiently understood how it affects migrants’ access to healthcare. This review aimed to understand the barriers of long-term migrants (>1 year of residency) when digitally interacting with healthcare services.

Methods

This systematic review identified 2,276 articles from the databases EMBASE, MEDLINE, Web of Science and CINAHL (up to October 2024). Two reviewers independently screened the articles, and quality was assessed using the Mixed Methods Appraisal Tool. We analysed data using framework synthesis, categorizing findings according to Levesque et al.’s 2013 framework for accessing healthcare. We included language as additional category.

Results

Across eight studies (n = 13 to n = 1,082), predominantly qualitative in design, five focused on migrants aged ≥50 years. The mapping onto the framework revealed 37% supply-side barriers, 28% demand-side barriers and 35% language barriers. The most common digital barriers for long-term migrants were lack of service appropriateness, ability to perceive services and health information, and limited language proficiency. No study identified the ability to pay as barrier; geographical access was least emphasized among the included studies.

Supply-side barriers mentioned were inadequate infrastructure, high costs, inflexible systems, added administrative burden, security concerns and reduced human interaction. Demand‑side barriers included anxiety and mistrust, limited digital skills, reliance on assistance, usability and language limitations.

Conclusions

Expectations between long-term migrants and digital health services are misaligned, specifically in language, awareness and effective use. Digitalisation has the potential to improve access if underlying digital health literacy and system design shortcomings are addressed.

Key messages

• Barriers emerge from how digital health systems are designed, including infrastructure gaps, rigid platforms, usability problems, administrative burden, privacy concerns, and reduced personal contact.

• Use of digital health services for migrants is limited by low digital confidence, mistrust, dependence on support, language and usability challenges, and continued preference for in person care.