Healthcare access for refugees in Germany: insights from stakeholders using cognitive affective maps
K Spanhel, S Schewe, E Buschmeyer, J Fenn, LB Sander, I MonnoAbstract
Background
Refugees and asylum seekers in Germany face persistent barriers to healthcare access, contributing to health inequalities. These barriers span structural, organisational, and individual levels. Understanding these factors from multiple perspectives is essential for improving service delivery.
Methods
Two studies applied Cognitive Affective Mapping (CAM), a visual network-based method capturing cognitive and affective representations. Study 1 included 30 refugees from West Africa, the Middle East, and Ukraine. Study 2 included 21 refugees, 12 general practitioners, and 19 social workers. Data were analysed by identifying recurring thematic domains across individual maps and aggregating patterns.
Results
Study 1 identified four domains influencing access: resources, treatment options, psychological challenges, and barriers. Participants emphasised resources (e.g. social support) alongside barriers. Study 2 identified four factors shaping perceived appropriateness of care: stakeholder interactions (e.g. discrimination), structural constraints (e.g. staff shortages), language, and individual stakeholder factors (e.g., inequality depending on nationality). Across groups, structural and communication-related factors were consistently linked to reduced access and perceived appropriateness.
Conclusions
CAM enables systematic integration of stakeholder perspectives on healthcare access and quality. Findings highlight the need to strengthen coordination between providers, reduce structural barriers, and improve language support. The approach can inform the development of culturally appropriate services and guide public health strategies aimed at reducing health inequalities among refugees.
Key messages
• Cognitive Affective Mapping identifies multilevel barriers and resources shaping refugee healthcare access.
• Integrating stakeholder perspectives can inform more equitable and culturally appropriate health services.