Primary healthcare accessibility for migrants in Sweden: a qualitative study

Background

Migrants in Sweden face unequal access to healthcare compared with non-migrants. Previous research has focused on individual level barriers such as language difficulties, whilst knowledge on structural factors remains limited. This study explores how primary healthcare (PHC) in Sweden is equipped to ensure equitable accessibility for migrant patients.

Methods

Participant observations at three PHC centers in Sweden [132 hours observation time, 47 healthcare workers (HCWs), 233 patient encounters], and individual interviews with 19 HCWs were conducted. Data was analyzed following reflexive thematic analysis.

Results

Preliminary findings indicate that HCWs have limited understanding of accessibility, including their role in ensuring it. HCWs perceive that they cannot influence decisions around PHC accessibility, viewing accessibility as the responsibility of higher management and policy makers. Further, preliminary findings point to inconsistencies in practice and care for migrants, such as differential application of policy guidelines (for instance, use/ non-use of translation services). HCWs perceive that complicated access systems in PHC centers unintentionally limit access for users who lack knowledge of the system, are not proficient in the language, or who cannot identify themselves digitally. HCWs perceive that “drop-in” visits by patients (mostly migrants) are burdensome, and this sometimes results in patients being turned away without getting care.

Conclusions

The PHC system in Sweden embodies a design that did not adequately anticipate the needs of a diverse migrant population, and this influences current patterns of inequity in access. Transitions towards a more person-centered and integrated care should adapt to a diverse population and engage migrant users to create a more inclusive PHC system. HCW roles in facilitating accessibility should be strengthened.

Key messages

• Channels to reach PHC services should aim to be both simpler and more flexible to accommodate diverse users, including migrants.

• Include migrant voices in policy decision making regarding healthcare accessibility in Sweden.