Negotiating Change: Migrants’ experiences of accessing primary care in the UK (Very much a work in progress!)

Migration and health – background Though many migrants are young and relatively healthy, many suffer poor health due to poor living and working conditions Although (still) free at the point of use, there are recognised problems with access to primary care Research often focuses on asylum seekers and migrants in immediate crisis; while this is very important, there are also long term issues

The project’s approach Qualitative research in this area has often been on distinct ethnic groups—differences within groups have been neglected On the other hand, we were interested in similar experiences /approaches from people from very different backgrounds Looking at experiences of health and illness & health service use in country of origin and the UK with a ‘lifecourse’ framework

Collecting narratives Narratives from recent migrants to the UK exploring their ‘health histories’ Knowledge about health gained ‘at home’ and since their arrival in the UK Experiences of navigating health sectors and how they make sense of and respond to daily complexities. This presentation focuses on experiences related to primary care in the UK

How to access these narratives? Community Researchers as ‘cultural brokers’ – Developed and trained by the Institute of Research into Superdiversity (IRiS) at Birmingham – Links with relevant communities – Language skills (technical and conceptual): language the participant feels ‘at home’ in – Research skills: qualitative interviewing, translating, transcribing

What has happened so far 6 CRs interviewed 4 people from their (wider) community (West Africa, Iran, Poland, China, Pakistan) Just over half of interviews have been transcribed and returned (though none yet from Pakistan) Preliminary analysis of these interviews to inform a proposal for SWSAPC

Notes of caution Even though some of the interviewees had difficulties with health services, none was totally disengaged or unable to access them We are dependent on the CR’s translation and interpretation Some are better interviewers than others and some participants more or less articulate Participants can’t be seen as ‘representative’ for their country of origin

Negotiating changes Eliciting comparison between health systems etc. enables narratives of negotiating change Emerging so far are three main ‘approaches’ to accessing primary care: Gratitude; Bewilderment; and ‘Mix-and-Match’ (most people have several of these approaches These in turn link to different experiences and issues

Broader Context Most participants moved from a health system where access to good/ fast health care needs to be paid for/ no or rudimentary primary care However, private access to specialists, tests etc. can be easy if one can afford it (or has connections to the health care system) Much wider availability of medications Huge differences within countries, e.g. rural vs. urban China

Gratitude Most strongly expressed by asylum seekers from Africa, but also by other participants Free access to healthcare can be very precious Also aspects of primary care being ‘well organised’: close to home, access to prevention, vaccinations, screening More widely a feeling of ‘being cared for’; continuity of care

Bewilderment GP system can be very different from those in participants’ countries of origin Unclear what is included (optician, dentist, community gynaecologist)? Losing access to taken-for-granted services Losing access to ‘strong’ medicine (antibiotics, injections, invasive interventions) which can lead to feeling fobbed off

Medical Pluralism / Mix-and-match Most participants have a pragmatic approach mixing different elements of health care Mix of formal healthcare and home remedies Using elements from both countries of origin and the UK, e.g. – Going privately to a Polish doctor who will prescribe stronger medication – Having medication sent by relatives in Iran – Use of Chinese herbal teas and health giving soup