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Table 1 Table of Results. Number of refugees marked witha indicate that it is a mixed population

From: A model explaining refugee experiences of the Australian healthcare system: a systematic review of refugee perceptions

Study Study Design Aim Study setting Service Explored Study Methods Number of Refugees Country of Origin or Background Main Findings
Bellamy et al. 2017[28] Qualitative African refugees’ experiences of barriers in accessing pharmacy services in Brisbane. Brisbane, Queensland Pharmacy services Focus groups 16 Somalia (5)
Congo (5)
South Sudan (2)
Uganda (1)
Burundi (1)
Liberia (1)
Eritrea (1)
When describing their experiences in accessing pharmacy services, refugees noted four overarching themes: health system differences, navigating the Australian health system, communication barriers and health care-seeking behaviour.
Carolan et al. 2010[29] Qualitative Experiences of African-born pregnant women receiving antenatal care in Melbourne. Melbourne’s western suburbs Maternity services In-depth interviews 18 Ethiopia (1)
Sudan (12)
Eritrea (2)
Somalia (2)
Kenya (1)
Five themes that African refugee women giving birth encounter: pregnancy is not special; resettlement is a priority; childbearing is a normal process; coming to value continuous pregnancy care; and cultural sensitivity is important.
Cheng et al. 2015[30] Qualitative Factors influencing Afghan refugees’ access at a single general practice in south-east Melbourne in 2013. City of Greater Dandenong and City of Casey, Victoria Primary care Semi-structured interviews and field observation 6 Afghanistan (6) Barriers to healthcare for newly arrived refugees include language and cultural responsiveness, appointments, difficulties with transport to the practice, long wait times and the cost of care.
Clark et al. 2014[31] Qualitative Barriers to accessing primary health care services and exploration of medicine-related issues as experienced by refugee women in South Australia. South Australia Using health services and medicines while living in Australia Focus groups 38 Sudan, Burundi, Congo (15)
Burma (10)
Afghanistan (5)
Bhutan (8)
Patients found that language barriers were the main barrier to accessing primary health care. Interpreters were used inconsistently, and patients noted poor literacy.
Correa-Velez et al. 2012[32] Mixed methods Developing a model of refugee maternity healthcare for from consultations with stakeholders, chart audit and surveys with health service providers and refugees. Mater Mothers’ Hospital, Queensland Maternity services Chart audit and surveys (separate surveys with hospital staff) 23 Sudan (14)
Burundi (5)
Ethiopia (2)
Congo (1)
Somalia (1)
Participants stated the need for interpreters, education programs for pregnant women, and continuity of care.
Henderson et al. 2011[33] Qualitative Access and use of health services by four CALD communities in Logan, Queensland. Logan, Queensland All services Focus groups 42a Sudan, Afghanistan, Pacific Islands and Myanmar Unfamiliarity with health services, difficulties accessing care were experienced by CALD communities. CALD communities valued traditional medical practices and wanted health practitioners to respect this. Language barriers and interpreter issues prominent.
Kay et al. 2016[34] Qualitative Barriers and facilitators of quality use of medicines for from primary healthcare providers and refugee health leaders in Brisbane. Brisbane, Queensland Pharmacy services Semi-structured interviews 3 Sudan (1)
Myanmar (1)
Liberia (1)
Five barriers were identified between HCWs and refugee health leaders: communication and language constraints, cultural issues, limited health literacy, financial cost, and health system concerns.
Liamputtong et al. 2006[35] Qualitative Experience of caesarean birth among Cambodian, Lao and Vietnamese women. Melbourne, Victoria Maternity services In-depth interviews 91a Laos (30)
Vietnam (30)
Cambodia (31)
Women’s experiences in caesarean birth have three main themes: trust in medical knowledge, expectations and communication with an understanding of their caregivers’ preferences.
McBride et al. 2016[36] Mixed methods Evaluation of the Refugee Health Nurse Liaison role at Dandenong Hospital. Dandenong Hospital, Victoria Refugee Health Nurse Liaison Semi-structured surveys (60) and chart audits (journals were only used with service providers) 60 Afghanistan (30)
Sri Lanka (12)
Iran (6)
Burma (2)
Iraq (2)
Sudan (1)
Pakistan (3)
Other (2)
Patients noted that Refugee Health Nurse Liaisons were helpful in interpreting and providing helpful information.
McBride et al. 2017[37] Mixed Methods Experiences of refugees in using Monash Health Refugee Health and Wellbeing services. South-East Region of Melbourne All services Semi-structured interviews (18) and surveys (159) 177 Afghanistan (77)
Sri Lanka (43)
Iran (11)
Myanmar (16)
Iraq (3)
Pakistan (14)
Bangladesh (7)
Other (6)
Refugees were highly satisfied with the service emphasising the importance of a trusting relationship with staff, access to bicultural support workers, onsite interpreting and integrated care.
McCann et al. 2016[38] Qualitative Help-seeking barriers and facilitators of mental health and substance use services in recently arrived young Sub-Saharan African migrants in Melbourne. Melbourne, Victoria Mental health and substance use services In-depth interviews (28) and focus groups (41) 69a Sub-Saharan Africa Participants noted four help-seeking barriers that prevented them from seeking help for mental health and alcohol and drug use: stigma of mental illness, lack of mental health literacy in parents and young people, perceived lack of cultural competency of formal help sources, and financial costs deterring access.
Murray et al. 2010[39] Qualitative Birth experiences of African refugee women in Brisbane. Brisbane, Queensland Maternity services Semi-structured interviews 10 Sudan (5)
Liberia (1)
Ethiopia (2)
Somalia (2)
Refugee birthing experiences faced some unique challenges such as language barriers, the refugee experience, female genital mutilation, and healthcare staff with little cultural competence.
Neale et al. 2007[40] Mixed Methods Health service use and barriers of recently arrived immigrants from the Horn of Africa in Melbourne. Melbourne, Victoria All services Semi-structured questionnaires 126a Somalia (67)
Eritrea (29)
Ethiopia (24)
Sudan (6)
Difficulties with language, including the availability of interpreters, were identified as the main barriers to accessing appropriate health services. Half reported difficulties with accessing services.
Nicol et al. 2014[41] Qualitative Refugee experience, access and understanding relating to early oral health. Western Australia Child dental health services Focus groups (interviews were only with service providers) 39 Burma (16)
Iraq, Kuwait (9)
Sudan (5)
Afghanistan (3)
Burundi (2)
Congo (2)
Rwanda (1)
Nigeria (1)
Many participants felt overwhelmed due to misinformation and low health literacy. Themes involved included parents’ past experience, resettlement issues, and enablers and barriers to accessing dental services.
Niner et al. 2013[42] Qualitative Experiences of pregnancy and birth before and after resettlement for Karen women in Australia. Not specified Maternity services Interviews 15 Myanmar (15) Many patients used self-reliance when emotionally distressed. They were unsettled by the medicalisation of birthing and reaction to health service varied from gratitude to feelings of discrimination.
O’Callaghan et al. 2007[43] Qualitative Experiences of older Vietnamese women in using medications in Fairfield, NSW. Fairfield, New South Wales Primary care Semi-structured interviews (20) and focus groups (20) 40 Vietnam (40) Women’s health literacy influence medication use and their rationale. Refugees have concerns about health professionals not favouring traditional medicine use.
Omeri, A et al. 2006[44] Qualitative Beliefs, practices and experiences of Afghan people in accessing healthcare in New South Wales. New South Wales (most likely Sydney) All services Semi-structured interviews and focus groups 38 Afghanistan (38) Four main themes emerge from Afghan refugee experiences of accessing healthcare: emotional responses to trauma and migration, culture specific health maintenance strategies, cultural views on mental health, barriers impeding accessibility and cultural factors influencing outcomes.
Owens et al. 2016[45] Qualitative Refugee and migrant women’s perceptions of using antenatal healthcare services in Perth. Perth, Western Australia Community-based maternity services Semi-structured interviews 12a Indonesia (1)
Pakistan (1)
Vietnam (1)
Iran (1)
Sudan (1)
Myanmar (6)
Thailand (1)
Women noted lack of social support during pregnancy, language difficulties, and cultural differences. They were happy with the completeness of care throughout pregnancy.
Phillips 2013[46] Qualitative Readily accessible remote telephone interpreting in the resettlement experience of refugees. Not specified Remote translation and interpreting services Chart audit (265) and interviews (8) 273 Afghanistan, Bosnia, Burma, Iran, Iraq, Sierra Leone, Sudan Remote interpreters do not provide the same care and attention as an on-site interpreter. Longer conversations, more interruptions, can occur with remote interpreters.
Riggs et al. 2012[47] Qualitative To explore the utilisation and experience of maternal and child health services in Melbourne for parents of refugee background from the perspective of users and providers. Wyndham and Hume in Melbourne, Victoria Maternal and child health services Focus groups (interviews were only with service providers) 87 Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese, Bhutanese Barriers for patients included access to transport, lack of confidence in speaking English. Continuity of care was appreciated and preferred. 4 identified themes included facilitating access to maternal and child health services, promoting continued engagement with the MCH service, language challenges, and what is working well and could be done better.
Riggs et al. 2016 [59] Qualitative Experiences of barriers, knowledge and surrounding beliefs of maternal oral health from refugees and service providers. South-East region of Melbourne Maternal dental health services Focus groups (interviews were only with service providers) 27 Afghanistan (14)
Sri-Lanka (13)
Afghan men provided transport, translation and their role in caring for their wives challenged traditional preconceptions. Afghan men would like health professionals to enquire about their health concerns.
Riggs et al. 2017[49] Qualitative Experiences of Karen women in group pregnancy care in Melbourne. Melbourne, Victoria Maternity services Focus groups 19 Karen (19) Women felt empowered and reassured when learning about pregnancy, sharing stories and developing trusting relationships in a group setting. Communication and privacy were issues encountered in the hospital.
Riggs, Yelland, Szwarc et al. 2016[48] Qualitative The experiences of Afghan women and men of refugee background having a baby in Melbourne, Australia. Greater Dandenong and Casey in Melbourne Maternal and child health services Interviews (focus groups were only with service providers) 30 Afghanistan (30) Afghan men found their role as a father changed in Australia but were generally pleased with the changes. Men appreciated when health professionals took an interest in them and would prefer if HCWs were responsive to issues surrounding settlement in a new country.
Robards et al. 2019 [60] Qualitative Understanding health system navigation and the role of technology for young people belonging to one or more marginalised groups. New South Wales All services Semi-structured interviews 9a   Marginalised young people are ambivalent about their healthcare journey. For refugees, confidentiality concerns, discrimination and confusion over the complexity of the health system were commonly encountered themes.
Russo et al. 2015[50] Qualitative Emotional and social wellbeing of new mothers from Afghanistan living in Melbourne. City of Greater Dandenong and City of Casey, Victoria Maternal and child health services Focus groups (28) and in-depth interviews (10) 38 Afghanistan (38) The majority of patients reported positive experiences with HCWs and the health system They felt respected and included in the decisions regarding their care. Some discussed how their care conflicted with traditional cultural practices. Emotional challenges and changes to improve emotional wellbeing were also identified.
Samuel et al. 2017[20] Qualitative Narratives of health-seeking behaviours of Sri-Lankan Tamil refugees in Melbourne. Melbourne, Victoria All services Semi-structured interviews 12 Sri Lankan (12) Tamil refugees describe their health-seeking influenced by the search for the ‘good life’ that was lost or never experienced, seeking help from familiar channels in an unfamiliar context, and the desire for financial and occupational independence.
Sheikh et al. 2011[51] Mixed methods Identifying issues affecting newly arrived refugees in accessing an emergency department. Liverpool Hospital, New South Wales Emergency department Semi-structured questionnaires 155 Africa (106)
Middle East (49)
Newly arrived refugees were aware of how to call for emergency medical help, but a large proportion noted they were fearful to make phone calls due to security implications on the basis of previous experiences in their home country.
Sievert et al. 2018[52] Mixed methods To characterise and identify health literacy of chronic hepatitis B and barriers accessing healthcare in at-risk migrant populations. Monash Health liver and refugee clinics in Melbourne suburbs Liver and refugee clinics Surveys (14) and semi-structured interviews (19) 33a Afghanistan (11)
Myanmar (8)
South Sudan (14)
Refugees and asylum seekers living with chronic hepatitis B have competing social pressures which impact their prioritisation of health. Poor knowledge about disease, testing, services as well as language barriers and cultural differences encountered impacted accessibility of services.
Stapleton et al. 2013[53] Mixed methods Women from refugee background’s experiences of antenatal healthcare at an Australian tertiary public hospital. Not specified Maternity services Focus groups (18), surveys (42) and chart audit (190) 250 Africa, Middle East and other countries Patients noted differences between their traditional birthing practices and Western practices. Continuity of care throughout antenatal period provided security and support to negotiate an unfamiliar setting.
Sypek et al. 2008[54] Qualitative Impact of regional resettlement of refugees on rural health services and critical health infrastructure in four rural towns in NSW. Four rural communities in New South Wales Primary care Interviews 7 East and West Africa
Middle East
Availability of appropriate primary health care services, language accessibility and mismatch in service delivery expectations were all concerns identified in health services and health infrastructure in rural NSW towns.
Valibhoy, Kaplan, et al. 2017[55] Qualitative Experiences of young people in using mental health services in Australia. Mainly in Melbourne, but not specified Mental health services Semi-structured interviews 16 Iraq (5)
Afghanistan (3)
Iran (2)
Sudan (1)
Pakistan (1)
Tanzania (1)
Ethiopia (1)
Côte d’Ivoire (1)
DR Congo (1)
Young refugee users of mental health services describe their experiences under the themes of accessible and responsive services, cultural sensitivity, recognising the impact of psychosocial stress, appropriate treatment strategies and the therapeutic relationship.
Valibhoy, Szwarc, et al. 2017[19] Qualitative Description of barriers young people face in accessing mental health services in Australia. Mainly in Melbourne, but not specified Mental health services Semi-structured interviews 16 Iraq (5)
Afghanistan (3)
Iran (2)
Sudan (1)
Pakistan (1)
Tanzania (1)
Ethiopia (1)
Côte d’Ivoire (1)
DR Congo (1)
Refugees face unfamiliarity with existence of services or thresholds needed to enter a service and stigma. Refugee youth more likely to turn to informal help than professional help. Negative expectations about seeking help, need for autonomy and structural barriers faced by refugees.
Wohler et al. 2017[56] Systematic review Systematic review into barriers culturally and linguistically diverse women face in accessing mental health services in Australia.   Mental health services     When accessing mental health services in Australia, culturally and linguistically diverse women (including refugees) face language and communication barriers, logistical barriers, barriers of cultural dissonance and have a preference for alternative interventions.
Yelland et al. 2014[57] Qualitative Responsiveness of health services to the social and mental health of Afghan women and men at the time of having a baby. City of Greater Dandenong and City of Casey, Victoria Maternal and child health services Semi-structured interviews (focus groups were only with service providers) 30 Afghanistan (30) Participants stated they were not asked about social circumstances despite social hardship during the antenatal and postnatal period.
Yelland et al. 2016[58] Qualitative Afghan refugee and service providers’ experiences of language support during pregnancy check-ups, labour and birth. Victoria Maternity services Interviews (focus groups were only with service providers) 30 Afghanistan (30) There was a lack of use of interpreters with family members often interpreting.