Keeping healthy and accessing primary and preventive health services in Glasgow: the experiences of refugees and asylum seekers from Sub Saharan Africa

Problem

Caring for asylum seekers and refugees (ASR) is an important activity for primary care. Many come from countries experiencing epidemiological transition, with the prevalence of non-communicable diseases increasing, alongside ongoing communicable disease risks. Primary care in countries of destination should include preventive, as well as reactive, care. However, little is known about how ASR think about prevention and respond to health prevention messages. This work aimed to understand the health-related experiences of ASRs from Sub Saharan Africa living in Glasgow, Scotland. Specifically, it explored: a) perceptions of health, wellbeing, and illness causation, b) experiences of accessing primary and preventive healthcare, and c) the factors influencing these perceptions and experiences.

Approach

A focused ethnography was undertaken, utilising multiple qualitative methods. (1) Engagement with three community groups to negotiate access. (2) Three participatory focus groups (16 participants) explored what it means to be healthy in Glasgow. (3) 24 semi-structured and ‘walk-along’ interviews to explore emerging issues in greater depth. The work was theoretically informed using ‘candidacy’ and ‘structural vulnerability’ to deepen our understanding of ASR health.

Findings

Candidacy enhanced understanding of how ASR identified and responded to messages about ‘healthy living’. Participants expressed the view that keeping healthy was an individual responsibility, with diet and exercise particularly mentioned. Diet and food preparation were particular issues for the women interviewed. However, the ability to identify as ‘candidates’ for such activities required ready access to cheap, available food and exercise facilities. The ability to access and use such facilities was tempered by their status and visibility, in particular being visibly and audibly ‘foreign’ restricted their willingness and ability to travel to buy appropriate fresh food and/or exercise. The theory of structural vulnerability identified those wider structural determinants which impacted on individual ability to respond. Poverty, racism, discrimination and visibility were all important. The greatest negative influence, however, was the asylum process which impacted on individuals’ ability to identify as candidates for prevention messages, access health care and/or respond to any potential services. This diminished individuals’ capacity to identify as candidates for prevention messages, engage in preventive health practices, and/ or access care in an optimal fashion.

Consequences

Efforts to engage ASRs in preventive health programmes and practices must take into account the ways in which the immigration and asylum system acts as a determinant of health, affecting both what it means to be healthy and what capacity individuals have to engage. The NHS, together with non-statutory bodies, has a role to play in mitigating some of the vulnerabilities to which ASRs are subject. Designing interventions which don’t take account of these wider influences will likely lead to a lack of uptake. Co-design and participation by ASR in intervention design should be developed.