Impact of COVID-19 on migrants’ access to primary care and implications for vaccine roll-out: a national qualitative study

  1. Felicity Knights
  2. Jessica Carter
  3. Anna Deal
  4. Alison F Crawshaw
  5. Sally E Hayward
  6. Lucinda Jones
  7. Sally Hargreaves

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Abstract

COVID-19 has led to big changes in UK primary care, including rapid digitalisation, with unknown impact on migrant groups.

Aim

To understand the pandemic’s impact on recently-arrived migrants and their access to primary health care, and implications for vaccine roll-out.

Design and setting

Qualitative study involving semi-structured interviews with primary care professionals (PCPs) and migrants in urban, suburban, and rural settings across England.

Method

Sixty-four PCPs and administrative staff, and 17 recently-arrived migrants were recruited using purposive, convenience, and snowball sampling. In-depth, semi-structured interviews were conducted by telephone. Data were analysed iteratively, informed by thematic analysis.

Results

PCPs and migrants concurred that digitalisation and virtual consultations have amplified existing inequalities in access to health care for many migrants, due to a lack of digital literacy and access to technology, compounded by language barriers. PCPs were concerned that virtual consultations resulted in difficulties building trust and risked missing safeguarding cues. Both PCPs and migrants highlighted challenges around registering and accessing health care due to physical closure of surgeries, as well as indirect discrimination, language and communication barriers, and a lack of access to targeted and tailored COVID-19 information or interventions. Migrants reported a range of specific beliefs, from acceptance to mistrust, around COVID-19 and potential COVID-19 vaccines, often influenced by misinformation. Innovative opportunities were suggested, including translated digital health advice using text templates and YouTube; these merit further exploration.

Conclusion

Pandemic-related changes to primary care delivery may become permanent; some migrant groups are at risk of digital exclusion and may need targeted additional support to access services. Solutions are needed to address vaccine hesitancy in marginalised groups to ensure equitable COVID-19 vaccine uptake.

Article activity feed

  1. Version published to 10.3399/bjgp.2021.0028
  2. ScreenIT

    SciScore for 10.1101/2021.01.12.21249692: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Ethics and informed consent: Ethics was granted by St George’s, University of London Research Ethics Committee (REC 2020.0058 and 2020.00630) and The Health Research Authority (REC 20/HRA/1674).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and Limitations: Our study has generated valuable insights into the experiences of both migrants and PCPs during the COVID-19 pandemic. The findings are of direct immediate relevance to the ongoing public health response, in terms of supporting primary care providers with delivering services to marginalised migrant groups and in understanding the unique risk factors of this group. The scale of this study- the use of multiple phases, and the engagement of diverse voices including the migrants themselves and a range of different primary care professionals from across the country and multiple settings-enhanced validity. The similarities in perspectives between migrants and professionals was striking. Next steps would be to engage migrants from all dominant nationality groups in the UK and different types of migrants (e.g. labour migrants, undocumented migrants) to explore the culture-specific impacts of COVID-19, and age-related differences within the different migrant populations, which could be particularly relevant to a COVID-19 vaccine targeting older groups. Additionally, the impact of the researchers’ ethnicity and social background, and professional training, may have influenced responses through perceived power differentials and social desirability bias, in a desire to express views they believe will be received favourably. Comparison with existing literature: Whilst there is a growing body of research exploring the impact of COVID-19 on BAME groups, the specif...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.01.12.21249692v1 on medRxiv