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Study: Health inequalities for marginalised migrant groups ‘amplified’ by remote consultations

by Awil Mohamoud
27 January 2021

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The digitalisation of general practice, including the widespread use of virtual consultations, has ‘amplified’ existing inequalities in access to healthcare for many migrants, a study published on medRxiv has found. 

Researchers carried out interviews with 81 individuals, including refugees and asylum seekers, GPs and practice managers, between June and November 2020, in a bid to understand the impact of the Covid-19 pandemic on migrants’ access to primary care.

The report found that the rapid shift to digitalisation in general practice has exacerbated inequalities for many migrant groups ‘due to lack of digital literacy and access to technology, compounded by language barriers’.

The use of virtual consultations in particular has resulted in concerns around building trust with patients and the risk of missing safeguarding cues, the report said, while participants also highlighted challenges patients faced in registering at practices due to Covid-19 visiting restrictions. 

One migrant in the study said: ‘They ask you to go onto the website, fill out the form, sign it, scan it, and then send it back to them, so they can register you. I mean, I don’t have a scanner, I don’t have printers, then how can I download it [and] scan? 

‘Or, if I can do it online, like an electronic signature, most people don’t know how to apply that. You need a computer. You can’t do that on your phone. So, those forms, for example, are not accessible at all for many people.’

Several migrants in the research suggested that there has been a ‘one size fits all’ approach to the changes made in primary care following the pandemic, adding that ‘flexibility’ is essential to ensure equitable access to healthcare. 

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Interpretation and public messaging

Some GPs interviewed in the study expressed a lack of knowledge or desire in engaging with digital consultations involving an interpreter, while several GPs and practice nurses expressed concerns about confidentiality and their ability to pick up on cues and safeguarding issues on virtual consultations. 

However, some primary care staff reported improved ability to organise language support and better access through digital consultations, the report added. 

Primary care staff, particularly practice managers, said the increased use of technology has also ‘presented actual and potential creative solutions for marginalised migrant groups’, the report said.

This includes using text messaging and being able to translate texts into the patient’s language, as well as targeted digital communications to support and encourage access, group video consultations, and the use of YouTube videos for delivering health advice.

However, both migrants and clinical primary care staff commented that before and during the pandemic ‘there has been a lack of information targeted and tailored towards migrants about access to healthcare services and basic information relating to the virus itself’.

The approach to distributing this information, where it does exist, has been ‘passive’ and ‘ineffective’, they added. 

Migrants also reported a lack of understanding of health service changes and that there is considerable misinformation circulating among migrant communities about Covid-19, and the Covid-19 vaccine, according to the report. 

‘Targeted additional support needed’

The researchers concluded: ‘Pandemic-related changes in primary care delivery may be here to stay, and some migrant groups are at risk of digital exclusion and may need targeted additional support to access services. 

‘As primary care networks operationalise the delivery of the Covid-19 vaccine, these findings provide critical information on specific strategies required to support migrant populations to access primary care and overcome misinformation around Covid-19 and the Covid-19 vaccine.’

The research was led by The Migrant Health Research Group, Institute for Infection and Immunity at St George’s, University of London.