Mechanisms and attitudes in responsive healthcare for forced migrant communities: a qualitative study of transnational practice.

Objectives: To understand the opportunities and practices that can support responsive healthcare for forced migrant communities.

Design: A qualitative study of five transnational case examples of services actively working to improve access and experiences of care for forced migrant communities, which is one strand of the MORRA Study.

Setting: Five services (Australia, Belgium, UK) providing a range of care (primary care, health advocacy, education and support, holistic health screening, care planning/coordination, transcultural mental healthcare). Delivered through state and not-for-profit structures in initial and contingency accommodation sites, health clinics and community spaces. Data collection took place between July and October 2022.

Participants: 47 participants including forced migrants using or having used one of the five services, service leads, clinical and non-clinical workers (paid and volunteer), interpreters and service partners. Services supported recruitment of a crude representative sample of worker roles and service users/clients. Participants were required to speak one of nine languages for which we had translated study materials.

Main Outcome Measures: Experiences, practices, knowledges, skills and attributes of workers; experiences of forced migrants engaging in services.

Results: Services showed a willingness to innovate and work outside existing practice and organisational structures, including a 'microflexibility' in their interactions with patients, and through the creation of safe spaces that encouraged trust in providers. Other positive behaviours included engaging in intercultural exchange; facilitating the connection of people with their cultural sphere (eg, nationality, language) and a reflexive attitude to the individual and their broader circumstances. Social and political structures can diminish these efforts.

Conclusions: Environments that enable good health and support forced migrants to live lives of meaning are vital components of responsive care. This requires flexibility and reflexivity in practice, intercultural exchange, humility, and a commitment to communication. A broader range of caring practitioners can, and should, through intentional and interconnected communities of care, contribute to the healthcare of forced migrants. Opening up healthcare systems to include other state actors such as teachers and settlement workers and a range of non-state actors that should include community leaders and peers and private players is a key step in this process. Future work should focus on the health and health service implications of immigration practices; the inclusion of peers in a range of healthcare roles; alliance-building across unlikely collaborators and the embedding of intercultural exchange in practice.