Current Status of Knowledge and Challenges for the Present Research

This review of previous research has highlighted a range of problems perceived by health professionals to impede the provision of care to immigrant populations. These included the socio-economic disadvantage of immigrants, communication barriers, difficulties in the continuity of care due to lack of official contact details and deficiencies in the medical history of patients, workforce limitations and other funding shortages. Concepts of health, disease and health care may be perceived differently by people of different cultural backgrounds and health professionals often lacked understanding of these differences. In addition, differences in cultural values – such as gender roles, social norms and religious adherence – were also found to compromise the quality of clinical contact. Professionals reported ethical dilemmas and substantial uncertainty concerning how to respond when providing care to undocumented immigrants in particular. At the same time, previous research also suggests that health professionals may feel that immigrants use health services inappropriately, particularly undocumented migrants. These difficulties were reported to add to the workload of professionals and cause stress. Previous research has also reported that health professionals can perceive immigrants to be using health services inappropriately,

particularly undocumented migrants. Some negative attitudes towards immigrants have also been reported amongst health staff.

Earlier research has also highlighted ways in which health service provision for immigrants could be improved. Health professionals were generally positive about the use of well-trained professional interpreters (although there were concerns about the costs involved and the additional time required). Professionals also highlighted the need for specific training and guidance on interacting with multicultural patients, managing tropical diseases, acknowledging legal and administrative issues and coping with occupational stress associated with the delivery of care to immigrants.

Most of the European research reviewed has been conducted in countries with a long tradition in the reception of immigrants – such as the UK, the Nordic states and the Netherlands – while among the southern European states the great majority of the reviewed studies have been conducted in the Iberian countries, especially in Spain. There is, however, a limited extent of research on the experience of health professionals in Greece where immigration on a significant scale is a recent phenomenon. Additionally, while the research review has identified a range of important factors that health professionals perceived to be influencing the provision of health services for migrants, the findings are not consistent across studies and do not reveal causal pathways of phenomena. Consequently, they cannot meet accurately the needs of health care policy or be the springboard for further health services research in countries with recent and large-scale immigration, like Greece. The present study attempted to fill this gap by providing a health workers’ perspective which may be relevant to other tax- based or social security-based health systems and health services with multi-cultural patients.

Nowadays, immigration in the developed countries has created social contexts where there is large diversity in ethnicity, birthplace, upbringing, education, language and religion. This situation poses demanding challenges in tackling the health care needs of increasingly multicultural populations by health systems (Torres-Cantero, et al, 2007) and achieving a mutual understanding between health professionals of the host country and immigrants (Daniels and Swartz, 2007 and McBride, 2005). Health services and professionals need to learn about the existing cultural and social variations, adapt accordingly and deliver high-quality services. Fuertes Goñi and colleagues (2010) suggested that immigration puts care services into a crisis which, on one hand, creates an overload to the system and the personnel, while on the other hand can lay the

foundations for improvement. However, many of the reviewed studies were driven mainly by exploring and solving practical problems without addressing the fundamental causes and associations of care issues in relation to policy, service operation and personal interaction. The present study aimed to reveal the complexity of issues in immigrants’ care from health professionals’ perspective deriving from interrelations within the fields of health policy, health systems operation and interpersonal contact.

The liberation of sufficient resources for the recruitment of personnel, the establishment of interpretation services and staff’s training was suggested by health professionals in many studies. However, the implementation of such measures is most likely to be influenced by political priorities in the modern context of financial crisis, especially in Greece which is managing a large public debt. In high-income countries, health systems and professionals could be better resourced to meet the complex needs of caring for immigrants. In contrast, the economic crisis has spread rapidly in Greece along with its effects on the state and people. The financial measures afflict the potential of the public health care system to maintain a satisfactory quality of care. Greek health professionals working in the public services are at the centre of a tug-of-war that comprises of the challenges to care for immigrant patients and the restrictions due to the economic crisis. This situation is likely to influence their views and experiences in caring for immigrants.

However, health care efficiency does not always depend on the availability of resources and may be partly achieved through appropriate policies and clinical protocols. For example, some of the most challenging aspects include the stimulation of health professionals’ interest in treating immigrants as well as the integration of different ethnic groups in the host society. In general, the views of health professionals may apply not only to immigrants, but also to wider groups of patients in difficult socio- economic situations. Greece has been facing an incessant influx of immigrants of multiple origins and identities and therefore the public health care system is exposed to newcomers with a variety of needs. Therefore, it is a context for topical research that could be useful for designing health policies and elaborate research in countries that have or will enter similar circumstances.

In order to underpin the research goal and questions and produce new evidence, the next chapter describes in detail theories that seek to illuminate factors and processes in relation to the provision of care to immigrants from the health professionals’ point of view. These theories were used for various reasons. Firstly, they served as a framework

for the formation and support of the research inquiries. Secondly, they constituted an organisational scheme for the presentation and interpretation of data. Thirdly, they were used as a starting point for the production of new knowledge from the research evidence. Lastly, they were destined to be a sensitising concept to inform the reader about the important aspects of the research.

Chapter 6