"We Should Not Call an Ambulance, Even If We are Very Sick": Ukrainian Refugee Women's Experiences in the United States Healthcare System.

Abstract

As the number and diversity of refugees worldwide increases, healthcare providers working with these populations face unique challenges. Thus, healthcare providers in host countries have limited understanding of challenges refugees face when using healthcare in host countries. The goal of the study is to achieve an interpretive understanding of women refugees' perspectives on their interactions with healthcare systems and providers, as well as to identify factors and processes that women refugees view as enabling or hindering their access to healthcare. Study participants were refugee women from Ukraine in the US (N = 17), who volunteered to take part in semi-structured interviews about their experiences in the US healthcare. The interviews were transcribed in original languages and analyzed using Charmaz's constructivist grounded theory methodology, which is based on constant comparison between codes and data exemplars within and between interviews. Three priority theoretical elements were identified: (1) barriers to care, which encompassed codes: uncertainty about costs, lack of health insurance, time constraints, difficulties in communication, problems of distance and transportation, and finding a trustworthy provider; (2) systemic and organizational features that hinder care, which encompassed codes: the system is confusing, inconsistencies across organizations and providers; limited scope of organizations meant to help refugees; and (3) processes and factors that do or would alleviate impediments to care, which encompassed codes: clear and relevant information, getting help from others, addressing patients' concerns, acknowledging patient circumstances. The study emphasizes the importance of continuity of care in refugee health, indicates the culture-bound nature of trust in healthcare providers, and underscores the essential role of non-formal and non-structured support for refugees.