PUB - Publikationen an der Universität Bielefeld

Background Research on healthcare for asylum seekers and refugees (ASR) has focused strongly on accessibility and legal entitlements, with quality of care receiving little attention. This study aimed to assess responsiveness - the non-medical quality of care - as perceived by recently arrived ASR in Germany. Methods 31 ASR with existing medical conditions were recruited in six refugee clinics and three psychosocial counselling centres. Semi-structured, qualitative interviews were conducted, reconstructing the patient journeys after arrival. Interviews were recorded, transcribed and analysed thematically. Results Responsive care is important in evaluations of the German health system. Trust in providers and their expertise as well as accounts of a “caring” attitude, respectful treatment - e.g. taking afflictions and the situation of ASR seriously - and clear communication resurfaced frequently in ASR narratives. Their evaluation of care was affected by related expectations being exceeded or disappointed. Other responsiveness dimensions, like cleanliness of facilities, autonomy of decision-making and choice of provider were mentioned seldom. Participants voiced a high overall satisfaction with German healthcare. We observed that positive experiences were often set in contrast to negative experiences in countries of origin or during transit and many participants evaluated their healthcare experience initially in terms of the perceived technical quality and outcome of care rather than referring to responsiveness. Conclusions Aspects of respectful treatment, clear communication and trust are important to ASR. To further strengthen the provision of high quality and responsive care to a diverse patient population, policy action is needed: expansion of professional interpreting services, provision of professional training to increase the reflective and structural competence of healthcare staff and alignment between the healthcare and asylum processes to promote continuity of care.