Barriers to accessing medicines and pharmacy services in Queensland, Australia, for resettled refugees from Africa

Abstract

Refugees are a vulnerable group of people with specific healthcare needs. They are usually resettled in countries where healthcare resources are superior to those in their home countries; however, utilising these resources depends on their ability to access and navigate healthcare systems. Limited health literacy and the compounding effects of language and cultural barriers are important issues for Australia’s culturally and linguistically diverse (CALD) community, including resettled refugees, as they can exacerbate underlying access and equity issues for this population. Refugees with a permanent resident visa are entitled to live and work in Australia and have access to Government subsidised healthcare through schemes such as Medicare and the Pharmaceutical Benefits Scheme (PBS); however, the ability of refugees to access mainstream health services, including community pharmacy and medication, may be limited.In this PhD study, a systematic review demonstrated that there is a paucity of published research exploring barriers to medication and pharmacy services among resettled refugees in Australia, specifically among resettled refugees from Africa. Consequently, a generic qualitative methodology was used to explore the barriers and/or facilitators to accessing medicines and pharmacy services in Queensland, from the perspective of healthcare professionals and resettlement workers in Townsville and Brisbane (semi-structured interviews) and resettled refugees from Africa (focus groups). The healthcare professionals included doctors, practice nurses, and pharmacists who were directly involved in the healthcare of resettled refugees from Africa. The resettlement workers had experience working with resettled refugees from Africa to help them settle in Australia.Fourteen semi-structured interviews were conducted with healthcare professionals in the cities of Brisbane and Townsville between August and November 2014. Eleven of the participants were female. Nine of the participants were pharmacists, two were GPs, and three were nurse practitioners. Ten semi-structured interviews were conducted with refugee resettlement workers also in the cities of Brisbane and Townsville, between August and November 2014. Through the analytical coding process, three overarching themes emerged from the data with healthcare professionals, namely: Communication Barriers, Navigating the Health System, and Belief Systems and Cultures. Three similar overarching themes developed from the data with resettlement workers: Communication Barriers, Navigating the Health System, and African Cultural Beliefs and Community Structure.Four focus groups were conducted in the city of Brisbane with African refugees between October and November 2014. A focus group was conducted with Somali (n=5) and Congolese (n=5) refugees respectively, and with refugee community health leaders from South Sudan, Liberia and Eritrea (n=3), and from Uganda, Burundi and South Sudan (n=3). There were eleven sub-themes that emerged from the coding process, which resulted in four overarching themes from the data: Health System Differences, Navigating the Australian Health System, Communication Barriers, and Healthcare-Seeking Behaviour.The PhD study demonstrates that the accessibility (approachability, acceptability, availability and accommodation, affordability, and appropriateness) of pharmacy services for resettled refugees from Africa needs to be improved. Knowledge of access barriers may provide avenues for Government and the private pharmacy industry to collaborate in the attempt to promote equity in the delivery of medicines and pharmacy services to resettled refugees.Drawing on the experiences and findings of the interviews/focus groups, it became apparent that a user-friendly pamphlet with information about OTC medicines should be developed and evaluated. \xa0The aim\xa0of the final phase of the PhD was to design a\xa0‘visual’ (limited text)\xa0pamphlet outlining some of the common symptoms of illnesses\xa0for which\xa0a pharmacist\xa0can provide over-the-counter medication without a prescription. Seven illnesses (headache, vomiting, rash, back pain, cough, diarrhoea and constipation) were included in the proposed pamphlet and were described using a medical pictogram accompanied by text in both English and in commonly spoken African languages. To ensure that the pictograms were most suited to the resettled refugee\xa0population from Africa, their preferences for three different pictograms describing each of the above seven common symptoms were determined. Pictograms were selected from the International Pharmaceutical Federation (FIP), from royalty-free stock images, and one set was specifically designed in South Africa for the local population. Findings indicated that resettled refugees from Africa prefer pictograms which resemble African people (darker skin, afro-textured hair).The PhD study contributes to the body of knowledge on access to healthcare for resettled refugees and provides insight into issues associated with health literacy. Although it has focused on resettled refugees from Africa, its findings may be transferable to the wider refugee population. The PhD study has established a foundation for further research into the barriers to accessing medicines and pharmacy services for resettled refugees.