Determining the barriers encountered in providing health services to migrant children in primary health care institutions in Ankara

Özyürek D, Determining the Barriers Encountered in Providing Health Services to Migrant Children in Primary Health Care Institutions in Ankara, Hacettepe University Faculty of Medicine, Department of Public Health, Public Health Specialty Thesis, Ankara, 2022.Migration has a direct impact on the health through individual life characteristics, social and community effects, living and working conditions, socioeconomic, cultural and environmental conditions. Children are among the vulnerable groups affected by migration. In this research, it is aimed to learn the views of family health physicians and family health workers working in family health centers in six districts of Ankara about the health status of immigrant children and the conveniences and barriers experienced in accessing health services; and identify factors associated with self-assessment of cultural competency and the difficulty they face in service delivery. In Ankara, 224 family health centers were reached at Altındağ, Çankaya, Keçiören, Mamak, Yenimahalle and Sincan districts, 224 family physicians and 250 family health workers voluntarily participated in the research. The mean age of the participants was 42.6 ± 9.2 (ss), the median age was 42, the age was ranging between 23-75, and 76.3% were women. 23.5% (n=52) of the family physicians participating in the study received specialty training. 53.9% (n=255) of the participants knew a foreign language and 7.0% (n=33) were abroad for more than one month. 92.4% of the participants stated that they did not take theoretical courses on immigrant health in the post-graduation period; however, 17.4% (n=83) had migrant health service experience before working in this unit. Frequent phone and address changes was identified as a significant problem by 75% of the participants for accessing migrant families. 57.8% of the participants stated that they had difficulties in pregnancy follow-up and 55.9% in breastfeeding education. In childhood screenings, 59.3% of the participants stated that they had difficulties. While the mean score of the cultural competency scale of the family physicians participating in the study was 59.4±15.9 (sd), the median value was 60.0, and the scores were between 20.0 and 100.0; The mean score of the cultural competency scale of family health workers is 62.67±15.7 (sd), the median value is 63.0, and the scores are between 20.0 and 100.0. Knowing a foreign language and taking immigrant health courses before graduation were associated with higher cultural competency scale scores than the other participants (p<0.05). The cultural competency scale score of the participants who stated that they had a low level of difficulty in serving immigrant patients was 1.083 times (CI 1,051-1,115) (p<0.001) compared to those who had a high level of disability; participants who stated that they had moderate difficulty in serving immigrant patients were 1.049 times (CI 1,030-1,069) higher (p<0.001). It is recommended that interventions that reduce the barriers experienced in the health service delivery process, increase positive communication and respond to different cultures, support health service delivery at the level of health professionals, immigrant individuals and the health system. Keywords: immigrant, child health, health service delivery; Ankara, family health center, family doctor, family health worker, cultural competency, healthcare service barriers