Barriers to access to healthcare services by immigrants population in Scandinavia. A systematic scoping review

Background: A universal coverage characterises Scandinavian healthcare systems. The system is financed through taxation. Immigrants with legal residence in Norway, Sweden or Denmark are entitled to the same health coverage as the native population. However, research has shown that despite legal residency, immigrants’ utilization of regular healthcare services is low compared to the native population, while the use of emergency services is higher among them. The increased use of emergency services has been associated with various barriers to access to healthcare services. However, there exist a few studies on the issue of access barriers regarding immigrants living in the three Scandinavian countries. This scoping review aims to identify, map, and discuss existing evidence on the barriers to accessing healthcare services by immigrants in Scandinavia. Methods: This scoping review was conducted based on Arksey and O’Malley methodology framework for undertaking scoping reviews. A search for articles published from 2007 to 2017 in the English language was performed in PubMed, MEDLINE, CINAHL, EMBASE and PsycINFO. The reference lists of the reviewed studies were examined for potentially relevant studies. Results: A total of 418 articles were identified through searching the literature databases. Fourteen studies were reviewed, and the results were reported using six interrelated themes or concepts identified from the articles. Among the six themes identified, communication and language barriers and culture were the most common barriers impeding access to healthcare services. Further, healthcare providers attitude or response limited access to available information. Unfamiliarity with the healthcare system made navigating the health systems difficult and created distrust in the healthcare providers and systems resulting in increased utilisation of emergency care. Some immigrants were reluctant to seek attention because of fear of stigmatisation, prejudice and deportation due to their health status. Immigrants with a low level of education had reduced understanding or lack of access to available information. Conclusions: This review has identified and mapped six thematic categories of barriers to accessing healthcare services that may impede access to healthcare by immigrants with legal residence in Scandinavia. Although 78% of studies indicated that communication and language barriers hindered access to healthcare, and interpreters were often unable bridged the communication gaps, cultural barriers further complicated interactions with care providers. In light of the interrelationship between these barriers, this review recommends that cultural competency is incorporated into the practices of healthcare professionals and systems. Keywords: Scoping review, healthcare services, access, barriers, immigrants, migrants and Scandinavi