{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:10:06Z","timestamp":1772169006680,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/hrbopenres.13671.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T00:00:00Z","timestamp":1702944000000}}],"reference-count":64,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T00:00:00Z","timestamp":1702944000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001637","name":"Trinity College Dublin","doi-asserted-by":"publisher","award":["SS2020-066"],"award-info":[{"award-number":["SS2020-066"]}],"id":[{"id":"10.13039\/501100001637","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["hrbopenresearch.org"],"crossmark-restriction":false},"short-container-title":["HRB Open Res"],"abstract":"<ns4:p>Context Social exclusion is characterised by and represents a form of disadvantage and marginalisation of vulnerable groups of people in society, who cannot fully participate in the normal activities of daily living. People who are socially excluded such as asylum seekers and refugees have complex healthcare needs and tend to present more to the acute hospital setting as emergency presentations. Little is known about barriers and facilitators experienced by this group to accessing nonhospital based care. Objectives This mixed methods systematic review, will critically examine the concept of barriers and facilitators for refugees and asylum seekers to accessing non hospital based care. Methods This methodological review will follow the Joanna Briggs Institute guidance for conducting mixed methods reviews. The following databases will be searched: Central Medline, PubMed, Embase, CINAHL, and the Cochrane Library. Relevant grey literature will be included. Title and abstract screening, followed by full-text screening will be undertaken independently by two reviewers. The Joanna Briggs Institute extraction tool will be adapted for data extraction. Discussion This mixed method review will comprehensively evaluate quantitative and qualitative data, synthesise both barriers and facilitators and follow a systematic approach through establishing use of mixed methods research across asylum seekers and refugees, and how they affect accessing non-hospital based care. It will explore conceptual models of access to healthcare and how they influence these factors.<\/ns4:p>","DOI":"10.12688\/hrbopenres.13671.2","type":"journal-article","created":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T07:45:05Z","timestamp":1702971905000},"page":"15","update-policy":"https:\/\/doi.org\/10.12688\/hrbopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Barriers and facilitators to refugees and asylum seekers accessing non hospital based care: A mixed methods systematic review protocol."],"prefix":"10.12688","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9496-1958","authenticated-orcid":false,"given":"Laura","family":"Fitzharris","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emer","family":"McGowan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2572-6479","authenticated-orcid":false,"given":"Julie","family":"Broderick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2023,12,19]]},"reference":[{"key":"ref-1","article-title":"Understanding and Tackling Social Exclusion: Final Report of the Social Exclusion Knowledge Network of the Commission on Social Determinants of Health.","author":"J Popay","year":"2008"},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"369-383","DOI":"10.1177\/1094670515583271","article-title":"The Impact of Online Social Support on Patients' Quality of Life and the Moderating Role of Social Exclusion.","volume":"18","author":"T Yao","year":"2015","journal-title":"J Serv Res-Us."},{"key":"ref-3","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-018-0732-1","article-title":"Measuring social exclusion in healthcare settings: a scoping review.","volume":"17","author":"P O\u2019Donnell","year":"2018","journal-title":"Int J Equity Health."},{"key":"ref-4","first-page":"13-34","article-title":"Migration and homelessness: measuring the intersections.","volume":"14","author":"K Hermans","year":"2020","journal-title":"Eur J Homelessness."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"493-511","DOI":"10.1146\/annurev-soc-070308-115926","article-title":"Income Inequality and Social Dysfunction.","volume":"35","author":"R Wilkinson","year":"2009","journal-title":"Annu Rev Sociol."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"405-412","DOI":"10.1016\/s0140-6736(71)92410-x","article-title":"The Inverse Care Law.","volume":"297","author":"J Hart","year":"1971","journal-title":"Lancet."},{"key":"ref-7","first-page":"245-250","article-title":"The future of migrant health in Europe.","author":"B Rechel","year":"2011"},{"key":"ref-8","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-6651-2","article-title":"Migrant health research in the Republic of Ireland: a scoping review.","volume":"19","author":"N Villarroel","year":"2019","journal-title":"BMC Public Health."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"357-71","DOI":"10.1007\/s00038-010-0145-4","article-title":"Poorer self-perceived health among migrants and ethnic minorities versus the majority population in Europe: a systematic review.","volume":"55","author":"S Nielsen","year":"2010","journal-title":"Int J Public Health."},{"key":"ref-10","doi-asserted-by":"publisher","DOI":"10.1186\/s13033-016-0065-7","article-title":"Beliefs and knowledge about post-traumatic stress disorder amongst resettled Afghan refugees in Australia.","volume":"10","author":"A Yaser","year":"2016","journal-title":"Int J Ment Health Syst."},{"key":"ref-11","doi-asserted-by":"publisher","DOI":"10.3402\/ehtj.v2i0.7091","article-title":"Migrants and emerging public health issues in a globalized world: threats, risks and challenges, an evidence-based framework.","volume":"2","author":"B Gushulak","year":"2009","journal-title":"Emerg Health Threats J."},{"key":"ref-12","first-page":"544-7","article-title":"Health needs of asylum seekers and refugees.","volume":"322","author":"A Burnett","year":"2001","journal-title":"BMJ."},{"key":"ref-13","first-page":"429-36","article-title":"Primary care for refugees.","volume":"83","author":"B Eckstein","year":"2011","journal-title":"Am Fam Physician."},{"key":"ref-14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmmh.2022.100088","article-title":"Structural barriers to refugee, asylum seeker and undocumented migrant healthcare access. 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status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/hrbopenres.15137.r37513, Rebecca Farrington, The University of Manchester, Manchester, England, 10 Apr 2024, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/6-15\/v2#referee-response-37513","order":0,"name":"referee-response-37513","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/hrbopenres.14950.r35436, Patrick O'Donnel, University of Limerick, Castletroy, Limerick, 16 Oct 2023, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/hrbopenresearch.org\/articles\/6-15\/v1#referee-response-35436","order":1,"name":"referee-response-35436","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Laura Fitzharris<\/b>; \n<i>Posted: 27 Nov 2023<\/i>; Dear Dr. O\u2019 Donnell,  Many thanks for your feedback, it is greatly appreciated.&nbsp;&nbsp;  \n<b>1. The terminology of 'non hospital based care' may be confusing &amp; make searching challenging. Primary care, GP care etc. are pretty straightforward and understood easily, but there are others. For example, would you consider community psychiatric clinics as part of this, even though they are considered secondary care services? Or newer services such as cardiology or care of the elderly community clinics, would they be included? Whatever you settle on, just be really clear in your inclusion criteria as this will help to streamline your search strategy.<\/b>  Thank you this is a very useful point, and we acknowledge that non-hospital-based care encompasses a broad array of services.&nbsp; It is likely that the exclusion of acute hospital-based services will guide the inclusion of the appropriate services to this review. We will add the other mentioned community services such as elderly clinics and psychiatric clinics as part of non-hospital-based care into the protocol paper. The authors appreciate mental health is part of the many physical and psychological illnesses that ASR experience in their host and native countries and has an impact on access to healthcare.&nbsp;   \n<b>2. I feel you need some more explanation on the rationale for examining the issues of homelessness and migration together. You do a good job of explaining the reasons for looking at each of these groups individually, and the likely barriers and facilitators to access for each of them. It is clear that both of these groups have significant problems with access. It seems that you think for the most part though that the&nbsp;likely barriers and facilitators will&nbsp;not overlap (&quot;Refugees and asylum seekers have also been found to demonstrate different patterns of health service access and utilisation.&quot;)&nbsp;- So where is the synergy in examining them together? Are you looking for common levers or barriers in order<\/b> to suggest practice or policy change, or are you looking to contrast these? &nbsp;  This is a most important aspect of the feedback and directly concurs with feedback provided by the other reviewer. We decided that we will only include the literature relevant to ASR.&nbsp; We recognise PEH as a group, are another distinct entity with unique characteristics that deserve separate consideration with regards to healthcare utilisation patterns and considering both groups together is beyond the scope of this review paper.&nbsp;&nbsp;    \n<b>3. What is the reason for excluding children &lt;13 years?<\/b>  We gave this age cut off a lot of consideration and chose it, as children &gt; 13 years of age who are asylum seekers or refugees have caring responsibilities and are therefore considered with adults in other literature including ASR.&nbsp; For instance the cut off chosen is the same as for two large scale systematic reviews by Fazel et al in (2005) and (2012),&nbsp; published in the Lancet which explored the effect of Pre-migratory adverse events and the complexities of post-migration settlement.&nbsp;   \n<b>4. What is the rationale for using the OECD member countries? Are there expected similarities across health systems in the OECD? Why OECD versus the EU versus the WHO Europe Region? This is important because some of the barriers and facilitators discovered may relate to the structure and universality of primary care in the countries under scrutiny, as well as other factors.&nbsp;<\/b> &nbsp;  This is a very important point and something we looked at in detail very soon after writing the original protocol.&nbsp; OECD countries includes Canada, Australia, and America and when looking at the volume of papers, there was a high volume of quite diverse data.&nbsp; As America and Canada have very different non-hospital-based services in place compared to most European settings, applicability to European settings was not clear. Therefore, it was decided to include European countries only and use the title \u2018Member states of the European council\u2019 which also includes the UK and Turkey. We felt it was important to include the UK and Turkey due to the concentration of refugees in both countries with Turkey holding the highest number of refugees across all of Europe.&nbsp;    \n<b>5. You mentioned using&nbsp;<\/b>\n<b>ETHOS Typology<\/b>\n<b>&nbsp;as a guide for your inclusion criterion of&nbsp; 'homelessness', but as well as groups we traditionally consider as homeless, ETHOS includes people in accommodation for migrants, domestic violence shelters, penal institutions, couch surfing, halting sites, overcrowded settings etc., so you may need to narrow the criteria here.<\/b>  This point will no longer be applicable as we are no longer including PEH as part of this protocol and future MMSR paper.&nbsp;","URL":"https:\/\/hrbopenresearch.org\/articles\/6-15\/v2#referee-comment-3579","order":2,"name":"referee-comment-3579","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by Trinity College Dublin [SS 2020 - 066]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}