{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T23:27:53Z","timestamp":1774740473343,"version":"3.50.1"},"reference-count":39,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T00:00:00Z","timestamp":1675036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>International studies indicate that Chinese immigrants face barriers when trying to access healthcare in the host country. The aim of this study was to identify the barriers that Chinese immigrants face when accessing the Portuguese National Health Service. An observational, cross-sectional and quantitative study was carried out via a bilingual Portuguese\/Mandarin self-completed paper questionnaire was applied. The study population consisted of individuals with Chinese nationality who were residing in mainland Portugal for at least one year and aged 18 years or over. A total of 304 individuals answered the questionnaire. The results show that 284 (93.4%) of the participants had already sought healthcare in Portugal. The participants identified language difficulties and health professionals\u2019 lack of knowledge of Chinese cultural habits as the most significant barriers to accessing healthcare in Portugal. Of a total of 165 participants who sought healthcare in China, confidence in treatment outcomes and health professionals\u2019 knowledge of Chinese cultural habits were the reasons given by 151 (91.5%) individuals. This study reveals the existence of linguistic and cultural barriers that can condition the access of the Chinese immigrant population to healthcare systems. Immigrants\u2019 access to healthcare can be promoted via policies that contribute to proficiency in the Portuguese language and medical literacy among the Chinese immigrant population. It can also be promoted by raising the awareness of health professionals to Chinese cultural habits.<\/jats:p>","DOI":"10.3390\/ijerph20032442","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T04:31:27Z","timestamp":1675053087000},"page":"2442","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Equity in the Access of Chinese Immigrants to Healthcare Services in Portugal"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1437-4401","authenticated-orcid":false,"given":"Sandra Lopes","family":"Apar\u00edcio","sequence":"first","affiliation":[{"name":"Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5160-7043","authenticated-orcid":false,"given":"Ivone","family":"Duarte","sequence":"additional","affiliation":[{"name":"Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1312-0154","authenticated-orcid":false,"given":"Lu\u00edsa","family":"Castro","sequence":"additional","affiliation":[{"name":"Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"School of Health of Polytechnic of Porto, 4200-072 Porto, Portugal"}]},{"given":"Rui","family":"Nunes","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,30]]},"reference":[{"key":"ref_1","first-page":"10","article-title":"Migration: A Social Determinant of the Health of Migrants","volume":"16","author":"Davies","year":"2009","journal-title":"Eurohealth"},{"key":"ref_2","unstructured":"United Nations (2018, October 07). Res 71\/1 New York Declaration for Refugees and Migrants (3 October 2016). Volume 16163. Available online: https:\/\/academic.oup.com\/ijrl\/article-lookup\/doi\/10.1093\/ijrl\/eew057."},{"key":"ref_3","unstructured":"World Health Organization (2021, October 20). Refugee and Migrant Health, Available online: https:\/\/www.who.int\/health-topics\/refugee-and-migrant-health#tab=tab_1."},{"key":"ref_4","unstructured":"Reis, S., Sousa, P., and Machado, R. (2021, July 10). Relat\u00f3rio de Imigra\u00e7\u00e3o, Fronteiras e Asilo 2020. Servi\u00e7o de Estrangeiros e Fronteiras. Published 2021. Available online: http:\/\/sefstat.sef.pt\/Docs\/Rifa_2020.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.gaceta.2019.09.008","article-title":"Access to healthcare among Chinese immigrants living in Seville, Spain","volume":"35","author":"Lucchetti","year":"2021","journal-title":"Gac. Sanit."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Badanta, B., Rodr\u00edguez-Burbano, A.Y., L\u00f3pez-Tarrida, A.C., Vega-Esca\u00f1o, J., Lucchetti, G., Barrientos-Trigo, S., and de Diego-Cordero, R. (2021). Health Problems and the Use of Medications and Traditional Therapies among Chinese Immigrants Living in Spain. Healthcare, 9.","DOI":"10.3390\/healthcare9121706"},{"key":"ref_7","unstructured":"Fernandes, A.I.P. (2019, October 10). Tr\u00e2nsitos Terap\u00eauticos\u2014Uma Biografia entre Lisboa e Zhejiang. Tese Mestr Univ Nov.:3. Available online: https:\/\/run.unl.pt\/handle\/10362\/20778."},{"key":"ref_8","unstructured":"Gon\u00e7alves, C.M.D. (2018). Na Cabe\u00e7a Do Drag\u00e3o, Escola Superior de Enfermagem de Coimbra."},{"key":"ref_9","first-page":"635853","article-title":"Barriers to Health Care for Chinese in the Netherlands","volume":"2011","author":"Liu","year":"2011","journal-title":"Int. J. Fam. Med."},{"key":"ref_10","first-page":"173","article-title":"Healthcare needs and access in a sample of Chinese young adults in Vancouver, British Columbia: A qualitative analysis","volume":"4","author":"Ou","year":"2017","journal-title":"Int. J. Nurs. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Pandey, M., Maina, R.G., Amoyaw, J., Li, Y., Kamrul, R., Michaels, C.R., and Maroof, R. (2021). Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: A qualitative study. BMC Health Serv. Res., 21.","DOI":"10.1186\/s12913-021-06750-4"},{"key":"ref_12","first-page":"7","article-title":"The Healthy Immigrant Effect: Is Canada\u2019s Health System Failing Immigrants?","volume":"1","author":"Karmali","year":"2021","journal-title":"Glob. Health Ann. Rev."},{"key":"ref_13","unstructured":"Moniz, A.M.F. (2019). Healthy Immigrant Effect Em Portugal: Estudo Sobre Os Imigrantes Extra UE Presentes No Inqu\u00e9rito Nacional de Sa\u00fade 2014. [Ph.D. Thesis, Universidade Nova de Lisboa]."},{"key":"ref_14","first-page":"131","article-title":"Accessing social service support: Barriers experienced by Chinese migrants living in Auckland, Aotearoa New Zealand","volume":"32","author":"Kan","year":"2020","journal-title":"Aotearoa New Zeal. Soc. Work."},{"key":"ref_15","unstructured":"Coutinho, G.N.S., and da Cunha, P. (2019, October 10). Acesso aos Cuidados de Sa\u00fade das Comunidades Imigrantes em Portugal. 2016. (Query date: 2021-03-18 14:16:41). Available online: https:\/\/repositorio.ul.pt\/handle\/10451\/26721."},{"key":"ref_16","unstructured":"Almedina (2021). Constitui\u00e7\u00e3o da Rep\u00fablica Portuguesa, Almedina. [7th ed.]."},{"key":"ref_17","unstructured":"Pereira, M.A.D.A. (2006). A Comunidade Chinesa Imigrante em Portugal e os Cuidados de Sa\u00fade: Um Estudo na Regi\u00e3o de Lisboa, Universidade Aberta. Available online: http:\/\/books.google.com\/books?id=KE87yzeQCO8C&pgis=1."},{"key":"ref_18","first-page":"27","article-title":"Insights in Public Health: Challenges Investigating Health Outcomes in Chinese Americans Using Population-Based Survey Data","volume":"76","author":"Tong","year":"2017","journal-title":"Hawaii J. Med. Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/NMD.0b013e3181999513","article-title":"Beliefs in traditional chinese medicine efficacy among chinese americans: Implications for mental health service utilization","volume":"197","author":"Yang","year":"2009","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_20","first-page":"195","article-title":"Use of traditional medicine by immigrant Chinese patients","volume":"39","author":"Wu","year":"2007","journal-title":"Fam. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e051499","DOI":"10.1136\/bmjopen-2021-051499","article-title":"Attitudes of Chinese immigrants in Canada towards the use of Traditional Chinese Medicine for prevention and management of COVID-19: A cross-sectional survey during the early stages of the pandemic","volume":"11","author":"Kong","year":"2021","journal-title":"BMJ Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s12939-017-0567-1","article-title":"Health is my capital: A qualitative study of access to healthcare by Chinese migrants in Singapore","volume":"16","author":"Tam","year":"2017","journal-title":"Int. J. Equity Health"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Qiu, J., Song, D., Nie, J., Su, M., Hao, C., Gu, J., Hao, Y., Kiarie, J.N., and Chung, M.H. (2019). Utilization of healthcare services among Chinese migrants in Kenya: A qualitative study. BMC Health Serv. Res., 19.","DOI":"10.1186\/s12913-019-4846-y"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1007\/s10900-018-0536-7","article-title":"Barriers to Care in Chinese Immigrants with Hepatocellular Carcinoma: A Focus Group Study in New York City","volume":"43","author":"Sarpel","year":"2018","journal-title":"J. Community Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e003232","DOI":"10.1136\/bmjgh-2020-003232","article-title":"Experience and perspectives on palliative or end-of-life care of Chinese people and their families as immigrants to high-income countries: A systematic review and thematic synthesis","volume":"5","author":"Kwok","year":"2020","journal-title":"BMJ Glob. Health"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Neal, A.C. (2019). Fundamental Social Rights at Work in the European Community, Routledge.","DOI":"10.4324\/9780429458460"},{"key":"ref_27","unstructured":"Devill\u00e9, W., and Lamkaddem, M. (2018, October 07). Project Report on Delphi Process on Best Practice of Health Care for Immigrants. Available online: http:\/\/hdl.handle.net\/2078.1\/74645."},{"key":"ref_28","unstructured":"(2004). ACC Arist\u00f3teles\u2014\u00c9tica a Nic\u00f3maco, Quetzal. [1st ed.]."},{"key":"ref_29","unstructured":"(2022, April 27). Servi\u00e7o de Estrangeiros e Fronteiras SEFSTAT\u2014Portal de Estat\u00edstica do, S.E.F. Popula\u00e7\u00e3o Estrangeira Residente em Portugal. Published 2022. Available online: https:\/\/sefstat.sef.pt\/forms\/distritos.aspx."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e122","DOI":"10.5001\/omj.2020.40","article-title":"Implications of language barriers for healthcare: A systematic review","volume":"35","author":"Almutairi","year":"2020","journal-title":"Oman Med. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e032596","DOI":"10.1136\/bmjopen-2019-032596","article-title":"Barriers to access of healthcare services by the immigrant population in Scandinavia: A scoping review protocol","volume":"35","author":"Appoh","year":"2020","journal-title":"BMJ Open"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1542\/peds.2005-0521","article-title":"Are language barriers associated with serious medical events in hospitalized pediatric patients?","volume":"116","author":"Cohen","year":"2005","journal-title":"Pediatrics"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"45","DOI":"10.32385\/rpmgf.v25i1.10590","article-title":"A sa\u00fade dos imigrantes em Portugal","volume":"25","author":"Estrela","year":"2009","journal-title":"Rev. Port. Cl\u00ednica Geral."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s40064-015-0815-z","article-title":"Education for values and bioethics","volume":"4","author":"Nunes","year":"2015","journal-title":"Springerplus"},{"key":"ref_35","first-page":"121","article-title":"Artificial intelligence in healthcare: A comprehensive review of its ethical concerns","volume":"1","author":"Kooli","year":"2022","journal-title":"Technol. Sustain."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Nunes, R. (2022). Healthcare as a Universal Human Right: Sustainability in Global Health, Routledge.","DOI":"10.4324\/9781003241065"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1111\/hex.12529","article-title":"Communication challenges experienced by migrants with cancer: A comparison of migrant and English-speaking Australian-born cancer patients","volume":"20","author":"Hyatt","year":"2017","journal-title":"Health Expect."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Adhikari, M., Kaphle, S., Dhakal, Y., Duwadi, S., Subedi, R., Shakya, S., Tamang, S., and Khadka, M. (2021). Too long to wait: South Asian migrants\u2019 experiences of accessing health care in Australia. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-12132-6"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1186\/1472-6963-9-207","article-title":"Age, chronic non-communicable disease and choice of traditional Chinese and western medicine outpatient services in a Chinese population","volume":"9","author":"Chung","year":"2009","journal-title":"BMC Health Serv. Res."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2442\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:19:50Z","timestamp":1760120390000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,30]]},"references-count":39,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["ijerph20032442"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20032442","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,30]]}}}