Abstract
Cultural competence has been demonstrated to be of great importance in the delivery of quality healthcare to immigrants. Iraqi immigrants experience a high burden of illness; however, little research exists regarding this group’s interactions with the healthcare system. Thus, we aimed to explore Iraqi immigrants’ perceptions and experiences with Norwegian healthcare.
We conducted 20 in-depth interviews and one group interview with Iraqi immigrants in the greater Oslo area. Interviews were analyzed using Systematic Text Condensation. We also carried out 15 informal key informant interviews.
We found that Iraqi immigrants generally evaluated Norwegian healthcare positively, compared to healthcare in Iraq. In-depth interviews with Iraqi immigrants revealed the following experiences with Norwegian healthcare: unmet expectations; distrust toward general practitioners; and perceived differential treatment, substantiated by concrete examples of differential treatment. However, respondents hesitated to voice criticism toward healthcare providers. We also identified several barriers to care, including intimate partner violence, inadequate provision of trained interpreters, limited health literacy, language gaps, and cost of outpatient care. Social support through advocacy and provision of information facilitated access to care.
Despite generally viewing Norwegian healthcare positively, Iraqi immigrants are subject to multiple barriers to care, including language gaps and inadequate provision of interpreters. Concrete examples of differential treatment in healthcare settings emerged; yet, participants hesitated to voice criticism, which may be partly explained by “The Happy Migrant Effect.” As perceived differential treatment was exacerbated by unmet expectations, divergent past experiences, and limited health literacy, efforts to reduce perceived differential treatment ought to include provision of adequate information and discussion of patients’ expectations, particularly in the establishment of GP-patient relationships.