Barriers and facilitators to health-care access by older Chinese migrants in high-income countries: a mixed-methods systematic review

Abstract

Abstract International migrants face barriers when accessing health-care in their destination countries. For older migrants, there are additional difficulties due to their age and associated health conditions. Chinese migrants are an understudied group with culture-specific barriers in addition to those shared with other migrant groups. This review aims to understand the barriers and facilitators to health-care access faced by older Chinese migrants in high-income countries. Literature from MEDLINE, Web of Science, EMBASE, Scopus, CINAHL Plus and ProQuest (1 January 2000 to 6 October 2021) were retrieved. Quantitative, qualitative and mixed-methods studies focusing on older Chinese migrants' access to, utilisation of and satisfaction with health-care services in high-income countries were included. Studies were appraised using checklists from the Joanna Briggs Institute and the Critical Appraisal Skills Programme. Qualitative and quantitative data were extracted and analysed narratively to identify barriers and facilitators to accessing health-care, then applied to Levesque's five-step health-care access journey framework. We included 33 studies in the analysis. Qualitative evidence identified barriers and facilitators to health-care access in four categories: health-care system, social factors, personal factors and health-care interactions. Quantitative studies found that health status and having insurance were positively associated with using non-preventive care, while time of residence and physician's recommendations were positively associated with using preventive care. Factors that influence older Chinese migrants' access to health care include practical barriers (communication, time and cost), social support (family and community), perceptions of health and care needs (beliefs and knowledge) and interactions with health-care professionals (patient–physician trust and support from physicians). Efforts to overcome universal barriers, acknowledgement of cultural contexts, improvements in translation services, and involvement of Chinese families and communities in health-care outreach will benefit this population.