Table 3.

Illustrative quotations

Theme		Quotation and reference*
Healthcare encounter
Trusting relationship	Challenge	"… you put your mind around trying to sort things out, the dreadful things that have happened to them, and then the next week it will be a different family there and you start the whole process all over again, trying to build up some sort of trust…" 42
	Facilitator	"Creating trust is an important aspect, to show that you are interested in the person, not only in the disease; to show that you want to know something about the context. Sometimes it is difficult to find time for it in a busy practice, but I see it is a worthwhile investment". 44
Communication	Challenge	"I've had some pretty bad examples recently of interpreters where they have actually started giving their opinion, which has been a nightmare, …they start adding their points of view". 40
		"The phone interpreter is too impersonal. And I found that a lot of them use mobile phones so you're constantly cutting out…" 50
	Facilitator	"Everything comes down to communication. To know what's going on, what they need, what you need, because it's a partnership, isn't it?" 38
		‘… this (telephone interpreting) is available 24 hours and is instantaneous… it is revolutionised, all the doctors use it, the receptionists, the nurses…’ 37
Cultural understanding	Challenge	‘…they have a different culture, so their cultural perception of symptoms and what they mean… trying to interpret the difference between a bloated abdomen and a painful abdomen, just becomes an impossible task’. 43
		"I sometimes say, ‘I am only a doctor’. Sometimes there are far greater expectations than what you can honour" 17
		"I think most people understand sadness…but in some cultures, they don't understand (depression) as a condition that requires treatment" 45
	Facilitator	‘…there were specialised nurses who had worked overseas, who gave workshops for us, and explained much of the history, and explained some of the conflicts which they bring over here’. 54
Health and social conditions	Challenge	"I am quite overwhelmed at times as to how complex these ladies’ lives are…" 38
		"I guess it is out of our comfort zone, because our medical experience doesn't include the exotic illnesses that they front up with…" 47
		"Midwives spoke of the emotional impact of working with women with trauma histories: ‘How does it affect me, you just feel sad you know, but you just do the best that you can and that's all you can do" 55
	Facilitator	"(Specialist team teaching sessions) is the sort of thing that people need to help give them a baseline of knowledge, and I suppose, the support to realise that there are other people they can talk to, to help them and signpost, or help them to signpost their clients in the right direction". 40
		‘We do not need to know the whole lot; we do not need the whole case history […] to have a bit more understanding'. 38
Time	Challenge	‘… generally speaking a consultation with a refugee will take twice as long (as with) a local patient'. 37
		‘…providing care with interpreters was more time consuming than without, meaning that midwives had to "juggle their time" to facilitate good care'.38
Healthcare system
Organisation	Facilitator	‘The flexibility of the general practice setting enabled providers to act on their commitment to provide refugee healthcare, allowing them to be responsive and innovative in their approach to caring for refugees and also providing flexibility in the hours they work'.43
		'Participants felt that significant gains had been made to the refugee healthcare system, with the establishment of a specialised service. One provider working in the field for some time described thinking… fantastic, finally’43
Resourcing and capacity	Challenge	‘… (asylum seekers) should be budgeted for… they are actually slightly harder work than somebody else (this) needs to be acknowledged'. 37
		"But I was more angry that I just needed more hands to help. So, for me it was about practical support". 46
Training and guidance	Challenge	"Even when we called… the [Division of General Practice]… they didn’t know how to guide us… I think we didn’t have a guideline…"43
	Facilitator	‘The specialist team facilitated a rolling programme of training for frontline staff working with refugees and asylum seekers, and this was regarded as an effective way of sharing knowledge'.39
Professional support	Challenge	‘…lack of institutional support all contributed to varying feelings of powerlessness on the part of the midwives themselves'.55
	Facilitator	‘They described the value of currently available external supports, including language classes, translation and interpreting services and specialised refugee health services, particularly in the area of mental health'.43
Connecting with other services	Challenge	"She explained she had seen a lot of problems…I put her touch with a voluntary (nationality specific) counselling organization to then discover she had to pay and she can't afford it". 42
	Facilitator	"So I referred her to… and we went together for a joint meeting… FORWARD [a women's campaign and support charity] specialises in FGM and I set her up for an appointment there and she was referred to a specialist nurse… who was able to look at potentially reversing part of the FGM and the client was happy for this to happen and actually did attend".40
Asylum and resettlement
	Challenge	‘These requirements differed: on the one hand to be the caregiver, to be the patient's advocate in fact, and on the other to act as advocate of the Federal Office for Refugees, and thirdly to be responsible for the organisation, to save costs for the health insurance. But that is simply not possible'. 19
		"I don't know if there is some sort of system that they go through, or some sort of protocol that they, medically, have to go through before they are granted visas…" 47

*Participant's quotations are in italics, study authors text is normal typeface.