Table 2.

Summary of included studies

Author and year	Method	Number of participants	Country	Aim	Results
Ahmed A et al. (2008)	Qualitative interviews	10 immigrant new mothers	Canada	To provide insight into attributions of symptoms of depression, their experience with health care and support services, barriers to receive help, and recovery of depression	The majority of the women felt that they could not discuss their feelings of depression with their doctors because they were too rushed, or that the doctors didn’t ask anything about their possible emotional disturbances during the check-ups. In contrast, many of the women had perceived the nurses visiting them after birth to be more helpful and spent enough time with them in order to feel comfortable to raise emotional issues.
Asgary R & Segar N (2011)	Qualitative focus groups interviews	35 asylum seekers and 15 health care providers	United States	To portray the experiences of health care for asylum seekers	The experiences varied between the participants regarding the health care in the US and the asylum seekers had fear of deportation, detention and loss of legal status. They would have liked more information about their health care rights as asylum seekers. They also expressed lack of interpretation and having problems communicating with health professionals.
Bhatia R & Wallace P (2007)	Qualitative interviews	11 adult asylum seekers and refugees	United Kingdom	To determine the views of asylum seekers and refugees regarding the health care experiences.	There were difficulties encountered in many aspects of the health care. Difficulties such as locating practices and experiencing language difficulties and difficulties to get a translator. Some respondents felt discrimination and felt that it had to be dealt with in the whole country and not just in the health care sectors.
Brandon Chen YY et al. (2015)	Qualitative study with focus groups and individual interviews	47 immigrants, refugees and non-status persons living with HIV/AIDS (IRN-PHA)	Canada	To report on the experience for IRN-PHA within mental health care	They reported problem with accessing and utilizing mental health service and this aggravated the stress they experienced and discouraged them for further on accessing support. They experienced stigma and discrimination since they perceived health professionals changing demeanors for example putting on extra pair of gloves. They lacked a sensitivity among health professionals, when handling information about their HIV status. Some had experienced difficulties communicating because of deficiency in English and French.
Cheng IH et al. (2015)	Semi-structured interviews	6 Afghan refugees (3 men and 3 women)	Australia	To analyse the factors influencing Afghan refugees’ access to general practice.	Refugees reported challenges in the language, transport to the practice and appointment waiting times. It was difficult to make appointments because of low proficiency in the English language. Also, they preferred verbal reminders over written reminders.
Donnelly T et al. (2011)	Qualitative interviews	10 women (5 from China, 5 from Sudan)	Canada	To increase understanding of the mental health care experiences of immigrant and refugee women by acquiring information regarding factors that either support or inhibit coping.	The participants reported that they trusted Western biomedicine and its effectiveness in treating mental illness. However, many were unfamiliar with the healthcare system and avoided to seek help as they were not familiar with the ideas of mental health and available treatments for such illness. Limited skills in English, lack of professional interpreters disabled most of the participants from getting access or benefits from mental health counselling services. Lack of information was and where to find information was also reported as well as the need of having written information. Many of the participants had experienced that their health care provider did not spend enough time with them and consequently they felt disappointed and there was a distrust to the health care system.
Fang ML et al. (2015)	Qualitative study with focus groups and individual interviews	35 asylum seekers, refugees and persons without legal status	United Kingdom	To explore health and health care experiences among Somali and Iraqi asylum seekers, refugees and persons without legal status	They reported problems with waiting and that could prolong the process of getting cure for diseases. Another aspect of complaints were lack of knowledge of how to access primary health care services. They also mentioned short consultations and that the doctors were too hastened to encourage full and honest assessments and especially if an interpreter were present. They also mentioned communication barriers for those that had a deficiency in English.
Feldmann CT et al. (2007)	Qualitative interviews	36 refugees participating in 24 interviews	Netherlands	To focus on the relationship between refugee patients and their general practitioners in Netherlands, from the perspective of the refugee patients	Rudeness, anger and impatience were part of several negative episodes. Some of the patients felt that they could not trust or trust their general practitioner, which were seen as an essential element in the health care. Some were very thankful for help given during critical moments at the hospital and others felt that the referral to specialist were too long of a wait.
Herrel N et al. (2004)	Qualitative study with focus groups	14 Somali women	United States	To understand how the Somali women experience pregnancy and childbirth, and improvements that could be done within this health care	Most women spoke highly about the support they had got during labor work, although some women questioned the competence of the nursing staff at the wards. Some felt discriminated on the basis of raceand felt less sensitive care from the staff and others felt discriminated because of not speaking English. They also felt an urgent need from the health care staff to understand the cultural differences of Somali Women. The women would have liked more information about the delivery room experience, pain medication, why prenatal visitsare important, interpretation use at the hospital and how they can expect the staff at hospital to work.
Heydari A et al. (2016)	Qualitative method with semi-structured interviews	19 Afghan refugees	Iran	To explore experiences of Afghan refugees from health service delivery in Iran	They perceived to be discriminated through not being admitted in some hospitals, higher costs and being ignored. They also expressed feelings like being alone and feeling isolated since some Iranians disgusted Afghans and were afraid that they would spread infections. Some participants expressed gratitude for helping them with diagnosing and curing their illnesses.
Lephard E& Haith-Cooper M (2016)	Semi-structured interviews	6 women (4 from sub-Saharan Africa, 2 from Eastern Europe)	United Kingdom	To explore the maternity care experiences of local, pregnant asylum-seeking women.	The women reported pre-booking challenges and also their lack of understanding their entitlement to free health care. Some of the women said that their midwife was a source of support in different ways, however it was also reported that the midwifes did not understand their immigrations status. They also described that they in different situations not were asked or listened to by healthcare personnel (midwifes, GPs, nurses).
Lipson JG et al. (2003)	Qualitative interviews	71 refugees (36 from Bosnia, 35 from former Soviet Union)	United States	To examine health, illness and health care use patterns of all refugees who used Santa Clara County health services during a 29-month period and to explore in more depth the health care experience of refugees from Bosnia and the FSU.	Some differences in the experiences of healthcare were seen among the refugees from Bosnia as compared to those from former Soviet Union. But overall, the participants worried about adequate health care insurance and did not like the long waits for appointment and in emergency room. The health care system was found confusing and the amount of paperwork required for healthcare was a source of distress. Lack of interpreters was a major problem and language barriers i.e., resulted in misunderstanding in directions for taking medications. Health care professionals was seen polite and very professional and the respondents liked the clean and well-equipped facilities.
Murray L et al. (2010)	Semi-structured interviews	10 women	Australia	To uncover first-person descriptions of the birth experiences of African refugee women in Brisbane.	The participants reported no or a little knowledge about the Australian health system and their rights in relation to standard treatment, hospital policies and health education opportunities. They also reported that they were not understood. They did not know that interpreters could be available in the hospital, instead they often used unofficial interpreters. They reported that they did not get any information about ultrasound and they experienced frustration over lack of continuity of care. However, most reported that the midwifes were kind, supportive and helpful.
Neale A et al. (2007)	Questionnaire with open-ended questions and focus groups	98 new arrivals from Iraq (n = 35), Afghanistan (n = 40) and Iran (n = 23). 62 female and 36 male.	Australia	To examine the knowledge of, use of and satisfaction with local primary healthcare services for new arrivals to Australia from Iran, Iraq and Afghanistan.	Confusion and lack of knowledge/information regarding Australian healthcare includingthe public and private systems emerged as a recurring theme. The use of healthcare services yielded significant associations with country of birth groups, type of visa, English language ability and employment status. Gender of the treating doctor and communication were also found as factors influencing the experiences of healthcare. The majority expressed a satisfaction with the care provided, however a number expressed concern with perceived lack of their doctor, and“unease” with the treatment provided. There was also a frustration at the length of time and complicated procedure to be referred to a specialist.
O’Donnell CA et al. (2008)	Qualitative study with focus groups and individual interviews	52 asylum seekers	Scotland	To explore how migrants’ previous knowledge and experience of health care influence their current expectations of the health care in Scotland.	They thought that the health care was good compare to the home country and the concept of free health care for all was welcome. They were used to quick access to doctors visits but didn’t get that every time here in Scotland and that was disappointing for them. Some perceived the GPs to not be specialized and lacked confidence in them. Some thought thatbeing examined by a GP meantto be examined physically and when that was not always done that way, they felt confused with misunderstanding and not understanding the system ofhealth examination here inthe West.
O’Donnell CA et al. (2007)	Qualitative study with focus groups and individual interviews	52 asylum seekers	Scotland	To identify barriers and facilitators to accessing health care, explore health care needs and beliefs among asylum seekers in Scotland	The asylum seekers received written information from health board telling how to register with a GP. But some didn’t get information. Complaints were given regarding long waiting for appointment, not feeling that the GP:s were specialized or lack of continuity. In general the interpretation service were appeared to be well organized, but some lacked interpreters at key points in their hospital stay and interpreters were less common at the dental care compared to the GP.
Omeri A et al. (2006)	Qualitative study with focus groups and individual interviews	38 Afghan refugees	Australia	To explore and describe health and related resettlement issues and barriers that Afghan refugees perceive while seeking health care in Australia.	There was a lack expressed of familiarity with the Australian health care system and the scarcity of Dari speaking interpreters in Australia. Some expressed feelings of discrimination because of accentor lack ofunderstanding. Othersexpressed stereotyping relating to religion and Islamic attire and this were perceived to inhibit access to health care. Complaints existed about gender issues, costsof travel, long waiting times and lack of health related information in Dari. Others were mentioning lack of culturally appropriatehealth promotion in order to help with necessary lifestyle changes.
Owens C et al. (2016)	Qualitative study with a phenomenological framework	12 pregnant refugee women	Australia	To explore the perceptions of care experienced by refugees and migrant women that had participated in an antenatal programme specialized in maternity care	The women appreciated the service given them by the midwifes and doctors at the Health center and appreciated flexible appointment times, but that was not the case regarding appointments at the hospitals. Many of the women lackedfriends and family and could see the midwives as friends andthey appreciated thecontinuity of the same midwife. Interpreters were available but some women wanted to converse in English. The women felt that they had received all necessary information about pregnancy and felt that they could ask questions when necessary.
Penagiota I (2008)	Semi-structured interviews.	26 refugee women.	Greece	To investigate whether refugee women, settled in Greece, receive antenatal care, which elements of antenatal visits are significant to them, which factors influence their attitude towards antenatal care and highlight any barriers that refugees may cope with to access maternity services.	The language barrier affected significantly the participants’ attitudes to antenatal care and also their access to maternity services. Greek maternity services lack interpreting services and written information is in Greek. Language barriers as well as financial barriers were to main reasons for missing appointments. The participants also reported unfamiliarity with the national health system. There was a lack of psychological support as social workers in public hospitals only take care of financial or bureaucratic issues and not issues concerning health. The time factor was also reported to be a barrier that prevented them from using the maternity service as they wanted the staff to have more time to listening to their feelings, discussing different perinatal issues as well as giving advice.
Razavi M et al. (2011)	Qualitative method with semi-structured interviews	Nine refugees with chronic disease and functional impairment	Sweden	To examine the viewpoints of refugees with chronic disease and functional impairment and their contact with health providers	Several participants appreciated having the same physician but some felt that they were sent between different health providers. Some felt that the health care providers showed interest in them as persons butsome felt routine medical examinations were given without commitment. Some informants wished for more information about their disease and treatment.
Redman EA et al. (2010)	A quantitative method with questionnaire	30 asylum seekers	United Kingdom	To describe the self-reported health problems of asylum seekers and their satisfaction with the initial health assessments	Only nine of the informants had received information about the free national health service andthey wished for more informationabout this service. The majority of the informants had received initial health assessment andwere positive about that.
Searight HR (2003)	Qualitative interviews	12 Bosnian immigrants	United States	To understand how Bosnian immigrants experienced and interpreted their interactions with the U.S. health care system.	An universally critical of the US health care system was reported. The participants described several core issues: confusion about insurance coverage, personalized quality of care, access to primary and speciality care; and a perception of U.S health care as bureaucratic.
Shannon P et al. (2012)	Qualitative interviews	50 refugees (32 women, 18 men)	United States	To explore refugees’ perspectives regarding the nature of communication barriers that impede the exploration of symptoms of war trauma in primary care.	Two-thirds of the participants had never been asked by a doctor about the political conflict in their country or the ways they had been affected by it. Many participants did not feel comfortable to start a conversation about their war trauma, but would most likely respond if the doctor initiated a discussion. A majority of the participants reported interest in learning more about the impact of stress and trauma on their health. Language was reported a barrier to communication. Several participants did not appear to define or understand health care as extending to mental health.
Spike EA et al. (2011)	Qualitative study with semi-structured interviews	12 asylum seekers	Australia	To determine whether community based asylum seekers experience difficulties in gaining access to primary health care and to determine the impact of any difficulties described	Some asylum seekers thought it was difficult to be able to see a doctor, since they couldn’t afford the consultation fee and theyexpressed negative experiences of being billed anyway. Some asylum seekers gained access todoctors through charitable services but reported that theiroptions were limited and longwaiting time. Many asylum seekers felt their access to health care was limited by lack of information, particularly when newly arrived.
Valibhoy M et al. (2017)	Qualitative interviews	16 refugees (9 women, 7 men) from Iraq, Iran, Afghanistan, Sudan, DR Congo, Ethiopia, Tanzania, Côte d’Ivoire, Pakistan	Australia	Refugee experiences how they accessed mental health services, their feelings about disclosing personal problems, what promoted and what discouraged engagement with services and practitioners, what assisted them and what they recommended to improve services.	Waiting lists, ineligibility criteria, and continuity of care issues, including referrals from service to service were described as distressing. Cultural responsiveness was very important to participants, and evidently often a challenge for practitioners. Participants wanted practitioners to be ready to learn about and accommodate nuances in ethnic and religious identities.
Wångdahl J et al. (2015)	Cross sectional study	360 Arabic speaking refugees	Sweden	To investigate refugees experiences of communication during their health examination for asylum seekers and the usefulness of the examination and whether health literacy is associated with those experiences	A considerable proportion of the participants experienced that they received little health care information during the examination and the quality of the communication was low. A higher proportion experienced that they were not informed about their rights to health care or where to go if mentally ill. Many of the participants experienced that they did not receive any new knowledge or help during the health examination. Refugees with inadequate health literacy, experienced more often poor quality of communication during health examinations and experienced the health examination less useful. They had also to a lower extent felt that they received enough with health care information.