Table 4.

GRADE-CERQual Evidence Profile (EP)

Summary of Review Finding	Studies contributing to the review finding	Methodological Limitations	Coherence	Adequacy	Relevance	CERQual Assessment of Confidence in the Evidence	Explanation of CERQual Assessment
1. Refugees are in an unfamiliar environment, manifested by differences in culture, differences in language, and differences in health systems	[19, 28–59]	Moderate concerns: A total of 6 articles were of high quality, 8 articles were of acceptable quality, and 19 articles were of low quality.	Minor concerns: data reasonably consistent across studies, with some minor deviations	No or very minor concerns: explanatory finding: very high data quantity and richness	No or very minor concerns	High confidence: It is highly likely that the review finding is a reasonable representation of the phenomenon of interest	Although there were moderate concerns over the methodology of some low-quality articles, we have high confidence that the coherence, adequacy and relevance of the data represents the phenomenon well.
2. Information sharing promotes power and autonomy and is important to help refugees navigate a complex health system. A lack of information sharing results in disempowerment and loss in autonomy.	[28, 29, 31–34, 38–42, 44, 45, 47–51, 53, 56, 59]	Moderate concerns: A total of 5 articles were high quality, 4 articles were acceptable quality, and 12 articles were low quality.	Minor concerns: data reasonably consistent across studies, with some minor deviations	No or very minor concerns: explanatory finding: very high data quantity and richness	No or very minor concerns	High confidence: It is highly likely that the review finding is a reasonable representation of the phenomenon of interest	Although there were moderate concerns over the methodology of some low-quality articles, we have high confidence that the coherence, adequacy and relevance of the data represents the phenomenon well.
3. Refugees reclaim power and autonomy through familiar means. At times, they may be successful, but this may perpetuate their unfamiliarity with the health system	[19, 20, 28, 30–34, 37–40, 42–46, 48–50, 52–60]	Moderate concerns: A total of 6 articles were high quality, 6 articles were acceptable quality, and 17 articles were low quality.	Minor concerns: data reasonably consistent across studies, with some minor deviations	No or very minor concerns: explanatory finding: very high data quantity and richness	No or very minor concerns	High confidence: It is highly likely that the review finding is a reasonable representation of the phenomenon of interest	Although there were moderate concerns over the methodology of some low-quality articles, we have high confidence that the coherence, adequacy and relevance of the data represents the phenomenon well.
4. Refugees face barriers and enablers in accessing health services which are related to the acceptability, accommodation, accessibility, affordability, and the availability of health services	[19, 20, 28–35, 37–42, 44–50, 52–60]	Moderate concerns: A total of 6 articles were high quality, 8 articles were acceptable quality, and 17 articles were low quality.	Minor concerns: data reasonably consistent across studies, with some minor deviations	No or very minor concern: descriptive finding, high quantity in data	No or very minor concerns	High confidence: It is highly likely that the review finding is a reasonable representation of the phenomenon of interest	Although there were moderate concerns over the methodology of some low-quality articles, we have high confidence that the coherence, adequacy and relevance of the data represents the phenomenon well.
5. Trust and privacy influence all aspects of access and engagement	[19, 20, 29, 33–35, 38, 39, 42, 44, 46, 47, 49, 52–54, 56, 60]	Moderate concerns: A total of 4 articles were high quality, 4 articles were acceptable quality, and 10 articles were low quality.	Minor concerns: data reasonably consistent across studies, with some minor deviations	Moderate concerns: descriptive finding: data quantity not sound, but considerably rich	No or very minor concerns	Moderate confidence: It is likely that the review finding is a reasonable representation of the phenomenon of interest	There were moderate concerns over methodology of articles and the adequacy of the data.