Table A2.

Summary of Themes and Subthemes and Example Quotes from the Personal Interviews with MM Users.

Theme	Subthemes	Selected Quotes
Concept of culture	Meaning of culture	“Often they come to me and ask “Is this true?” and then I give them more information about the topic (…) People ask me why I still wear it (a yarmulke) (…)” (M5) “Each doctor asks me “where are you from”? (M10) “Some Jewish people prefer to not go to the hospital on Saturday and Friday in the afternoon (…) There are also people who don’t want to have contact or shake hands with the opposite sex (…) these habits are typical of our culture” (M7) “I wear the veil, but they do not look at me as if I was alien, I do not know (M11) “We were raised Dutch-speaking. We came here and then my father told us to adapt and speak Dutch” (M5) “I try to talk to my African friends always in Portuguese, in order to better train the Portugese language and so we make amends to each other” (M13) “What I see is that, in the healthcare sector, they see all people as equal, there is no minority, or a black or a white person” (M11)
	Impact of culture on health	“Most people are not aware that specific diseases are more common in certain populations (…) For instance: breast cancer, the PSCA gene is more common in the Jewish population. I don’t think it is well-known. If it was more known, people would get screened more” (M7) “If you are a non-native speaker it can be different. Often it’s about misunderstanding” (M1) “For the migrant people that are here (Spain) for less than a year, there are a lot of difficulties (…) First, to regularize its situation, second, to think of oneself as having rights. There could be a part that has to do with the place of origin, where maybe the conception of rights’ bearer is not internalized as much” (M8)
Impact of culture on healthcare experience	Perception of own culture and its impact on healthcare	“It is difficult (for healthcare staff) to be aware of small customs of other cultures (…) I do not think they should be prepared for such small things (…) Perhaps provide activities for patients who receive few visitors, definitely during the corona pandemic. The food could perhaps also be improved” (M4) “I am not religious (…) I have a more objective view (…) Life is precious and if you can save someone you are allowed to break all the (religious) rules” (M7) “People think that if they restore to public healthcare everything is going to be perfect, they are going to get assistance even with the smallest details, and it is not like that, so people lose confidence” (M9) “I always try to speak in Portuguese, to try to improve my communication. I avoid speaking Creole with my African friends’’ (M12) “Everyone who has a family doctor have their needs met, the problem is that there are many Africans without a family doctor” (M15)
	Perception of others’ culture and its impact on healthcare experience	“Brussels is even more multicultural so I expect the problems about culture would be even smaller” (M7) “Istanbul is more cosmopolitan so the health staff have more exposure to the multicultural community. However, central Anatolia is not as cosmopolitan. The health professionals need language proficiency and cultural awareness in order to deal with foreign patients. They may not be adequately sensitive at times” (M18) “There is a mantra that the immigrants use healthcare more than anyone else (…) and that generates that immigrants do not think of themselves as worthy of such assistance” (M8)
	Culture as a source of misunderstanding and conflict	“No, I have never experienced a problem in a hospital or even in school. A lot of people have had questions about my culture, but I have not experienced any problems” (M4) “I am in counseling with Vaga (local Mental Health Center) and there I do feel that we are not on the same wavelengths. However, that has nothing to do with (cultural) background” (M1) “Apart from my name, I don’t think many caregivers know that I have a Jewish background. I don’t experience any difference. The ones who are aware I am Jewish or see my name, do not respond differently and if they do, they ask questions about my religion so it is only in a positive way. I have never been in a negative situation about my culture” (M7) “Wherever I went, I’ve always been appreciated no matter who I am and where I’m from. That’s how I approach other people too. That also has something to do with it. I think the way you approach others. I may have a dark skin color, but I’m not crazy. laughs]” (M5) “I can imagine a Moroccan or African boy having problems with that, but I don’t experience those problems”. (M5) “My language is not perfect after a few years, but if people notice that you are making an effort, they are friendly”. (M6) “It is about what the patients expect (…) you can’t expect to be treated as a Muslim if you live in a Christian country (…) Faith and care are separate, I think. I don’t believe in discrimination” (M5) “To listen and be listened to. If you are going to talk to a doctor, and he or she is in another world, the patient gets angry, because you see in the doctor’s face that he/she is not with you” (M11)
Discrimination and racism	No personal experience as patient	“(I have not experienced discrimination), not from the staff. Sometimes there are other patients who are discriminated and/or prejudiced” (M1) “I know friends that do internships and I have heard that some companies reject them because of their culture” (M4) “(I faced) discrimination as an intern, but as patient no (…) Everyone is equal and everyone gets the same access to health services. ” (M6) “I can’t speak on that. I also used to be the only child with a different skin color, but never missed out on help. I hope not, but I dare not rule it out. If that were the case, I would be shocked. It is possible that I am discriminated against because of my name, but once I explain it I don’t experience any problems. I often have to explain myself where I come from, but I’m used to that from childhood. At school they used to ask where I and my parents come from. My daughter also has to explain it in turn” (M5)
	Discrimination and equal access/treatment	“We have doubts if they could assist us (…) we are not Spanish (…) at the counter they said that we must pay for private insurance because I do not have documents (…) I do not think it is an obligation, but I feel it is a right to belong to public healthcare” (M10) “If we do not have a family doctor or used card it is very difficult to buy medicines without a discount. I think foreigners should have this possibility” (M12) “(With language) some people (staff) don’t have much patience in that (…) (A foreign name can cause to offer help) less enthusiastically” (M2) “(Staff) think that because you are in Spanish soil you have to know the language (…) (There is misinformation) and people are not stupid, they see their rights violated, things are denied, and this could be discriminatory (M8)
	Racist treatment	“I do not know if this racism or not, but because she was a Muslim, a girl wearing the veil (…) that person (the doctor) wants to end it, does not respond to questions, maltreat, and such” (M9) “It is a more personal thing, I think. People would like to work with Spaniards better than Africans” (M9) “I did volunteer work at the Sint-Lodewijk rest home in Schilde. The patients appreciated the help, but they were racist. That is also due to the generation (…) I had to feed in the retirement home one time and there was couscous on the menu. There was a lady at the time who was not very open to this. “That’s from the macaques”, she said.” (M2)
Integrating social diversity in care	Importance of diversity in healthcare	(…) Do those minorities need different care than Belgians? I wonder. I don’t believe that a nurse looks at your origin, they want to make someone better. At that point, there is no room for pigeonholing” (M5) “I am not sure. I don’t think it would have that much of an influence. In all cultures there are people on both sides. You will find Jewish, Muslim, Hindu Doctors, etc. I don’t think that should be an argument. If you really need help, you will always be able to find someone. You should not judge access based on religion, when you need help you should go to the first person that can help you” (M7) “It would be better if help were provided more quickly. Using a motorcycle instead of a car can sometimes be quicker” (M4) “There is no tact, there is no… I see the healthcare professional as any other civil servant, and he lacks the ability to think that we are not identical, to think that you have a person in front of you who does not have to adapt herself to you, not you to her, but you must find common ground (…) (M8) “On the one hand, I think it’s good that Polish doctors are available in Belgium, but on the other hand, a few Polish doctors are not enough to help the whole Polish community. People of my age are able to learn a new language faster and will also go to Belgian doctors, but when you are older it is not so easy and you prefer Polish doctors” (M6) “If for example I go for a mammogram and they ask me (…) and I do not understand the question, they explain me perfectly, they pose a simpler question so I can answer it. Or I give the answer they are looking for (…) “ (M7) “One small point of work is that the caregivers are not always empathetic. Of course, it is very busy now so I understand that there is often little time, but there is still room for improvement in terms of individual treatment so that the patient feels understood and worthy. For example, they should not be afraid to ask questions. Other than that, I have no major minuses, I only have pluses (laughs) (M6) “Yes, I think it is something that is lacking in our current healthcare. The services are not personalised and remain very general, despite the fact we live in a multicultural society” (M7) “Everyone should have mandatory insurance so that everyone is equal and entitled to the same care. It should not be allowed for someone who has more money to be better cared for. We all have a right to be taken care of” (M5) “I actually think it’s positive when many different cultures work together. The diversity ensures that people are helped better. People of different origins working as nurses or bakers, for example (…) that would improve care” (M2) “When I go to a hospital, it is not necessary to have a Jewish caregiver who helps me. The staff is often multicultural so it gives me the feeling that everyone is welcome” (M4) “I think most hospitals have a kosher room. On Saturdays, we are not allowed to switch the lights on. Most hospitals are aware of this and do what they can” (M4) “First of all, I know that the practitioners switch to the language of the patient’s preference so they usually speak French with Jewish patients. They easily adapt to the language. Some Jewish people prefer to not go to the hospital on Saturday and Friday in the afternoon. Usually the doctors are quite flexible in adapting to our culture” (M7)
	Education and training of healthcare professionals	“I am very satisfied with that (healthcare professionals trained to provide care to people who have different cultural backgrounds)” (M2) “I do not know if that is important. They already have a lot to study” (M4) “Yes (there is room to improve healthcare in Belgium), definitely in terms of communication. Soon we will have an online session on international communication skills, which will also be given in English. It’s about the way we communicate with the patient” (M6) “There is no course on culture, or trans-cultural (…) so it is the sensibility you have as an individual, if you wanted to get a training yourself, or your personal experience (…) I think there should be internal training for professionals” (M8) “There are a lot of people that have empathy. They put themselves in others’ shoes (…) We can say that 85% have that empathy, they understand that, to cure a sick person (they need to) give her love, more than give her medication” (M11) “I don’t think it is adequate. In the public healthcare services, qualified nurses as well as other healthcare professionals are available but they do not make any special effort to reach you because you are a foreigner. They still need to train themselves to provide the efficient medical services to the people belonging to diverse cultural background” (M16)
Barriers	Communication and language	“I have faced difficulties in communicating with the healthcare professionals. Here, Turkish language is the official language and professionals didn’t had enough skills in English especially in the public hospitals” (M16) “People who don’t work here (in hospitals) have a harder time with the terminology. For example, I speak English, but I also have to look up the meaning of words regularly. That’s why we sometimes need interpreters. That is a small disadvantage, but on the other hand you can’t provide an interpreter for all nationalities.” (M7) “They do not allow you to explain yourself enough (…) I drop off from that doctor” (M9)
	Institutional barriers	“(…)when you come here (Spain), this happens a lot, every person with a uniform, be it police be it healthcare uniform, exercises a power, a reaction (on the part of the migrant) of submission and fear (…) there are civil servants in one rail, and in another the migrant population, and there are clashes” (M8) “In the beginning, when I went to register myself in the primary care center they told me why I did not pay for private insurance if I had no documents” (M10) “It’s just hard to have a family doctor” (M12)
	Diversity within staff	“Often my language is not good enough to communicate with Belgian healthcare providers, so sometimes I go to Polish healthcare providers, but because there are only a few Polish healthcare providers, they are often very busy so the quality of care is not so good. That’s the reason why we changed GPs”. (M6)
	Resources	“Sometimes there is a lack of information regarding appointments from national electronic appointment system for public hospitals” (M19) “I experience long waiting lists on a regular basis (…) I had a difficult time (…) many people experience that” “I had a bladder infection last year (…) I had explained my situation on the phone to the Polish GP and went for a consultation afterwards. I missed the contact and interaction with the doctor which made me feel like one of many patients” (M6)
Facilitators	Communication and language	“There are more people from migrant origin who are doctors, nurses, there is a change that is going to happen (…) But we are talking about a very long process, one that is very slow. What can be done in the meantime? Think about what we are doing now and change it, for example, with translators (…) cultural mediators, social educators” (M8)
	Institutional orientation	“Training on how you can exercise your right as a user of a public service. Companionship, intercultural mediation, but those are strategies that imply money, an effort to try to integrate those people in the good sense of the word, to integrate them in their rights” (M8) “There is a need for more individual support (…) individualized care” (M2)
	Diversity within staff	“I actually think it’s positive when many different cultures work together. The diversity ensures that people are helped better. People from different origins working as nurses or bakers, for example” (M2) “Probably more health staff should be engaged and multilingual ones would be an added asset” (M19)
	Resources	“People reach for their cell phones very quickly. People who are older, like my parents, rely on their children to help them (…) the Internet is also used, often the Facebook group is used and people help each other (with documents) Real resources are not used much, but we mainly help each other” (M6) “Accompaniment, I go with a companion, or with my husband, or I call another person to intermediate between us (her and the doctor) (…) I say words in English, in French, I draw, I make an effort until I reach my objective” (M11) “It is interesting that the Jewish community has its own ambulance service, they work together with hospitals. This increases the access and collaborations” (M7)