Migrants’ precarities in accessing and using digital healthcare services

Digital health services play an increasingly vital role in healthcare systems and service delivery, offering new opportunities for improved care, efficiency, and patient engagement. However, the integration of digital technologies in health care can also exacerbate existing health inequities, especially for vulnerable groups. Systemic disparities in digital access, literacy, and the ability to engage with online platforms can deepen inequalities, leaving some populations—such as migrants—at a significant disadvantage in navigating healthcare services.

In response to these challenges, NORCE and The Open University are co-organizing a webinar to discuss how socio-digital inequalities shape different forms of precarity for migrants when accessing and using health care services. The webinar will draw on research examples from the UK, Finland, and Norway, highlighting the barriers faced by migrant populations in different health systems. This event is part of the broader research project DIGcapabilities: Fostering Digital Capabilities Among Youth funded by the Research Council of Norway.

Program

13.30-13.40: Welcome
Rebecca Lynn Radlick, Senior Researcher at NORCE

13.40-14.00: Digital Access to Healthcare: experiences of minoritised ethnic communities in the UK
Farjana Islam, Sara Bailey, Gina Netto, Agnes Kukulska-Hulme and Elizabeth FitzGerald, Heriot-Watt University and The Open University

14.00-14.20: A Sisyphean task of qualifying for digital citizenship? The precarious learning processes of disadvantaged migrant women in the context of inordinate expectations
Ulla Buchert, Helsinki University

14.20-14.40: A Rhetorical exploration of Middle Eastern Immigrant’s Trust in the Norwegian Healthcare System
Maryam Alavi Nia and Najat Mohammad, University of Bergen

14.40-15.00: Discussion lead by Gilda Seddighi, Senior Researcher at NORCE

Abstracts

Digital Access to Healthcare: experiences of minoritised ethnic communities in the UK

Farjana Islam, Sara Bailey, Gina Netto, Agnes Kukulska-Hulme and Elizabeth FitzGerald, Heriot-Watt University and The Open University

Barriers to accessing and using primary care services among minoritised ethnic communities have been extensively evidenced in the UK. However, the impact of the rapid digitalisation of these services on these communities remains under-researched. This paper, therefore, explores the impacts of digitalisation on access to and use of primary care services among minoritised ethnic communities in the UK. Underpinned by a critical realist intersectional approach, and employing qualitative research methods, this study explores minoritised ethnic individuals’ experiences of digital primary care. In terms of our methods, we purposively recruited and interviewed 100 minoritised ethnic adults who identify as Black African, Black Caribbean, Bangladeshi, Indian, Pakistani, Chinese or of mixed or multiple ethnic heritage from four project sites across the UK. The interviews were thematically analysed to increase understanding of how individuals’ ethnicity intersects with other characteristics (e.g. language, age, gender, socio-economic status) to identify constraints and enablements to accessing healthcare. We found that access to digital primary care for minoritised ethnic individuals is impeded by several factors, including digital precarity—such as inadequate devices, poor internet connectivity, and limited digital literacy—and shortcomings in healthcare staff’s ability to address the needs of ethnically diverse populations. A significant issue is the overreliance on diagnostic tools that fail to account for variations in skin tone. Furthermore, inadequate language support exacerbates the inequities in accessing digital healthcare. This challenge is partly driven by the shift from spoken to written English, necessitated by digital health systems that require users to convey complex information, such as medical histories and symptoms, in writing. This shift disadvantages individuals who can speak but not read or write in English, as well as those who previously relied on informal language brokers, such as bilingual receptionists, who facilitated access to care in non-digital, ‘traditional’ systems. However, it is also important to note that in some areas, intergenerational support and bespoke services offered by general practices help individuals navigate and overcome some of the barriers they face. We conclude that the rapid digitalisation of primary care services is replicating and potentially exacerbating barriers to using these services among minoritised ethnic communities, a finding which merits urgent attention by practitioners and policymakers.

A Sisyphean task of qualifying for digital citizenship? The precarious learning processes of disadvantaged migrant women in the context of inordinate expectations

Ulla Buchert, Helsinki University

Contemporary states aiming to increase cost-effectiveness in public services through digitalisation advocate for digital citizenship. All citizens are expected to become fluent users of digital public services despite their varying circumstances. This study explores this issue for migrant women in Finland acquiring essential skills for digital citizenship: digital proficiency, fluency in the Finnish language, and understanding public administration. Using semi-structured interviews with structurally disadvantaged migrant women (N = 22), I analyse each skill acquisition as a complex temporal process. The analysis reveals that acquiring digital citizenship skills can be a prolonged process influenced by multiple temporal orders originating from both individual circumstances and external processes. Despite the investments made in acquiring these skills, citizens may remain unqualified. In conclusion, states that emphasise digital citizenship skills may assign structurally disadvantaged people a Sisyphean task, thereby leading to the narrowing of the realisation of their citizen rights and, consequently, their citizenship.

A Rhetorical exploration of Middle Eastern Immigrant’s Trust in the Norwegian Healthcare System

Maryam Alavi Nia and Najat Mohammad, University of Bergen

Drawing from Mayer et al.’s (1995) definition of trust as “the willingness of a party to be vulnerable to the actions of another party based on the expectation that the other will perform a particular action important to the trustor, irrespective of the ability to monitor or control that other party” (p. 712), this project examines the various vulnerabilities faced by migrant communities and how these shape their trust in healthcare providers. Our findings indicate that Delays in diagnosis, long waiting times, and financial constraints exacerbate physical suffering, while inadequate communication from healthcare providers contributes to confusion (i.e. cognitive vulnerability) and emotional distress. These vulnerabilities push migrants to seek alternative solutions such as self-diagnosis through online searches, consulting specialists abroad, and pressuring GPs for specific treatments. This behavior reflects an erosion of trust, as patients feel the need to closely monitor their healthcare providers. This study emphasizes the importance of effective communication in addressing vulnerabilities and restoring immigrants’ trust in the Norwegian healthcare system. Enhancing communication and understanding migrants’ perceptions can help create a more inclusive and trustworthy healthcare environment.

Reference:

Mayer, R. C., Davis, J. H., & Schoorman, F. D. (1995). An integrative model of organizational trust. Academy of Management Review, 20(3), 709–734.