Navigating new healthcare systems: a qualitative exploration of barriers, facilitators, and service utilization among Ukrainian refugees in five host countries.

Abstract

The invasion of Ukraine by the Russian Federation on 24 February 2022 displaced millions. While the European Union's Temporary Protection Directive aims to facilitate the right to healthcare for Ukrainian citizens staying in European Union Member States, health systems were already heavily burdened. Ensuring efficient and accessible care for refugees requires insights into individual and context-specific barriers to and facilitators of uptake of health services. In depth interviews were conducted between May 2022 and September 2023 in five countries receiving refugees from Ukraine. Interview guides and rapid analysis procedures followed a modified capability, opportunity, motivation-behaviour (COM-B) framework. Language was a cross-cutting issue touching all COM-B factors. Mental health services use was characterized by specific barriers and drivers across COM-B factors. Additional barriers include health literacy, long wait times for appointments, and lack of sufficient focus on the most vulnerable groups. Drivers include peer and community support, perceived high quality of care and trust in health workers. Successful navigation of new health systems depends on strong health literacy, availability of actionable information, additional support for the most vulnerable and support for health workers. Study insights can inform revisions to health services being offered to refugees from Ukraine and provide considerations for future refugee health crises in any location.