# A critical interpretive synthesis of the constructed identities and experiences of refugees, asylum seekers, and undocumented migrants in relation to accessing primary care services in the UK

## TL;DR

This paper explores how refugees, asylum seekers, and undocumented migrants in the UK experience barriers to accessing primary healthcare, and proposes a new theoretical model to better understand these challenges.

## Contribution

The paper introduces the Tangibility of Access theory, which conceptualizes how identities and experiences influence healthcare access for vulnerable migrant groups.

## Key findings

- Refugees, asylum seekers, and undocumented migrants face structural and social barriers in accessing UK primary care.
- The Tangibility of Access theory suggests that recognizing the tangible aspects of identities and experiences can improve understanding of healthcare access barriers.
- Interdisciplinary research is needed to address how assumptions about identities affect help-seeking behavior and healthcare policy.

## Abstract

•Forced immigrants face difficulties in recognising and responding to help-seeking cues.•This article conducts a critical interpretive synthesis of research on primary care access in the UK.•From the analysis, we generated the Tangibility of Access theory.•Penchansky and Thomas’ theory and post-colonial theories enabled a critical discussion of barriers and facilitators to access.•Interdisciplinary research is necessary to understand how identities and experiences of vulnerable groups are conceptualised.

Forced immigrants face difficulties in recognising and responding to help-seeking cues.

This article conducts a critical interpretive synthesis of research on primary care access in the UK.

From the analysis, we generated the Tangibility of Access theory.

Penchansky and Thomas’ theory and post-colonial theories enabled a critical discussion of barriers and facilitators to access.

Interdisciplinary research is necessary to understand how identities and experiences of vulnerable groups are conceptualised.

Refugees, asylum seekers, and undocumented migrants face significant structural and social barriers when accessing, or attempting to access, primary care delivered by the NHS in the United Kingdom. The aim of this research is to conduct a critical interpretive synthesis of primary research articles, identified via a systematic search of several online databases. This review approach was chosen in order to develop a new synthesis of the constructed identities and experiences of refugees, asylum seekers and undocumented migrants, and contribute to a further understanding of the barriers and facilitators that these populations face in relation to primary care access. This research used an interdisciplinary framework, guided by Penchansky and Thomas’ theory of healthcare access, as well as Bhaba’s, Spivak’s and Berry’s post-colonial theories. Differences in social cues, the impact of the past, and the role of communities are examples of the various barriers and enablers that refugees, asylum seekers, and undocumented migrants face in relation to primary care in the UK. This analysis generated a new model, the Tangibility of Access, which theorises that recognising the tangibility of various identities and experiences can provide a deeper insight into persisting barriers of primary care access. These findings highlight the implications of assuming the nature of identities and experiences in research, and identifying how differences in the knowledge of these vulnerable groups between research and policymaking can lead to continued difficulties surrounding primary care access. Further interdisciplinary research is necessary to determine the causal effects of deterrents to approaching primary care, and provide insights into how the quality of primary care can be improved, especially concerning intangible identities and experiences. A holistic perspective is needed to challenge assumptions regarding the identities and experiences of refugees, asylum seekers, and undocumented migrants, which may prove harmful to help-seeking behaviour if not confronted.