Experiences of antibiotic use and healthcare access among migrants to the UK: a qualitative study

In recent years, migration to and within Europe has increased. Human mobility has been hypothesised as a contributing factor towards antimicrobial resistance (AMR). However, there is limited evidence to explain how migration contributes towards antibiotic resistance. More qualitative research regarding migrants' perspectives of antibiotic use is needed to understand this complex interaction. The aim of this study was to explore experiences of antibiotic use and healthcare access among migrants in the UK, and how this might influence the risk of AMR.

Adult migrants were purposively recruited through community organisations, collaborators, online platforms and snowball sampling representing different migrant statuses, countries of origin and ethnicities. Semi-structured interviews were conducted online, by phone or face-to-face, in participants' preferred languages, between March and July 2022 exploring antibiotic use and healthcare access. Data were analysed thematically and the study was informed by a Project Advisory Committee, with members from Doctors of the World and professionals who were previously refugees or asylum seekers.

Twenty-seven migrants (17 males and 10 females), aged 21-60, from 17 different countries were interviewed. Four main themes were generated: 1) Uncharted territory: navigating a new healthcare system (sub-themes (a) access to care during journey, (b) difficult access to healthcare in the UK and (c) comparison between different healthcare systems); 2) Preserving the sense of agency and decision-making around antibiotic use, 3) Self-perpetuating cycle (sub-themes - (a) co-infections; (b) using alarming symptoms or "red-flags" and (c) taking antibiotics due to previous similar symptoms or persisting symptoms), and 4) The fragile state of the patient-doctor relationship.

These findings give useful insight into barriers faced by migrants when trying to access healthcare services both en route and after arriving in the UK, as well as their attitudes and behaviours in relation to antibiotics. Results also shed light on the complexity of factors contributing to health-seeking behaviour and antibiotic use, and how these may vary depending on previous experiences. We discuss implications for future research and practice, and how current policies may need to evolve to better support and reduce possible risk factors for AMR in migrant communities.