Expectations Shaped Elsewhere: Refugee Experiences of Healthcare in Aotearoa New Zealand

We know that many refugees arrive in host countries, including Aotearoa New Zealand, with complex health needs and are at risk of poorer outcomes. Little attention has been paid to the expectations and understandings of care that they bring with them and how these shape their health experiences. Many refugees come from hospital-based healthcare systems with direct, timely access to specialists, tests and procedures but resettle into primary care systems where GPs act as gatekeepers to public and private specialists and nonemergency hospital services.

Refugee health literature often focuses on provider perspectives. With two recent projects, we explored refugees' experiences of healthcare and access to medicines in southern New Zealand. The first gathered refugees' experiences of healthcare through 20 open-ended interviews. The second project followed five refugee households over a year through in-person interviews, video calls and texts. Both generated extensive qualitative data, analysed and coded thematically by research teams.

Both studies found that refugees felt significant dissatisfaction with healthcare in New Zealand. This stems in large part because refugees' expectations of healthcare are shaped by previous experiences of healthcare overseas. New to a primary care system, refugees described it as strange and slow and were openly frustrated by its more limited access to tests, referrals and follow-up-features that previously signified care. Different prescribing practices (namely, more frugal, with a perceived over-reliance on painkillers) also sowed scepticism of GPs. Waitlists deepened doubts about the system's ability to care for them.

Different experiences and understandings of care, formed overseas, contribute significantly to refugees' dissatisfaction with healthcare in New Zealand. Listening to their perspectives and understanding how and why their expectations are not being met is an important step in improving refugee healthcare provision and outcomes. PPIE: Our methodological approach prioritised relationship-building and responsiveness; we spent significant time building relationships with service providers who work with refugees and interpreters before beginning. Service providers helped develop our research and interview questions and facilitated recruitment. As early themes emerged during interviews with refugees, they were integrated into subsequent interviews for participants to verify or refute. In the first study, we brought early findings to community partners and two participating households for validation. One household continued into the second project. The longitudinal approach of the second study fostered sustained participant engagement. Both studies centred the underrepresented voices of refugees themselves, aiming to bring their perspectives to practitioners and, in doing so, contribute to improving refugee healthcare experiences.