Factors influencing utilization and perception of health care: a qualitative study among traumatized Yazidi refugees in Germany

Virginia M Tran,Patrick Vinck,Florian Junne,Caroline Rometsch,Jana K Denkinger,Laila Fozouni,Phuong Pham

doi:10.1186/s12888-021-03335-7

Abstract

BackgroundEnsuring adequate utilization of healthcare services for displaced populations is critical, yet there are well-documented treatment gaps. Yazidi women captured by the Islamic State (IS) were subjected to extreme trauma and violence. This study aims to understand perceptions of healthcare providers and utilization of these services among women who experienced extreme trauma.MethodsThis is a qualitative study with voluntary participation offered to approximately 400 women resettled through the Special Quota Program. An empirical approach was used to collect data and a grounded theory approach was used for content analysis. Participants ranked their interactions with providers on a Likert scale. Posttraumatic stress disorder (PTSD) symptoms were assessed using the impact of event scale-revised questionnaire.ResultsA total of 116 Yazidi women participated in this study. The women experienced an average of 6.8 months of captivity by IS and 93% met criteria for probable PTSD. Eighty-three percent of the women interacted with a physician; 80% found this interaction helpful. Sixty-nine percent interacted with psychologists; 61% found this interaction helpful. Six themes emerged: “reminders of trauma” and “hopelessness” in relation to the traumatic experience; “immediate relief” and “healing through pharmaceutical treatment” in relation to provider interventions, and “support” and “cultural differences” in relation to interactions with providers.ConclusionsThere exist major barriers to care for Yazidi women who experienced extreme trauma, particularly in regards to psychiatric care. Perceptions of healthcare providers and perceived effectiveness of therapy are critical factors that must be taken into consideration to improve healthcare utilization and outcomes.

Highlights

Ensuring adequate utilization of healthcare services for displaced populations is critical, yet there are well-documented treatment gaps
Rates of post-traumatic stress disorder are higher among this population [34, 35] than reported previously in other similar populations, and ensuring unobstructed access to treatment is critical to recovery
Our study suggests that overcoming avoidance behaviors by addressing reminders of trauma, feelings of hopelessness, and cultural barriers may be important first steps to improve perception of healthcare providers and health care utilization

Summary

Introduction

Ensuring adequate utilization of healthcare services for displaced populations is critical, yet there are well-documented treatment gaps. This study aims to understand perceptions of healthcare providers and utilization of these services among women who experienced extreme trauma. The need for medical, psychiatric, and psychotherapeutic care among this population is recognized and has been associated with higher healthcare utilization in some settings [11, 12], but lower utilization of mental health care services elsewhere [13, 14]. Compared to local host populations, refugees have generally been found to have a large treatment gap, in regards to psychiatric care [15, 16], and tend to have poorer health outcomes [17, 18]. Avoidance behaviors associated with trauma-related disorders such as PTSD appear to reduce entry into care, potentially perpetuating a cycle of lack of treatment, reduced resilience, continuation of PTSD symptoms, and further avoidance [23,24,25,26]

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