\u201cI try the one that they say is good.\u201d - factors influencing choice of health care provider and pathways to diabetes care for Syrian refugees in Lebanon

Flora Haderer,Michella Ghassibe-Sabbagh,Wilma Van Den Boogaard,Josefien Van Olmen,Emilie Venables,Miriam Orcutt

doi:10.1186/s13031-021-00375-4

Abstract

BackgroundNavigating health systems in host countries can be a challenge for refugees, particularly in a multi-provider system such as Lebanon. Syrian refugees in Lebanon face a high burden of Non-Communicable Diseases (NCDs) including diabetes mellitus. Evidence on how refugees navigate the health system is essential to improve provision of NCD services. We conducted a qualitative study amongst Syrian diabetes patients visiting Médecins Sans Frontières (MSF) clinics in one urban and one rural setting in Lebanon to explore factors influencing choice of and pathways to diabetes care.MethodsIn-depth interviews were conducted with male and female adult participants with DM type 1 or type 2 who were receiving treatment at MSF clinics. Participants were recruited using convenience sampling. Interviews were conducted in Arabic and directly transcribed and translated into English. Data were coded in NVivo and analyzed using an inductive thematic approach.ResultsA total of 29 in-depth interviews were conducted with 13 men and 16 women. Knowledge and understanding of diabetes management differed among participants. Syrian refugees in Lebanon gathered information about health services for diabetes largely from social networks of family and peers rather than through formal means. Pathways to care included different combinations of providers such as clinics, pharmacists and informal providers.ConclusionsSyrian refugees with diabetes in Lebanon face considerable challenges in navigating the health care system due to their vulnerable status and limited knowledge of the host country systems. To ensure access to care for diabetes, efforts need to be made to support patients’ orientation in the Lebanese health system.

Highlights

Study participants included male and female Syrian refugees living with Diabetes Mellitus Type 1 (T1DM) or Diabetes Mellitus Type 2 (T2DM) who were receiving care from Médecins Sans Frontières (MSF) clinics in Wadi Khaled or Shatila
The subjective level of knowledge about diabetes and its management varied amongst the Syrian refugees in our study, which partially confirms other studies showing that diabetes patients from the Middle Eastern region have generally limited knowledge about disease management [31, 32]
This study shows that Syrian refugees lack orientation in health-care services in Lebanon when they arrive, and may still rely on their social networks to obtain their medication from Syria before accessing the Lebanese health system

Summary

Introduction

I would like to ask you some questions about your experiences regarding health care for diabetes. Navigating health systems in host countries can be a challenge for refugees, in a multiprovider system such as Lebanon. Syrian refugees in Lebanon face a high burden of Non-Communicable Diseases (NCDs) including diabetes mellitus. Integration of care is challenging when refugees live in non-camp settings and access care through multiple providers, as is the case in Lebanon. In 2018, Lebanon hosted approximately 1.5 million Syrian refugees; one in four of its residents is a refugee [6] and most live in non-camp settings. Diabetes is a chronic disease that needs continuous, lifelong treatment, similar to other NCDs such as hypertension, or communicable diseases like HIV. Additional morbidity and disability of diabetes could be avoided through adequate care provision [11]

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Results

Discussion

Conclusion