Background
Methods
Participants, recruitment and data collection
Data analysis
Results
Characteristics of participants
Total (%) | |
---|---|
Total population | 47 (100) |
Gender | |
Women | 26 (55.3) |
Men | 44.7 (21) |
Age distribution | |
18–30 | 15.0 (7) |
31–40 | 28.0 (13) |
41–50 | 45.0 (21) |
51–60 | 8.5 (4) |
≥ 60 | 4.1 (2) |
Country of origin | |
Somalia | 23.4 (11) |
Sudan | 17.0 (8) |
Nigeria | 10.6 (5) |
Cameroon | 8.5 (4) |
Ethiopia | 6.4 (3) |
Ghana | 6.4 (3) |
Senegal | 6.4 (3) |
Eritrea | 4.3 (2) |
Uganda | 4.3 (2) |
Gambia | 4.3 (2) |
Liberia | 2.1 (1) |
Congo | 2.1 (1) |
Burundi | 2.1 (1) |
Tanzania | 2.1 (1) |
Social status | |
Married | 78.7 (37) |
Single | 17.0 (8) |
Divorce | 2.1 (1) |
Undisclosed | 2.1 (1) |
Education | |
No formal education | 12.8 (6) |
Primary | 6.4 (3) |
Secondary | 36.2 (17) |
High school | 29.8 (14) |
University | 23.4 (11) |
Employment status | |
Employed | 74.5 (35) |
Unemployed | 19.1 (9) |
Retired | 4.3 (2) |
Undisclosed | 2.1 (1) |
Years living in Norway | |
Born in Norway | 2.1 (1) |
≤ 10 years | 36.2 (179 |
11–20 years | 46.8 (22) |
≥ 20 years | 17.0 (8) |
Themes | Sub-themes |
---|---|
Difficulties before accessing the healthcare system | • Information accessibility • Preference for doctors with an immigrant background • Financial barrier • Long waiting time • Family and Job responsibility |
Difficulties when in the healthcare system | • Comprehension/expression and language • The “Black Elephant in the room” • Dissatisfaction with healthcare providers |
Difficulties before accessing the healthcare system
Information accessibility
“I don’t know if they are available and where to get them. Sometimes I go about reading through the net and asking people if they know if a particular health service does exist in Oslo. I am really lost in terms of knowing and navigating the Norwegian healthcare system.” (FGD, group 2)
“I have not been to the hospital for depression because I do not know if the service is here in Oslo and even if it is here where can I find it. It is very difficult to know where mental health services are in Oslo. I don’t know where to start finding the hospital [ … ]”. (Interview, participant C7)
“Everyone struggle to get information from the left or right, either by asking friends who are health professionals or read from Google.” (Interview, participant D10)
“To get information about health is difficult. I only get information about cancer but not for HIV, high blood and diabetes. They are also very dangerous diseases. The government should also send us a letter about them. I also need information about vitamin D and iron. Many of my friends are suffering from a lack of vitamin D and iron. The government should tell us why many black people are facing that problem […]” (Interview, participant A8)
“My father finds it difficult getting health information on diabetes. We only hear from friends or people who have lived here for a long time.” (FGD, group 1)
Preference for doctors with an immigrant background
“I get respect from my doctor [the immigrant doctor] and he is very friendly to my family. I am very satisfied with him. He cares for me and refers me to a specialist. He does a lot of investigation on me [ … ]. He visits us at home and we can call him whenever we want and can go at any time to see him [ … ]. He has never refused to see us on the same day. He will look [physical examination] at us and take his time to know about the start of the sickness.” (Interview, participant A5)
“If my children are sick I don’t go to a Norwegian doctor [non-immigrant background], I just call my Sudanese friend who is a doctor here and things will go very fast.” (FGD, group 1)
“I prefer going to see a private doctor, especially those from Nigeria.” (Interview, participant E1)
“I really will prefer a foreign doctor especially one from Africa.” (Interview, participant B6)
Financial barrier
“The dental care services here are unaffordable. One needs to look for alternative treatment when needing dental care. Some Africans take the bus and go to the Czech Republic for dental care.” (FGD, group 2)
“Physiotherapy is expensive for me. Some days I do not go, I skip until I can afford it. It cost me a lot just for single physiotherapy treatment.” (Interview, participant E7)
“ … The healthcare in Turkey is cheaper than that of Norway. So, if my illness is serious I go to Turkey and if it is not that serious I consult with a private doctor … the money will pay for healthcare in Turkey is almost the same as the money we pay in Norway for consultations and laboratory fees.” (Interview, participant A4)
“The treatment for dental care is very expensive. … I cannot visit the dentist because it is expensive. I use some herbs on the hole in my teeth to relieve the pains. I am waiting for my next trip to Ghana so that I can visit a dentist for treatment and filling.” (Interview, participant A7)
Long waiting time
“They take a long time in diagnosis. The results of my test took a long time. I was without treatment until when I got the result of the test from the laboratory [ … ]. It can take about 5 to 6 months to see a specialist in this country.” (FGD, group 2)
“The emergency room may have many patients to attend to and waiting for treatment can be a big problem.” (Interview, participant D8)
“Here [Norway] waiting for a long time to get an appointment can lead to the death of a patient.” (Interview, participant B7)
“It took a long time for my wife to get ultrasound [ … ]. I was so afraid of complication. People going in for an ultrasound, MRI, and x-ray always complained of having a long time to wait before the procedures.” (Interview, participant A8)
“The nurses in the front desk told me that my doctor could not see me until after 2 weeks because she has many patients [ … ] I was spitting out blood.” (Interview, participant C1)
Family and job responsibility
“Family responsibility as household chores and sometimes our jobs are a barrier to access to healthcare. You know as Africans, we still maintain our responsibility in caring for the family. Our family comes first before ourselves … our family comes first.” (Interview, participant D6)
“I am a single mother and I have to only attend hospital appointment when my children are at school. When they are at home, especially during the holiday I cannot attend an appointment because there is no one to take care of them.” (FGD, group 2)
“I fear to lose my job because my boss is also complaining that I am taking leave all the time. I am afraid that one day he may say I should stop working and how will I take care of my family back in Africa.” (Interview, participant A10)
“ Our job is our life and the life of those back at home, so we cannot leave our job for simple hospital treatment for body pains.” (FGD, group 2)
“Sometimes I barely find time for the appointment, because of the nature of my job. I start very early to distribute or take parcels to various destinations. [ …] Either I forget to go to the appointment or I cannot find time to attend because of work.” (Interview, participant D2)
Difficulties when in the healthcare system
Comprehension/expression and language
“With a non-immigrant doctor, he will ask you the same question more than two times. I do not know if they do not understand the Norwegian I speak, or they do not understand the symptom. I cannot tell if it is my accent or if they do not understand what I am saying. Sometimes I feel very embarrassed. They ask and ask and ask. Maybe our accent is difficult to understand. I speak in Norwegian, yet the doctor will ask that I repeat myself.” (FGD, group 1)
“It takes a long time for them to understand me. I do not speak good Norwegian. The doctor understand English but I do not understand English and when I speak little Norwegian they too do not understand. I have to repeat myself over and over […] ” (Interview, participant D5)
“Every information’s in the hospital or on medication packages are written in Norwegian and it makes things very difficult for us. I know that educated people do not suffer, but for those who can barely speak nor understand the language is a very big challenge.” (FGD, group 1)
“Medications instructions are labeled in Norwegian and how can we follow the instructions written on the leaflets.” (Interview, participant A9)
The “Black Elephant in the room”
“They pretend not to understand you [someone] and they ignore your presence and concentrate on different patients that are white.” (Interview, participant A4)
“[…] she will ask me many questions concerning my private life, like what brought me to this country and why don’t I go back to Uganda and find a better job.” (Interview, participant D9)
“Sometimes when I go to my doctor, he immediately asks the questions: what are you sick of? What do you want? Did you come for sick leave? The first thing when they see me, they think I am there for sick leave.” (FGD, group 1)
“I was surprised that my doctor told me it is good that I do not have HIV and that I should take care of contacting it and if I want to do further test, I can do that after 6 months. What is the problem with these guys [doctors]!. Is it HIV test I went for!. I was so angry that I wanted to explode but for a fact, I respected myself. Can they do that to a Norwegian?” (Interview, Participant D3)
“One day I had anemia and when I went to the hospital, the doctor listed a very long list of test for me to do, including HIV.” (Interview, participant C4)
“You need to see them [nurses] when they want to physically examine an African child. Some do double their gloves and the expression on their faces shows they are avoiding to have direct contact with the child.” (Interview, participant D3)
“One day I was in the hospital and I was the next to give my blood for a blood test, the nurse that was collecting the blood was not wearing gloves. I saw it because I was right at the door and she asked me to give her some minute to finish with the patient in the room. When she finished collecting the blood and it was my turn, she gazes at me straight in the eyes and immediately pick up her gloves and wore them before collecting my blood.” (FGD, group 2)
“The nurse that was supposed to perform the dialysis was ignoring me during the process and was paying attention to the Norwegian guy that was on the other bed. We were two but she was only asking the other guy how he was feeling while ignoring me.” (Interview, participant D7)
“The doctors treat the African differently. We are not always greeted in a friendly manner as compared […] the people are always biased towards Africans. They treat us different and they talk to other white people with respect, but with us, they are very rigid. They do not smile and only send us to do the test or prescribed medications. No physical examination.” (Interview, participant D2)
Dissatisfaction with care providers
“I had swollen throat last year and went to see the doctor and he asked for series of test to be carried out and finally after some time, he said I have no problem and I was given pain medication. The problem and the pains continued and I went back to him he called some other doctors in and they examined my neck and they were murmuring and after some minutes they said I have to see a specialist for he has to examine me for cancerous cells. It took another 3 weeks and they said I still have to go for further test. My husband said I should travel to Germany to see a Nigeria doctor and I did, it took just a single examination and the result came out to be a problem of the thyroid.” (Interview, participant B6)
“When I had a kidney problem, the doctor did not give me the right medication. They tested me with a lot of medication and the case was getting worse. It actually took them about 8 months before they started the real treatment.” (FGD, group1)
“The baby was sick and I took him to see the doctor […]. The doctor could not diagnose what was wrong with the baby. The baby’s health was not improving so I had to visit and revisit the hospital for the third time.” (Interview, participant B6)
“The doctor in the “legevakt” [emergency room] never touched me [physical examination]. They only allow you to speak but they can never touch you. I was asked to go and rest and take water and eat well. When I got back home the problem continues and it became chronic […].” (Interview, participants A5)
“I do not trust the doctors here. I am always afraid that they are testing drugs on us and may use us for experiments. I am very careful when taking the medication. I also call someone to read all the things written on the medications to confirm before taking the medication.” (FGD, group 1)