Background
Methods
Participants and recruitment
Conduct of groups
Main theme | Sub-theme |
---|---|
Perceptions on general health/well-being | • What are common health problems and how do you usually report them for healthcare? |
• What are your health concerns/priorities | |
Perceptions of the Dutch healthcare system | • Does the Dutch healthcare system meet your need(s)? |
• What would you have changed in the present healthcare system? | |
• What do you particularly like about the healthcare system? | |
Enabling in seeking healthcare | • What factors make it easier for you in seeking healthcare? |
• What factors make it difficult for you in seeking healthcare? | |
Barriers to access to healthcare | • What is the usual reception (e.g. language, general atmosphere) at your healthcare facility? |
• What are your beliefs in the care (e.g. prescriptions/advice) offered by the healthcare worker at these facilities? |
Results
Characteristics of study participants
Demographics | Number (%) of participants |
---|---|
Gender (n = 51) | |
Male | 22 (43.1) |
Female | 29 (56.9) |
Country of birth | |
Ghana | 46 (90.2) |
The Netherlands | 5 (9.8) |
Year of migration | |
< 1990 | 11 (23.4) |
1991-2000 | 22 (46.8) |
2001-2009 | 14 (29.8) |
Age | |
18-30 | 16 (31.4) |
31-40 | 13 (25.5) |
41-50 | 15 (29.4) |
51-60 | 5 (9.8) |
> 60 | 2 (3.9) |
Education level | |
Primary | 7 (13.7) |
Secondary | 28 (54.9) |
University/Tertiary | 16 (31.4) |
Living situation | |
Studying | 17 (33.3) |
Employed | 18 (35.3) |
Unemployed | 11 (21.6) |
Unable to work | 5 (9.8) |
Household situation | |
Couples with children at home | 24 (47.1) |
Couples without children | 4 (7.8) |
Single parent with children at home | 11 (21.6) |
Living alone | 7 (13.7) |
Others | 5 (9.8) |
Group | Location | Language used in discussion | Gender/number of participants | |
---|---|---|---|---|
Male | Female | |||
A1- A4
(n = 4)
| AMC | English | 2 | 2 |
B1- B5
(n = 5)
| Community centre | Twi | 4 | 1 |
C1- C9
(n = 9)
| AMC | English | 5 | 4 |
D1- D9
(n = 9)
| AMC | Twi | 0 | 9 |
E1- E13
(n = 13)
| Community centre | English | 5 | 8 |
F1- F11
(n = 11)
| Community centre | English | 4 | 7 |
Enabling factors
Knowledge
"When you migrate, educated people will find ways to figure things out". (Male, 31 yrs- A2).
Perceived quality of the healthcare system
"First of all, I think the system is informative. The delivery of information is usually through the press, radio and television, which I think is good .... Secondly, I appreciate the doctor-patient ratio; I assume a doctor can only attend to a few number of people at a time. Unlike in Ghana, one doctor may be attending to about thousands of people....this I think is bad. I think the Dutch delivery system is very efficient. Lastly, when your house doctor prescribes medication for you, he knows the pharmacy will have it, so you only walk in and collect your medication. (Male, 55 yrs- B1).
"The day I came to the (.....) Hospital, the theatre was very clean. I said to myself that oh today, here I know I'm not going to die. Because in Ghana when you are going to the theatre, everyone is like hey, he is going to die". (Male, 41 yrs- F3).
Community initiatives/cohesion
"I know there are a lot of different Ghanaian organisations .... Through discussions, you can really find out about that generation and indeed the views towards the hospitals or the other way round, we can work towards solutions". (Male, 31 yrs- A2).
Availability/accessibility of family support
Moderator: And how do you find it? Like going to the doctor with your parents? It can't be easy, isn't it?"I have no problem with that. Because they are my parents and I don't have to think twice to do it, so I do it" (Male, 22 yrs- A4).
Barriers
Communication/expression and language
"English is not really our language. And even for those who have attended school in Ghana, some find it difficult to express themselves. Besides, [English] it is not an easy language too. Even for the Dutch, some find it difficult to express themselves or communicate how they feel to their doctors. So, language should not be underestimated". (Male, 25 yrs- C5).
"I think it's all or a part of communication and also non-verbally how you portray yourself. Because even if it's broken English, you can express yourself a little bit. And you can make clear signs with your hands and feet or whatever; the other person doesn't have a choice but to listen to you". (Female, 33 yrs -A1).
Trust in doctor/system
"And when it comes to the time when they have to prescribe something for you; they behave as if the drug they are prescribing, they are going to test it on you. You can get the feeling that he [the doctor] is trying you like an experiment". (Male, 45 yrs- F6).
"One more thing that I don't really like about the system; you are attended to by different doctors. Anytime you go to say the [local academic hospital]; you don't meet the one who you first met. That is confusing, because then they don't know you or take time to study your file". (Female, 45 yrs- F4).
"Yes, it goes wrong when it comes to spending. The hospitals make their monies from the insurance companies. Some of the hospitals allow the insurance companies to dictate to them. But the doctors should know that they have sworn to save lives first". (Male, 45 yrs- F5).
Perceived benefit/value of the healthcare system
"Yes, quite recently, I had pain in my left leg and my house doctor referred me to a specialist in a hospital. The specialist didn't do much with me, except examining my leg and pressing it here and there. I was not given any kind of medication, only an advice." (Female, 41 yrs- D9).
"But there is this protocol that I know; they start with the cheapest drug first. So when you visit your GP, he will not prescribe say the 100 euro drug first, maybe the 50/60 euro..." (Male, 25 yrs- C7)."So they don't prescribe the drugs that will cost the health system?" (Female, 25 yrs- C8)."But listen.....if we all want a medicine of 100 euro, can you calculate how much it will cost the healthcare system?" (Male, 25 yrs- C7)."But you have to understand that the healthcare is not free and we know that. It is not like we don't pay anything and all of a sudden we want some expensive medicine. I pay over 100 euro a month, therefore when I am sick; I expect to get the best of care". (Male, 26 yrs- C6).
Expectations regarding treatment
"When I went to my house doctor last month with pain in my breast and chest area, I was expecting her to at least come over and examine me; instead she used that thing....stethoscope to check my heartbeat and then she said everything is alright." (Female, 26 yrs- C1).The issue with time spent at the GP's was different for most participants, even though averagely many were dissatisfied with it."Eh, the longest time I've had... that I can say this doctor has read something about me is 5 min." (Male, 45 yrs- F5).However, some were consoled with the perception that this was due to the system as a whole which only allows a minimum time with patients."But also it's the system because the house doctor gets like maybe 10 min per patient but he has in his whole case log maybe about 500 people". (Female, 33 yrs- A1).
Culture and acculturation
"That is why I wanted to say that culture plays a big role here. Here in this country, we talk about everything...the Dutch way of doing things; they talk about everything from A to Z. But we [Ghanaians] have hyphens and clauses and codes". (Female, 45 yrs- F5).
"So I think for our generation, if you go to school and are educated [and speak Dutch], you should be able to do things on your own. You don't necessarily need other people. From the simple thing I remember from a long time, translating letters should be on your own". (Male, 22 yrs- A2).
The role of stress
"Most of the people have high blood pressure according to the situation they are living here. The government is giving you money pressure; lots of people have debts.... Lots of people have so much to think and with that you can get high blood pressure". (Male, 45 yrs- F4).