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      Learning to navigate the healthcare system in a new country: a qualitative study

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          Abstract

          Objective

          Learning to navigate a healthcare system in a new country is a barrier to health care. Understanding more about the specific navigation challenges immigrants experience may be the first step towards improving health information and thus access to care. This study considers the challenges that Thai and Filipino immigrant women encounter when learning to navigate the Norwegian primary healthcare system and the strategies they use.

          Design

          A qualitative interview study using thematic analysis.

          Setting

          Norway.

          Participants

          Fifteen Thai and 15 Filipino immigrant women over the age of 18 who had been living in Norway at least one year.

          Results

          The women took time to understand the role of the general practitioner and some were unaware of their right to an interpreter during consultations. In addition to reliance on family members and friends in their social networks, voluntary and cultural organisations provided valuable tips and advice on how to navigate the Norwegian health system. While some women actively engaged in learning more about the system, they noted a lack of information available in multiple languages.

          Conclusions

          Informal sources play an important role in learning about the health care system. Formal information should be available in different languages in order to better empower immigrant women.

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          Most cited references18

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          Norway: health system review.

          Norways five million inhabitants are spread over nearly four hundred thousand square kilometres, making it one of the most sparsely populated countries in Europe. It has enjoyed several decades of high growth, following the start of oil production in early 1970s, and is now one of the richest countries per head in the world. Overall, Norways population enjoys good health status; life expectancy of 81.53 years is above the EU average of 80.14, and the gap between overall life expectancy and healthy life years is around half the of EU average. The health care system is semi decentralized. The responsibility for specialist care lies with the state (administered by four Regional Health Authorities) and the municipalities are responsible for primary care. Although health care expenditure is only 9.4% of Norways GDP (placing it on the 16th place in the WHO European region), given Norways very high value of GDP per capita, its health expenditure per head is higher than in most countries. Public sources account for over 85% of total health expenditure; the majority of private health financing comes from households out-of-pocket payments.The number of practitioners in most health personnel groups, including physicians and nurses, has been increasing in the last few decades and the number of health care personnel per 100 000 inhabitants is high compared to other EU countries. However, long waiting times for elective care continue to be a problem and are cause of dissatisfaction among the patients. The focus of health care reforms has seen shifts over the past four decades. During the 1970s the focus was on equality and increasing geographical access to health care services; during the 1980s reforms aimed at achieving cost containment and decentralizing health care services; during the 1990s the focus was on efficiency. Since the beginning of the millennium the emphasis has been given to structural changes in the delivery and organization of health care and to policies intended to empower patients and users. The past few years have seen efforts to improve coordination between health care providers, as well as an increased attention towards quality of care and patient safety issues. Overall, comparing mortality rates amenable to medical intervention suggests that Norway is among the better performing European countries. Despite having one of the highest densities of physicians in Europe, though, Norway still struggles to ensure geographical and social equity in access to health care.
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            Patient navigation in breast cancer: a systematic review.

            The role of the patient navigator in cancer care and specifically in breast cancer care has grown to incorporate many titles and functions. To better evaluate the outcomes of patient navigation in breast cancer care, a comprehensive review of empiric literature detailing the efficacy of breast cancer navigation on breast cancer outcomes (screening, diagnosis, treatment, and participation in clinical research) was performed. Published articles were reviewed if published in the scientific literature between January 1990 and April 2009. Searches were conducted using PubMed and Ovid databases. Search terms included MeSH (Medical Subject Headings) terms, "patient navigator," "navigation," "breast cancer," and "adherence." Data-based literature indicates that the role of patient navigation is diverse with multiple roles and targeted populations. Navigation across many aspects of the breast cancer disease trajectory improves adherence to breast cancer care. The empiric review found that navigation interventions have been more commonly applied in breast cancer screening and early diagnosis than for adherence to treatment. There is evidence supporting the role of patient navigation in breast cancer to improve many aspects of breast cancer care. Data describing the role of patient navigation in breast cancer will assist in better defining future direction for the breast navigation role. Ongoing research will better inform issues related to role definition, integration into clinical breast cancer care, impact on quality of life, cost-effectiveness, and sustainability.
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              Discovering statistics using IBM SPSS. Discovering Statistics Using SPSS

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                Author and article information

                Journal
                Scand J Prim Health Care
                Scand J Prim Health Care
                IPRI
                Scandinavian Journal of Primary Health Care
                Taylor & Francis
                0281-3432
                1502-7724
                December 2017
                31 October 2017
                : 35
                : 4
                : 352-359
                Affiliations
                [a ]Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
                [b ]Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
                Author notes
                CONTACT Melanie L. Straiton Melanie.Straiton@ 123456fhi.no Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O Box 4404, 0403, Oslo, Norway
                Article
                ipri-35-352
                10.1080/02813432.2017.1397320
                5730033
                29087232
                7d3599d1-17d0-4d94-a2a7-fc2790013fdc
                © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 03 March 2017
                : 27 August 2017
                Funding
                Funded by: The Research Council of Norway
                This work was supported by The Research Council of Norway.
                Categories
                Research Articles

                primary health care,immigrant women,barriers to care,qualitative research

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