Digital health problems and opportunities for migrants and refugees

The use of online and video consultation technology has skyrocketed since the onset of the pandemic. Access to smartphones is now essential to receiving care during periods of lockdown or ‘work from home’ orders. To complicate matters, many people seeking asylum in the UK have had their phones confiscated at the border, and smartphones are not routinely provided by the government and local charities. Those refugees that do have mobile phones are often on pay-as-you-go plans and struggle to access remote GP services that require text message responses to confirm appointments or monitor long term conditions [2]. Newly arrived refugees may also have older smartphone models that do not support the latest apps, such as the NHS App, NHS Test & Trace, or apps used to submit online consultations at GP practices.

Navigating the NHS can be difficult for the average patient, but trying to navigate its many services with English as a second language can be more challenging still. Online consultations which require patients to complete lengthy health questionnaires are a particular struggle, and often caseworkers or volunteer advocates have to help complete these online forms in such cases. Difficulties in accessing interpreter services during GP or hospital appointments are also a barrier to expressing health needs and understanding clinicians’ advice.

Data and Wi-Fi plans with mobile phone networks are often expensive and unaffordable for people living on asylum support (internet is not always provided to asylum seekers in dispersal accommodation) [2]. Where internet connectivity is provided, signal is often poor and downloading apps or opening web pages is a time-consuming task. Online and video consultations with health and social care professionals can be a very frustrating experience for both the patient and clinician due poor internet connectivity, in addition to language barriers.

For older migrants, digital and health literacy is often quite low, and engaging with health services can sometimes feel like more effort than it’s worth. Mistrust of government services is also a common experience for migrants from countries notorious for surveilling citizens, so smartphone apps such as the NHS Test and Trace service can lead to scepticism or re-traumatisation. A lack of reliable health sources in easy-to-read formats can also lead people to trust incorrect sources and conspiracy theories which can disseminate quickly.

People on asylum support are offered accommodation on a no-choice basis for where they are located across England. Depending on individual circumstances, some asylum seekers are forced to regularly move to different cities. Before the pandemic, this necessitated a change of GP every time they were offered accommodation in a different location, or some would even travel inter-city because they developed such a close relationship with a GP who understood their health needs. Mary was forced to change her GP three times after moving from London to Leeds and then Birmingham. The widespread introduction of virtual consultations makes it easier for asylum seekers to remain with their current GP, as most appointments can now be completed over the phone or through video consultation. Virtual consultations can also save money on transport costs, which can sometimes be unaffordable for migrants on asylum support.

Before the pandemic, GP correspondence would often be via phone call or post. For migrants with English as a second language, receiving calls from unknown numbers, which may be their GP or hospital, can be anxiety-provoking. Letters from the NHS in English could also be difficult to read and understand. The move to digital communication has enabled patients with English as a second language to share text messages or digital letters with friends and family proficient in English to help them understand the context of the message. However, it should be noted that family and friends may also misinterpret the correspondence, so professional interpreting services should always be considered the gold standard.

A report by the Migrants Forum found that 58% of migrants and refugees they interviewed described loneliness and isolation as their biggest challenge in London, which stem from difficulties in creating meaningful networks upon arrival into a new country [4]. New digital online tools for education and health enables people from migrant backgrounds to learn new skills, find better work, start businesses, explore new marketplaces, and build up a network of like-minded friends.

Primary care services are available at no cost to all people visiting or living in the UK, regardless of their immigration status. Only some secondary care services are available to all migrants, such as accident and emergency services, COVID-19 diagnosis and treatment, and family planning services. More information can be found here.

Websites and online consultation forms with no option for language translation may deter patients with limited English proficiency from accessing essential health services. Patients should also be able to request an interpreter with the right language and dialect for any health-related matter.

If patients require a smartphone or app to access your services, you need to consider what alternative pathways are available to those without access to a smartphone, strong internet connectivity, or the latest IOS or Android updates.

EHIAs should be a core component of all digital transformation work. It is essential that NHS project managers and innovators work alongside your organisation’s equality and diversity lead to ensure these assessments are thorough and actioned upon.

A trauma-informed approach to healthcare aims to provide an environment where a person who has experienced trauma feels safe. This approach must be built into the technology and services we deliver to prevent the replication of traumatic experiences for our patients.

Remember that video consultations are easier for patients with English as a second language because they can read your facial expressions and body language alongside the conversation, which can greatly aid comprehension.

If you’re not sure, then ask. Migrant groups want services to meet their needs. Engagement with vulnerable groups should be a core focus of any digital transformation work and should begin as soon as possible to ensure your solution meets the needs of migrant patients and other groups.