Potential barriers to the use of health services among ethnic minorities: a review.
BACKGROUND
Ethnic minority patients seem to be confronted with barriers when using health services. Yet, care providers are often oblivious to these barriers, although they may share to some extent the burden of responsibility for them. In order to enlighten care providers, as to the potential pitfalls that may exist, there is a need to explore the different factors in the creation of the barriers.


OBJECTIVE
Therefore, the objective of this paper is to present an overview of the potential barriers and the factors, which may restrict ethnic minority patients from using health services, according to the literature available.


METHODS
Articles published from 1990 to 2003 were identified by searching electronic databases and selected through titles and abstracts. The articles were included if deemed to be relevant to study health services use by ethnic minorities, i.e. the different factors in the creation of a barrier.


RESULTS
There were 54 articles reviewed. They reported on studies carried out in different countries and among different ethnic minorities. Potential barriers occurred at three different levels: patient level, provider level and system level. The barriers at patient level were related to the patient characteristics: demographic variables, social structure variables, health beliefs and attitudes, personal enabling resources, community enabling resources, perceived illness and personal health practices. The barriers at provider level were related to the provider characteristics: skills and attitudes. The barriers at system level were related to the system characteristics: the organisation of the health care system.


CONCLUSIONS
This review has the goal of raising awareness about the myriad of potential barriers, so that the problem of barriers to health care for different ethnic minorities becomes transparent. In conclusion, there are many different potential barriers of which some are tied to ethnic minorities. The barriers are all tied to the particular situation of the individual patient and subject to constant adjustment. In other words, generalizations should not be made.
Scheppers
Emmanuel
E
JBI Institute for Rheumatology and Rehabilitation Medicine, Department of Research and Education Amsterdam, The Netherlands. e.scheppers@janvanbreemen.nl
van Dongen
Els
E
Dekker
Jos
J
Geertzen
Jan
J
Dekker
Joost
J
D000069:Acculturation; D003695:Delivery of Health Care; D005260:Female; D014943:Global Health; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008019:Life Style; D008297:Male; D017533:Marital Status; D008913:Minority Groups; D009426:Netherlands; D012737:Sex Factors; D012944:Social Support; D012959:Socioeconomic Factors