title: Asylum seekers' expectations of and trust in general practice: a qualitative study.
abstract: BACKGROUND
  The UK has substantial minority populations of short-term and long-term migrants from countries with various types of healthcare systems.
  
  
  OBJECTIVE
  This study explored how migrants' previous knowledge and experience of health care influences their current expectations of health care in a system relying on clinical generalists performing a gatekeeping role.
  
  
  METHODS
  Two qualitative methods.
  
  
  METHODS
  Glasgow, UK.
  
  
  METHODS
  Focus groups or semi-structured interviews were conducted with 52 asylum seekers. Analyses identified several areas where previous experience affected current expectations. An overview of health systems in each country of origin was established by combining responders' accounts with World Health Organization statistics.
  
  
  RESULTS
  Asylum seekers had previous experience of a diverse range of healthcare systems, most of which were characterised by a lack of GPs and direct access to hospital-based specialists. For some responders, war or internal conflict resulted in a complete breakdown of healthcare systems. Responders' accounts also highlighted the difficulties that marginalised groups had in accessing health care. Although asylum seekers were generally pleased with the care they received from the NHS, there were areas where they experienced difficulties: confidence in their GP and access to hospital-based specialists and medication. These difficulties encountered might be explained by previous experience.
  
  
  CONCLUSIONS
  GPs and other healthcare professionals need to be aware that experience of different systems of care can have an impact on individuals' expectations in a GP-led system. If these are not acknowledged and addressed, a lack of confidence and trust in the GP may undermine the effectiveness of the clinical consultation.
authors.affiliation: General Practice and Primary Care, Division of Community-based Sciences, University of Glasgow, Scotland. Kate.O'Donnell@clinmed.gla.ac.uk
authors.forename: Catherine A
authors.initials: CA
authors.lastname: O'Donnell
authors.forename: Maria
authors.initials: M
authors.lastname: Higgins
authors.forename: Rohan
authors.initials: R
authors.lastname: Chauhan
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mullen
mesh_terms: D000328:Adult; D001294:Attitude to Health; D005194:Family Practice; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012036:Refugees; D012606:Scotland; D013222:State Medicine; D011795:Surveys and Questionnaires; D055815:Young Adult