title: An exploration of the enablers and barriers in access to the Dutch healthcare system among Ghanaians in Amsterdam.
abstract: BACKGROUND
  Sub-Saharan African populations are growing in many European countries. Data on the health of these populations are rare. Additionally, many sub-Saharan African migrants are confronted with issues of low socio-economic status, acculturation and language difficulties, which may hamper their access to health care. Despite the identification of some of those barriers, little is known about the enabling factors. Knowledge about the enablers and barriers in access to healthcare experienced is important in addressing their health needs and promoting healthcare access. This study aimed to investigate the enabling factors as well as barriers in access to the Dutch healthcare system among the largest sub-Saharan African migrant group (Ghanaians) living in Amsterdam, the Netherlands.
  
  
  METHODS
  Six focus groups were conducted from November 2009 to February 2010. A semi-structured interview guideline was used. Discussions were conducted in English or Twi (Ghanaian dialect), recorded and transcribed verbatim. Analysis was based on the Andersen model of healthcare utilisation using MAXQDA software.
  
  
  RESULTS
  Knowledge and perceived quality of the health system, awareness of diseases, family and community support, community initiatives and availability of social support were the main enablers to the healthcare system. Difficulties with the Dutch language and mistrust in health care providers were major barriers in access to healthcare.
  
  
  CONCLUSIONS
  Access to healthcare is facilitated mainly by knowledge of and the perceived efficiency and quality of the Dutch healthcare system. However, poor Dutch language proficiency and mistrust in health care providers appear to be important barriers in accessing healthcare. The enablers and barriers identified by this study provide useful information for promoting healthcare access among this and similar Sub-Saharan African communities.
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands. l.boateng@amc.uva.nl
authors.forename: Linda
authors.initials: L
authors.lastname: Boateng
authors.forename: Mary
authors.initials: M
authors.lastname: Nicolaou
authors.forename: Henriëtte
authors.initials: H
authors.lastname: Dijkshoorn
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
mesh_terms: D000328:Adult; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D005869:Ghana / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006293:Health Promotion / Q000379:methods; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D007802:Language; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011785:Quality Assurance, Health Care / Q000592:standards*; D012944:Social Support; D012959:Socioeconomic Factors