title: Barriers and enablers to healthcare access and use among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes mellitus: a qualitative comparative study.
abstract: OBJECTIVE
  The objective of this study was to explore the decision-making processes and associated barriers and enablers that determine access and use of healthcare services in Arabic-speaking and English-speaking Caucasian patients with diabetes in Australia.
  
  
  METHODS
  Face-to-face semistructured individual interviews and group interviews were conducted at various healthcare settings-diabetes outpatient clinics in 2 tertiary referral hospitals, 6 primary care practices and 10 community centres in Melbourne, Australia.
  
  
  METHODS
  A total of 100 participants with type 2 diabetes mellitus were recruited into 2 groups: 60 Arabic-speaking and 40 English-speaking Caucasian.
  
  
  METHODS
  Interviews were audio-taped, translated into English when necessary, transcribed and coded thematically. Sociodemographic and clinical information was gathered using a self-completed questionnaire and medical records.
  
  
  RESULTS
  Only Arabic-speaking migrants intentionally delayed access to healthcare services when obvious signs of diabetes were experienced, missing opportunities to detect diabetes at an early stage. Four major barriers and enablers to healthcare access and use were identified: influence of significant other(s), unique sociocultural and religious beliefs, experiences with healthcare providers and lack of knowledge about healthcare services. Compared with Arabic-speaking migrants, English-speaking participants had no reluctance to access and use medical services when signs of ill-health appeared; their treatment-seeking behaviours were straightforward.
  
  
  CONCLUSIONS
  Arabic-speaking migrants appear to intentionally delay access to medical services even when symptomatic. Four barriers to health services access have been identified. Tailored interventions must be developed for Arabic-speaking migrants to improve access to available health services, facilitate timely diagnosis of diabetes and ultimately to improve glycaemic control.
authors.affiliation: Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Alzubaidi
authors.affiliation: Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, Victoria, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Mc Namara
authors.affiliation: Institute at Royal District Nursing Service, Melbourne, Australia.
authors.forename: Colette
authors.initials: C
authors.lastname: Browning
authors.affiliation: Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Marriott
mesh_terms: D000328:Adult; D000368:Aged; D018912:Arabs; D001315:Australia; D003144:Communication Barriers; D003469:Culture; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D015438:Health Behavior / Q000208:ethnology*; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000208:ethnology; D036301:Qualitative Research; D012067:Religion; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000523:psychology; D044465:White People
keywords: DIABETES & ENDOCRINOLOGY; PUBLIC HEALTH; QUALITATIVE RESEARCH