title: Use of healthcare services in the region of origin among patients with an immigrant background in Denmark: a qualitative study of the motives.
abstract: BACKGROUND
  In Denmark, immigrants have been found to have a higher use of healthcare services abroad. Since this use may have an impact on both the individual patient and the healthcare system in the country of residence, research into underlying reasons is of increasing relevance. This study therefore investigates what motives patients with an immigrant background have for seeking healthcare services in their region of origin.
  
  
  METHODS
  The study was based on 10 semi-structured interviews with 10 patients who had an immigrant background, primarily originating from Turkey and the Middle East, recruited at a clinic of immigrant medicine in Denmark. The interviews were analysed thematically to elucidate motives for seeking healthcare services abroad, with focus on identifying push and pull factors.
  
  
  RESULTS
  Four motives for seeking healthcare in the region of origin were salient in the material: the perception of availability, in terms of quantity and access; familiarity, conceptualised as feeling comfortable within the healthcare system; perception of quality of services; and finally, the perceived need for a second opinion. All motives emerged simultaneously as push factors, motivating immigrants to explore healthcare services abroad, and pull factors, attracting them to their country of origin. Affordability did not emerge as an independent motive but influenced the other factors.
  
  
  CONCLUSIONS
  The use of healthcare services abroad by patients with an immigrant background constitutes active health-seeking behaviours shaped by a range of factors perceived to be limiting access to high-quality services in Denmark. Further research, including quantitative studies, should be initiated to investigate the importance of these motives among larger, more diverse immigrant groups, consequences for treatment regimes, and the healthcare professionals' perspective on the use of healthcare in the region of origin among immigrant patients.
authors.affiliation: Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark. gqn260@alumni.ku.dk.
authors.forename: Nicoline
authors.initials: N
authors.lastname: Lokdam
authors.affiliation: Research Centre for Migration, Ethnicity and Health, Institute of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark.
authors.forename: Maria
authors.initials: M
authors.lastname: Kristiansen
authors.affiliation: Research Centre for Migration, Ethnicity and Health, Institute of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark.
authors.forename: Line Neerup
authors.initials: LN
authors.lastname: Handlos
authors.affiliation: Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.|Research Centre for Migration, Ethnicity and Health, Institute of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark.
authors.forename: Marie
authors.initials: M
authors.lastname: Norredam
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care; D003718:Denmark; D054242:Emigrants and Immigrants; D004644:Emotions; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D007493:Iraq / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009018:Morocco / Q000208:ethnology; D009042:Motivation; D010465:Perception; D036301:Qualitative Research; D014421:Turkey / Q000208:ethnology
keywords: Cross-border healthcare use; Denmark; Immigrants; Mobile patient