Exploring discrimination and racism in healthcare: a qualitative phenomenology study of Dutch persons with migration backgrounds

• Published in: BMJ open 2024-06, Vol.14 (6), p.e082481-e082481
• Main Authors: Zemouri, Charifa, Nait Kassi, Assia, Arrazola de Oñate, Wouter, Çoban, Gökhan, Kissi, Ama
• Format: Article
• Language: English
• Subjects: Adult; Aged; Dictionaries; Discrimination; Emigrants and Immigrants - psychology; Ethnicity; Female; Global Health; Health care; Health care access; Health disparities; Health Equity; Health Services; Health Services Accessibility; Healthcare Disparities - ethnology; Humans; Male; Middle Aged; Migration; Netherlands; Phenomenology; Population; Prejudice - psychology; PUBLIC HEALTH; Qualitative Research; Race; Racial discrimination; Racism; Racism - psychology; Social Discrimination; Social networks; Surveys and Questionnaires
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-082481

ObjectiveTo explore and characterise the discrimination and racism experienced in healthcare from the perspective of Dutch patients with a migration background.DesignThis was a qualitative phenomenological study incorporating an inductive thematic analysis of the answers provided to a free form online survey. Descriptive and differential analyses were conducted for the closed-ended questions.SettingThis study used an online survey distributed in Dutch about experiences of discrimination and racism in healthcare to the general population in the Netherlands.ParticipantsThe survey was completed by 188 participants (Mage=39.89, SDage=10.2). Of whom 80 (Mage=37.92, SDage=10.87) met the eligibility criteria for thematic analysis (ie, has a migration background or a relative with a migration background and experienced discrimination in healthcare based on their background) and were thus included in the analysis.ResultsFrom the total sample, women, relative to men, were 2.31 times more likely to report experiencing healthcare discrimination (OR=2.31; 95% CI 1.23 to 4.37). The majority of the participants (60.1%) had a Moroccan or Turkish background. Six themes were identified relating to experienced discrimination in healthcare based on one’s migration background: (1) explicit discrimination, (2) prejudice, (3) not being taken seriously, (4) discriminatory behaviour, (5) language barriers and (6) pain attribution to cultural background. Some participants reported that their attire or religion was linked to their migration background, thus contributing to their experiences of discrimination.ConclusionDutch patients with a migration background may experience discrimination based on their ethnic identity or other factors related to their backgrounds, such as their faith, culture and skin colour. Discrimination manifests as intersectional and may take different forms (eg, discrimination based on the intersection between race and gender). Therefore, healthcare discrimination may increase health inequities and lead to unequal access to healthcare services. Implicitly or explicitly discriminating against patients is immoral, unethical, illegal and hazardous for individual and public health. Further research on the magnitude of discrimination in healthcare and its relation to health is needed.