Healthcare access for refugees in Germany: insights from stakeholders using cognitive affective maps
Abstract
Background: Refugees and asylum seekers in Germany face persistent barriers to healthcare access, contributing to health inequalities. These barriers span structural, organisational, and individual levels. Understanding these factors from multiple perspectives is essential for improving service delivery.
Methods: Two studies applied Cognitive Affective Mapping (CAM), a visual network-based method capturing cognitive and affective representations. Study 1 included 30 refugees from West Africa, the Middle East, and Ukraine. Study 2 included 21 refugees, 12 general practitioners, and 19 social workers. Data were analysed by identifying recurring thematic domains across individual maps and aggregating patterns.
Results: Study 1 identified four domains influencing access: resources, treatment options, psychological challenges, and barriers. Participants emphasised resources (e.g. social support) alongside barriers. Study 2 identified four factors shaping perceived appropriateness of care: stakeholder interactions (e.g. discrimination), structural constraints (e.g. staff shortages), language, and individual stakeholder factors (e.g., inequality depending on nationality). Across groups, structural and communication-related factors were consistently linked to reduced access and perceived appropriateness.
Conclusions: CAM enables systematic integration of stakeholder perspectives on healthcare access and quality. Findings highlight the need to strengthen coordination between providers, reduce structural barriers, and improve language support. The approach can inform the development of culturally appropriate services and guide public health strategies aimed at reducing health inequalities among refugees.
Key messages: • Cognitive Affective Mapping identifies multilevel barriers and resources shaping refugee healthcare access.
• Integrating stakeholder perspectives can inform more equitable and culturally appropriate health services.
Related
- Beyond coverage: reviewing barriers and facilitators to healthcare access among Ukrainian refugees
- Cognitive-Affective Factors Associated with Psychological Distress in Young Adults: A Cross-Sectional Structural Equation Modelling Study
- Cognitive and affective networks in patients referred for cognitive screening: latent profiles, bridge nodes, and exploratory directional structures
- Cognitive Control Neural Correlates of Negative Affective in Psychosis Spectrum Disorders: A Laboratory and Ecological Momentary Assessment Study
- Remote Online-Based Application of the Cerebellar Cognitive Affective Syndrome Scale.
BibTeX
@article{spanhel2026healthcare,
title = {{Healthcare access for refugees in Germany: insights from stakeholders using cognitive affective maps}},
author = {K Spanhel and S Schewe and E Buschmeyer and J Fenn and LB Sander and I Monno},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.364},
url = {https://doi.org/10.1093/eurpub/ckag169.364},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Healthcare access for refugees in Germany: insights from stakeholders using cognitive affective maps
AU - K Spanhel
AU - S Schewe
AU - E Buschmeyer
AU - J Fenn
AU - LB Sander
AU - I Monno
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.364
UR - https://doi.org/10.1093/eurpub/ckag169.364
AB - Background: Refugees and asylum seekers in Germany face persistent barriers to healthcare access, contributing to health inequalities. These barriers span structural, organisational, and individual levels. Understanding these factors from multiple perspectives is essential for improving service delivery. Methods: Two studies applied Cognitive Affective Mapping (CAM), a visual network-based method capturing cognitive and affective representations. Study 1 included 30 refugees from West Africa, the Middle East, and Ukraine. Study 2 included 21 refugees, 12 general practitioners, and 19 social workers. Data were analysed by identifying recurring thematic domains across individual maps and aggregating patterns. Results: Study 1 identified four domains influencing access: resources, treatment options, psychological challenges, and barriers. Participants emphasised resources (e.g. social support) alongside barriers. Study 2 identified four factors shaping perceived appropriateness of care: stakeholder interactions (e.g. discrimination), structural constraints (e.g. staff shortages), language, and individual stakeholder factors (e.g., inequality depending on nationality). Across groups, structural and communication-related factors were consistently linked to reduced access and perceived appropriateness. Conclusions: CAM enables systematic integration of stakeholder perspectives on healthcare access and quality. Findings highlight the need to strengthen coordination between providers, reduce structural barriers, and improve language support. The approach can inform the development of culturally appropriate services and guide public health strategies aimed at reducing health inequalities among refugees. Key messages: • Cognitive Affective Mapping identifies multilevel barriers and resources shaping refugee healthcare access. • Integrating stakeholder perspectives can inform more equitable and culturally appropriate health services.
SN - 1101-1262
SN - 1464-360X
ER -