Introduction and Aim: Chronic illness, gender and origin can all lead to stereotyping. In the health sector stereotyping based on social identities has been shown to interfere with access to healthcare. In this study, we investigated stereotyping in healthcare settings and its effects on health care utilization based on patient-reported experience. We examined the impact of stereotyping on healthcare seeking, reaching, using and the health consequences.

Materials and Methods: In this qualitative study, we conducted in-depth interviews with first generation women of Turkish (n=12), Portuguese (n=12) and German (n=12) origin and Swiss women (n=12) living in Bern or Geneva. Inclusion criteria were being first generation migrant who entered Switzerland after compulsory schooling, being over 18 years of age and having one or more medically diagnosed chronic disease(s). We reached the participants through healthcare providers, cultural associations, institutions and other key persons; also with snowballing approach. Using a semi-structured guide, four trained researchers interviewed women in their mother tongue in 2017-2018. The study was approved by the Bern Cantonal Ethics Committee. Informed consent of the participants was obtained; all but one of the interviews were audio-recorded. Each transcript was coded by two researchers using a combination of deductive and inductive coding and thematic content analysis was applied.

Results: Women’s age ranged from 23 to 85 years. Most of them had multiple and long-lasting chronic conditions. When asked about their experiences with health care services, some reported that they did not receive sufficient information about their health problems and treatment options because physicians acted based on an idea that “migrants do not understand”. Some women stated that health providers generally think, “the health problems of migrant women are mainly psychological and therefore their complaints do not require or deserve further investigation”. This was particularly evident in the case of chronic pain. Many women felt uncomfortable that origin was being associated with prejudices, such as (an alleged) "desire to retire early and receive funding" and somehow “try to illegally infiltrate the country”. They suspected that physicians and other service providers perceived and approached migrants' complaints from this biased perspective. In some cases, participants reported that the stigmatization was made by health insurance representatives.

Conclusions and Recommendations: Women reported concerns about stereotyping and being stigmatized due to their group membership as being migrant, woman and chronically ill. The feeling of unfair treatment has some important consequences related to “doctor shopping” and delayed consultations. Our results indicate that intersections between multiple social categories may be key in creating particular forms of inequality and in-efficiency in health care.

Keywords: Migrant, women, chronic diseases, stereotyping, stigmatization, intersectionality, access to healthcare, Switzerland

Note: This study is a part of the greater MIWOCA project (funded by the Swiss National Science Foundation) which examines migrant women’s health care needs for chronic disease services in Switzerland. http://www.nfp74.ch/en/projects/healthcare-across-sectors/project-abel

This paper was prepared in collaboration with the members of the MIWOCA research project. Other contributors (in alphabetical order): Thomas Abel, Sandro Cattacin, Luna De Araujo, Romaine Farquet, Annika Frahsa.