Navigating the Spanish Healthcare System : Perspectives of Newcomers and Cultural Mediators on Communication, Relationships, and Fear of Deportation

Introduction: The process of caring for immigrants is influenced by different cultural elements, and patients and health professionals perceive it differently. The literature often uses the concept of "immigrant patients" as if it comprises a homogeneous and nondiverse group. In this study, we focus on newcomers, since the number of years an immigrant has spent in a country conditions their experience as a patient. Despite being a more vulnerable population, there are few studies on the perspective of newcomers. Given this gap, we aimed to explore the relationship of newcomers with Spanish healthcare professionals and whether the care provided is sensitive and culturally competent from the perspective of newcomers and cultural mediators. Materials and Methods: Qualitative study with a socioconstructivist approach based on 18 interviews with newcomers and two focus groups (one with newcomers and one with cultural mediators). Purposive sampling was used to recruit newcomers, while cultural mediators were recruited by convenience sampling. The Charmaz method was applied for data analysis. Results: Newcomers and mediators point out the cultural insensitivity of health systems in their discourse, clearly expressed by newcomers' fear of deportation, the perception of standardized care, and the prevalence of formal communication styles. For newcomers, the fear of being deported as an undocumented immigrant is a major reason for not using the health system. Newcomers and cultural mediators agreed that nursing care is standardized but disagreed about cultural issues. Conclusions: This study detected a fear of deportation and the perception of standardized care when navigating an insensitive healthcare system. Due to growing inequalities, there is an urgent need for the critical self-reflection of the entire health system. Specific interventions, such as developing cultural competence training, revising communication protocols, and including cultural mediators on care teams, are critical to including newcomers' needs in care practice and reducing inequalities.