Factors leading to health care exclusion among African refugees in Australia: the case of blood donation

Developed countries that accept refugees are obligated, under the UN Convention for Refugees, to integrate refugees into host
communities, with inclusion in the health system being pivotal. Integration programs can be difficult though, because many refugees’
home countries have different health systems, lower health literacy, and different expectations of health services. Country
health system differences require cultural adaptation of host country services when designing targeted, inclusive health care
programs. Using a sample of 317 Australian-based African refugees, the authors examine how refugees’ acculturation, perceptions
of discrimination, past behavior, objective knowledge, and medical mistrust affect their health inclusion, depending on their blood
donation intentions. The results indicate that perceived discrimination and objective blood donation knowledge directly affect
donation intentions. Perceived discrimination mediates the relationships between acculturation and intentions and between
medical mistrust and donation intentions, and objective knowledge mediates the relationship between past behavior and donation
intentions. The authors offer recommendations to policy makers designing social inclusion programs and health service providers
designing and delivering targeted initiatives, to better facilitate refugee participation in host country health systems.