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, as many refugees’ home countries have different health systems, they have lower health literacy, and different expectations of health services. Country health system differences, require cultural adaption of host country services when designing targeted inclusive health care programs. Using a sample of 317 Australian-based African refugees, this study examines how refugees’ acculturation, perceptions of discrimination, past behavior, objective knowledge and medical mistrust influence their health inclusion, based on their blood donation intentions. The results indicate that perceived discrimination and objective blood donation knowledge directly affect donation intentions. Perceived discrimination mediates the relationship between acculturation and intentions, and between medical mistrust and donation intentions; and objective knowledge mediates the relationship between past behavior and donation intentions. Recommendations are made for policymakers designing social inclusion programs and health service providers designing and delivering targeted initiatives, to better facilitate refugee participation in host country health systems.