Characteristics of the included literature

A total of nine studies [4, 5, 19, 20, 31,32,33,34,35] were included in this review. The included literature was published between 2013 and 2022, and the total number of study participants recruited were 133. The methods of data collection were two focus group interviews [4, 31], three in-depth interviews [19, 20, 35], one participant observation and in-depth interviews [32], one participant observation and focus group interviews [33], one literature review and in-depth interviews [34], and one meeting minutes and focus group interviews [5]. In addition, the methods of data analysis were two grounded theories [19, 20], one directed content analysis [31], one ethnography [32], one life history analysis [33], one deductive content analysis [4], one narrative analysis [5], one triangulation [34], and one thematic analysis [35].

Meta-synthesise

As a result of synthesising research on the healthcare and healthcare service experience of migrant workers in Korea, the following three themes were derived: (1) personal factors, (2) cultural factors, (3) social institutional factors (Table 2). Because migrant workers prioritise work before health, they choose work despite poor working conditions, and suffer from physical and mental health problems due to hard work, changes in living environment, and cultural differences, but they bore the pain by force or reduce the pain in their own way after self-diagnosis because of a society that restricts access to medical services. They used healthcare services centred on medical support projects or free clinics, but they did not reveal that they were sick even when they were sick, and repeated the vicious cycle of threatening their health with a work-centred life pattern to show that their body is a productive labour force.

Table 2 Themes of Health and Medical Experience of Migrant WorkersPersonal factorsPersonal health beliefs

Migrant workers immigrated to Korea to find jobs for making money. He entered poor working conditions to find a job in Korea, and showed an addiction to investing his body and time with the idea that it would be over if he failed to work due to the currency value several times higher than his home country [33]. Migrant workers should not be sick to take responsibility for the living expenses of their families in their home country, and even if they were sick, it was difficult to pay for medical expenses and receive treatment [32]. Migrant workers overworked their bodies with constant labour to show that their bodies were a productive labour force, revealing physical pain was difficult to reveal diseases because it meant they had to quit work, and continued labour by connecting the cause of the disease to ageing or underlying diseases [33]. In the process of enduring hard labour by dismissing migrant labour in Korea as temporary labour to make a lot of money and return home [33], they were difficult to take care of their health even if there were signs of health problems because they have been pushed out of their priorities in life [19]. Migrant workers delayed taking care of their health by comforting themselves with the fact that they could work despite physical or psychological pain [33], or they hoped that their family or time would solve their health problem because they could not solve it themselves [19]. Some migrant workers have health belief that make them reluctant to use hospital due to distrust of western medicine, which become a threat to their health [4].

Financial burden of medical expenses

Migrant workers were financially burdened with medical and insurance costs, and they were unable to actively use medical services, such as giving up treatment when hospital costs such as examination or surgery were high [4, 20, 31, 32]. Especially, unregistered migrant workers gave up the use of medical services due to their low ability to pay for health insurance due to an environment where they had no visas and low wages [20]. If it was possible that support from friendly medical staff and medical expense support groups, healthcare services could be revisited, but few organisations provide full medical expenses, so it was difficult to solve high treatment costs such as large surgery alone [20].

Cultural factorsCultural differences in living conditions

Migrant workers were at risk of exposure to various diseases due to stress and long hours of work under a different weather, food, and language from their home countries [19, 32]. Migrant workers consumed a lot of sugar such as cakes, resulting in type 2 diabetes, and their bodies were ruined by junk food and high-calorie food-oriented eating habits [34]. In the case of married migrant women, physical health problems were experienced due to the food culture of their in-laws different from their home countries, and hard work instead of their husbands with physical and economic difficulties in foreign country [19]. In the case of married migrant female workers, it was invisible that postpartum depression, loneliness, and homesickness, so they could not ask for help, and they also developed diseases by enduring health abnormalities due to lack of Korean language skills [19]. In some cases, medical staff forced Muslim women to take off hijab even though they did not interfere with the examination [20], and the conflict felt by migrant workers due to cultural differences did not end up as an inconvenience, but as a health threat [5]. It also had difficulty choosing appropriate medical institutions or using medical services as language barriers regardless of gender [4, 20, 32, 34].

Cultural differences in medical environment

The experience of using medical services different from the home country made it reluctant to reuse medical services, and cultural differences in the medical environment acted as a factor that threatened the health of migrant workers [5]. Migrant workers felt psychological burdens and difficulties in the process of using general hospitals in Korea due to their experiences in using medical services different from their home countries. They felt anxious about treatment due to a lack of understanding of the detailed divisions of the Korean medical community and confusion arising from institutional differences, and confidence in hospitals decreased [5]. Unlike in their home country, migrant workers felt frustrated because they did not know the causes and treatment methods of their health problems, as well as the types and effects of medicines due to the unilateral doctor’s treatment method [31], the lack of explanations about medicines at pharmacies, and felt like discriminated against [5]. They also asked for a prescription of drugs or fluids that worked in their home country, but they felt humiliated when their doctor refused or advised them to stop taking the medicine they had taken previously taken [5]. In addition, traditional first aid methods vary from country to country, which also became a conflict factor in the process of interaction with Korean doctors, making them hesitant to reuse medical services [5]. Migrant workers had restrictions on the use of healthcare services due to much greater psychological stress due to limitations of language communication disorders and cultural differences in the use of medical services [5].

Folk remedies in one’s country

Migrant workers purchased and took health supplements through their acquaintances or used folk remedies such as moxibustion treatment [20, 33], and used them for emergency treatments experienced in the cultural environment of their home country [5]. When they were sick, they took drugs brought from their home country after self-diagnosis [33], received help from religious institutions or religious leaders, and found a shaman due to unknown symptoms [4]. They also exercised such as stretching, hiking, and cycling [20].

Social institutional factorsPoor and hard-working conditions

It was difficult for migrant workers to use hospitals on weekdays because they were concerned that employers would negatively view the use of medical institutions in migrant workers mainly working in difficult jobs with poor working conditions [4, 20, 31, 32]. As a result, since most symptoms were tolerated and preventive medical services were not available [4], even if there was a health problem, it had become a factor that threatens the health of migrant workers because they cannot respond properly. Public hospitals and private medical support organisations that can provide medical support are concentrated in Seoul [34], so geographical access to medical services was low. When employed, they experienced psychological burdens and stress due to discrimination caused by being limited to jobs avoided by Koreans, distrust of migrant workers, tension that cannot be free to eat or rest due to walking on eggshells around their boss, and job insecurity [31]. In particular, unregistered migrant workers experienced emotional pain, psychological atrophy, disability caused by industrial accidents, depression and despair, employers’ distrust of physical pain, and inappropriate follow-up measures as illegal residents [33]. Migrant workers were tired of mental stress from long-term labour, and physically felt pain in their limbs, neck, thyroid gland, abdomen, and kidneys [20]. Female migrant workers experienced physical burdens and the risk of musculoskeletal diseases due to the act of hugging children while working as a housekeeper and restaurant employee, repeated handling of heavy tableware, long standing or uncomfortable posture, repeated use of hands and wrists, long working hours, and lack of rest [31, 33].

Insufficient information about medical institutions

Migrant workers were not aware of information probably related to the use of medical services such as medical expenses, medical departments, examination status, and use procedures because there was no place to obtain information on medical institutions [4, 20, 31, 34]. Even if there was health insurance, they were not aware of how to use it or benefits, and they were not aware of emergency medical services or free medical services, so there was a limit to the use of health medical services [4]. Migrant workers obtained health information through family, friends, acquaintances, employers, and migrant communities [4, 33], but in the case of communities and communal groups, uncertain information was supplied with commercial medical information, and the necessary information was not well provided [4, 34]. Migrant workers also obtained health information through TV or the Internet [19, 31]. Migrant workers use medical services based on their own description on disease condition or symptoms rather than expert diagnosis or advice, so they often rely on personal information from acquaintances when choosing a medical institution [4].

Policies with a lack of practical applicability

- Industrial accident.

In the case of unregistered migrant workers, it was rare to treat for diseases or accidents caused by industrial accidents when using medical institutions, and they rarely received health check-ups or supported medical expenses at work [20]. In the event of an industrial accident, compensation can be applied for, but in the process to deal with industrial accidents, employers were fined for hiring unregistered migrants, and unregistered migrants could be forcibly repatriated for illegal stay, making it almost impossible to deal with industrial accidents [20]. In addition, there was an institutional loophole in which migrant workers could not apply for industrial accidents at all when they first entered the country and start working [34]. In the case of female migrant workers, they usually worked at small business offices or private homes that did not have industrial accident insurance, and their physical pain was not visible because it was a chronic disease that was not included in industrial accident [33].

- Health insurance policy.

Migrant workers were very passive in signing up for health insurance, considering migrant labour as a short-term temporary labour [33], and the requirements for joining medical insurance should be confirmed residency for more than three months, and for migrant workers who are unfamiliar with life in Korea, the differential medical welfare system according to their status of residence felt discriminatory and became a factor threatening their health [5]. In the case of medical insurance, not only unregistered migrant workers, but also migrant workers employed in occupations such as nursing labour, domestic labour, and farms were excluded [