Primary health care experiences of Indian immigrants living with chronic illnesses in Australia: a qualitative study.

Chronic illnesses are prolonged conditions lasting for at least six months, which have persistent effects on quality of life and require ongoing care and management from a multidisciplinary health care team (Australian Health Minister’s Advisory Council, 2017 ; Gordon et al ., 2018 ). Around 41 million people die each year as a result of chronic illnesses, equating to 74% of deaths globally (World Health Organization, 2023 ). In 2022, 171,500 deaths (90% of all deaths) in Australia were due to chronic illnesses and around 12.6 million people (49.9%) residing in Australia for at least 12 months were living with at least one chronic condition (Australian Bureau of Statistics [ABS], 2023 ). Primary health care (PHC) delivers essential early interventions that facilitate prevention, early detection, and treatment by a multidisciplinary team of health care professionals for people living with chronic illnesses in the community (Bierman et al ., 2021 ; World Health Organization, 2023 ). The Australian health care system comprises of a public and private sector (Australian Institute of Health and Welfare [AIHW], 2025 ). Medicare, Australia’s universal health insurance scheme is a federal funded programme. It provides free or subsidized treatment for Australian citizens, permanent residents, and visitors from countries with reciprocal health agreements who use public hospitals, community services, and general practitioners (GPs) (AIHW, 2022 ). Private health insurance provides Australian citizens with the option to access private hospitals, specialists, dental care, and allied health services that are not fully covered by Medicare (AIHW, 2025 ). Nursing services are provided in both public and private sectors and, therefore, are funded by either Medicare or private health insurances (Department of Health, Disability and Ageing, 2025 ). Over the years, PHC in Australia has evolved to adapt to the changing health care needs of the diverse population, of which, over 30% was born overseas (ABS, Australian Bureau of Statistics, 2026 ). However, culturally and linguistically diverse immigrants with complex health care needs face challenges of accessing suitable health care and navigating Australia’s complex health system (Department of Health, 2022 ; Mengistu et al ., 2023 ). These include language barriers (Kay et al ., 2016 ), lack of recognition of cultural diversity, and limited levels of cultural competence (Harrison et al ., 2019 ). Chinese immigrants, particularly the elderly and those with poor English proficiency, faced language and communication problems and had difficulties navigating the health care system and resources (Jin et al ., 2020 ; Zhang et al ., 2020 ). Vietnamese immigrants reported to have similar access barriers by way of language difficulties and a lack of health information available in their language (Jin et al ., 2020 ). Furthermore, travel time, cultural and religious differences and affordability affected accessibility among African immigrants (Anaman-Torgbor et al ., 2017 ). These issues influence poor heath service utilization and, consequently, increase the risks of unmanaged chronic health conditions. Indian immigrants in Australia are the largest group born overseas, with a population of 916,000, and thus, the largest group to avail Australia’s PHC services (ABS, Australian Bureau of Statistics, 2026 ). One in three Indian immigrants in Australia has a chronic condition which is managed and treated through PHC (AIHW, 2022 ; Department of Foreign Affairs and Trade, 2022 ). People of Indian cultural background in Australia are at a higher risk of insulin resistance and have the third-highest prevalence of type 2 diabetes mellitus (Department of Foreign Affairs and Trade, 2022 ). Back pain, depression, hypertension and heart disease were the most reported diseases in an Australian study (Nisar et al ., 2025 ). South Asian immigrants in the UK, US, Norway and Canada are at a higher risk of abdominal obesity, hypertension, dyslipidemia and impaired glucose intolerance, which directly contribute to cardiovascular disease and type 2 diabetes mellitus (Mahadevan et al ., 2023 ). In America, one in four deaths among Indian immigrants is caused by cardiovascular disease (Gidwani et al ., 2021 ). Deficiency in Vitamin D is also common among Indian immigrants living in countries such as the UK, US, Canada, South Africa, and Australasia (Darling, 2020 ; Partha, 2024 ). Apart from Indian immigrants being the largest immigrant group in Australia, and the largest to use PHC services to manage their chronic health conditions, they consider medical expertise, responsiveness, and inclusion in decision making processes when assessing the quality of the health care they receive (Chatterjee and Srinivasan, 2013 ). Communication due to socio cultural differences is reported to be a barrier in accessing health care among south Asian migrants (Adhikari et al ., 2021 ; Nisar et al ., 2022 ). However, the specifics for Indian immigrants in PHC is lacking in empirical research. While the above evidence explores the access and decision-making issues experienced by migrants, the current study focuses solely on the experiences of Indian immigrants with PHC services in Australia. Considering the large proportion of Indian immigrants with chronic illnesses that are managed through PHC, their cultural variations and ethno-specific healthcare needs warrant concerted information on their experiences with PHC services.

This study highlights the importance of timely and compassionate PHC for Indian and other immigrants living with chronic illness in Australia. A commitment to meeting the lifelong health needs of culturally diverse groups requires that the Australian health care system attend to the ongoing untimely access to PHC services. While the findings of this study presented common experiences among Australian immigrants, it is the first study to specifically present those described by Indian immigrants alone.

A qualitative exploratory approach was adopted using virtual semi-structured interviews that facilitated in-depth exploration of personal experiences of Indian immigrants regarding PHC services across Australia, a topic that remains under-explored (Denzin and Lincoln, 2018 ). This approach facilitated deeper insights that form the foundation of more specific research in future. Rigour was maintained throughout the study by meeting four criteria as recommended by Hammarberg et al ., ( 2016 ). These criteria were trustworthiness, credibility, applicability, and consistency. Trustworthiness was achieved by presenting a detailed description of the study purpose and process, including how decisions were made and how data was generated. Credibility was achieved by using robust quotes and contextual details to support the findings, along with details on reflexivity. Detailed descriptions of the sampling, recruitment, data collection and data analysis methods, and participant information are presented to achieve applicability. Additionally, presenting detailed findings that were verified by all members of the research team helped achieve consistency. The guidelines for Consolidated Criteria for Reporting Qualitative Studies (Tong et al ., 2007 ) and the Consensus Reporting Items for Studies in Primary Care (CRISP) checklist (Phillips et al ., 2023 ) were followed. A social constructionism perspective guided this study. This perspective supports the notion that there are multiple realities and that one’s understanding of the world and, therefore, their perception of reality depends upon dynamic social and cultural contexts of the time (Burr and Dick, 2017 ; Doyle et al ., 2019 ). Social constructionism has a number of assumptions including social reality being socially constructed, and reality not being an objective truth. Guided by these assumptions, we utilized semi-structured interviews that enabled participants to provide their subjective experiences of accessing PHC for the management of their chronic illnesses. Social constructionism assumes that multiple realities are possible. This informed the adequate attention that we paid to each of the participants’ interview transcripts in the course of data analysis. Even when participants provided competing and contrasting responses to the interview questions, our understanding of the social constructionism assumption that there is no single correct and factual reality guided the wide presentation of participants’ subjective quotes. Participants were eligible for inclusion in this study if they (1) identified as Indian immigrants in Australia, (2) were aged 18 years and over, (3) had an existing chronic condition that had been diagnosed for at least 6 months, for which they were utilizing PHC services, and (4) were willing to participate. The exclusion criteria for this study were people who could not converse in the English language and people who self-reported with any cognitive impairment that would prevent them from providing informed consent and, thus, participating in the interview. Purposive sampling was used to intentionally recruit participants who met the inclusion criteria. Self-identified adult Indian immigrants with chronic illnesses were considered central to obtaining an in-depth understanding of their lived experiences. Participants were informed of the study using a flyer that was posted on unpaid social media platforms, including personal Facebook and WhatsApp community groups between April and May 2024. These platforms have been successfully used in previous studies to recruit research participants from diverse communities and geographical areas efficiently (Darko et al ., 2022 ; Pathak et al ., 2025 ). Examples of Facebook groups used in this study included ‘Indian Mums of Australia’, ‘Indian Families Connect (Sydney)’, ‘Blacktown Indian Community – Sydney’, and ‘Penrith LGA Indian Community Group’. These groups provide members with opportunities to reach out for help, support, and advice, and allow for social and community connections and networking. The first author (RS) is an Indian migrant in Australia and a member of these groups (not an administrator). There are a few similar WhatsApp groups of which the researcher is a part. These provide more localized connections and ease of access to a diverse range of potential participants. Such groups include ‘Glenmore Park Mums’ Group’ and ‘Penrith LGA Unity Group’. However, despite using social media recruitment, this did not result in a favourable outcome, perhaps due to the sensitive nature of the topic. It was anticipated that interviewing 10 to 15 participants would provide adequate data to identify common patterns and recurring themes to gain deeper insights into Indian immigrants’ experiences with PHC services. However, data collection was stopped after engaging 11 participants, as no new concepts were identified for this exploratory study (Vasileiou et al ., 2018 ; Braun and Clarke, 2022 ;). A participant information sheet detailing the aims of the study, data collection method, confidentiality, and voluntary participation and withdrawal was provided to interested participants. They were also provided with an informed consent form which they were asked to read, understand, and sign prior to participation. They were able to seek any clarification and ask further questions before providing their written consent and taking part in an individual interview. Before the commencement of the interview, another opportunity was provided to participants for any questions or clarifications. Their consent and willingness to participate and have their unidentifiable data used in this and further related research and publication was confirmed. They were reinformed that they could withdraw at any stage and/or refuse to answer any questions, without repercussion. No incentives were provided to participants. Data for this study was collected through semi-structured interviews conducted and recorded virtually via Zoom. This was due to the convenience that remote interviews provided to participants and to ensure the comfort of a familiar environment, potentially allowing them to express their thoughts more easily (Pocock et al ., 2021 ; Taherdoost, 2023 ). Participants were given the option to turn their video off prior to the interview and all the interviews were audio recorded. These interviews were conducted by the first author (RS), a registered nurse and researcher working in PHC. The researcher received training in qualitative interviewing techniques. To ensure methodological rigour and interviewer confidence, the first interview was conducted jointly with an experienced qualitative researcher from the team. Participants were required to provide pseudonyms to which they were referred to in this study. An interview guide with open-ended questions was utilized (Appendix A). This guide was informed by the expertise and experience of the research team and after examining existing literature while ensuring that the questions addressed the research topic. The semi-structured interviews ranged from 30 minutes to one hour, allowing for a relatively set agenda and predetermined questions while permitting probing and clarification and hence, facilitating the collection of rich data (Taherdoost, 2023 ). Participants were asked to share their experiences regarding the PHC services they used for the management of their illnesses. The interviewer took brief notes during the interviews, followed by detailed contextual descriptions and reflections from the interviews. The recorded interviews were transcribed verbatim, and data was stored securely in password-protected documents and folders on a secure file-sharing platform on the university’s network ( Privacy and Personal Information Protection Act 1998 (NSW), pt 2, div 1 ; Western Sydney University, 2022 ; National Health and Medical Research Council, 2023 ). Data analysis was commenced simultaneously with data collection to ensure adequacy of data until no new concepts were introduced (Braun and Clarke, 2022 ; Klem et al ., 2022 a). Analysis of the data from the transcribed interviews was guided by Braun and Clarke’s ( 2023 ) six phases of thematic analysis of qualitative data, namely, phase one: familiarization with the data; phase two: generating initial codes; phase three: generating themes; phase four: reviewing potential themes; phase five: defining and naming themes; and phase six: producing the report. The first phase involved the first author (RS) becoming familiar with the data to identify similarities and differences across the dataset. Then, initial codes were generated before descriptive themes and subthemes were identified, reviewed, defined, and named by the research team (RS, OO, SP, AL). The themes and subthemes reflected the participants’ experiences as understood and collectively interpreted by the research team. This non-linear and iterative process was documented in NVivo 14 (Lumivero, 2023 ) to track the evolution of the codes and their prospective themes by the research team, thereby facilitating a transparent process of data analysis (Byrne, 2022 ; Braun and Clarke, 2023 ). Additionally, debriefing during weekly meetings, and maintaining an audit trail with a detailed log of the research processes and decisions was maintained (Cope, 2014 ; Klem et al ., 2022 b). This included records of the research process such as interview transcripts, stages of data analysis, and draft reports. Furthermore, rich, vivid, and verbatim participant quotations were used to confirm that the analysis presented was collated directly from the collected data. Member checking was not used in this study as the research team felt that revisiting the sensitive areas of chronic illnesses and PHC experiences and the potential reporting of negative experiences may be triggering. It is important to acknowledge that the first author (RS) who conducted interviews of participants, is an Indian immigrant and a registered nurse working in PHC, positioning her as an insider with shared experiences to those of the participants. Of the other researchers, SP is also an Indian immigrant, and all (SP, OO, and AL) are registered nurses who have had experiences caring for Indian immigrants. As such, it was imperative to address the role, biases, assumptions, prejudices, beliefs, attitudes, and learning of the research topic to eliminate potential bias in the design of the study, recruitment of participants, collection and interpretation of data, and writing of the findings (Berger, 2015 ; Teh and Lek, 2018 ). This was achieved via a reflective journal and weekly debriefing meetings held by the research team where perspectives, interpretations and assumptions from the interviews were critically reflected upon to ensure credibility throughout the duration of this study. This study was approved by the institutional Human Research Ethics Committee (Approval Number: H15813 ).

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