Dementia in primary care: a qualitative study with general practitioners and caregivers with and without migration backgrounds

Dementia care presents significant challenges for caregivers and healthcare providers. Understanding these challenges, particularly in the context of cultural diversity, is essential for improving care quality. This study examines caregiving experiences among three groups—caregivers without migration background, caregivers with migration background, and general practitioners (GPs)—to gain insights into their distinct challenges and identify areas for support. An explorative qualitative study design was used, employing semi-structured interviews with participants from three groups: caregivers without migration background, caregivers with migration background, and GPs. Participants were recruited in Hesse, western-central Germany, through GP practices, dementia support organizations, and social institutions. GPs were drawn from the research network of the Department of Primary Care in Marburg. Interviews, conducted between October 2020 and June 2021, were analyzed thematically. Findings were compared across groups to identify shared and unique experiences. The analysis revealed six main themes: 'Core health care challenges,' 'communication approaches and information sharing,' 'role of GP,' 'situation of caregivers,' 'influence on caregiver-GP relationship,' and 'socio-cultural barriers and care preferences'. Key differences emerged in GP approaches to dementia diagnosis and communication, as well as in expectations of the GP's role. Caregivers expressed the need for more time, empathy, and information from GPs, while GPs highlighted challenges such as limited consultation time and concerns about treatment effectiveness. Caregivers with a migration background experienced additional challenges such as cultural and linguistic barriers, which impacted their access to and navigation of dementia care. This is the first qualitative study to explore caregiving experiences across these three groups. The findings highlight the importance of addressing the specific needs of dementia patients and their caregivers, particularly those from migration backgrounds. Enhancing culturally sensitive support services and promoting cultural competence among healthcare providers are critical to improving dementia care. Addressing these gaps requires collaborative efforts to better align healthcare services with the diverse needs of caregivers and patients.