Table 3 Challenges in engaging stakeholders

Engaging migrant communities:

 • Austria: GPs work in single handed practices without migrant patient representative groups. The research team fostered dialogue between academically-oriented stakeholders from primary care and migrant representatives.

 • Greece & the Netherlands: GPs engaged with migrants at project meetings in general but expressed discomfort about involving migrant representatives directly in discussions about the practice. Research teams addressed this by engaging in parallel dialogues about these issues with migrant representatives and shared the information across the groups.

Engaging primary care staff:

 • England: Restructuring of primary care made it difficult to involve a GP practice in the early stages of fieldwork. GP members of the stakeholder group offered their perspectives until a primary care team agreed to participate.

 • Greece & the Netherlands: Healthcare staff found it difficult to attend long PLA focus groups. In the Netherlands research teams introduced shorter sessions; in Greece they met individually with practice staff.

 • Ireland: Poor engagement of some GPs and administrators in the participating practice was offset by sustained commitment by the principal GP and practice manager.

Engaging interpreters:

 • Greece: No formal primary care interpreting service existed. The research team made innovative arrangements with an NGO and a certified interpreter to negotiate telephone-based interpretation services for primary care patients.

 • Ireland: There was no national interpreting service with trained interpreters. This was resolved by exploring and drawing on expertise of trained community interpreters within the stakeholder group.

Engaging policy makers and health service planners:

 • England: Restructuring of primary care due to policy changes meant that a key policymaker stakeholder was moved to a different job. The stakeholder group brought in new policymakers/health service planners at a later stage of the project.