Exploring perceptions, barriers, and facilitators of access to primary health services among African immigrant women in the U.S. : a study of Ethiopian immigrant women
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Access to healthcare services remains a top public health concern in the United States and immigrants are disproportionately affected by low rates of health insurance coverage and poor access to healthcare services. It is reported that 23 percent of lawfully present immigrants and 45 percent of undocumented immigrants are uninsured as compared to the 8 percent of uninsured citizens. Particularly, immigrant women experience multiple barriers in accessing healthcare services and are at higher risk of health problems. Within the immigrant women population, African immigrant women have the lowest access and utilization of healthcare, a high rate of HIV and STDs, high rate of employment in unskilled labor that is hazardous and with no protection. However, African immigrant women remained understudied and underrepresented in the immigrant health literature. This study explored the perceptions, barriers, and facilitators experienced by African immigrant women in accessing primary healthcare (PHC) with a particular focus on Ethiopian immigrant women (EIW). A qualitative design with a phenomenological approach was conducted to investigate what challenges were experienced by EIW and how they experienced them. Data were collected using in-depth interviews with EIW (N=21) aged 18 and older (M=36.6) conducted both in-person and virtually via phone and Zoom. Interviews were audio-recorded and transcribed verbatim. Data were analyzed thematically using Nvivo12 software. Findings showed that the transition and adjustment into a new country and healthcare system delayed EIW's timely access to PHC services. EIW believe that PHC in the U.S. is of better quality but inaccessible. Compared to their past experiences, EIW started using annual general checks ups in the U.S. but tended to avoid PHC unless they are faced with severe health issues or had maternal care needs. Lack of trust in the PHC system that was underlined by personal barriers including contradictory health beliefs, language and communication, and limited health literacy hindered EIW's access to PHC. Findings demonstrated that structural barriers, mainly immigration status, unaffordability of PHC, complexity, and discrimination in healthcare impeded EIW's access to PHC. Social support and having a stable job were the two major facilitators to accessing PHC. The findings suggested that in addition to expanding customized health information, translation, maternal health, and affordable care services; it is imperative to make immigration policy reform, decolonize the PHC system and diversify the health workforce. As the first known study on EIW's PHC experience, the study highlighted the need to view access through a lens of everyday life struggles of immigrant women, investigate the lack of trust, and move toward a structural approach in understanding and addressing barriers to access among immigrant women.
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Ph. D.