Experiences and Perspectives of Immigrant Women in Accessing Healthcare Services in the United States: A Qualitative Meta-Synthesis

Background and Purpose: In 2018 nearly one in four (23%) of lawfully present immigrants and almost half (45%) of undocumented immigrants in the United States are uninsured. Within the immigrant population, women are more vulnerable than men to health problems because they are disproportionately affected by lack of access to health services. However, the experiences and needs of healthcare services among immigrant women are not well-represented in the immigrant health literature. Qualitative meta-synthesis can address this gap as it helps look deeper than analyzing numbers and counts by recording the feelings and perspectives of immigrant women. This study is to examine experiences and perspectives of immigrant women in utilizing healthcare services in the United States by synthesizing results from primary qualitative studies. It is intended to inform policymakers and stakeholders in the healthcare system about the challenges and real experiences of immigrant women in accessing healthcare services.

Methods: This study used a theory-generating qualitative meta-synthesis method. This method has an assumption that theory can be inductively generated from qualitative data. PubMed, ProQuest, Scopus, GenderWatch, PsychINFO, psychological, sociological, and social work abstract databases searched using keywords such as immigrant women, access to healthcare services, and qualitative study to retrieve 147 study reports. A two-staged review, a title and abstract review followed by a full-text review, was done to select the final 11 study reports for synthesis. We used PRISMA 2020 Flow diagram for systematic reviews. Each of the selected studies were assessed for quality appraisal using the 10 questions of the Critical Appraisal Skills Programme (CASP) checklist. The findings sections from the selected studies were extracted and coded using Nvivo12 software. The software generated code reports were assembled to create meaning and further establish relationships among the themes and sub-themes. A diagram was developed to visualize the findings and guide the discussion.

Results: Our study showed that immigrant women perceived a number of barriers to utilize healthcare services. These include lack of transportation, health insurance, distrust, financial instability, and inadequate health information. They also experienced language barriers, miscommunication, gender issues, and eligibility issues because of their immigration status. In addition, immigrant women were frequently subject to continuous discrimination in the healthcare system. For example, immigrant women experienced racial discrimination in healthcare places particularly among Black immigrants and older immigrants. In order to deal with these barriers, immigrant women relied on family and community support (e.g., physical and emotional help, transportation), cultural solutions (e.g., traditional medicine, home-made remedies), organizational support (e.g., translation services), and positive health behavior (e.g., exercise).

Conclusion and Implications: Using the theory-generating qualitative meta-synthesis method from the 11 selected studies, this study identified that immigrant women perceived both personal and system-level barriers to utilize healthcare services, and experienced a number of difficulties due to miscommunication and cultural differences Policymakers and healthcare providers should integrate culturally relevant and inclusive approaches into healthcare systems, include more places with multi-lingual health information services, and work with immigrant women and their community in the decision-making process Further implications will be discussed.