The Centrality of Trust: Examining Perceptions of African Immigrant Women on Access and Utilization of Primary Healthcare Services in the United States

Background and purpose: It is well documented that immigrants are influenced by low rates of health insurance and access to healthcare services in the United States. Previous studies in the immigrant health literature reported barriers such as the high cost of insurance, language, and challenges of acculturation impede immigrants’ ability to access and utilize healthcare services. However, most studies focused on larger U.S. immigrant groups such as Latinx and Asian immigrants. In order to fill this gap, this study examined perceptions of Ethiopian immigrant women’s (EIW) healthcare services in the United States. and how that affects their motivation and ability to access and utilize primary healthcare (PHC) services.

Methods: The study used a cross-sectional qualitative design to explore perceptions of EIW on PHC, and how it impacted their experience and healthcare decisions. A combined method of purposive and snowball sampling was used to recruit participants (N=21) who identified as Ethiopian female immigrants, 18 years and older, who arrived in the U.S. within the last five years, and who spoke Amharic or English languages. Participants were recruited from six different states and Washington DC. In-depth interviews were conducted both in-person and virtually, audio-recorded, and transcribed verbatim. A comprehensive codebook was developed and Nvivo12 software was used to analyze data thematically.

Results: Results of the thematic analysis revealed that participants had mixed perceptions about PHC of the U.S.–technologically advanced but inaccessible. Participants recognized the disparities in the quality of services available to low-income and immigrant communities. Participants expressed that the PHC is heavily reliant on medication and lacks transparency, particularly for immigrants with limited knowledge of the U. S. healthcare system. Participants’ perceptions were influenced by their faith and preference for traditional remedies over modern medicine. Lack of trust was the central factor across all the themes that emerged during the analysis and the fundamental challenge in accessing and utilizing PHC services among EIW. Lack of trust also led to the avoidance of PHC and adjustments of healthcare needs for this population.

Conclusion and implications: Overall the findings demonstrated that EIW’s perceptions are influenced by contradictory beliefs they hold contrary to the nature and procedures of PHC in the U.S. More importantly, the findings revealed that lack of trust is the primary concern impacting EIW’s decision-making in accessing and utilizing PHC services. Unlike most immigrant literature focusing on financial and linguistic barriers, this study emphasizes the importance of trust for immigrants to improve their access and utilization of PHC services. Promoting medical and financial transparency in the PHC system is key to building trust with immigrants and improving their access and utilization of care. In addition, enhancing immigrants’ health literacy through community-based health information initiatives could help mitigate the erosion of trust in PHC services. There is a clear need for further research examining the root causes of the lack of trust at a larger scale for the development of practical solutions.