Barriers and Facilitators of Access to Healthcare Among Immigrants with Disabilities: A Qualitative Meta-Synthesis

Background and Purpose: By the close of 2022, there were approximately 54.8 million immigrants in the United States and Canada. Immigrants face unique challenges in accessing healthcare due to a complex interplay of legal, financial, linguistic, and cultural barriers. Within the immigrant population, those with disabilities are more vulnerable and are disproportionately affected by a lack of access to healthcare services. However, the unique challenges, experiences, and needs of immigrants with disabilities are not adequately studied and represented in the extant health literature. This qualitative meta-synthesis examines the barriers, facilitators, and lived experiences of immigrants with disabilities accessing healthcare in the U.S. and Canada. The study also aims to inform policy and practice to improve access and health outcomes for this marginalized population.

Methods: The study used a theory-generating qualitative meta-synthesis. This approach meticulously harnesses qualitative data from a spectrum of published research reports by engaging in an inductive analytical process that allows for extracting and integrating raw qualitative insights. A comprehensive search was conducted using keywords such as immigrants with disabilities, barriers to access, healthcare experiences, and facilitators of access. Databases searched included Medline, APA PsycINFO, ProQuest, Web of Science, Medical Subject Headings (MeSH), PubMed, EBSCO, and Google Scholar. Zotero bibliographical software was used to collect, manage, and screen peer-reviewed and published qualitative studies. The original search yielded a total of 752 articles, which, upon title review, reduced to 110 preselected for the second stage of abstract review, and 24 made it to the third stage of full-text review. Only 11 articles met the inclusion criteria for this meta-synthesis. The final articles were assessed using the Critical Appraisal Skills Program (CASP) checklist, and a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart was used to report on the selection process. A comprehensive codebook was developed, and Nvivo12 software was used to code and analyze data.

Results: The study highlighted that immigrants with disabilities faced several barriers to utilizing healthcare services. The analysis identified systemic barriers (including bureaucratic challenges and lack of insurance), socioeconomic factors (financial constraints and employment barriers), lack of social support, and cultural and linguistic barriers as significant obstacles to healthcare access. Our study also found that caregivers and immigrants with disabilities also experience language barriers, miscommunication, gender issues, discrimination, and eligibility issues because of their immigration status. Facilitators of access included community support, targeted healthcare programs, organizational support, social networks, some knowledgeable social workers, and translation services.

Conclusion and Implications

This study identified that immigrants with disabilities face multiple challenges in accessing healthcare services. Government and healthcare providers should ensure reduced barriers to healthcare access through improved communication, provide cultural competency training for both service providers & immigrants, and support immigrant families to create supportive networks within their communities. Different levels of government should ensure the provision of integrated, culturally relevant, and inclusive approaches within the healthcare systems, have more places with multilingual health information services, and work with immigrants with disabilities to improve healthcare access.