Health-Seeking Decision-Making Process and Behavior Among Haitian Immigrants

Background and Purpose: Although Haitian immigrants in the U.S. are more likely than other immigrants to be U.S. citizens or have legal permanent residence, they are lagging behind other racial/ethnic and immigrant groups regarding health. For health advice and treatment, Haitians are more likely to rely on family, friends, and faith-based leaders, and seeking healthcare services is a last resort. Accessing healthcare is crucial to health and well-being, and delaying medical attention can lead to negative outcomes. Prior research on immigrant health-seeking behavior has largely focused on Asian and Hispanic populations. Given the unique culture and immigration experiences of Haitian immigrants, it is necessary to understand their health-seeking decision-making process and behaviors. This study aims to increase knowledge about Haitian immigrants’ health-seeking to inform interventions that seek to reduce/eliminate health disparities and address the health concerns of this population.

Methods: This qualitative study applied the constructivist grounded theory approach. Convenience sampling was used to recruit participants through flyers shared with local nonprofit organizations, researcher’s social networks, and enrolled participants. A total of 16 first-generation Haitian immigrants living in Central Florida and from varying age groups, educational backgrounds, and amount of time living in the U.S. participated in the study: 12 through one-on-one semi-structured interviews, and four in a semi-structured focus group. The following research question was explored: How do Haitian immigrants make decisions about their health-seeking behavior? Data analysis occurred through initial, focused, and theoretical coding using the Atlas.ti qualitative software. Memos and member checking were employed to increase the validity and credibility of the findings.

Results: Findings from this study led to the development of the Haitian Immigrant Health-Seeking Decision-Making Process Model. Steps in this process include 1. Self-diagnosing, 2. Self-treating as informal health-seeking, 3. Self-monitoring, 4. Considering formal health-seeking, and 5. Seeking medical services as formal health-seeking. The model shows that cultural identity, social support, the stigmatization of using healthcare services, a cost-benefit analysis, fear of immigration issues, and attitudes toward the healthcare system are significant factors related to Haitian immigrants’ health-seeking decision-making process. Haitian immigrants draw upon their cultural identity in each step to guide their decisions and behaviors, and they frequently consult with their social networks. Haitian immigrants can bypass barriers such as lacking resources by relying upon their social network when they are desperate due to severe illness.

Conclusion and Implications: Understanding the health-seeking decision-making process and behavior of Haitian immigrants is essential to addressing the health disparities they disproportionately face and to promoting their overall well-being. Findings from this study has implications for pursuing policy reform to reduce health disparities by supporting culturally inclusive practices in healthcare and using collaborative, community-based approaches to reduce stigmas associated with the use of formal healthcare services. This includes partnering with religious leaders to provide health education and preventive healthcare services for illness prevention and early intervention. In addition, this study has implications in advocating for housing reform to promote health through the allowance and provision of private and/or community spaces for gardening, a significant cultural health practice.