"They Don't See Us As Humans": Multilevel Factors Affecting Trust in Healthcare Among African Immigrants in the U.S

Background: Trust is essential to healthcare access, utilization, and health outcomes, yet many African immigrants in the U.S. experience deep mistrust in healthcare systems. This mistrust is rooted in individual, interpersonal, and institutional factors, often compounded by systemic racism, cultural differences, and anti-immigrant sentiment. While previous research has often centered on historical events and structural discrimination affecting African Americans, African immigrants bring unique experiences and expectations shaped by their cultural backgrounds and migration histories. This study explores how personal beliefs, healthcare interactions, and institutional practices intersect to shape trust in healthcare among African immigrants living in Florida.

Methods:This qualitative study employed a grounded theory approach to explore the multifaceted dimensions of trust in healthcare. Participants (N=19) were recruited using purposive and snowball sampling from diverse African countries and interviewed via Zoom or phone. Eligible participants were African immigrants over the age of 18, living in Florida for five or more years, and had recent experience with the U.S. healthcare system. Interviews were audio-recorded, transcribed verbatim, and analyzed using open and axial coding with NVivo14. Researchers developed themes through constant comparison and collaborative analysis, leading to a framework identifying personal, interpersonal, and institutional factors influencing healthcare trust.

Results: Thematic analysis uncovered a range of personal, interpersonal, and institutional contributors to participants’ distrust in healthcare. On the personal level, language and communication barriers, lack of knowledge about the healthcare system, past negative experiences, fear of jeopardizing immigration status, and reliance on traditional medicine or prayer all created skepticism and hesitancy toward care. Interpersonally, participants shared that they often felt disrespected, rushed, ignored, or stereotyped during encounters with providers. Many described cultural disconnects, such as discomfort with shared decision-making or fear of being seen as burdensome. Others noted that providers lacked cultural sensitivity, dismissed their concerns, or made assumptions based on age, race, or immigration status. These experiences not only deepened mistrust but also shaped decisions to delay or avoid care. Institutionally, participants pointed to providers’ lack of training in tropical medicine and immigrant health, racial and ethnic underrepresentation among healthcare professionals, overmedicalization, financial opacity, excessive paperwork, and discriminatory policies (e.g., documentation requirements tied to immigration status). These systemic issues reinforced perceptions of an uncaring and profit-driven system, where immigrant patients felt dehumanized, stereotyped, and underserved.

Conclusion: Trust in healthcare among African immigrants is undermined by the intersection of personal, interpersonal, and institutional factors. A culturally competent, patient-centered approach is urgently needed to rebuild trust and ensure equitable access to healthcare. This includes expanding interpreter services, increasing provider diversity, improving provider training on immigrant and race-specific health issues, and addressing discriminatory policies and financial barriers. Interventions must be rooted in cultural humility, empathy, and respect, and be responsive to the lived realities of African immigrant communities.