Barriers & facilitators to healthcare and social services among undocumented Latino(a)/Latinx immigrant clients: Perspectives from frontline service providers in Southeast Michigan

Abstract

Immigration-and enforcement-related policies and laws have significantly and negatively impacted the health and well-being of undocumented immigrants. We examine barriers and facilitators to healthcare and social services among undocumented Latino(a)/Latinx immigrants specifically in the post 2016 US presidential election socio-political climate. By grounding our study on the perspectives of frontline providers, we explore their challenges in meeting the needs of their undocumented clients. These include client access to healthcare and social services, the barriers providers face in providing timely and effective services, and avenues to reduce or overcome factors that impede service provision to improve quality of care for this population. Data are from 28 in-depth interviews with frontline healthcare and social service providers. Based on data analysis, we found that the domains of the Three Delays Model used in obstetric care provided a good framework for organizing and framing the responses. Our findings suggest that these undocumented clients encounter three phases of delay: delay in the decision to seek care, delay in identifying and traveling to healthcare facilities, and delay in receiving adequate and appropriate care at healthcare facilities. Given the current socio-political climate for immigrants, healthcare and social services organizations that serve undocumented clients should adapt existing services or introduce new services, including those that are not site-based.

Application of the Minority Stress Theory: Understanding the Mental Health of Undocumented Latinx Immigrants

“…The research question addressed in this manuscript was identified later in the process after our committee analyzed and disseminated initial results (Doshi et al, 2020; Fleming et al, 2019; Mesa et al, 2020). After these initial findings, partner agencies and clients wanted to focus on how to respond to mental health concerns within these communities.…”

Barriers and Facilitators to Accessing Health Services for People Without Documentation Status in an Anti-Immigrant Era: A Socioecological Model

“… 3 These challenges are manifested in concrete process measures, such as delays in the decision to seek care, difficulty in identifying and traveling to health care facilities, and receipt of lower quality care at those facilities. 8 …”

“…Lack of insurance and other policy restrictions create an environment of fear and stress that dissuade patients from seeking care, even when absolutely necessary. 8 , 13–16 The recent promulgation of the public charge rule, a federal regulation that limits the social services immigrants can utilize to qualify for legal permanent residency, has exacerbated this sense of fear and avoidance of the health care system. 2 , 17 In addition to the policies that directly restrict health care access, several federal and local measures curtail social and economic opportunities for PWDS.…”

“…This includes fear of legal repercussions, language and cultural barriers, transportation and childcare costs, housing and education access, and so on. 8 , 18–20 In some cities, community-based nonprofits focus interventions on the social determinants of health. Such organizations provide educational and social assistance (i.e., linkage to food, housing, and employment services) that ultimately improve health care access.…”

Medicaid expansion and accessibility to healthcare: The Illinois experience

“…Black or Latino/a adults also had increased access to healthcare, but they still face less access than White adults. It is at least noteworthy that there was no significant improvement among the Latino population, which could be associated with language barriers, limited experience using health insurance, and eligibility requirements which have been documented elsewhere (Doshi et al., 2020; Edward et al., 2018). Our findings suggest that earlier research on the challenges that rural residents face accessing healthcare might apply more to low‐income, nonwhite groups as opposed to rural residents overall.…”