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

Abstract

Purpose: This qualitative study explores the barriers and facilitators to health care from the perspective of providers who care for patients without documentation status in the San Francisco Bay Area. Methods: Twenty-four direct providers were interviewed using semi-structured in-depth interviews. Participants included health care providers and community-based organization leaders. Interviews were independently coded using grounded theory analysis. The socioecological framework was used to develop the interview guide, analyze findings, and guide the discussion. Results: Participants identified fear as a barrier that transcended multiple levels of influence. At the public policy level, national policies, such as public charge and anti-immigration rhetoric, limited access to services. Local expansion of health care coverage, such as Healthy San Francisco, facilitated access to care. At the organizational level, law enforcement presence generated fear. This was countered by a welcoming environment, described as culturally concordant clinical sites, representation of the community in the provider pool, and resources to address social needs. Individual-level fear, rooted in trauma and economic insecurity, was eased by trauma-informed care and health navigators. Community engagement and sustained partnerships built trust and credibility to transcend the fear that hindered access to care. Conclusion: In a region with expansive policies for improved health care access, barriers are rooted in fear and span individual, organizational, and public policy levels of access to care. Richer community engagement may lessen the national and systemic barriers that this vulnerable population continues to face. Developing an understanding of this topic improves health care providers' ability to meet the needs of this growing and vulnerable population.

Barriers and facilitators to healthcare for people without documentation status: A systematic integrative literature review

“…PWDS also feared deportation, discovery of their undocumented status, being reported to immigration authorities and family separation, which resulted in delaying or forgoing healthcare altogether. This finding was consistent with other studies that found even in sanctuary cities of San Francisco and Los Angeles that have local safety‐net healthcare programs for all its residents regardless of immigration status, services remained underutilized due to persisting fear and misinformation (Alwan et al, 2021; Yu et al, 2020). Thus, it is crucial that healthcare systems aim to establish and maintain trust with PWDS to address their fears of using the healthcare system.…”

“…The United States (US) is home to the world's largest immigrant population, constituting over 44.9 million individuals, of whom nearly 25% (11 million), are not legal residents and do not possess authorization to live or work in the United States (Baker, 2021; Ward & Batalova, 2023). These foreign‐born non‐citizens are often referred to as undocumented immigrants (Kaiser Family Foundation [KFF], 2022), unauthorized immigrants (Baker, 2021) and people without documentation status (PWDS, Alwan et al, 2021). Most PWDS entered the US without authorization or remained after their visas expired (Baker, 2021).…”

“…[KFF], 2022), unauthorized immigrants (Baker, 2021) and people without documentation status (PWDS, Alwan et al, 2021). Most PWDS entered the US without authorization or remained after their visas expired (Baker, 2021).…”

Knowledge of Family Planning and Access to Sexual and Reproductive Health Services by Immigrant Youth in Hillbrow, South Africa: A Cross-sectional Study.

“…Researchers globally have examined barriers and facilitators of KFP and access to SRH services by immigrant youth [11][12]). Factors in uencing KFP and access to health care services include individual factors such as gender, age, level of education and wealth index [13] and migration status [14][15].…”

Factors associated with knowledge about family planning and access to sexual and reproductive health services by sexually active immigrant youths in Hillbrow, South Africa: a cross-sectional study

“…Hillbrow is an immigrant-dense urban suburb of Johannesburg, with a total population of approximately 74,000; of which 58% are between 18 and 34 years, and 27% are immigrant youths [ 6 ]. Researchers globally have examined factors influencing knowledge of family planning KFP and access to SRH services by immigrant youths [ 7 , 8 ]), which include gender, age, level of education, wealth index [ 9 ] and migration status [ 10 , 11 ]. Other influencing factors identified by researchers include experiences of discrimination and lack of social support [ 12 , 13 ]; as well as attitude of health care practitioners [ 8 , 14 ].…”