Barriers to accessing preventive health care among African-born individuals in King County, Washington: A qualitative study involving key informants

Abstract

Studies of African immigrant health in the U.S. have traditionally focused on infectious diseases. However, the rising burden of non-communicable diseases (NCDs) indicates the increasing importance of general preventive health care. As part of a series of community health events designed for African-born individuals in King County, Washington, we administered key informant interviews (KIIs) with 16 health event participants, medical professionals, and community leaders to identify barriers and facilitators to use of preventive health care among African-born individuals. We used descriptive thematic analysis to organize barriers according to the socio-ecological model. Within the individual domain, KII participants identified lack of knowledge and awareness of preventive health benefits as barriers to engagement in care. Within the interpersonal domain, language and cultural differences frequently complicated relationships with health care providers. Within the societal and policy domains, healthcare costs, lack of insurance, and structural racism were also reported as major barriers. Participants identified community outreach with culturally competent and respectful providers as key elements of interventions to improve uptake. In conclusion, African immigrant communities face several barriers, ranging from individual to policy levels, to accessing health services, resulting in substantial unmet need for chronic disease prevention and treatment. Community-centered and -led care may help facilitate uptake and engagement in care.

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“…Lack of information and inability to navigate the US healthcare system is a critical barrier to healthcare access for immigrants [ 42 ]. Our finding that language barriers and inadequate health literacy limited participants’ ability to communicate effectively with doctors and comprehend health information was also consistent with the results of other studies of immigrant health in the U.S. [ 31 , 42 ].…”

“…However, it may be necessary to address the cultural attitudes and beliefs that we observed in order to most effectively reach African immigrant populations with preventative care. Other studies have found similar themes when examining the uptake of health care among African immigrants, including lack of health insurance [ 41 ], difficulty navigating the healthcare system [ 31 , 42 ], and barriers related to language and inadequate health [ 31 , 42 ]. However, our study fills an important gap in the existing literature in that we focused on an uptake of preventive health care overall as opposed to the uptake of care or prevention services for one specific health problem, and we focused on three East African immigrant communities rather than one community.…”

“…Lack of health insurance is also an obstacle among many immigrants in the U.S., despite the expansion of healthcare access granted by the Affordable Care Act, due to lack of or ineffective methods of enrollment [ 41 ]. Furthermore, we and others have found that insured individuals reported having problems navigating the healthcare system, particularly when it came to determining exactly what insurance benefits they were receiving [ 31 ]. Lack of information and inability to navigate the US healthcare system is a critical barrier to healthcare access for immigrants [ 42 ].…”

“…This study was part of an academia-community partnership between the University of Washington (UW) researchers and the Somali, Ethiopian and Eritrean health organizations in King County, WA [ 31 , 32 ]. This partnership arose from our ongoing work to address barriers to HIV testing amongst local African immigrant communities utilizing the principles of community-based participatory research.…”

“…However, the uptake of health care by individual immigrant communities likely also varies by community and cultural norms, including attitudes around health, wellness, and medicine [ 27 , 28 , 29 , 30 ]. In our previous formative work examining barriers to HIV testing in largely East African immigrant communities in the Seattle area, participants reported that uptake of preventative services generally was low in their communities [ 31 ]. Indeed, in the same study, we found a high prevalence of non-communicable diseases among African immigrant participants in community-based health fairs, including overweight/obesity, hypercholesterolemia, and hypertension [ 32 ].…”