Understanding the healthcare experiences and needs of African immigrants in the United States: a scoping review

Abstract

Background: Africans immigrants in the United States are the least-studied immigrant group, despite the research and policy efforts to address health disparities within immigrant communities. Although their healthcare experiences and needs are unique, they are often included in the "black" category, along with other phenotypically-similar groups. This process makes utilizing research data to make critical healthcare decisions specifically targeting African immigrants, difficult. The purpose of this Scoping Review was to examine extant information about African immigrant health in the U.S., in order to develop lines of inquiry using the identified knowledge-gaps. Methods: Literature published in the English language between 1980 and 2016 were reviewed in five stages: (1) identification of the question and (b) relevant studies, (c) screening, (d) data extraction and synthesis, and (e) results. Databases used included EBSCO, ProQuest, PubMed, and Google Scholar (hand-search). The articles were reviewed according to title and abstract, and studies deemed relevant were reviewed as full-text articles. Data was extracted from the selected articles using the inductive approach, which was based on the comprehensive reading and interpretive analysis of the organically emerging themes. Finally, the results from the selected articles were presented in a narrative format. Results: Culture, religion, and spirituality were identified as intertwined key contributors to the healthcare experiences of African immigrants. In addition, lack of culturally-competent healthcare, distrust, and complexity, of the U.S. health system, and the exorbitant cost of care, were identified as major healthcare access barriers. Conclusion: Knowledge about African immigrant health in the U.S. is scarce, with available literature mainly focusing on databases, which make it difficult to identify African immigrants. To our knowledge, this is the first Scoping Review pertaining to the healthcare experiences and needs of African immigrants in the U.S.

A Scoping Review of the Health of African Immigrant and Refugee Children

“…Health is a human right that can influence the ability to enjoy other rights. However, many African migrants experience health challenges upon settlement in a new country [ 8 , 9 ]. Pre-migration factors (e.g., experience of trauma) and post-migration challenges (e.g., access to health care) contribute to the health of immigrants in destination countries [ 1 , 10 ].…”

“…Pre-migration factors (e.g., experience of trauma) and post-migration challenges (e.g., access to health care) contribute to the health of immigrants in destination countries [ 1 , 10 ]. A scoping review that included 14 articles found that culture, religious beliefs, linguistic barriers, and barriers accessing health care contributed to the health of African immigrants in the United States [ 8 ]. Barriers to access to health care for this population include cost, health system complexity, lack of culturally competent health providers, long wait times, and discrimination [ 8 , 11 ].…”

“…A scoping review that included 14 articles found that culture, religious beliefs, linguistic barriers, and barriers accessing health care contributed to the health of African immigrants in the United States [ 8 ]. Barriers to access to health care for this population include cost, health system complexity, lack of culturally competent health providers, long wait times, and discrimination [ 8 , 11 ]. Moreover, despite an overall higher level of education than native-born populations and other immigrant groups, African migrants to high-income countries often experience a higher rate of poverty, a key social determinant of health [ 12 ].…”

Implementing Hypertension Management Interventions in Immigrant Communities in the U.S.: a Narrative Review of Recent Developments and Suggestions for Programmatic Efforts

“…Access to healthcare remains a major obstacle across immigrant communities [ 14 , 15 ]. Factors attributed to these barriers in healthcare access include interconnected structural and individual-level barriers, including ineligibility for certain healthcare programs [ 16 ], limited in-language support for culturally appropriate healthcare services [ 17 ], lack of knowledge of the healthcare system [ 18 ], distrust of the U.S. healthcare system [ 19 ] and, particularly among undocumented immigrants, fears related to deportation due to policies linking documentation status with use of public services [ 15 , 20 ]. Access-related issues often intersect with other barriers to healthcare utilization and health behaviors among immigrants, including specific customs or unique cultural or religious understandings of health and disease [ 19 , 21 ].…”

“…Factors attributed to these barriers in healthcare access include interconnected structural and individual-level barriers, including ineligibility for certain healthcare programs [ 16 ], limited in-language support for culturally appropriate healthcare services [ 17 ], lack of knowledge of the healthcare system [ 18 ], distrust of the U.S. healthcare system [ 19 ] and, particularly among undocumented immigrants, fears related to deportation due to policies linking documentation status with use of public services [ 15 , 20 ]. Access-related issues often intersect with other barriers to healthcare utilization and health behaviors among immigrants, including specific customs or unique cultural or religious understandings of health and disease [ 19 , 21 ]. These various influences also underpin hypertension outcomes among immigrants; U.S. immigrants are more likely to be unaware of their hypertension [ 22 ], have undiagnosed or uncontrolled hypertension [ 23 ], and display lower treatment rates of hypertension, particularly among those without a usual source of care or health insurance [ 3 ].…”