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

Monika Doshi,Ellen Rabinowitz,Richard Bryce,Raymond Rion,Hannah Mesa,William D Lopez,Paul J Fleming,Lisa Merry

doi:10.1371/journal.pone.0233839

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.

Highlights

For this phase of the research, we focused on healthcare and social service providers at three partner sites in Southeast Michigan, namely a federally qualified health centers (FQHCs) in Detroit, a FQHC in Washtenaw County, and a non-profit organization co-located with the county health department in Washtenaw County
The socio-political, economic and cultural factors that frontline service providers perceived to affect their clients’ decision to seek care, and, in turn, their own ability to provide timely and effective services, include: (a) generalized fear resulting from anti-immigrant rhetoric; (b) behavior change due to threat of immigration enforcement; (c) financial and opportunity costs related to healthcare access; and (d) culturally discordant health seeking practices informed by country of origin (Fig 2)
Our findings suggest that frontline service providers perceived that their undocumented clients confront a host of factors associated with accessibility to facilities that influence the delay in identifying and traveling to healthcare facilities, and, in turn, their own ability to provide timely and effective services

Summary

Methods

While we currently focus on perspectives of service providers, the phase of our work will center on perspectives and experiences of clients For this phase of the research, we focused on healthcare and social service providers at three partner sites in Southeast Michigan, namely a FQHC in Detroit, a FQHC in Washtenaw County, and a non-profit organization co-located with the county health department in Washtenaw County. Both Detroit and Washtenaw County are home to considerably large immigrant populations in the state, including persons with origins in Latin America. In our study, experiences and perspectives of the participants are grounded within the context of their undocumented clients with origins in Latin America

Results

Discussion

Conclusion