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.
Highlights
The number of African-born immigrants in the U.S has risen dramatically, with a fivefold increase since 1980 [1]
King County, Washington state (WA), has a larger percentage of foreign-born residents (24%) compared to the U.S as a whole (14%), and the over 40,000 African-born residents make up about 8% of the foreign-born population in King County [2, 3]
The follow-up events included: a free community clinic hosted in an apartment complex housing many African-born individuals; an apartment complex community event which included health screenings; an annual, community health fair hosted by an ethnic health board; and a monthly social gathering and health fair hosted by another ethnic health council
Summary
The number of African-born immigrants in the U.S has risen dramatically, with a fivefold increase since 1980 [1]. Studies of health needs of African immigrants in the U.S have traditionally focused on infectious diseases [6]. Other studies of African immigrants living in high-income settings have found low levels of health insurance [10] and linkage to primary care [11, 12] as well as low or delayed uptake of vaccination [13, 14], cancer screening [15, 16], antenatal care [17], and diabetes screening [18]. Identifying and addressing specific barriers to engagement in preventive health care (defined here as proactive measures taken to prevent or mitigate future illness) is needed to improve health outcomes of African immigrant populations in the U.S
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