Barriers and facilitators to improving access to healthcare for recently resettled Afghan refugees: A transformative qualitative study

Introduction: Refugee communities in the United States require increased attention to reduce barriers to public health. The current dearth of research on Afghan refugees in the U.S. does not move beyond the binary identification system of ‘sick-immigrant’ versus ‘healthy immigrant’, fails to provide a platform for Afghan refugees to provide critical insight into systematic issues, and to articulate a path towards actionable change. Methods: Researchers utilized a transformative qualitative approach to explore the health-related issues by identifying barriers and facilitators to accessing healthcare for Afghan refugees resettling in a county near the US capital. Twenty participants were recruited using purposive sampling. Data were collected using in-depth semi-structured interviews and were analyzed thematically. Results: A range of barriers and facilitators were identified. Barriers included: Trust, communication, mental health, and navigation. Facilitators included: Practical support (public assistance with finances and medical insurance, orientation class, and interpreting), provider rapport, and continuity of care. Qualitative research demonstrates the complex overlap between different issues that should be understood contextually. Implications from this study are discussed in a socio-ecological perspective (individual, relationships, organizations, community, and policy/systems). Conclusion: A nuanced understanding of stakeholders’ experiences in healthcare is necessary to shape policy and improve the quality of services for this vulnerable community. To promote a more equitable health care system, more research must be done to understand refugee health conditions in post-resettled populations from a culturally responsive approach.