Abstract
BACKGROUND: Lack of trust is a critical issue in healthcare that contributes to the growing disparities in access and utilization of health among minoritized and disadvantaged populations in the U.S. This study explored how lack of trust affects Ethiopian immigrant women's (EIW) primary healthcare (PHC) experience and the personal and structural factors exacerbating the problem. METHOD: A qualitative cross-sectional design was used to collect data through in-depth interviews with EIW (N = 21) living in six states (MO, MD, VA, KS, MI and IN) and Washington DC using a pilot-tested semi-structured interview guide. A mix of purposive and snowball sampling was used to recruit participants who: (1) identify as an Ethiopian immigrant; (2) identify as a female; (3) be 18 years and older; (4) arrived in the U.S. within the last five years; and (5) speak Amharic or English languages. The interviews were recorded, transcribed verbatim, translated and cleaned for errors. An inductive thematic analysis was followed to analyze data using Nvivo12 software. RESULTS: The findings showed that lack of trust is a significant concern among EIW negatively affecting their PHC experience and decisions in seeking care. The thematic analysis revealed five major factors contributing to the erosion of trust in PHC among EIW: (1) reliance on medication in U.S. healthcare system (2) preference for traditional homemade remedies over PHC recommendations and modern medicine (3) faith and its influence on trust and PHC decisions (4) lack of transparency in PHC, and (5) multilevel discrimination in PHC. CONCLUSION: The analysis suggested that PHC professionals provide understandable and contextualized health information, practice transparency, familiarize themselves with the healthcare system in immigrants' countries of origin by asking their patients, and prioritize culturally competent care to gain trust. At structural and policy levels, reform is needed to dismantle systemic problems that enable and perpetuate discrimination, diversify the healthcare workforce, revise healthcare training curriculums and procedures to reflect immigrant needs, establish multi-sectoral collaboration between health, education, and immigration sectors to create conducive care environment for immigrants. Further research and conversation around alternative medicine is vital to expand evidence-based and inclusive PHC services for immigrants.