Trust Matters: A Qualitative Study on Healthcare Access and Utilization Among African Immigrants in the United States.

Trust in healthcare is declining in the U.S. and is associated with decreased engagement in preventive care, low adherence to treatments, lack of motivation to seek care and poor health outcomes. Using the Health Belief Model (HBM), this study examined the impacts of trust on the healthcare access and utilization among African immigrants in Florida, United States. In-depth interviews were conducted with purposively selected African immigrants (N = 19) over the age of 18, lived in Florida for five or more years, and had recent experience with the U.S. healthcare system. Interviews were audio-recorded, transcribed verbatim, and analyzed using NVivo14. Perceived barriers to trust led to discontinuation and delays of care. Uncertainties on insurance coverage, ambiguous medical bills, and broken patient-provider communication constitute perceived barriers. Perceived benefit determined trust and medical adherence among participants. Findings revealed that being Black immigrant and legal requirements such as proof of legal status fueled perceived susceptibility. To counter their susceptibility and earn trust from providers, participants were pressured to present themselves in an 'acceptable' manner in healthcare settings. Self-efficacy was demonstrated through self-research on their cases and self-advocacy. Cues to action included seeking second opinions and changing providers depending on availability. Healthcare systems should prioritize billing transparency, effective communication, equitable practices, and legal protections for immigrants. Providers need continuous training in cultural humility and trauma-informed care, centered on immigrant experiences. Co-developing multilingual health information and engaging trusted messengers such as community and faith leaders will enhance the credibility of health promotion efforts.