title: A socio-ecological analysis of Ethiopian immigrants' interactions with the Israeli healthcare system and its policy and service implications.
abstract: OBJECTIVE
  Despite receiving full medical care and many social services, many Ethiopian immigrants in Israel feel frustrated, and even alienated, by the care they receive. This study uses a qualitative approach to explore the obstacles Ethiopian immigrants face regarding effective health seeking behavior and optimal interactions with healthcare providers in Israel.
  
  
  METHODS
  We gained a three-cornered perspective by conducting semi-structured interviews with healthcare providers, immigrants, and interpreters who mediate between the two. An ecological system or socio-ecological model guided the data analysis. It allowed organizing the varied and complex relationship between the factors that influence healthcare delivery and receipt among this population.
  
  
  RESULTS
  The advanced analysis of our results delineated four themes which we grouped into two domains: the cultural divide and the interpreters. Within each of these themes, we explored influences on health or healthcare at each level of the socio-ecological model. We demonstrated that the problems surrounding health seeking behaviors and receiving treatment stem mainly from a cultural divide. This cultural incongruity and its effects are apparent at multiple levels of the ecological model and must be recognized and addressed programmatically at these levels.
  
  
  CONCLUSIONS
  Necessary program and service modifications include that cultural mediation become an integral part of health personnel's training for healthcare delivery and a necessary criterion for good practices. We recommend that professionals from within the health system be trained to act as interpreters. Lastly, the integration of traditional healers into the allopathic health system should be considered. These modifications require a system-wide change in policy, structure of services, and practices.
authors.affiliation: The Braun School of Public Health and Community Medicine of the Hebrew University and Hadassah Medical Organization, Jerusalem, Israel. ronnys@ekmd.huji.ac.il
authors.forename: Ronny A
authors.initials: RA
authors.lastname: Shtarkshall
authors.forename: Fassil
authors.initials: F
authors.lastname: Baynesan
authors.forename: Becca S
authors.initials: BS
authors.lastname: Feldman
mesh_terms: D018912:Arabs / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D003469:Culture; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005002:Ethiopia / Q000208:ethnology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007398:Interpersonal Relations; D007557:Israel; D008297:Male; D010817:Physician-Patient Relations; D011287:Prejudice; D036301:Qualitative Research; D012935:Social Justice; D012959:Socioeconomic Factors