title: Barriers to health care access among refugee asylum seekers.
abstract: OBJECTIVE
  Asylum seekers have poor access to health care. Qualitative data portraying their experience is lacking.
  
  
  METHODS
  We conducted focus groups and comprehensive interviews with 35 asylum seekers and 15 expert providers/advocacy organization representatives. Purposive sampling was used to recruit subgroups. Interviews were recorded, coded, and analyzed.
  
  
  RESULTS
  
  
  
  METHODS
  85% male, mostly from African countries. Major barriers: a) Internal, including mental illness, fatalism, mistrust, and perceived discrimination; b) Structural, including affordability, limited services, inadequate interpretation, resettlement challenges such as shelter, food, and employment insecurity; health care for urgent care only; and poor cultural competency; c) Barriers in social assimilation, including difficulty navigating a complex system and inadequate community support.
  
  
  CONCLUSIONS
  Significant inter-related barriers exist at the individual, provider, and system levels. Strategies to improve access include targeting social programs and mental health services, expanding Medicaid eligibility/enrollment, promoting community-based organizations, enforcing the use of trained medical interpreters, and improving cultural competency.
authors.affiliation: Mount Sinai School of Medicine, New York, NY 10029, USA. ramin.asgary@mssm.edu
authors.forename: Ramin
authors.initials: R
authors.lastname: Asgary
authors.forename: Nora
authors.initials: N
authors.lastname: Segar
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D001294:Attitude to Health; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D001523:Mental Disorders; D009519:New York City; D036301:Qualitative Research; D012036:Refugees / Q000523:psychology*; D012944:Social Support; D012959:Socioeconomic Factors