title: [Perceptions and experiences of access to health services and their utilization among the immigrant population].
abstract: OBJECTIVE
  To identify and describe the needs and problems of the immigrant population related to access and utilization of health services.
  
  
  METHODS
  A descriptive, qualitative, phenomenological study was conducted using focus groups. The study area was the county of Campo de Gibraltar (Spain), which represents the gateway to Europe for immigration from Africa. The final sample size (51 immigrants from 11 countries) was determined by theoretical saturation. A narrative analysis was conducted with QSR NVivo9 software.
  
  
  RESULTS
  Immigrants' discourse showed four categories of analysis: response to a health problem, system access, knowledge of social and health resources, and health literacy needs. Responses to health problems and the route of access to the health care system differed according to some sociodemographic characteristics (nationality/culture of origin, length of residence, and economic status). In general, immigrants primarily used emergency services, hampering health promotion and prevention. The health literacy needs identified concerned language proficiency and the functioning of the health system.
  
  
  CONCLUSIONS
  There is a need to promote interventions to enhance health literacy among immigrants. These interventions should take into account diversity and length of residence, and should be based on an action-participation methodology.
authors.affiliation: Departamento de Enfermería y Fisioterapia, Universidad de Cádiz, Cádiz, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: Bas-Sarmiento
authors.affiliation: Departamento de Enfermería y Fisioterapia, Universidad de Cádiz, Cádiz, España. Electronic address: martina.fernandez@uca.es.
authors.forename: Martina
authors.initials: M
authors.lastname: Fernández-Gutiérrez
authors.affiliation: Departamento de Enfermería, Universidad de Sevilla, Sevilla, España.
authors.forename: M A Jesús
authors.initials: MA
authors.lastname: Albar-Marín
authors.affiliation: Departamento de Psicología Social, Universidad de Sevilla, Sevilla, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: García-Ramírez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D054242:Emigrants and Immigrants / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D057220:Health Literacy; D006293:Health Promotion; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D000069342:Medical Overuse; D008875:Middle Aged; D010358:Patient Participation; D036301:Qualitative Research; D012938:Social Perception; D012959:Socioeconomic Factors; D013030:Spain; D055815:Young Adult
keywords: Accesibilidad a los servicios de salud; Alfabetización en salud; Cultural diversity; Disparidad en atención de salud; Diversidad cultural; Health literacy; Health promotion; Health service accessibility; Healthcare disparities; Immigration; Inmigración; Investigación cualitativa; Participación del paciente; Patient participation; Promoción de la salud; Qualitative research