Navigating the Maze of the Healthcare System in the United States: An Insight Into the Experiences of African Refugees

Date of Award

Fall 2025

Document Type

Dissertation

Degree Name

Doctor of Healthcare Administration (DHA)

Committee Chair

Joann Jordan

Committee Member

Karen Lankisch

Committee Member

Andy Igonor

Abstract

African refugees resettled in the United States (U.S.) face persistent challenges when accessing healthcare services. Although initial federal and state support exists, the broader US healthcare system is characterized by complexity, administrative demands, and an insurance-based structure, making it difficult for refugees arriving from different health systems. African refugees must quickly adjust to unfamiliar appointment procedures, insurance requirements, and communication norms while managing linguistic and cultural barriers. Existing research identifies language gaps, cultural misunderstandings, racialization, trauma histories, and limited provider cultural competence as major factors influencing refugees’ health experiences and outcomes.< .p>

This qualitative study using an interpretive framework examines how African refugees navigate the U.S. healthcare system and its associated barriers. The study explores refugees’ perceptions of provider interactions, medical decision-making, insurance processes, and overall system navigation. The research also highlights refugee reliance on community networks, informal advice, and adaptive strategies to overcome barriers. Centering on participants’ experiences, the study contributes to broader discussions on health equity, cultural responsiveness, and refugee-centered models of care.

Qualitative design was used to gather descriptive accounts from 18 African refugees originating from various regions who resettled across the U.S. Semi-structured interviews focused on experiences with healthcare institutions, providers, insurance agencies, interpreters, and community support systems. Thematic analysis allowed patterns related to communication difficulties, cultural expectations, and structural inequities to emerge and provided insight into how participants interpret and navigate the healthcare environment.

Challenges included linguistic, cultural, and systemic domains. Participants frequently iv described difficulty understanding medical terminology, treatment plans, and insurance processes, often related to limited interpretation services. Reliance on family members, including children to translate, raised concerns about accuracy and confidentiality. Cultural gaps contributed to feelings of dismissal, misunderstanding, and reduced trust. Structural barriers, including fragmented services, complex paperwork, and financial constraints, further hindered access and continuity of care.

Despite obstacles, refugees demonstrated resilience, adaptability, and strong reliance on community networks. Ethnic organizations, religious groups, and peer mentors played critical roles in helping individuals navigate healthcare systems and advocate for appropriate services. The findings underscore the need for improved interpretation services, culturally responsive care practices, health literacy initiatives, and trauma-informed provider training to support equitable healthcare access for African refugees in the U.S.

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