Understanding Access and Utilization of Healthcare Services Among African Immigrant Women in the United States: the Application of Health Belief Model

African immigrants in the U.S. are among the most economically and socially disadvantaged groups, with minimal access to healthcare and disproportionate adverse health outcomes. This qualitative study used the Health Belief Model (HBM) to explore how various health-related beliefs shape African immigrant women's healthcare access, with a particular focus on Ethiopian immigrant women. In-depth interviews were conducted with 21 Ethiopian immigrant women who lived in six U.S. states and Washington DC, recorded and transcribed verbatim. An inductive thematic analysis was conducted using Nvivo12 software, and the themes were organized under the HBM constructs. The findings showed that perceived susceptibility is influenced by past and present immigrant experiences, lack of knowledge, and being a recently arrived immigrant. Perceived severity was shaped by perceived barriers and benefits, and participants decided to seek healthcare if the problem was life-threatening and the severity outweighed the barriers. Perceived benefits of healthcare were affected by a lack of trust, a component not represented in the HBM. Social support and having or knowing a Habesha (Ethiopian or Eritrean) provider served as cues to action and boosted self-efficacy in seeking healthcare. The study findings showed that the HBM can be a valuable framework for understanding and promoting healthcare-seeking behavior among Ethiopian immigrant women. However, the HBM has limitations in capturing external non-medical and structural factors that shape immigrants' healthcare-seeking behavior and access. Future research using large-scale quantitative surveys to expand the HBM to include non-medical and structural factors is warranted.