Understanding Multilevel Barriers to Healthcare Access Among Immigrants with Limited English Proficiency: A Qualitative Study

Over 25 million individuals with limited English proficiency (LEP) live in the United States (U.S.). These individuals often face significant barriers to accessing preventative care and cancer screenings. This study aims to amplify the voices of immigrants with LEP and highlight their lived experiences in accessing preventive care in the US. A qualitative study using grounded theory methodology was conducted to analyze 23 interviews with immigrants with LEP. Using Bronfenbrenner's Ecological Systems Theory as an interpretive framework, we identified four categories of barriers at the individual, microsystem, mesosystem, and macrosystem levels. At the individual level, participants reported limited knowledge of preventive care and described feelings of guilt and shame when seeking assistance from family members or caregivers. At the microsystem level, mistrust toward healthcare providers and anticipation of mistreatment emerged as salient categories. At the mesosystem level, participants identified limited access to interpreters, a lack of language-concordant providers, and insufficient culturally responsive healthcare environments as significant barriers. Finally, at the macrosystem level, structural challenges, particularly transportation barriers and affordability concerns, were described as primary factors limiting access to care. Participants articulated concrete, community-driven solutions to mitigate these inequities, including the development of community-organized initiatives aimed at supporting navigation of the U.S. healthcare system. They emphasized that creating healthcare environments responsive to the linguistic needs of individuals with LEP is essential to fostering a sense of belonging, trust, and support within an otherwise English-dominant healthcare system.