Immigrant perspectives on navigating the US healthcare system in the Post-COVID-19 landscape: a photo-elicitation project.

Introduction: The experiences of immigrants navigating the United States (US) healthcare system in the post-COVID-19 pandemic era are unknown. This study explores the experiences of recently arrived Haitian and Ugandan immigrants navigating this greatly changed system. Methods: This single-center study used photo-elicitation, a qualitative method in which photos taken by participants served as an interview guide. Participants were recruited between 11/2022 and 08/2023 and took photos that captured their experiences in healthcare overall and as they related to COVID-19. Interviews were in English or Haitian Creole. All interviews were translated as necessary, transcribed, coded, and analyzed using an inductive, grounded approach. Results: Eleven Haitian and 8 Ugandan participants completed interviews. Five themes emerged: (1) US response to COVID-19 compared to country of origin; (2) the US healthcare system as a welcoming, supportive space; (3) influence of isolation and longing for home on immigrant experience and social determinants of health; (4) difficulties navigating a complex, foreign healthcare system; and (5) experiences participating in photo-elicitation. Discussion: Free protective resources (e.g., masks) and translated public health information engendered trust and should be included in future pandemic efforts. More attention should be devoted to the social isolation of immigrants, especially during pandemics. Supporting health systems to integrate immigration-informed and trauma-informed care into training for all staff is important, as many recent immigrants interact with clinical and nonclinical staff to address health and social needs. Finally, photo-elicitation is an effective research methodology in this population, but must be done thoughtfully to avoid exacerbating feelings of alienation.