Immigrant and Refugee Experiences of Healthcare Access and Wellbeing During Covid-19 in Vermont: A Qualitative Evaluation

Background: Refugee and immigrant communities all over the world have been historically underserved in health and social services and more negatively impacted by policies meant to address crisis rather than focusing on preventive care and culturally sensitive services. The lack of culturally responsive services coupled with systemic discrimination faced by refugee and immigrant populations are amplified during the Covid-19 pandemic. Perspectives from refugee and immigrant groups are often lacking in the published literature. This qualitative evaluation includes focus groups with five distinct refugee and immigrant communities who shared perspectives on their experiences accessing healthcare during the Covid-19 pandemic in Vermont. Methods A total of 114 participants who identify as refugees and/or immigrants, and who reside in Vermont, participated in 10 focus groups representing the following five different cultural groups of refugees and immigrants: Nepali/Bhutanese, Congolese, Somali/Somali Bantu, Burmese and Arabic. Cultural brokers or community case managers helped recruit participants and assisted in the focus groups providing interpretation and translation services. Focus groups took place remotely via online platforms. Although focus groups were conducted in English, interpreters were present and focus group guides were translated to the languages spoken by the aforementioned groups. Focus groups were audio recorded and transcribed with patient confidentiality maintained. Four themes were identified through a process of thematic analysis as identified by Braun and Clarke. Results Participants encountered several challenges in having meaningful interactions with health care providers and found it difficult to schedule appointments. Interpretation and translation services were also sporadic and inadequate. Interpretation was most reliable via Telehealth and Zoom calls, yet most participants did not experience this as an ideal format for health care. Participants shared their experiences with Covid testing and vaccination. Although some reported positive experiences, many participants communicated barriers in the process and shared experiences of discrimination. Although vaccine hesitancy was expressed by some participants, some also felt eager and hopeful about the Covid-19 vaccine. Conclusions Refugee and immigrant participants encountered many challenges in accessing health care during the Covid-19 pandemic. Discussions with the community and trusted cultural brokers created space for shared solutions and patient-driven ideas for care improvement.