Barriers and facilitators of preventive healthcare access among immigrants in rural America: a scoping review

Abstract

Preventive healthcare services are essential for improving health outcomes and reducing disparities; however, immigrant populations in rural America face significant barriers to accessing such care. This scoping review examines the barriers and facilitators to preventive healthcare access among rural immigrant populations in the United States, utilizing a systematic analysis of 21 peer-reviewed studies published between 2011 and 2025. Key findings reveal interconnected barriers at multiple levels, spanning from individual psychological factors to policy-level exclusions. Facilitators include community-based initiatives, culturally responsive care, and policy-driven supports such as Medicaid and vaccination programs. The review also highlights critical gaps in the literature, including limited research on non-Hispanic immigrant groups and underrepresentation of certain preventive care services, such as diabetes management and oral health. Addressing these challenges requires multilevel interventions that prioritize affordability, accessibility, and cultural relevance. This review underscores the need for comprehensive, equity-driven strategies to ensure that rural immigrant populations can fully benefit from preventive healthcare services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-025-02603-2.

Introduction

Preventive healthcare—including check-ups, screenings, immunizations, and counseling—helps prevent and detect serious conditions early [67]. Evidence has shown that receiving preventive healthcare services can lead to a significant number of health benefits across all age groups, including the early detection of unrecognized health risks [23, 72], prevention and eradication of certain infectious diseases [4, 59], promotion of long-term healthy childhood physical outcomes [32], and reduction of morbidity and mortality rates associated with various types of cancer [6, 44]. Increasing data suggest that preventive healthcare benefits society beyond individuals and families by reducing long-term healthcare costs, advancing health equity, strengthening infrastructure, and boosting productivity [9, 16, 59, 71].

Despite the well-documented benefits of preventive healthcare, many immigrants in the U.S. face significant barriers to access [20, 22]. Language barriers, limited health literacy, and fear of deportation often discourage them from seeking essential services like disease screenings [8, 10, 19, 27, 33]. These challenges are further compounded by structural obstacles, including lack of insurance, inadequate healthcare facilities, and discriminatory policies that disproportionately affect immigrants in vulnerable circumstances [27, 57, 58]. As a result, many immigrants struggle to access timely preventive care, increasing their risk for undiagnosed conditions and long-term health complications.

The number of immigrant populations, particularly those of Hispanic origin, has increased rapidly in rural areas in the U.S., contributing to population growth and community vitality [48]. Hispanic immigrants accounted for over 60% of the population growth in nonmetropolitan and rural areas over the past three decades [43]. Other groups, such as Asian immigrants, have also experienced nearly universal growth across all regions [13]. Driven by the increasing demand for labor in industries such as agriculture and manufacturing, immigrant workers in rural areas of the U.S. are largely employed by farms, meat processing plants, and other sectors that typically do not require extensive educational qualifications [36, 37, 47].

Despite their significant contributions to these industries, many rural immigrant workers remain “invisible” or viewed as “unwanted byproducts of an industrial system” [70], p. 570), making them more vulnerable to poor working, living, and health conditions [14]. A systematic review on migrant worker health found that rural immigrant laborers, particularly in agriculture, often experience musculoskeletal pain, respiratory issues, and mental health challenges like stress and depression [28]. Migrant and seasonal farmworkers also face higher risks of obesity, diabetes, hypertension, and other chronic diseases [5, 12, 54, 65]. Additionally, children from immigrant families in rural areas experience health disparities, including higher rates of obesity and dental caries [17].

Access to healthcare remains a major challenge for rural immigrants in the U.S., where geographic isolation, limited resources, and inadequate infrastructure create unique barriers [24, 63]. Studies showed significantly lower rates of preventive healthcare use among foreign-born rural workers compared to U.S.-born or non-Hispanic White populations [30, 55]. This lack of access can lead to undiagnosed conditions like diabetes, resulting in long-term health consequences [54]. Furthermore, rural immigrant populations living in the United States may continue to encounter dire health consequences and disparities, as abrupt and rapid shifts in recent U.S. immigration policies perpetuate restrictive and even discriminatory practices towards immigrant communities [40]. Addressing these disparities requires a deeper understanding of the barriers to care and the resources that can bridge the health gap. However, there is limited synthesized evidence on these challenges and facilitators. This scoping review aims to fill that gap by systematically analyzing existing literature to provide a comprehensive understanding of healthcare access and utilization among rural immigrant communities. It is important to note that the term “immigrant” in this review refers broadly to foreign-born individuals, regardless of legal status.

Methods

This scoping review was guided by Arksey and O’Malley’s framework [2] and conducted by (a) identifying a research question, (b) identifying relevant studies, (c) selecting the studies, (d) charting the data, and (e) collating, summarizing, and reporting the results.

Identifying the research questions

This scoping review focuses on two research questions: (1) What are the barriers and facilitators to accessing preventive healthcare for immigrants in rural America? (2) How are these factors associated with health outcomes, and how do they inform or appear in strategies to improve healthcare access for this population?

Identifying relevant studies

A systematic search across MEDLINE with Full Text, APA PsycInfo, and CINAHL was conducted under three broad headings—“immigrant,” “rural,” and “preventive health care,” as described in Table 1 and Supplementary File 1. The search strategy was built with input from librarian and subject experts. This review considered preventive healthcare a proactive approach aimed at maintaining health and preventing or treating diseases before they become serious. It includes a variety of medical services such as regular check-ups, screenings, immunizations, and counseling to detect potential health issues early on and manage them effectively. Search terms for “preventive health care” included keywords such as physical exams, screenings, vaccinations across various types of diseases. Boolean logic (using OR and truncation*) was used to combine the search terms. When combining the blocks, the term AND was used. The first author completed the search for potential publications across all databases on July 14, 2025.

Table 1.

Searching strategy

Search Terms	Search Area
Immigrant related
immigrant* OR refugee* OR asylum OR"undocumented person*"OR"undocumented worker*"OR"undocumented people"OR"illegal alien*"OR"unauthorized worker*"OR"green card holder*"OR"greencard holder*"OR migrant* OR"foreign born"OR foreignborn	Title, subject, abstract
Rural related
rural* OR village* OR town OR towns OR farming OR farms OR"farm worker*"OR farmworker* OR agriculture* OR forestry OR ranching OR ranches OR"ranch worker*"OR ranchworker*	Title, subject, abstract
Preventive care related*
prevent* OR prophyla* OR screening OR screenings OR vaccination OR vaccinations OR immunization OR immunizations OR immunisation OR immunisations	Title, subject, abstract

^*Full list of preventive care related search terms is in Supplementary File 1

Selecting the studies

Articles published in English in 2010 and after were included. A total of 1,704 articles were imported into Covidence, a systematic review platform, and duplicates were removed. The first-round review involved title and abstract screening based on the following criteria. Each study: (1) focused on immigrant populations (i.e., foreign-born populations or families with foreign-born members); (2) was conducted in rural America; (3) was empirical; and (4) focused on preventive rather than curative care.

Each article was reviewed independently by two reviewers to determine eligibility; in case of a conflict, a third reviewer was involved, and conflict was resolved after a team discussion. Articles that met the criteria or could not be categorized based on title and abstract were subjected to a full article review (n = 88). The first three authors conducted full-text screening, with each article independently reviewed by two reviewers, who provided reasons for exclusions. Special attention was given to data collection dates and preventive healthcare types. We excluded studies with data collected before the passage of the Affordable Care Act (2010), as the ACA significantly altered access to preventive services, particularly through Medicaid expansion and insurance marketplaces. We differentiated preventive healthcare from health promotion programs, which are typically group-based and not directly tied to healthcare services. The selection process is shown in the PRISMA Flowchart (Fig. 1).

Fig. 1.

PRISMA Article Searching and Screening Flowchart

Charting the data

Using a pre-designed Covidence form, four authors independently extracted data from selected articles: study characteristics, participant criteria, recruitment methods, preventive healthcare focus, barriers, resources, and significant findings.

Collating, summarizing, and reporting the results

We analyzed and synthesized the findings using the “charted” information from the selected studies. We organized relevant information on the authors, study design, study participants, country of origin of immigrants, primary focus of preventive healthcare, and barriers/resources to accessing preventive healthcare services (Table 2). Using thematic analysis, we categorized the barriers and resources into individual, relationship, community, and societal levels, guided by the Centers for Disease Control and Prevention (CDC)’s four-level Social Ecological Model (SEM) [15]. This model offers a framework for multilevel interventions and systemic change and has been widely used to guide rural health practice (Rural Health Information [62]).

Table 2.

Summary of the included studies (N = 21)

#	Author (s) (year)	Design	Country of Origin	Region of Study	Population(s)/Community	Sample Size	Outcome	Barriers	Facilitators
1	Alasagheirin et al. [1]	Qualitative	Somalia	Northern Wisconsin	Somalia community living in Northern Wisconsin	17 (2 focus groups)	COVID-19 vaccine beliefs and attitudes	Hesitancy from distrust in medication and fear of side effects	Strong sense of protecting themselves and others; care about others’ health; collective memory; trusting community leaders
2	Barral et al. [3]	Quantitative	US Mexico	Kansas	Rural immigrant Latino communities	55	Sexual and reproductive health services access; beliefs and attitudes	Fear of non-confidential services, past negative healthcare experiences, and limited knowledge of SRH resources; SRH education/services and methods like condoms were perceived to encourage teen sexual activity; Females cited legal documentation issues more; Parental hesitation or resistance to teens accessing birth control without parental consent; Inconsistent contraceptive recommendations from health providers; Lack of transportation, distrust in the healthcare system, and discrimination; Immigration status and fear of deportation; Nearly half of participants found it difficult to access professional SRH information locally	Knowledge and positive attitudes toward SRH; Peer and family support; Majority of healthcare providers, public health staff, and school officials support SRH education and services; Support for effective contraceptive methods; Increasing openness to SRH services among some community members and professionals; Broad agreement among stakeholders that teens should have access to birth control methods, even without parental approval
3	Buro et al. [7]	Qualitative	N/A	Southwest Florida	Southwest Florida rural Latino migrant and immigrant communities	25	COVID-19 vaccine and testing uptake	Fear and sense of lack of control; misinformation; Immigration issues (e.g., lack of documentation)	Strong sense of protecting themselves and others and willingness to follow protective advice; Faith
4	Casanova et al. [11]	Qualitative	N/A	South Florida	Latinx Farmworker Community	68	Breast cancer screening access	Psychosocial concerns (e.g., fear of judgment); Lack of health knowledge (e.g., perceived that mammograms could harm the breast); Inadequate resources in rural communities (e.g., mammogram often out of reach in community health centers or programs); Social and economic barriers (e.g., lack of health insurance); Systemic challenges (e.g., private hospital requires certain eligibility, county hospital that does not require SSN is 30 miles away); Cultural taboos about their bodies (e.g., shame, husband’s machismo attitude)	Word of mouth to share health information; Clear and positive doctor-patient communication; Community health workers’ support
5	Gehlbach et al. [26]	Qualitative	Latin America	Eastern Coachella Valley	Latinx farm-working communities	55	COVID-19 testing and vaccination perceptions and beliefs	Language barriers; Difficulties in accessing reliable public health information; Limited access to the internet; Misinformation in the community	Not specified
6	Gehlbach et al. [25]	Qualitative	Latinx and indigenous Mexican immigrant communities	Eastern Coachella Valley	Latinx and Indigenous Mexican immigrant communities	53	COVID-19 vaccine and testing perceptions	Fear and sense of lack of control; Misinformation; Immigration status and legal concerns (e.g., law enforcement at testing sites) Distrust in government and institutions	Promotores or other trusted members such as religious leaders
7	Hassane Dan Karami et al. [29]	Mixed	N/A	Midwestern state	First generation Latina immigrant mothers in rural communities	109	COVID-19 vaccine uptake	Mistrust or skepticism of vaccine; disbelief in vaccine	Belief vaccine as Protector; confidence in vaccine
8	Knoff et al. [39]	Quantitative	Mexico	Michigan	Hispanic migrant and seasonal farmworkers	324	Cervical cancer screening knowledge, attitudes, and practice	Lack of health knowledge (e.g., limited awareness, and education about cervical cancer risk factors); Demographic and acculturation factors (e.g., younger women, aged 21–29, and those with lower acculturation levels, and seasonal farmworkers were less likely to report recent Pap tests); Embarrassment about screening and cultural attitudes toward healthcare	Higher acculturation levels; Clinic-based interventions: Clinics may serve as effective sites for education and outreach;
9	Leon et al. [41]	Quantitative	South America, Central America	N/A	Hispanic patients in a rural farm-working community	35	Preventive healthcare access and childhood immunization uptake	Limited English proficiency; Lack of knowledge about healthcare system; Lack of transportation; Immigration and documentation status; Lack of insurance and inability to pay	Not specified
10	Luque et al. [45]	Qualitative	N/A (providers and Hispanic parents—Mexico and Honduras)	Georgia		8 providers and 12 parents (5 mothers and 7 fathers)	HPV vaccination access	Language barriers; Lack of knowledge and information (e.g., misperception about HPV); Lack of transportation; Migrant living patterns (i.e., difficulty in completing the 3-dose HPV vaccine series with a mobile population); Cultural issues; Lack of insurance	Mother-daughter communication; Hispanic patients were overall very positive toward vaccines; School level promotion (pointed by parents)
11	Luque et al. [46]	Quantitative	Mexico	Southeast Georgia	Hispanic immigrant parents	39	Cervical cancer screening and HPV vaccination beliefs, attitudes, and knowledge	Fear (of going to doctors, of positive results, of the exam, wait for symptoms to appear); Language barriers; Lack of knowledge (purpose, expectations, cost, service); Restrictions from spouses (e.g., “My husband won’t give me permission.”) Lack of transportation; Lack of insurance	Not specified
12	Maxwell et al. [50]	Mixed methods	Indigenous populations from Mexico	N/A	Mexican Immigrant Women	813 from survey; 27 from group dialogue	Breast and cervical cancer screening knowledge and access	Fear of medical visits, positive test results, and symptom onset; Language barriers; Lack of knowledge; Lack of time and transportation; Health seeking behaviors (e.g., not used to seeing a doctor for screening in the absence of disease); Restriction from spouse Lack of insurance and with low income Lack of trust in the medical system	Having female providers; Conducting door-to-door outreach; Increased cancer screening in convenient community settings and flexible timing; Available interpreters; Disseminate screening information through radio; Providing small incentives
13	Maxwell et al. [49]	Qualitative	Mexico-Mixteco and Zapoteco indigenous people	California	Mixtec and Zapotec Women in a Farmworker Community in California	49	Healthcare utilization	Being afraid of unfamiliar procedure and western healthcare; Being embarrassed to ask questions or during a physical exam; Long waiting times in getting appointments; Difficulties in completing paperwork; Language barriers; Negative experiences in communication with healthcare providers and staff; Lack of transportation; Lack of insurance, low income	Having interpreters (especially among women); Having help with making appointments and completing paperwork; Availability of free services promoted through community organizations; Cultural and social norms supported by community organizations that help bridge health disparities between groups
14	Minneman et al. [51]	Qualitative	Mexico	Georgia	Latino immigrants	82	Chagas disease testing perceptions and health service seeking behaviors	Fear of being diagnosed with a fatal or expensive illness; Lack of trust in mainstream healthcare providers in the USA; Reluctance to take time off from work (rural men); A culture of machismo (men) Lack of financial resources and fear of high cost to pay for healthcare; Traditional process of seeking healthcare (traditional remedies, stoicism, consulting a health provider),	Educational campaigns and access to low-cost or free services as suggested opportunities for improving preventive care
15	Muñoz Bohorquez et al. [53]	Qualitative	Central America or the Caribbean (56% Mexican, 33% Dominican)	N/A	Farmworkers/community stakeholders in the counties in Maryland (Allegany, Garrett, Washington, Prince George’s, Frederick, and Caroline) or Delaware (Kent and Sussex)	migrant workers: 9, community stakeholders: 15	COVID-19 vaccine beliefs and attitudes	Language—Lack of staff that spoke Spanish; Barriers to access information (some due to limited internet access); Overload of information and difficult to assess; Lack of transportation; unaware of community transportation resources; Lack of workplace accommodation (e.g., penalized for taking a sick day); Mental burden caused by legal status (fear); Difficulties in navigating US health system;	Translated information with graphics; Understandable information (matched with education level, high school or below)
16	Redwine et al. [56]	Quantitative	Mexico, Peru, Cuba, and Spanish origin	Southwest Florida	Rural Latino communities	493	COVID-19 vaccine uptake and testing intention	Distrust in health agencies/officials and misinformation; Concerns regarding vaccine side effects and safety; Lack of knowledge of how the vaccine worked; Lack of confidence in COVID-19 testing accuracy	Protecting friends and family; The utility of leveraging family and community safety; Faith leaders and doctors in the community
17	Rosado et al. [60]	Quantitative	N/A	N/A	Latino agricultural community	186	COVID-19 vaccine beliefs and vaccine history	Hesitancy from distrust in medication and fear of side effects; political mistrust	Culturally informed health promotion (to increase health literacy)
18	Rowden et al. [61]	Qualitative	N/A	Kansas	German Mexican Mennonite Farmworker Community	25	Oral health service access and practice	Fear of pain; Limited English proficiency; Unawareness of local available dental services; lack of insurance	Not specified
19	Tulimiero et al. [66]	Qualitative	Mexico (largely)	Eastern Coachella Valley	Latino farmworkers in rural communities	97 (82 + 15) Focus group discussions (n = 82) and one-on-one interviews (n = 15)	Healthcare services access	Fear of border patrol; Regular clinic hours were not feasible as work demands and the inability to obtain time off; Lack of bilingual providers; Long travel distances and waiting time; Difficulty in scheduling; Financial issues (high cost of services relative to income)	Incorporating student-run clinics; Reducing power differentials between providers and patients; Healthcare services in open spaces reduce deportation risk and fears; Services should be offered outside of business hours; Services with education materials
20	Vamos et al. [69]	Qualitative	Mexico	Florida	Hispanic farmworker families	13	HPV vaccination acces, uptake, and completion of HPV vaccine series	Fear of needles; Religious beliefs discouraged HPV vaccination; Lack of knowledge about HPV vaccine; Challenges in negotiating appointment times with children’s school schedules; Long waiting time during a clinical visit; Language barriers; Lack of flexibility due to employment; Difficulty in navigating the Medicaid process due to limited acceptance	Requested/mandatory vaccination records; Phone call and text reminders for appointment; Transportation to appointments; Clinics that have appointment hours in the afternoons and evenings; Educational workshops; Spanish-speaking healthcare staff person or interpreter; Improve access to HPV vaccination through easily accessible locations (i.e., schools); Physicians that accept Medicaid; Existing state programs and collaborations to ease healthcare burdens
21	Vamos et al. [68]	Qualitative	N/A	N/A	Hispanic migrant farmworkers	13	HPV vaccination access	Lack of education and low health literacy; Lack of transportation; Poor patient-provider communication; Lack of healthcare service continuity due to migratory patterns after getting HPV vaccine; HPV vaccine availability at local clinics; Immigration status and access to health insurance	Parental vaccine acceptance/knowledge; Accurate immunization registries/programs where vaccines can be tracked by physicians; Adequate insurance coverage Federal level programs such as Medicaid, Vaccine for Children

Results

This review included 21 of 1,704 articles published between 2011 and 2025. Most studies used qualitative methods (n = 12), including in-depth interviews (n = 8), focus groups (n = 5), and community-based participatory research (CBPR) (n = 1). Quantitative methods (n = 6, 29%) primarily involved surveys, while mixed methods (n = 3, 14%) combined surveys with group dialogues. Participant numbers varied, with qualitative studies ranging from 13 to 97, quantitative studies ranging from 39 to 493, and mixed methods ranging from 27 to 813.

The included studies covered various types of preventive healthcare, focusing on vaccination and disease testing, including COVID-19 (n = 8), breast and cervical cancer screening (n = 4), HPV vaccination (n = 3), and Chagas disease testing (n = 1). Five studies examined healthcare access and utilization, emphasizing childhood immunizations, sexual and reproductive health, and oral health. Most rural immigrants were from Mexico (n = 11) and South/Central/Latin America (n = 3), with others from Somalia (n = 1) or unspecified (n = 6). All studies explored barriers and facilitators of preventive healthcare, with key findings summarized in Table 2.

Barriers and facilitators to accessing preventive healthcare using the SEM

We used the four-level Social Ecological Model (SEM) to organize findings (See Tables 2 and 3).

Table 3.

Barriers and facilitators identified in the included studies at the individual, relationship, community, and societal levels

Four-level Social Ecological Model (SEM)	Barriers	Facilitators
Individual	Fear and sense of lack of control Fear of needles Fear of medical visits, positive test results, and symptom onset Fear of being diagnosed with a fatal or expensive illness Fear of non-confidential services Fear of side effects Hesitancy from distrust in medication Limited English proficiency Limited health literacy or misperception about disease Lack of knowledge about healthcare system Health care seeking behaviors (e.g., not used to seeing a doctor for screening in the absence of disease) Younger women, low acculturation level, farmworkers less likely to undergo test Males reluctant to take time off from work for Chagas disease testing Financial issues (high cost of services relative to income) Religious beliefs discouraged HPV vaccination Embarrassment about screening and cultural attitudes toward healthcare	Strong sense of protecting themselves and others Care about others’ health Trusting community leaders Knowledge and positive attitudes toward diseases and healthcare services Faith and hope for the future Higher levels of acculturation
Relationship	Parental hesitation or resistance to teens accessing birth control without parental consent Restrictions and jealousy from husbands to seeking care (Breast and cervical cancer screening)	Parental acceptance for vaccination uptake Mother-daughter communication Peer and family support
Community	Difficulties in accessing reliable public health information Misinformation in the community Overload of health information and difficult to process Limited internet access Difficulty accessing healthcare facilities due to long travel distances Inadequate transportation resources within community Unaware of community transportation resources Lack of workplace accommodation Lack of bilingual providers and staff for scheduling and care Poor patient-provider communication Long waiting times at clinics Absence of critical health services at rural community health centers	Community support for transportation to appointments Flexible clinic hours (afternoons and evenings) Availability of Spanish-speaking staff at the clinic Word of mouth to share health information Clear and positive doctor-patient communication Availability of free services promoted through community organizations Having female healthcare providers Conducting door-to-door outreach Promotores or other trusted members such as religious leaders School-based promotion for HPV uptake
Societal	Lack of insurance High cost of services and inability to pay Structural fear for those undocumented individuals or those with temporary immigration status Migrant living patterns (i.e., difficulty in completing the 3-dose HPV vaccine series with a mobile population) Stigma around sexual behavior discouraged HPV vaccination Machismo and cultural taboos shaped attitudes toward breast and cervical cancer screenings, with shame, embarrassment Reluctance to seek care due to shame or a preference for traditional remedies Male control over healthcare decisions restricting women’s autonomy	Medicaid and Vaccines for Children expanded HPV vaccine access State policies allowing teens to access birth control without parental consent enhanced SRH care and education Collectivist community values encouraged protective health behaviors

Individual-level factors: barriers

The first level of SEM focuses on individual factors, including age, education, income, and health history (CTSA Consortium, 2011). Psychological barriers, particularly fear and perceived lack of control, frequently hindered access to preventive health services such as COVID-19 testing and vaccination [7, 25]. Similarly, fear of needles, concerns about additional risks, and religious beliefs discouraged HPV vaccination [69]. For breast and cervical cancer screenings, fears related to doctors, positive test results, medical exams, and waiting for symptoms led to avoidance [46, 50]. Fear of being diagnosed with a fatal or costly illness also discouraged Chagas disease testing [51]. Additionally, women with less experience in the U.S. healthcare system feared confidentiality breaches, deterring them from seeking sexual and reproductive health (SRH) services [3]. Some individuals also avoided medical care unless symptoms appeared, further limiting participation in cancer screenings [50].

Limited English proficiency was another significant individual-level barrier, restricting rural immigrants’ access to healthcare [41] and reliable public health information [26]. Specifically, the reviewed studies highlighted that low English proficiency impeded access to preventive healthcare services, including COVID-19 testing and vaccination [26], HPV vaccination [45], oral/dental health services [61], and Chagas disease testing [51].

Knowledge and awareness of diseases, healthcare procedures, and community resources were also critical factors influencing access to preventive healthcare. For example, limited health literacy about cervical cancer was cited as a barrier to both HPV vaccination and cervical cancer screening [39, 68]. Similarly, a lack of knowledge regarding the purpose, expectations, cost, and availability of breast cancer and cervical cancer screenings hindered participation in these services [46, 50]. While transportation is a known barrier to accessing healthcare in remote rural areas, study also found that many immigrants were unaware of available transportation services in some communities [53], highlighting a lack of awareness of community resources.

Socio-demographic factors, such as sex, age, and socioeconomic status (SES), also influenced access to preventive health services. The reviewed studies indicated that younger women were less likely to undergo Pap smear tests [39], while male immigrants often hesitated to take time off from work for Chagas disease testing [51]. Key aspects of SES, such as income and work constraints, were significant barriers in accessing preventive healthcare services [66].

Individual-level factors: facilitators

While various individual-level factors hindered access to preventive healthcare, several, such as personal attitudes, knowledge, and faith, were facilitators. For COVID-19 testing and vaccination, a strong sense of responsibility to protect oneself and others, coupled with a willingness to follow protective measures, was a key facilitator among rural immigrant communities [1, 7]. Faith and hope for the future also played a positive role in promoting vaccination uptake. One study participant described the COVID-19 vaccination as “the light at the end of the tunnel” [7], p. 8). Additionally, individuals with higher levels of acculturation were more likely to have recently undergone a Pap test and to correctly identify cervical cancer risk factors [39].

Relationship-level factors: barriers

The second level of SEM focuses on close social relationships with family, friends, and partners that shape individual behavior and experiences (CTSA Consortium, 2011). Parents’ attitudes and beliefs play a critical role in minors’ access to preventive healthcare, as parental hesitancy, perceived risks, and stigma often discourage children from utilizing these services [3]. For instance, a study on HPV vaccination highlighted that parents’ controversial perceptions of the vaccine served as key barriers, with concerns that it might encourage sexual activity among their children [69]. Similarly, parental opposition to teens seeking birth control without parental consent was cited as a significant obstacle to youths accessing SRH services [3]. Some women reported that their husbands would not permit them to undergo these screenings [46], and jealousy from husbands was also cited as a barrier to seeking care [50].

Relationship-level factors: facilitators

Support from close relationships facilitated preventive healthcare use, particularly in SRH education and care. Parental acceptance and informed knowledge were key to HPV vaccination uptake, with mother-daughter communication playing a crucial role [45, 68]. Additionally, individuals with social support felt more empowered to seek SRH services without fear of judgment [3]. These findings highlight the impact of social influences in overcoming barriers and promoting healthy behaviors.

Community-level factors: barriers

The community level of SEM examines the impact of social environments such as schools, workplaces, and neighborhoods on health (CTSA Consortium, 2011). A key issue in the reviewed studies was limited access to timely and accurate health information in rural communities. Participants struggled to find reliable information [26] and faced data overload, making it difficult to process health messages [53]. Rural immigrants also lacked awareness of local health services, including dental care [61] and SRH education and services [3]. These challenges were compounded by limited internet access, further isolating them from critical health information [26].

Another common theme of barriers at the community level was inconvenience, stemming from a lack of transportation, need-based services from healthcare providers, and appropriate accommodations from workplaces. Many participants reported difficulty accessing healthcare facilities due to long travel distances [53, 66] or inadequate transportation resources within their community [53]. In fact, as mentioned above, some communities did provide transportation support,however, the limited awareness among immigrant residents points to inadequate community outreach and communication efforts.

Challenges in accessing preventive healthcare also arose from interactions with healthcare providers. These included language barriers caused by the lack of bilingual providers and staff for scheduling and care [11, 53,66], poor patient-provider communication [68], and distrust of certain healthcare facilities [45]. Some migrant and seasonal workers found the continuity of care challenging due to their migratory patterns, especially for timely follow-up doses such as the HPV vaccine [68]. Additional challenges included long waiting times at clinics and the absence of critical health services, such as mammograms, at rural community health centers [11].

Workplace-related barriers significantly impacted healthcare access, with many patients unable to schedule and attend medical appointments due to insufficient workplace accommodations [50, 53]. These barriers included challenges attending appointments during working hours and penalties for taking sick leave [53]. The lack of flexibility from employers or supervisors further hindered the ability to balance work demands with health needs [69], and regular clinic hours were often incompatible with participants’ work schedules [66].

Community-level factors: facilitators

At the community level, a variety of facilitators were identified that promoted access to preventive healthcare. These facilitators highlight community-based strategies that mitigate barriers to healthcare access, underscoring the importance of local involvement, flexible service delivery, and effective communication. For example, community support for transportation to appointments, flexible clinic hours (afternoons and evenings), and the availability of Spanish-speaking staff at the clinic were identified as key facilitators [66, 69]. Community health workers, clinic-based interventions, and the promotion of free services through community organizations also enhanced healthcare access, especially in non-clinical community settings [11, 49]. In the context of breast cancer and cervical cancer screenings, having female healthcare providers was an important facilitator [50].

Trusted local messengers, including community members and religious leaders, played a vital role in building trust and promoting health behavior change [1, 25]. Culturally competent, bilingual promotores significantly improved healthcare access, particularly for COVID-19 testing and vaccination [1, 7]. Community outreach efforts, such as door-to-door initiatives and accessible healthcare settings, facilitated breast and cervical cancer screenings [50]. Accurate immunization registries and school-based promotion supported HPV vaccination uptake [45, 68]. Additionally, word-of-mouth and clear doctor-patient communication enhanced trust and understanding of health recommendations [11].

Societal-level factors: barriers

Societal-level factors include cultural and social norms as well as policies related to health, economics, and education, which can either mitigate or exacerbate socioeconomic inequalities between groups (CTSA Consortium, 2011). The first significant barrier identified was the lack of insurance among rural immigrants. Medicaid reimbursement shortfalls and insurance coverage gaps significantly limited access to necessary services [45, 50, 61]. The high cost of services relative to income and the absence of health insurance collectively made preventive healthcare out of reach for many rural immigrants living in poverty [41, 49,66].

Another crucial barrier stemmed from identity-related issues, particularly for undocumented individuals or those with temporary immigration status, who felt vulnerable due to their legal status or the potential for deportation. This structural fear was compounded by general distrust in the government and institutions, often resulting in avoidance of preventive healthcare services, especially for those with limited access to insurance [1, 53,25, 60].

Cultural barriers significantly impacted preventive healthcare access. Stigma around sexual behavior discouraged HPV vaccination, especially among rural immigrants, as norms against teen and premarital sex intersected with policy-related barriers like immigration status, further limiting SRH education and care [3]. Machismo and cultural taboos shaped attitudes toward breast and cervical cancer screenings, with shame, embarrassment, or male control over healthcare decisions restricting women’s autonomy [11, 39, 45]. Additionally, reluctance to seek care due to shame or a preference for traditional remedies deterred preventive services, including Chagas disease testing [51].

Societal-level factors: facilitators

Federal and state efforts, though not specifically for immigrants, have improved access to preventive healthcare. Medicaid and Vaccines for Children expanded HPV vaccine access [68], while state policies allowing teens to access birth control without parental consent enhanced SRH care and education [3]. Additionally, collectivist community values encouraged protective health behaviors, as individuals were more likely to seek testing and vaccination when they believed it benefited others [1, 7].

Discussion

This scoping review highlights the multilevel barriers and facilitators to accessing preventive healthcare among immigrant populations in rural America, emphasizing the unique challenges at the intersection of immigrant status and rurality. Immigrants in rural areas often face compounded obstacles that differ from those encountered by immigrants in urban areas or native-born rural residents. The convergence of geographic and social isolation, limited healthcare infrastructure, and systemic inequities creates a complex landscape where immigrants in rural settings are more vulnerable to barriers such as transportation challenges, language barriers, and fear of deportation. Although we categorized the barriers according to specific levels of the Social Ecological Model (SEM), it is important to acknowledge that some barriers are cross-cutting—shaped simultaneously by individual and structural factors. These overlapping factors not only restrict access to preventive care but also exacerbate existing health disparities, underscoring the urgent need for targeted, multilevel interventions for this growing and diverse population [42].

The findings from the included studies reveal a significant gap in the scope of preventive healthcare outcomes examined for immigrants in rural America. The studies primarily focused on a limited range of services, such as COVID-19 vaccinations, cervical cancer screenings, and specific disease testing, with less evidence on other outcomes such as diabetes that disproportionately affect rural population and minorities [38]. The omission of these outcomes from existing studies is itself a critical finding, highlighting the need for more comprehensive research to uncover and address the full spectrum of preventive health challenges faced by this vulnerable population.

This review identified multilevel barriers, spanning from individual psychological factors to policy-level exclusions. Systemic obstacles, such as lack of health insurance, legal precarity, and language exclusions, further compounded by cultural stigmas, misinformation, and logistical difficulties like limited transportation and inflexible work schedules, make access to preventive healthcare complicated and challenging for immigrants residing in rural areas. These challenges are interconnected and should be addressed systematically. For example, structural barriers such as a lack of insurance among rural immigrants can manifest at the individual level as fear of diagnosis of illness that is beyond their financial means to address. In such cases, an individual-level intervention that addresses fear alone, without focusing on expanding insurance coverage in rural immigrant communities, may not lead to improved access to preventive healthcare. Therefore, an interpretation of barriers that highlights the nuances of the issues has important implications for intervention strategies.

Additionally, the complexities of the healthcare system pose significant challenges; for instance, one study highlighted that private hospitals nearby often have specific eligibility criteria, while county hospitals that do not require a Social Security Number may be located 30 miles away [11]. The reviewed studies also highlighted barriers that created significant inconveniences for immigrants to access preventive healthcare, leading them to forgo these services. It is important to note that accessing preventive healthcare, or healthcare in general, can be an engendered issue among immigrant communities in rural areas. Family dynamics, gender norms, and inequalities may place some women at an elevated risk of missing preventive care.

Despite these barriers, the review revealed promising facilitators that could inform multilevel interventions. Community-based initiatives that involve promotores and trusted local messengers (e.g., religious leaders) were highlighted as critical in bridging gaps in healthcare access. In addition, community-level efforts to eliminate inconveniences, such as providing transportation, bilingual providers, and flexible clinic hours, have proven effective. More broadly, policy-driven supports, including Medicaid and state-level vaccination programs, have shown potential to alleviate financial barriers to access care. The impact of policy mandates, such as required HPV and other immunizations in school systems [31], also emerged as a significant factor. Expectations set by schools or healthcare providers influence family behavior, often encouraging adherence to vaccination schedules. However, we also found that there were limited efforts from rural employers, despite the studies’ description of many barriers originating from the workplace.

Implications for policy and practice

Policy and practice implications for improving preventive healthcare access among rural immigrants must address their unique challenges through systematic and innovative solutions. Additionally, it is essential to clarify how rural immigrants are situated within healthcare insurance plans, as rural plans differ significantly from those in urban areas, often leaving immigrants with inadequate coverage. At the policy design level, several limitations and challenges regarding the impact of existing legislation on immigrant health require careful examination. For example, despite that fact that the Affordable Care Act (ACA) significantly expanded access to preventive services—such as cancer screenings—through Medicaid expansion and marketplace subsidies, its eligibility for these benefits depends on immigration status. Specifically, lawfully present immigrants may qualify (though often with restrictions such as a five-year waiting period for Medicaid), while undocumented immigrants are excluded from ACA coverage altogether. As most studies in this review did not disaggregate findings by immigration status, the actual reach of ACA provisions in rural immigrant communities remains unclear and warrants further attention.

The recent One Big Beautiful Bill Act, passed and signed on July 4, 2025, introduces significant cuts to Medicaid—estimated between $800 billion to $1 trillion—with new work requirements, increased cost-sharing, and changes likely to reduce coverage for millions, especially in rural areas [35]. The law also scales up funding for immigration enforcement and tightens benefit eligibility and application fees for lawfully present immigrants, further complicating access to preventive care. Though its full effects are yet to be evaluated, these policy changes could disproportionately harm rural immigrants—both documented and undocumented—by reducing insurance coverage, increasing cost burdens, and heightening fear related to visibility in healthcare settings. Therefore, policymakers and health practitioners should monitor the implementation of these provisions—particularly Medicaid work requirements and eligibility restrictions—and consider targeted outreach to immigrant families in rural areas.

From the policy implementation perspective, effective strategies are needed to reduce address access barriers and concerns among immigrant populations. Access to preventive care must be coupled with affordable follow-up treatment, as evidence indicates that some immigrants struggle to proceed with treatment despite early detection of disease during screening [64]. Furthermore, the structural fear of visibility among this population—intensified by the political climate and other factors—requires creative approaches to build trust and reduce vulnerabilities. For example, although Children’s Health Insurance Program (CHIP) had been shown to decrease disparities in access to care for children living in rural areas [18], the benefit utilization rate of such assistance programs remains low among children from immigrant families in rural areas due to fears that it may jeopardize future citizenship [52]. It underscores the need for reassurance strategies and protection of immigrant families within rural healthcare frameworks.

Last, from the practice perspective, engaging immigrant populations through both grounded and innovative approaches is critically importance. Community-level programs should engage diverse stakeholders, including employers, schools, and religious groups, to collectively make preventive healthcare accessible for immigrants, who contribute significantly to the local economy and vitality. Leveraging resources within immigrant communities is also essential, as trusted members like religious leaders play a key role in health promotion. Schools with children of immigrant parents serve as critical venues and programs such as the Migrant Education Program can enhance engagement and support for preventive health initiatives. Addressing these challenges requires culturally informed, trust-building strategies and policies that promote affordable, continuous, and accessible care. Mobile and onsite clinics, as well as telehealth, are particularly needed in remote rural areas and for those working in labor-intensive jobs with less flexibility, requiring collaboration and accommodation from rural employers.

Implications for future research

This review highlights key directions for future research. Most studies relied on qualitative methods, which, while valuable for capturing lived experiences, limit generalizability. To better understand rural immigrants’ healthcare access, future research should incorporate large-scale, disaggregated data. Additionally, the study population was largely limited to Latinx immigrants, with minimal focus on Asian, multiracial, or other growing rural minority groups [34]. Research also overlooked children from immigrant families, whose healthcare access may be shaped by their parents’ immigration status, despite being U.S.-born. As rural demographics continue to shift, broader, more inclusive research is essential to fully capture the healthcare challenges and needs of diverse immigrant populations. Although documenting participants’ legal immigration status can be important for studying this topic, the included studies did not explicitly report them. Instead, several relied on proxy indicators, such as country of origin, length of U.S. residence, or insurance status, and others omitted direct questions about legal status to avoid exacerbating participant fears [41, 50]. This ethical decision, grounded in a commitment to protect participants amid rising anti-immigrant rhetoric, highlights both the distinctive concerns of this group and the challenges of researching marginalized communities. At the same time, it limits our ability to precisely discern how different legal statuses (e.g., naturalized citizens vs. permanent legal residents) shape structural barriers, underscoring the need for future, ethically attuned studies that can safely capture this critical dimension.

Limitations

This review has several limitations that should be acknowledged. First, the focus on peer-reviewed articles may have excluded valuable insights from gray literature, which often provide practical and community-level perspectives on healthcare access. Second, while we defined “rural” based on the U.S. Census Bureau’s definition, some areas that do not meet this definition but still experience significant resource limitations may have been excluded. These areas may face similar challenges, warranting further investigation. Third, our search strategy did not include racial or ethnic group identifiers, which may have contributed to the overrepresentation of Latinx-focused studies. As rural areas become increasingly diverse, further research is needed to examine barriers and facilitators among other racial and ethnic immigrant groups. Addressing these limitations could provide a more comprehensive understanding of the barriers and facilitators to preventive healthcare access among immigrant populations.

Conclusion

Preventive healthcare is crucial for improving long-term health outcomes and reducing costs, particularly for vulnerable populations such as rural immigrants. This review highlights barriers and facilitators to access, revealing structural, cultural, and policy challenges, but also promising community-based initiatives and policy-driven supports. Achieving equitable preventive healthcare for rural immigrants requires multilevel interventions that tackle systemic barriers and enhance community-driven solutions.

Authors’ contributions

YZ conceptualized the study, conducted the database search, screening, data extraction, analysis, and led the writing. XK contributed to screening, data extraction, and writing. YY and EH contributed to data extraction. YZ, XK, and YY jointly wrote the main sections of the manuscript. EH supported the literature screening and review.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-forprofit sectors.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Competing interests

The authors declare no competing interests.