. 2020 Jan 8;20:27. doi: 10.1186/s12889-019-8127-9

Table 3.

Themes and subthemes generated from the analysis of included studies

Themes	Sub-themes	Examples
• Cultural Influence • U.S. Healthcare System	• Traditional Beliefs • Religiosity and Spirituality • Stigma in the community • Linguistic discordance • Cultural competence • Complex U.S. healthcare system • Cost of healthcare • Biased/hostile provider attitudes • Lack of trust of the U.S. health system	• “Why pay to find out that nothing is wrong? And why pay to find out that I have a costly problem that I can’t feel, like diabetes and high blood pressure?” • “God makes people differently and God creates people with imperfections. If you go to the doctor, God gives the doctor power to help.” • “In the eyes of a family with a person with hepatitis B, hepatitis B equals AIDS. If a family member is sick, the family no longer has the same image in the community.” • ‘If you don’t speak English, they just ignore you, or you can’t even understand your name when they call it.” • “If I’m seeing a doctor here, the doctor doesn’t understand what I’m eating in terms of the African dishes …” • “Whenever I have a hospital visit coming up, I always pray and fast for days to ensure it goes well.” • “Hospital visits are expensive; unfortunately, there are very few ethno-medical centers. In America, I don’t have access to local herbs...local herbs work!” • “If you go to a hospital and you are wearing African clothing, they don’t even want to touch you. They think we bring diseases from Africa.” • “Cancer will kill you anyway … it is a cover-up meant to use African immigrants as guinea pigs.”

Themes

Sub-themes

Examples

• Cultural Influence

• U.S. Healthcare System

• Traditional Beliefs

• Religiosity and Spirituality

• Stigma in the community

• Linguistic discordance

• Cultural competence

• Complex U.S. healthcare system

• Cost of healthcare

• Biased/hostile provider attitudes

• Lack of trust of the U.S. health system

• “Why pay to find out that nothing is wrong? And why pay to find out that I have a costly problem that I can’t feel, like diabetes and high blood pressure?”

• “God makes people differently and God creates people with imperfections. If you go to the doctor, God gives the doctor power to help.”

• “In the eyes of a family with a person with hepatitis B, hepatitis B equals AIDS. If a family member is sick, the family no longer has the same image in the community.”

• ‘If you don’t speak English, they just ignore you, or you can’t even understand your name when they call it.”

• “If I’m seeing a doctor here, the doctor doesn’t understand what I’m eating in terms of the African dishes …”

• “Whenever I have a hospital visit coming up, I always pray and fast for days to ensure it goes well.”

• “Hospital visits are expensive; unfortunately, there are very few ethno-medical centers. In America, I don’t have access to local herbs...local herbs work!”

• “If you go to a hospital and you are wearing African clothing, they don’t even want to touch you. They think we bring diseases from Africa.”

• “Cancer will kill you anyway … it is a cover-up meant to use African immigrants as guinea pigs.”