Table 4.

Thematic categories and subcategories for barriers and facilitators

Barriers for immigrant populations in accessing healthcare services
Theme	Subtheme	Participant quote
Fear of deportation and interaction with law enforcement	Fear of federal immigration services	“Sometimes, it feels like they might bundle us up or in case you just suspected of something small, they could deport you. Sometimes feels like we are unwanted. Sometimes, I’m a bit scared.”
	Fear of outcomes from immigration proceedings	“My worry is will I get the asylum? I want to get my asylum. I need to get asylum. That is where my worry is, because I don’t want to go back to [country of origin]. They are killing people every day. Everyday people die. Politics in my country are not going in a good direction. People who die. If I get asylum and stay here, that will be better for me. I don’t want to go back to that country again.”
	Fear of law enforcement	“We have heard of some people being arrested from our community members. And the challenges they went through were not easy. When I was coming into [hospital], I met two police officers. It was a challenge, it was a fear. I thought, agh, why is it that the two officers are in the department I am going. I think, I think, let me go. It comes to anything, it’s all fear. It’s really fear. Fear of them.”
Safety concerns delaying healthcare access	Fear of leaving the home	“Yeah some people, when we are discussing in the community, some people tell us why you people go to [hospital]? If they arrest you there, what will you do then? That also brings a challenge. It may even stop others too. Because people fear to come to here and be arrested. But we still persisted, to come, to pick the medication and uh as soon as I get out of here, I cannot stay. For even more than ten minutes. And I don’t want to stay in [city], because the streets look extremely tight. We fear.”
	Fear stemming from word-of-mouth	“Yeah, a number of people are worried. Some of, some of people say if that day comes, that will be death. Some of them compare it to, they call it the doomsday. We share a lot of things. What will be the next step? We ask ourselves what will be the next step after here? And how will we go back if the government are to send us back. People begin discussing in different aspects. Some people reach to an extent, so say going back, they don’t want to die from torture, they would rather die from here. Like that. That’s the attitude we get.”
	Fear stemming from media	“Yeah, because when they talking on the TV, radio like that, so one day they said they will deport everybody. You know, I’m scared. I know they might take him or me.”
Socioeconomic-cultural factors impacting healthcare access	Insurance coverage	“We just worried about insurance. I know how long we are covered this insurance. And like, how many, this is like a year already working. Like will it working later?”
	Concerns with financial means	“Sometimes I don’t have the means to come. Like I don’t have money on my bus ticket. Yeah sometimes, like that. Those are issues. I just can’t visit.”
	Cultural adjustments	“In [country of origin], you don’t go to a doctor unless you are sick. And so this is the same pattern that they carry. None of the refugees have ever gone to the dentist even though MassHealth covers it for free, the dental insurance for free. Everybody thinks that only crazy people go to therapy. No one goes to therapy.”

Facilitators of care for immigrant populations in the healthcare setting
Theme	Subtheme	Participant quote
Supportive community networks	Support from religious affiliation	“I stayed at the church. I introduced myself to [pastor], I told him my problems. So he introduced me to the church members. So I stayed at the church. People at the church they were, they were people who would bring food for me. So I was so, so depressed, stressed, traumatized for what I went through in [country of origin]. So, I stayed there with [pastor]. I told him my problems of being, uh, of having HIV and that I had not come with my medication.”
	Support from cultural community	“I met friends here. [Ethnic group], they helped me. The first one was in [city]. I stayed in [city]. And after some time, she was a lady and she tell me nope, you should go and look for another friends. I’ve helped you for some time. Then I found another friend. And now I stay in [city].”
	Support from family members	“[Doctor] was saying things about that to me, but we said that we talked to our brother-in-law and he said to decline it. He said he will help until you start working. I think, he say what is it, he say it was social support. Until you have social security and working permit. You need that to do work. But you don’t need to worry. Right now, he is help us.”
Immigrant-friendly hospital infrastructure	Specific programs/services available	“Because I knew I needed a primary care doctor and I had some pain in me, so they recommended me to come here. So I started from the refugee center, ‘cause that’s where I went. I also needed to get legal representation. There are so many things I needed to know. So when I went to the refugee center, that’s when I got to know about everything that is here.”
	Perception of an immigrant-friendly environment	“They are the ones that receive people from other countries. I don’t know what other hospital does that but [hospital] that I know that be liked for the immigrants here. They are the ones that give life to immigrants here whether you speak English or you don’t speak English. They are attend you and they do everything that they say is good for you.”
Positive interactions with hospital staff	Case workers and social workers	“My mental situation was really complicated, because I was in the dark, in the dark. In the dark means, I didn’t know what to do, where to go. And I couldn’t see anything in front of me, so whenever I came here, I feel that oh, there are people they care. There are people, they show people the light… first person I remember is [case manager], so I call her. I said to [case manager], this is my situation now and I don’t know what to do. So [case manager] advise me. Whenever I feel confused or something happen very bad, scary, or worry, I used to talk to [case manager].”
	Doctors	“They check my blood and I got the bad news that I’m sick with HIV. And I get worried, but [doctor], said no, we can take care of you. And you can start the medication and live longer. And I said okay, then I accept that. And I talked to her, they helped me to get a lawyer, and I applied for my asylum. It was going slow, you know, and I wait. And now, I wait and I get a card.”
Trust in Being a ‘Good Citizen’		“To not do anything wrong. I hear people another thing. They drink alcohol. They end up making accidents, those are the things that take them to deportation. Such a things, at my age, I am mature enough. I cannot do such a thing. I am mature enough.”