Table 3.

Barriers to seeking healthcare

Barrier type	Examples	Illustrative participant quotes
Pragmatic	Prohibitive costs No insurance Transportation Geographic location Family responsibilities Work hours conflict with medical clinic hours	I don't have the money to get there. Even [if] somebody gives me a ride or swipe on the train. To get there it’s hard…So, most of the time I've got to reschedule it…I can't go a month or two now because the last thing that I did is the MRI. I really need a dentist, but I don't have the money so where would I go? I can’t chew on it… Sometimes I don't have time to go to see the doctor. I have to cancel the appointment and make another one. But I have to cancel that again. But I keep trying. That happens sometimes. So you can’t just go to the clinic, and, you know, even the community clinics, you need some money to pay them. You know, when I came in, newly [sic] even if I feel sick, it was really hard for me to go to the clinic, because I wasn't sure which clinic I'm supposed to go to, I have no insurance…there was not a lot of opportunity for me to see a doctor so, you know, my body just I guess, has to try to make this defense mechanism and not get sick.
Knowledge	Difficulty navigating complex systems Lack of understanding of healthcare system	[My] visa was denied. And I didn't have like, any authorization to work. I was undocumented. So I was like, experiencing…a lot of anxiety, depression and all of that. And I never sought medical treatment, because I thought there was no access for that. I mean, for example, because I needed like to see a therapist…I thought that I had not no access at all. And if I had, it was gonna be super expensive… …My wife told me before I go for a blood test. She said the doctor told her that I can do it. So you went there. And the lady over there said, doctor, then no assistant is there to work…know the system, unless I have the Medicare. And she sent me downstairs to get my appointment for the Medicare…then I called my lawyer to ask if I could apply and she said no. Other things that have me upset, actually is that for a psychology pill or therapy or support it’s really hard to get it even if you have insurance. For example, I came last year because the doctor sent me because of my special case. But I never was able to get a therapist. I went to several places. But I never got to get the therapy that I needed. I think that the main barrier is the wait that we have to go through in order to have an appointment or to be assisted by the doctor, be seen by the doctor.
Mistrust	Stigma Mistrust of healthcare system or technology Lack of understanding of culture	I was also scared, because I thought that if I wanted to have access to any health provider, I was scared that the government was gonna track what I was doing…I was paranoid thinking that they will have access to my emails, to everything. They treat you like you're like you're lying at the first place so they're like the interviews goes by that like say you're lying and I'm gonna find why you're lying. I don't trust the healthcare…I asked him to tell me, how much would it be? I mean, I don't have to say exact price. But I want to know, what is the average price? She’s like, ‘I don't know, I don't think it’s too much.’ I don't mind what is too much…just give me a number that I would decide if I wanted to do it or not. She’s like, ‘No, I can't give you the budget. It’s not gonna cost that much.’ And then it was like, over $1000. When I first came to this country, I didn't know anything. I didn't know about the rights I had…I had always this feeling kind of persecution or sadness.