Date of Award

May 2021

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

AkkeNeel Talsma

Committee Members

Shawn Cahill, Lucy Mkandawire-Valhmu, Timothy Ehlinger

Keywords

Acculturation, English Language Proficiency, Ethiopian immigrants, Health Behavior, Immigrant Health, Length of Stay in the United States

Abstract

ABSTRACTFACTORS THAT INFLUENCE THE HEALTH SEEKING BEHAVIOR AND DEGREE OF HEALTH SERVICE UTILIZATION OF ETHIOPIAN IMMIGRANTS LIVING IN ONE OF THE MIDWEST CITIES OF THE UNITED STATES: A MIXED METHODS

Immigrants have a significantly higher prevalence of chronic diseases, such as diabetes, hypertension, heart disease, and worse health outcomes than native-born individuals in the United States. The disproportionate adverse outcomes have been associated with structural, systemic, and socioeconomic inequalities and individuals’ Health-Seeking Behavior (HSB) and patters of Health Service Utilization (HSU). The purpose of this study was twofold. First, the survey explored (a) factors influencing the HSB of Ethiopian immigrants and the extent of HSU, (b) the relationship of predisposing and enabling factors related to HSU. Secondly, the study examined the role of religious and community leaders in influencing the HSB of their members. The study used a combined conceptual framework adapted from Andersen Behavioral Health and Health Belief Models. This cross-sectional, parallel convergent, community-based mixed-method study employed survey questions to collect data on HSB, access, and HSU, and a seven Focus Group Discussions (FGDs) of faith and community leaders. The result demonstrated that lack of insurance coverage (p=.009), immigration status (p=.005), English language proficiency (p=.045), and acculturation (p<.000), time to schedule urgent (p=.007) and non-urgent (p=.031) appointments were found to be associated with AHS, while English Language Proficiency (ELP) was associated with HSU (p=.034). In addition, COVID-19 related health behavior changes demonstrated that 72.9% (n= 153) participants practice social distancing and limit social gathering, 70% (n= 153) wash their hands more often, 65.7% wear masks in public, 63.3% (n=133) stopped handshaking/hugging, 56.2% (n=118) clean grocery carts, and 28.6% closely watch what other people do with their hands. Findings from the FGDs found that pre-immigration health practice, mistrust of professionals and the health system, lack of knowledge about the US health system and common diseases, and fear of the unknown about their health were key factors influencing their health behavior. Community engagement aimed at sharing health information with the Ethiopian immigrants to increase awareness and partnering with faith and community leaders could help influence their health behaviors.

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