Improving the health outcomes of African migrants in the U.S. largely depends on how comfortable they feel seeking out health services.

That was a key finding of research conducted by Direct Relief’s University of Michigan Gerald R. Ford School of Public Policy intern, Celia Sawyerr, who interviewed providers from four federally qualified health centers in Houston, Texas, Washington, D.C., and The Bronx, New York.

African migrants face high rates of chronic disease and mental health issues—similar to other minority populations in the United States—but the obstacles preventing them from accessing medical care vary.

According to providers, food insecurity and a lack of transportation, in addition to histories of trauma, low levels of health literacy, and distrust of western medicine, prevent many from being able to achieve better health outcomes. Overcoming these barriers, according to Sawyerr’s research, requires a culturally sensitive approach.

“If you want to be able to impact health outcomes, you have to first be able to connect with the culture, understand the various cultures, and then design your delivery systems around those cultures,” said Dr. Douglas York, the CEO of Union Community Health Center in New York.

At the Bee Busy Wellness Center in Houston, Texas, patients’ inability to purchase healthy food has made it difficult to get their chronic conditions, like diabetes, under control. While some can’t afford to buy healthy food, others don’t have grocery stores in their neighborhoods or within walking distance. Providers also said stress, often related to migratory experiences, hinders patients’ ability to manage their conditions and exacerbates diseases like hypertension.

In addition to chronic disease management, mental health support is a common need among African patients–many of whom have witnessed violence in their home country and isolation in the states. This often manifests as depression and anxiety.

While stigma around mental health care prevents many from reaching out for help, providers said that normalizing this kind of care increases patient engagement. For example, the Bee Busy Wellness Center saw an uptick in the use of mental health services when therapy was offered through telemedicine, rather than a traditional office setting. “African immigrants utilize the services where they feel most comfortable,” said Norman Mitchell, the CEO of Bee Busy Wellness Center. Telemedicine has also helped expand access to chronic disease care during the pandemic when stay-at-home orders made it difficult for patients to manage their conditions independently.

To address these barriers, Sawyerr offers a range of solutions including installing community fridges in public spaces, van shuttles to grocery stores, and signing people up for federally-subsidized internet to lower the costs of telemedicine. While structural changes are needed, Sawyerr says, they will only go so far.

“To effectively meet the health needs of Sub-Saharan African migrants in the United States, it is imperative that they feel comfortable seeking out care,” she wrote. This requires health care providers to understand the cultural circumstances of their patients and meet them where they’re at. “Health centers that tailor their services to the specific needs of this population will be the most successful in connecting with and improving the well-being of their African patients.”