As health equity efforts in health services research continue to grow, innovating current methodologies must be included as part of the conversation. This is particularly necessary when seeking to better understand health outcomes for foreign-born communities living in the U.S., as comprehensive data is often lacking. This is a prominent issue if you are seeking clarity on a specific ethnic group within a racial category. Asian immigrants, for example, could be from 51 different countries with well over two thousand languages spoken among them. Not only do health outcomes vary among these ethnic groups, but how diseases present themselves can differ within minority groups as well. Immigrants should not be treated as a monolith if we hope to document their health disparities more accurately.

With the increasing size of the immigrant population, there is a parallel growing need to build upon the current body of health services research and improve their care delivery.  Due to the gaps in ability to properly identify immigration status or ethnic group in claims or electronic health record databases, the dominant HSR methods of econometrics and strict quantitative approaches may fall short in reaching foreign-born populations. Thus, it is essential to consider what we as health services researchers can change moving forward to better align immigrant health equity with HSR.

The key component of addressing these blind spots in the field is including the voices of community members in your research. This could be through qualitative work or engaging with these communities in numerous aspects of the research spectrum.

Potential approaches to do so include:

  • Qualitative Research methods are still underutilized in HSR and immigrant populations may often be left out of recruitment efforts due to language barriers. These hard-to-reach populations are important to seek out given how little data currently exists on their health care outcomes and experiences. There are questions that simply cannot be answered with quantitative methods, such as why Mexican immigrants travel to Mexico for their health care or whether dementia diagnostic criteria are culturally effective.
  • Mixed Methods Research, the use of both quantitative and qualitative data in an integrated framework, could be of particular use when researching foreign both populations. Using mixed methods can provide context through the inclusion of community voices to what is seen in quantitatively collected data. This methodology is particularly useful with sensitive topics, such as mental health, which can be stigmatized. Whether you collect your own data or use existing sources, mixed method studies are typically of smaller scale than traditional quantitative research.
  • Community-based participatory research methods (CBPR) bring in participants from your community of interest to be involved in all aspects of your research as partners. This could include everything from formulating research questions to disseminating results. Given the emphasis on tailoring interventions to the specific community involved in the research, CBPR is particularly suited to developing culturally effective solutions for foreign-born groups.  There is also the sense of parity this approach provides, as participating in research can seem daunting.

Overcoming Barriers to Research Participation

When seeking to include immigrants in HSR, building trust is of the utmost importance. Language and cultural barriers between study participants and researchers can add to the stress of the unfamiliar.  A recently published article in Health Services Research detailed helpful considerations when seeking to engage immigrant populations in research, emphasizing the importance of flexibility throughout the study process and meeting communities where they are. Adapting typical research practices to be more culturally effective could mean, for example, modifying how informed consent is delivered so as not to intimidate potential participants.

As members of this field, we must continue to adapt to the needs of our populations of interest. The approaches listed above are by no means exhaustive, but potential tools to strive for health equity in immigrant populations. These groups may currently be severely underrepresented in health services research, but I am hopeful that will soon change.

Julie Ressalam, M.P.H.

Doctoral Student - University of Colorado School of Public Health

Julie Ressalam is AcademyHealth’s Spring 2023 Health Policy Fellow Read Bio

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