This review included 21 of 1,704 articles published between 2011 and 2025. Most studies used qualitative methods (n = 12), including in-depth interviews (n = 8), focus groups (n = 5), and community-based participatory research (CBPR) (n = 1). Quantitative methods (n = 6, 29%) primarily involved surveys, while mixed methods (n = 3, 14%) combined surveys with group dialogues. Participant numbers varied, with qualitative studies ranging from 13 to 97, quantitative studies ranging from 39 to 493, and mixed methods ranging from 27 to 813.
The included studies covered various types of preventive healthcare, focusing on vaccination and disease testing, including COVID-19 (n = 8), breast and cervical cancer screening (n = 4), HPV vaccination (n = 3), and Chagas disease testing (n = 1). Five studies examined healthcare access and utilization, emphasizing childhood immunizations, sexual and reproductive health, and oral health. Most rural immigrants were from Mexico (n = 11) and South/Central/Latin America (n = 3), with others from Somalia (n = 1) or unspecified (n = 6). All studies explored barriers and facilitators of preventive healthcare, with key findings summarized in Table 2.
Barriers and facilitators to accessing preventive healthcare using the SEM
We used the four-level Social Ecological Model (SEM) to organize findings (See Tables 2 and 3).
Individual-level factors: barriers
The first level of SEM focuses on individual factors, including age, education, income, and health history (CTSA Consortium, 2011). Psychological barriers, particularly fear and perceived lack of control, frequently hindered access to preventive health services such as COVID-19 testing and vaccination [7, 25]. Similarly, fear of needles, concerns about additional risks, and religious beliefs discouraged HPV vaccination [69]. For breast and cervical cancer screenings, fears related to doctors, positive test results, medical exams, and waiting for symptoms led to avoidance [46, 50]. Fear of being diagnosed with a fatal or costly illness also discouraged Chagas disease testing [51]. Additionally, women with less experience in the U.S. healthcare system feared confidentiality breaches, deterring them from seeking sexual and reproductive health (SRH) services [3]. Some individuals also avoided medical care unless symptoms appeared, further limiting participation in cancer screenings [50].
Limited English proficiency was another significant individual-level barrier, restricting rural immigrants’ access to healthcare [41] and reliable public health information [26]. Specifically, the reviewed studies highlighted that low English proficiency impeded access to preventive healthcare services, including COVID-19 testing and vaccination [26], HPV vaccination [45], oral/dental health services [61], and Chagas disease testing [51].
Knowledge and awareness of diseases, healthcare procedures, and community resources were also critical factors influencing access to preventive healthcare. For example, limited health literacy about cervical cancer was cited as a barrier to both HPV vaccination and cervical cancer screening [39, 68]. Similarly, a lack of knowledge regarding the purpose, expectations, cost, and availability of breast cancer and cervical cancer screenings hindered participation in these services [46, 50]. While transportation is a known barrier to accessing healthcare in remote rural areas, study also found that many immigrants were unaware of available transportation services in some communities [53], highlighting a lack of awareness of community resources.
Socio-demographic factors, such as sex, age, and socioeconomic status (SES), also influenced access to preventive health services. The reviewed studies indicated that younger women were less likely to undergo Pap smear tests [39], while male immigrants often hesitated to take time off from work for Chagas disease testing [51]. Key aspects of SES, such as income and work constraints, were significant barriers in accessing preventive healthcare services [66].
Individual-level factors: facilitators
While various individual-level factors hindered access to preventive healthcare, several, such as personal attitudes, knowledge, and faith, were facilitators. For COVID-19 testing and vaccination, a strong sense of responsibility to protect oneself and others, coupled with a willingness to follow protective measures, was a key facilitator among rural immigrant communities [1, 7]. Faith and hope for the future also played a positive role in promoting vaccination uptake. One study participant described the COVID-19 vaccination as “the light at the end of the tunnel” [7], p. 8). Additionally, individuals with higher levels of acculturation were more likely to have recently undergone a Pap test and to correctly identify cervical cancer risk factors [39].
Relationship-level factors: barriers
The second level of SEM focuses on close social relationships with family, friends, and partners that shape individual behavior and experiences (CTSA Consortium, 2011). Parents’ attitudes and beliefs play a critical role in minors’ access to preventive healthcare, as parental hesitancy, perceived risks, and stigma often discourage children from utilizing these services [3]. For instance, a study on HPV vaccination highlighted that parents’ controversial perceptions of the vaccine served as key barriers, with concerns that it might encourage sexual activity among their children [69]. Similarly, parental opposition to teens seeking birth control without parental consent was cited as a significant obstacle to youths accessing SRH services [3]. Some women reported that their husbands would not permit them to undergo these screenings [46], and jealousy from husbands was also cited as a barrier to seeking care [50].
Relationship-level factors: facilitators
Support from close relationships facilitated preventive healthcare use, particularly in SRH education and care. Parental acceptance and informed knowledge were key to HPV vaccination uptake, with mother-daughter communication playing a crucial role [45, 68]. Additionally, individuals with social support felt more empowered to seek SRH services without fear of judgment [3]. These findings highlight the impact of social influences in overcoming barriers and promoting healthy behaviors.
Community-level factors: barriers
The community level of SEM examines the impact of social environments such as schools, workplaces, and neighborhoods on health (CTSA Consortium, 2011). A key issue in the reviewed studies was limited access to timely and accurate health information in rural communities. Participants struggled to find reliable information [26] and faced data overload, making it difficult to process health messages [53]. Rural immigrants also lacked awareness of local health services, including dental care [61] and SRH education and services [3]. These challenges were compounded by limited internet access, further isolating them from critical health information [26].
Another common theme of barriers at the community level was inconvenience, stemming from a lack of transportation, need-based services from healthcare providers, and appropriate accommodations from workplaces. Many participants reported difficulty accessing healthcare facilities due to long travel distances [53, 66] or inadequate transportation resources within their community [53]. In fact, as mentioned above, some communities did provide transportation support,however, the limited awareness among immigrant residents points to inadequate community outreach and communication efforts.
Challenges in accessing preventive healthcare also arose from interactions with healthcare providers. These included language barriers caused by the lack of bilingual providers and staff for scheduling and care [11, 5366], poor patient-provider communication [68], and distrust of certain healthcare facilities [45]. Some migrant and seasonal workers found the continuity of care challenging due to their migratory patterns, especially for timely follow-up doses such as the HPV vaccine [68]. Additional challenges included long waiting times at clinics and the absence of critical health services, such as mammograms, at rural community health centers [11].
Workplace-related barriers significantly impacted healthcare access, with many patients unable to schedule and attend medical appointments due to insufficient workplace accommodations [50, 53]. These barriers included challenges attending appointments during working hours and penalties for taking sick leave [53]. The lack of flexibility from employers or supervisors further hindered the ability to balance work demands with health needs [69], and regular clinic hours were often incompatible with participants’ work schedules [66].
Community-level factors: facilitators
At the community level, a variety of facilitators were identified that promoted access to preventive healthcare. These facilitators highlight community-based strategies that mitigate barriers to healthcare access, underscoring the importance of local involvement, flexible service delivery, and effective communication. For example, community support for transportation to appointments, flexible clinic hours (afternoons and evenings), and the availability of Spanish-speaking staff at the clinic were identified as key facilitators [66, 69]. Community health workers, clinic-based interventions, and the promotion of free services through community organizations also enhanced healthcare access, especially in non-clinical community settings [11, 49]. In the context of breast cancer and cervical cancer screenings, having female healthcare providers was an important facilitator [50].
Trusted local messengers, including community members and religious leaders, played a vital role in building trust and promoting health behavior change [1, 25]. Culturally competent, bilingual promotores significantly improved healthcare access, particularly for COVID-19 testing and vaccination [1, 7]. Community outreach efforts, such as door-to-door initiatives and accessible healthcare settings, facilitated breast and cervical cancer screenings [50]. Accurate immunization registries and school-based promotion supported HPV vaccination uptake [45, 68]. Additionally, word-of-mouth and clear doctor-patient communication enhanced trust and understanding of health recommendations [11].
Societal-level factors: barriers
Societal-level factors include cultural and social norms as well as policies related to health, economics, and education, which can either mitigate or exacerbate socioeconomic inequalities between groups (CTSA Consortium, 2011). The first significant barrier identified was the lack of insurance among rural immigrants. Medicaid reimbursement shortfalls and insurance coverage gaps significantly limited access to necessary services [45, 50, 61]. The high cost of services relative to income and the absence of health insurance collectively made preventive healthcare out of reach for many rural immigrants living in poverty [41, 4966].
Another crucial barrier stemmed from identity-related issues, particularly for undocumented individuals or those with temporary immigration status, who felt vulnerable due to their legal status or the potential for deportation. This structural fear was compounded by general distrust in the government and institutions, often resulting in avoidance of preventive healthcare services, especially for those with limited access to insurance [1, 5325, 60].
Cultural barriers significantly impacted preventive healthcare access. Stigma around sexual behavior discouraged HPV vaccination, especially among rural immigrants, as norms against teen and premarital sex intersected with policy-related barriers like immigration status, further limiting SRH education and care [3]. Machismo and cultural taboos shaped attitudes toward breast and cervical cancer screenings, with shame, embarrassment, or male control over healthcare decisions restricting women’s autonomy [11, 39, 45]. Additionally, reluctance to seek care due to shame or a preference for traditional remedies deterred preventive services, including Chagas disease testing [51].
Societal-level factors: facilitators
Federal and state efforts, though not specifically for immigrants, have improved access to preventive healthcare. Medicaid and Vaccines for Children expanded HPV vaccine access [68], while state policies allowing teens to access birth control without parental consent enhanced SRH care and education [3]. Additionally, collectivist community values encouraged protective health behaviors, as individuals were more likely to seek testing and vaccination when they believed it benefited others [1, 7].