Barriers and facilitators to healthcare for people without documentation status: A systematic integrative literature review

AimsTo identify the barriers and facilitators to healthcare for people without documentation status.DesignWe conducted a systematic integrative literature review following the Whittemore and Knafl methodology.MethodsLiterature search was conducted to identify studies addressing barriers or facilitators to healthcare for people without documentation status in the United States between 2012 and 2022. Studies were critiqued for quality, with results analysed thematically using the social-ecological model.Data SourcesSearches were conducted in PubMed, PAIS, Web of Science, CINAHL and Psych Info in October 2022.ResultsThe review incorporated 30 studies (19 qualitative and 11 quantitative). People without documentation status encountered numerous healthcare barriers such as intrapersonal (lack of financial resources and health insurance, fear), interpersonal (language and cultural discrepancies, discrimination), community (bureaucratic requirements, anti-immigrant rhetoric) and policy-related barriers. Conversely, linguistically and culturally competent care, empathetic and representative staff, health navigators, safety-net clinics and supportive federal policies emerged as key facilitators.ConclusionThese findings illuminate the complex healthcare disparities experienced by people without documentation status and underscore facilitators enhancing care accessibility. Future research is needed to explore interventions to increase access to care for this population.ImpactThis paper provides a comprehensive examination of the complex barriers and facilitators to healthcare for people without documentation status in the United States. The findings support the value of universal healthcare access, a priority of the World Health Organization, and can inform healthcare policies and practices worldwide.Reporting MethodThe review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework.Patient or Public ContributionNo patient or public contribution was needed.Trial and Protocol RegistrationThe study protocol was registered with the PROSPERO database (registration number: CRD42022366289).