An exploration of the social determinants of the health and well-being among older African immigrants living in San Diego. A socio-ecological approach

Background As immigration continues to be a global phenomenon, the number of aging immigrants will increase. There is a knowledge gap in the United States on the social determinants of health among older immigrants, especially the older refugee population. We aimed to explore the social determinants of health among older African immigrants living in San Diego, California, and to suggest strategies that can inform the design of health-promoting interventions. Methods We employed a qualitative approach using semi-structured interviews with 11 participants (nine females and two males). We used deductive thematic analysis to explore and analyse the factors that influence their health and well-being based on the five levels of the socio-ecological model (individual, interpersonal, organizational, community, and public policy). Results Participants were aged between 62 and 90 years; eight participants had arrived as refugees. Thematic analysis resulted in the following themes within the five levels: individual (pre-migration and migration experiences and impact on health, aging-related health decline, sedentary lifestyle, side effects of medications,language barrier); interpersonal (social support and social participation); organizational (access to healthcare and support services, transportation, - disruption to services due to COVID-19, perception of healthcare and support services); community (social, emotional and practical support, connecting older adults to services) and public policy (financial barriers, immigration policies and legal status). Conclusions Given the distinct linguistic and cultural backgrounds coupled with the unique health needs of our study participants, there is a need for diverse and complementary interventions that seek to build a sense of community and social support for older adults. Such interventions ought to be co-developed with immigrant communities and local organizations to ensure cultural acceptability and effectiveness. Crucially needed are immigration policies that consider the unique situation of older immigrants from low-income backgrounds to ensure equitable access to health and social care services.