State Context, Post-Migration Stress, and Unmet Healthcare Needs for Somali Refugees Resettled In the U.S.

This study examines health service utilization (HSU) among Somali refugees with chronic conditions (n=165), a population facing significant health disparities. Guided by an integrative behavioral and socio-ecological framework, a cross-sectional survey assessed predisposing, enabling, and need factors—including health status, insurance, trauma exposure, and ethnic density, . Hierarchical logistic regression and path analysis were used to model predictors of primary care use in the past six months. The sample reported high morbidity: 69% had multiple chronic conditions and 32% reported poor health. Economic strain was widespread (81% had difficulty affording basics), and insurance instability was common (22% uninsured; 61% experienced recent loss). Logistic regression revealed insurance (OR=6.40, p=.015) and moderate (vs. poor) health status (OR=3.54, p=.037) as the strongest direct predictors of HSU. Path analysis indicated that while post-migration stress did not directly predict utilization, it increased unmet needs, which in turn lowered HSU (β=-0.28). State of residence moderated the stress-unmet needs relationship, indicating geographic disparities in healthcare access barriers. Findings highlight the critical role of structural factors in shaping care-seeking. Implications include policies to expand and stabilize insurance coverage, careful consideration of ethnic enclave resettlement, and targeted efforts to reduce geographic inequities in refugee healthcare.