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Table 2 Experiential themes and exemplary quotes

From: “Many people have no idea”: a qualitative analysis of healthcare barriers among Yazidi refugees in the Midwestern United States

Primacy of language
  “The first [barrier] might be language.” [P1]
“Yes, language, language, and language – the big problem that we all face.” [P1]
“One of the biggest issues is the language barriers between providers and clients.” [P4]
Contrast and tension
 Before and after “Everything is different.” [P3]
“Might be the reason because we come from different country, different culture so we don’t know a lot about the process here in the U.S.” [P1]
“I think they need to know about the Yezidi culture and history because our medical history is reflecting our history in Iraq.” [P1]
 Caught in-between “We are here and we still asking, and we don’t know, so what about people?” [P1]
“I spend 3 years with military, I know some cultural stuff with American people but we still surprising me all this detail here. So, imagine people never seen anything like that.” [P3]
 Negative perceptions / experiences impede care “The process took between 12 and 13 h until I got treatment at emergency room. So, this point makes people hate getting insurance or even getting to doctors and seeking health care.” [P1]
 Uncertainty / Not knowing “They don’t know a lot of information about health insurance. They don’t know how to apply. And even if they know how to apply, they don’t know how much they will pay, how much it will cost them. This is something our community afraid from it. They are confused about it.” [P1]
“For example, I am working at [major retailer], and if I got late one minute, they will put one point on my record. My wife doesn’t have driver license and I have three kids. How we will go to appointment if we have one?” [P5]
 Overwhelm “Right now, I don’t have enough time to do all tasks that I need to do to my family and myself.” [P3]
“Maybe you can’t see stress on my face, but probably I have stress inside due to the war which affected all my life. That happens to many Yazidi when they survived from genocide on the 2014.” [P1]
 Financial instability “We are new in this country and many of us have kids and some have chronic disease like me. So, when I got work just 8 h more than 20. Next day, I see they send me email saying your Medicaid stopped. You can’t work and try to depend on yourself.” [P5]
“Many people don’t work more than limited time because they are afraid of losing Medicaid benefits for parents.” [P1]
Adaptation and transition
 Importance of education “The system over all is good but we need transition. People need to know how to use that and they need education.” [P3]
“Client should be educated in the same times, providers should know a little bit about the client culture, services he need.” [P1]
 Importance of social connection “Yezidi community is like a net, is all connected together.” [P3]
“I know two elder people got back to Iraq because of social isolation; the community in Lincoln is so closed and we grow up in a social environment.” [P9]
 Importance of trust “I don’t trust private insurance.” [P9]
“People don’t trust nurse due to the bad experiences with nurse work at our previous country.” [P9]
“Health care provider need education about those barriers and how they can build a trust relationship with the client to get the health services they need.” [P4]
 Doing the best you can “We need to adapt with the situation. We need to arrange our time; if you don’t go to gym you can run; if you don’t want to run, you can do some exercise at your home. But you need to arrange your time, and because of transition and because of a lot of new things in our life.” [P3]