Barriers and facilitators of preventive healthcare access among immigrants in rural America: a scoping review

Abstract

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Preventive healthcare services are essential for improving health outcomes and reducing disparities; however, immigrant populations in rural America face significant barriers to accessing such care. This scoping review examines the barriers and facilitators to preventive healthcare access among rural immigrant populations in the United States, utilizing a systematic analysis of 21 peer-reviewed studies published between 2011 and 2025. Key findings reveal interconnected barriers at multiple levels, spanning from individual psychological factors to policy-level exclusions. Facilitators include community-based initiatives, culturally responsive care, and policy-driven supports such as Medicaid and vaccination programs. The review also highlights critical gaps in the literature, including limited research on non-Hispanic immigrant groups and underrepresentation of certain preventive care services, such as diabetes management and oral health. Addressing these challenges requires multilevel interventions that prioritize affordability, accessibility, and cultural relevance. This review underscores the need for comprehensive, equity-driven strategies to ensure that rural immigrant populations can fully benefit from preventive healthcare services.

Introduction

Preventive healthcare—including check-ups, screenings, immunizations, and counseling—helps prevent and detect serious conditions early [67]. Evidence has shown that receiving preventive healthcare services can lead to a significant number of health benefits across all age groups, including the early detection of unrecognized health risks [23, 72], prevention and eradication of certain infectious diseases [4, 59], promotion of long-term healthy childhood physical outcomes [32], and reduction of morbidity and mortality rates associated with various types of cancer [6, 44]. Increasing data suggest that preventive healthcare benefits society beyond individuals and families by reducing long-term healthcare costs, advancing health equity, strengthening infrastructure, and boosting productivity [9, 16, 59, 71].

Despite the well-documented benefits of preventive healthcare, many immigrants in the U.S. face significant barriers to access [20, 22]. Language barriers, limited health literacy, and fear of deportation often discourage them from seeking essential services like disease screenings [8, 10, 19, 27, 33]. These challenges are further compounded by structural obstacles, including lack of insurance, inadequate healthcare facilities, and discriminatory policies that disproportionately affect immigrants in vulnerable circumstances [27, 57, 58]. As a result, many immigrants struggle to access timely preventive care, increasing their risk for undiagnosed conditions and long-term health complications.

The number of immigrant populations, particularly those of Hispanic origin, has increased rapidly in rural areas in the U.S., contributing to population growth and community vitality [48]. Hispanic immigrants accounted for over 60% of the population growth in nonmetropolitan and rural areas over the past three decades [43]. Other groups, such as Asian immigrants, have also experienced nearly universal growth across all regions [13]. Driven by the increasing demand for labor in industries such as agriculture and manufacturing, immigrant workers in rural areas of the U.S. are largely employed by farms, meat processing plants, and other sectors that typically do not require extensive educational qualifications [36, 37, 47].

Despite their significant contributions to these industries, many rural immigrant workers remain “invisible” or viewed as “unwanted byproducts of an industrial system” [70], p. 570), making them more vulnerable to poor working, living, and health conditions [14]. A systematic review on migrant worker health found that rural immigrant laborers, particularly in agriculture, often experience musculoskeletal pain, respiratory issues, and mental health challenges like stress and depression [28]. Migrant and seasonal farmworkers also face higher risks of obesity, diabetes, hypertension, and other chronic diseases [5, 12, 54, 65]. Additionally, children from immigrant families in rural areas experience health disparities, including higher rates of obesity and dental caries [17].

Access to healthcare remains a major challenge for rural immigrants in the U.S., where geographic isolation, limited resources, and inadequate infrastructure create unique barriers [24, 63]. Studies showed significantly lower rates of preventive healthcare use among foreign-born rural workers compared to U.S.-born or non-Hispanic White populations [30, 55]. This lack of access can lead to undiagnosed conditions like diabetes, resulting in long-term health consequences [54]. Furthermore, rural immigrant populations living in the United States may continue to encounter dire health consequences and disparities, as abrupt and rapid shifts in recent U.S. immigration policies perpetuate restrictive and even discriminatory practices towards immigrant communities [40]. Addressing these disparities requires a deeper understanding of the barriers to care and the resources that can bridge the health gap. However, there is limited synthesized evidence on these challenges and facilitators. This scoping review aims to fill that gap by systematically analyzing existing literature to provide a comprehensive understanding of healthcare access and utilization among rural immigrant communities. It is important to note that the term “immigrant” in this review refers broadly to foreign-born individuals, regardless of legal status.

Methods

This scoping review was guided by Arksey and O’Malley’s framework [2] and conducted by (a) identifying a research question, (b) identifying relevant studies, (c) selecting the studies, (d) charting the data, and (e) collating, summarizing, and reporting the results.

Identifying the research questions

This scoping review focuses on two research questions: (1) What are the barriers and facilitators to accessing preventive healthcare for immigrants in rural America? (2) How are these factors associated with health outcomes, and how do they inform or appear in strategies to improve healthcare access for this population?

Identifying relevant studies

A systematic search across MEDLINE with Full Text, APA PsycInfo, and CINAHL was conducted under three broad headings—“immigrant,” “rural,” and “preventive health care,” as described in Table 1 and Supplementary File 1. The search strategy was built with input from librarian and subject experts. This review considered preventive healthcare a proactive approach aimed at maintaining health and preventing or treating diseases before they become serious. It includes a variety of medical services such as regular check-ups, screenings, immunizations, and counseling to detect potential health issues early on and manage them effectively. Search terms for “preventive health care” included keywords such as physical exams, screenings, vaccinations across various types of diseases. Boolean logic (using OR and truncation*) was used to combine the search terms. When combining the blocks, the term AND was used. The first author completed the search for potential publications across all databases on July 14, 2025.

Table 1 Searching strategy

Selecting the studies

Articles published in English in 2010 and after were included. A total of 1,704 articles were imported into Covidence, a systematic review platform, and duplicates were removed. The first-round review involved title and abstract screening based on the following criteria. Each study: (1) focused on immigrant populations (i.e., foreign-born populations or families with foreign-born members); (2) was conducted in rural America; (3) was empirical; and (4) focused on preventive rather than curative care.

Each article was reviewed independently by two reviewers to determine eligibility; in case of a conflict, a third reviewer was involved, and conflict was resolved after a team discussion. Articles that met the criteria or could not be categorized based on title and abstract were subjected to a full article review (n = 88). The first three authors conducted full-text screening, with each article independently reviewed by two reviewers, who provided reasons for exclusions. Special attention was given to data collection dates and preventive healthcare types. We excluded studies with data collected before the passage of the Affordable Care Act (2010), as the ACA significantly altered access to preventive services, particularly through Medicaid expansion and insurance marketplaces. We differentiated preventive healthcare from health promotion programs, which are typically group-based and not directly tied to healthcare services. The selection process is shown in the PRISMA Flowchart (Fig. 1).

Fig. 1

PRISMA Article Searching and Screening Flowchart

Charting the data

Using a pre-designed Covidence form, four authors independently extracted data from selected articles: study characteristics, participant criteria, recruitment methods, preventive healthcare focus, barriers, resources, and significant findings.

Collating, summarizing, and reporting the results

We analyzed and synthesized the findings using the “charted” information from the selected studies. We organized relevant information on the authors, study design, study participants, country of origin of immigrants, primary focus of preventive healthcare, and barriers/resources to accessing preventive healthcare services (Table 2). Using thematic analysis, we categorized the barriers and resources into individual, relationship, community, and societal levels, guided by the Centers for Disease Control and Prevention (CDC)’s four-level Social Ecological Model (SEM) [15]. This model offers a framework for multilevel interventions and systemic change and has been widely used to guide rural health practice (Rural Health Information [62]).

Table 2 Summary of the included studies (N = 21)

Results

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).

Table 3 Barriers and facilitators identified in the included studies at the individual, relationship, community, and societal levels

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].

Discussion

This scoping review highlights the multilevel barriers and facilitators to accessing preventive healthcare among immigrant populations in rural America, emphasizing the unique challenges at the intersection of immigrant status and rurality. Immigrants in rural areas often face compounded obstacles that differ from those encountered by immigrants in urban areas or native-born rural residents. The convergence of geographic and social isolation, limited healthcare infrastructure, and systemic inequities creates a complex landscape where immigrants in rural settings are more vulnerable to barriers such as transportation challenges, language barriers, and fear of deportation. Although we categorized the barriers according to specific levels of the Social Ecological Model (SEM), it is important to acknowledge that some barriers are cross-cutting—shaped simultaneously by individual and structural factors. These overlapping factors not only restrict access to preventive care but also exacerbate existing health disparities, underscoring the urgent need for targeted, multilevel interventions for this growing and diverse population [42].

The findings from the included studies reveal a significant gap in the scope of preventive healthcare outcomes examined for immigrants in rural America. The studies primarily focused on a limited range of services, such as COVID-19 vaccinations, cervical cancer screenings, and specific disease testing, with less evidence on other outcomes such as diabetes that disproportionately affect rural population and minorities [38]. The omission of these outcomes from existing studies is itself a critical finding, highlighting the need for more comprehensive research to uncover and address the full spectrum of preventive health challenges faced by this vulnerable population.

This review identified multilevel barriers, spanning from individual psychological factors to policy-level exclusions. Systemic obstacles, such as lack of health insurance, legal precarity, and language exclusions, further compounded by cultural stigmas, misinformation, and logistical difficulties like limited transportation and inflexible work schedules, make access to preventive healthcare complicated and challenging for immigrants residing in rural areas. These challenges are interconnected and should be addressed systematically. For example, structural barriers such as a lack of insurance among rural immigrants can manifest at the individual level as fear of diagnosis of illness that is beyond their financial means to address. In such cases, an individual-level intervention that addresses fear alone, without focusing on expanding insurance coverage in rural immigrant communities, may not lead to improved access to preventive healthcare. Therefore, an interpretation of barriers that highlights the nuances of the issues has important implications for intervention strategies.

Additionally, the complexities of the healthcare system pose significant challenges; for instance, one study highlighted that private hospitals nearby often have specific eligibility criteria, while county hospitals that do not require a Social Security Number may be located 30 miles away [11]. The reviewed studies also highlighted barriers that created significant inconveniences for immigrants to access preventive healthcare, leading them to forgo these services. It is important to note that accessing preventive healthcare, or healthcare in general, can be an engendered issue among immigrant communities in rural areas. Family dynamics, gender norms, and inequalities may place some women at an elevated risk of missing preventive care.

Despite these barriers, the review revealed promising facilitators that could inform multilevel interventions. Community-based initiatives that involve promotores and trusted local messengers (e.g., religious leaders) were highlighted as critical in bridging gaps in healthcare access. In addition, community-level efforts to eliminate inconveniences, such as providing transportation, bilingual providers, and flexible clinic hours, have proven effective. More broadly, policy-driven supports, including Medicaid and state-level vaccination programs, have shown potential to alleviate financial barriers to access care. The impact of policy mandates, such as required HPV and other immunizations in school systems [31], also emerged as a significant factor. Expectations set by schools or healthcare providers influence family behavior, often encouraging adherence to vaccination schedules. However, we also found that there were limited efforts from rural employers, despite the studies’ description of many barriers originating from the workplace.

Implications for policy and practice

Policy and practice implications for improving preventive healthcare access among rural immigrants must address their unique challenges through systematic and innovative solutions. Additionally, it is essential to clarify how rural immigrants are situated within healthcare insurance plans, as rural plans differ significantly from those in urban areas, often leaving immigrants with inadequate coverage. At the policy design level, several limitations and challenges regarding the impact of existing legislation on immigrant health require careful examination. For example, despite that fact that the Affordable Care Act (ACA) significantly expanded access to preventive services—such as cancer screenings—through Medicaid expansion and marketplace subsidies, its eligibility for these benefits depends on immigration status. Specifically, lawfully present immigrants may qualify (though often with restrictions such as a five-year waiting period for Medicaid), while undocumented immigrants are excluded from ACA coverage altogether. As most studies in this review did not disaggregate findings by immigration status, the actual reach of ACA provisions in rural immigrant communities remains unclear and warrants further attention.

The recent One Big Beautiful Bill Act, passed and signed on July 4, 2025, introduces significant cuts to Medicaid—estimated between $800 billion to $1 trillion—with new work requirements, increased cost-sharing, and changes likely to reduce coverage for millions, especially in rural areas [35]. The law also scales up funding for immigration enforcement and tightens benefit eligibility and application fees for lawfully present immigrants, further complicating access to preventive care. Though its full effects are yet to be evaluated, these policy changes could disproportionately harm rural immigrants—both documented and undocumented—by reducing insurance coverage, increasing cost burdens, and heightening fear related to visibility in healthcare settings. Therefore, policymakers and health practitioners should monitor the implementation of these provisions—particularly Medicaid work requirements and eligibility restrictions—and consider targeted outreach to immigrant families in rural areas.

From the policy implementation perspective, effective strategies are needed to reduce address access barriers and concerns among immigrant populations. Access to preventive care must be coupled with affordable follow-up treatment, as evidence indicates that some immigrants struggle to proceed with treatment despite early detection of disease during screening [64]. Furthermore, the structural fear of visibility among this population—intensified by the political climate and other factors—requires creative approaches to build trust and reduce vulnerabilities. For example, although Children’s Health Insurance Program (CHIP) had been shown to decrease disparities in access to care for children living in rural areas [18], the benefit utilization rate of such assistance programs remains low among children from immigrant families in rural areas due to fears that it may jeopardize future citizenship [52]. It underscores the need for reassurance strategies and protection of immigrant families within rural healthcare frameworks.

Last, from the practice perspective, engaging immigrant populations through both grounded and innovative approaches is critically importance. Community-level programs should engage diverse stakeholders, including employers, schools, and religious groups, to collectively make preventive healthcare accessible for immigrants, who contribute significantly to the local economy and vitality. Leveraging resources within immigrant communities is also essential, as trusted members like religious leaders play a key role in health promotion. Schools with children of immigrant parents serve as critical venues and programs such as the Migrant Education Program can enhance engagement and support for preventive health initiatives. Addressing these challenges requires culturally informed, trust-building strategies and policies that promote affordable, continuous, and accessible care. Mobile and onsite clinics, as well as telehealth, are particularly needed in remote rural areas and for those working in labor-intensive jobs with less flexibility, requiring collaboration and accommodation from rural employers.

Implications for future research

This review highlights key directions for future research. Most studies relied on qualitative methods, which, while valuable for capturing lived experiences, limit generalizability. To better understand rural immigrants’ healthcare access, future research should incorporate large-scale, disaggregated data. Additionally, the study population was largely limited to Latinx immigrants, with minimal focus on Asian, multiracial, or other growing rural minority groups [34]. Research also overlooked children from immigrant families, whose healthcare access may be shaped by their parents’ immigration status, despite being U.S.-born. As rural demographics continue to shift, broader, more inclusive research is essential to fully capture the healthcare challenges and needs of diverse immigrant populations. Although documenting participants’ legal immigration status can be important for studying this topic, the included studies did not explicitly report them. Instead, several relied on proxy indicators, such as country of origin, length of U.S. residence, or insurance status, and others omitted direct questions about legal status to avoid exacerbating participant fears [41, 50]. This ethical decision, grounded in a commitment to protect participants amid rising anti-immigrant rhetoric, highlights both the distinctive concerns of this group and the challenges of researching marginalized communities. At the same time, it limits our ability to precisely discern how different legal statuses (e.g., naturalized citizens vs. permanent legal residents) shape structural barriers, underscoring the need for future, ethically attuned studies that can safely capture this critical dimension.

Limitations

This review has several limitations that should be acknowledged. First, the focus on peer-reviewed articles may have excluded valuable insights from gray literature, which often provide practical and community-level perspectives on healthcare access. Second, while we defined “rural” based on the U.S. Census Bureau’s definition, some areas that do not meet this definition but still experience significant resource limitations may have been excluded. These areas may face similar challenges, warranting further investigation. Third, our search strategy did not include racial or ethnic group identifiers, which may have contributed to the overrepresentation of Latinx-focused studies. As rural areas become increasingly diverse, further research is needed to examine barriers and facilitators among other racial and ethnic immigrant groups. Addressing these limitations could provide a more comprehensive understanding of the barriers and facilitators to preventive healthcare access among immigrant populations.

Conclusion

Preventive healthcare is crucial for improving long-term health outcomes and reducing costs, particularly for vulnerable populations such as rural immigrants. This review highlights barriers and facilitators to access, revealing structural, cultural, and policy challenges, but also promising community-based initiatives and policy-driven supports. Achieving equitable preventive healthcare for rural immigrants requires multilevel interventions that tackle systemic barriers and enhance community-driven solutions.