Houston is one of the most diverse rapidly expanding metropolitan areas in the USA. Statistics indicate within the decade between 2000 and 2010 Houston population grew by more than 1.2 million people a number that exceeded all the metropolitan areas in the country (Capps, Fix, & Nwosu, 2015) . To no small extend immigration has contributed to Houston area population growth and diversity. Over the past two decad es, the Latino population in the area has doubled. Statistics indicate Houston is currently home of the third-largest Hispanic population in the USA (Capps, Fix, & Nwosu, 2015) .
Accessing and utilizing healthcare in the country of migration is vital to the quality of life of immigrants. However, it is reported immigrants especially women often have lower rates of health insurance coverage and subsequently medical usage compared to their US-born compared. Moreover, studies on the concept of racial and ethnic disparities in healthcare access and delivery identify Latinos as one of the most disadvantaged ethnic groups (Paz & Massey, 2016) . A comprehensive understanding of health and health-care recognizes the necessity to account for gender differences since health and illnesses are experienced differently bet ween the two genders. If demographics projections are to be trusted, suggestions indicate Latinas will soon represent more than twenty-five percent of the total female population in the USA owing to high rates of immigration (Paz & Massey, 2016) .
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One in every six residents in the USA is foreign-born as such pinpointing to a large number of immigrants in the country (Schenker, Castaneda, & Rodriguez-Lainz, 2014) . Female immigrants often face various issues in the access of healthcare including but not limited to financial difficulties, language barriers, cultural differences, lack of healthcare insurance, differences in health expectations and discrimination based on race, ethnicity or gender among other issues (Schenker, Castaneda, & Rodriguez-Lainz, 2014) . Additionally, the recently implemented Patient Protection and Affordable Care Act commonly referred as the Affordable Care Act (ACA) was intended to increase the affordability of healthcare insurance and as such reduce the number of uninsured individuals. However, ACA explicitly excludes undocumented immigrants, a factor that disadvantages many immigrant women in Houston. It is crucial to understand the culture of the Latinas to analyze how they ascribe to health in efforts to develop health promotions techniques that will work to reduce disparities in healthcare access. Moreover, it is necessary to explore different options to ensure healthcare provision for immigrants of varying citizenship statuses to facilitate quality healthcare across the USA.
Analyzing the Mexican immigrant population and focusing on women that make-up one of the fastest growing demographics in the USA is essential in the creation of a better understanding of the needs and consideration for healthcare providers and social policies. The study to no small extent takes into the concept of culture in health and health disparities based not only on ethnicity but also on gender. The conclusions from this study can influence professional and public consciousness and as such provide vital considerations for health and social policy at large. Undeniably, since Latinas and Latina women by extension are the fastest growing demographic in the USA and particularly in Houston, it is necessary to address the challenges and the barriers that may affect the quality of health and healthcare among the Latina women.
Purpose of the Research
The research focuses on how immigration, a case in point of immigrant women in Houston influences access to healthcare. The primary purpose of the study is to gain an understanding of female Mexican immigrants' perspectives and experiences with the healthcare system in the USA. The study aims to study health-related experiences and problems of Mexican immigrant women in Houston Texas. The health-related experiences encompass the culture of the Latinas and the values the Hispanic community holds dear in association with health. By extension, the research focuses on the case of disparity in access to health between Hispanic women and non-Hispanic women in the USA. The findings of the research will be important in providing insight into factors that may contribute to disparities in access and utilization of healthcare and subsequently influence healthcare providers’ decisions and social policies in the USA.
The research hypothesizes Latino immigrant women in Houston are vulnerable to negative experiences with the USA healthcare system. Moreover, these women often face disparity in access and utilization of healthcare compared to their USA-born counterparts. Inequality in access and delivery of health care is grounded on the fact that many healthcare providers fail to integrate different cultures in the delivery of healthcare (Chaudry, Fortuny, & Pedroza, 2014) . Moreover, thousands of migrants in Houston are undocumented and are such often denied healthcare. Indeed, while varies studies have concentrated on challenges of accessing healthcare in the USA, there is little information that focuses explicitly on Mexican women immigrants, a gap that this study intends to fill.
Methods
The research was conducted in one large healthcare facility located in Houston, Texas. As mentioned, Houston is home to the third largest Mexican population in the USA. The research applies the qualitative technique of researching. A convenience sample of twenty Mexican-born immigrant women residing in Houston participated in the study. As an employee in one of the most extensive healthcare facilities in Houston, I requested the hospital administration for an opportunity to conduct a small survey to determine the experiences of immigrant Mexican women in Houston. The healthcare facility approved a fifteen to twenty minutes session for the researcher to interact with the willing patients. In efforts of avoiding any delays in the queuing system, the research focused on patients waiting to be seen by the healthcare providers. The qualitative technique is the most appropriate research method in this particular case since it facilitates detailed answers which are essential in discerning the perspectives and experiences of immigrant women.
Ethics and Consent
The administration of the healthcare facility in question approved the protocol of the research. Individuals eligible to participate in the study encompassed female Mexican immigrants of 18 years of age and above. Qualified individuals must have resided in the USA for more than 12 months. Since the research focuses on the experiences and perspectives of female Mexican immigrants, most of the participants are mothers. Before participating, the individuals were informed of the purpose of the research and assured of their anonymity. All the participants were informed that participation is voluntary.
Data collection
The primary technique of data collection applied in the research is interviewing. The interviews were conducted in English, but a Spanish translator was available throughout the discussions to eliminate the issue of language barrier. The questions were designed to investigate three main matters including access to healthcare, satisfaction with the healthcare system, barriers in accessing and utilizing healthcare facilities in addition to recommendations for improving the quality of healthcare. Some of the questions in the interviews included;
How was your first clinic visit experience in the United States?
How can you describe the access to healthcare since you came to the USA?
How would you describe your health?
Would you seek medical help for depression?
Do you feel as though the providers are sympathetic to your situation?
Are you generally satisfied with the quality of healthcare that you have received since coming to the USA?
Have you faced any barriers in accessing healthcare? If so which barriers?
At a personal capacity. Do you have any suggestions on how our healthcare facility can improve the access and delivery of healthcare?
Findings and Data Analysis
Under the domain of accessibility of healthcare in the USA, the majority of the participants asserted that the fact that they are immigrants often limit their access to care since in most cases hospital require insurance cover. However, a good number reported being able to easily access healthcare services for not only themselves but also their families. Indeed, others voiced that it is even easier to access healthcare in the USA compared to Mexico due to the lack of extensive bureaucratic delays. Concerning satisfaction with healthcare services in the USA, several reported satisfaction with healthcare services in the USA with a majority appreciating prompt services. However, several voiced their dissatisfaction citing that in the event one does not speak translating services are often time-consuming. Regarding barriers to access to health, a majority of the participants reported witnessing and experiencing discrimination based on their ethnicity citing that their unfamiliarity with health systems in the USA often prompts adverse reactions from healthcare providers. Many participants expressed the importance of the healthcare system facilitating cultural competence training to the healthcare providers.
Discussion
The study applied the qualitative methodology to explore Mexican-born immigrant women perspectives and experiences in access and the delivery of healthcare in the USA. The design of the study facilitated the identification of various factors that can influence the experiences of Mexican women in Houston. The study was conducted in Houston, one of the largest Mexican metropolitan population areas in the USA. Majority of the women reported difficulties in accessing healthcare and while some perceived the services at the hospital as being high quality compared to their personal experiences in Mexico others reported barriers that often decrease the quality of service. The observations in the particular research collaborates a multitude of study which often reports that Mexican immigrant women in the USA have limited access to healthcare and regularly report low levels of satisfaction with the quality of health care (Paz & Massey, 2016) .
Moreover, similar to previous studies, the present research indicated several barriers in accessing and utilizing health including but not limited to communication issues and the perception of discrimination among others (Suurmond, Uiters, Bruijine, Stronks, & Essink-Bot, 2011) . Communication is an essential aspect in the access of healthcare since lack of efficient communication often results in frustrating experiences, confusion which might lead to devastating outcomes in extreme cases. Several individuals reported discrimination from the hospital staff sometimes since they could not speak English fluently or due to their ethnicity. Indeed, the perceptions of the participants illustrate a lack of cultural sensitivity on the part of healthcare providers. The finding agrees with other studies which have asserted that immigrants often face discrimination and as such disparity in access to healthcare based on their ethnicity (Chaudry, Fortuny, & Pedroza, 2014) .
In recent years, research supports the importance of cultural competence in delivering quality care (Schenker, Castaneda, & Rodriguez-Lainz, 2014) . The USA is one of the most diverse societies across the globe as such necessitating the incorporation of cultural sensitivity in the provision of quality care. Cultural sensitivity expands beyond the concept of being aware of the different cultures to incorporating the cultures of the various ethnic groups in the delivery of healthcare. Undeniably, it emphasizes being knowledgeable beyond a single culture on the part of the healthcare provider (Dunkelberg, 2016) . Therefore, it involves discarding the stereotypic perceptions, attitudes, and behaviors in access to healthcare.
Similar to previous studies that focused on the perceptions of immigrants in access to healthcare, the study revealed the cultural difference in expectations of healthcare practices (Lindsay et al., 2016) . The differences were particularly evident in productive healthcare services particularly relating to doctors decisions regarding labor and the delivery in the USA. It is important to acknowledge there are differences in obstetric care between the USA and Mexico. For instance, Mexico reports higher cases of cesarean births compared to the USA.
The findings of the study imply there is a necessity of aggressive health promotion efforts in Houston, particularly concerning reproductive services. Moreover, it is essential for healthcare providers and by extension for healthcare training to encompass additional training on the importance of cultural sensitivity in the delivery of healthcare (Padilla & Villalobos, 2007) . Sinc e satisfaction with care is a standard measure of the quality of care in the contemporary society, it is necessary for healthcare professionals to acknowledge immigrants often have a different perception on what encompasses quality care and as such cultural competence is vital.
Conclusion
Understanding immigrants’ interactions with the US healthcare system is important in making it possible for healthcare providers to meet their health needs and as such improve the quality of life. The present research reveals that there are barriers such as communication issues and perception of discrimination that limit immigrants’ satisfaction with the access and utilization of healthcare services in the USA. Healthcare is a crucial part of the quality of life paradigm, yet many immigrants and other ethnic minorities in the USA remain vulnerable to the disparity in access to health. The study is relevant since it expands on the information on immigrants in the USA in addition to providing a new report that focuses on Mexican immigrant women in Houston in addition to providing insight that will facilitate the improvement of access and utilization of healthcare in the immigrant population.
References
Capps, R., Fix, M., & Nwosu, C. (2015). A profile of immigrants in Houston, the nation's most diverse metropolitan area. Migration Policy Institute , 1-23.
Chaudry, A., Fortuny, K., & Pedroza, J. (2014). Improving access of low-income immigrant families to health and human services: The role of community-based organizations. Urban Institute .
Dunkelberg, A. (2016). Immigrants' access to health care in Texas: An updated landscape. Center for Public Policy Priorities , 1-24.
Lindsay, A. C., Oliveira, M. G., Wallington, S. F., Greaney, M. L., Machado, M. M., Pagliuca, L. F., et al. (2016). Access and utilization of healthcare services in Massachusetts, United States: A qualitative study of the perspectives and experiences of Brazilian-born immigrant women. BMC Health Services Research, 16 (1), 147-156.
Padilla, Y., & Villalobos, G. (2007). Cultural responses to health among Mexican American women and their families. Family and Community Health, 30 (1), 24-33.
Paz, K., & Massey, K. P. (2016). Health disparity among Latina women: Comparison with non-Latina women. Clinical Medical Insights Womens Health, 9 (1), 71-74.
Schenker, M. B., Castaneda, X., & Rodriguez-Lainz, A. (2014). Migration and health: A research methods handbook. University of California Press.
Suurmond, J., Uiters, E., Bruijine, M. C., Stronks, K., & Essink-Bot, M.-L. (2011). Negative health care experiences of immigrants patients: A qualitative study. BMC Health Services Research, 11 (10).
