'You never know when you will need an antibiotic': A qualitative study of structural barriers and cultural assumptions in antibiotic misuse among immigrants in the United States.

This article examines the structural and cultural factors influencing the misuse of nonprescribed antibiotics among immigrants in the United States who come from countries with easier access to antibiotics. Through qualitative interviews with 34 immigrants who had recently traveled to their home countries, the study identifies key structural barriers in the US—such as lack of insurance, high emergency department costs, fear of missing paid work, complexity of the healthcare system, and communication challenges with providers—that limit healthcare access and encourage self-medication. Additionally, cultural assumptions rooted in immigrants' experiences with antibiotics, beliefs about their effectiveness, habitual self-medication, and uncertainty about future medical needs contribute to bringing and using nonprescribed antibiotics. The findings suggest that antibiotic stewardship programs should address both these structural challenges and cultural beliefs to effectively reduce inappropriate antibiotic use in immigrant communities.