Objective: To identify and describe the needs and problems of the immigrant population related to access and utilization of health services. Method: Adescriptive, qualitative, phenomenologicalstudy was conducted using focus groups. The study area was the county of Campo de Gibraltar (Spain), which represents the gateway to Europe for immigration from Africa. The final sample size (51 immigrants from 11 countries) was determined by theoretical saturation. A narrative analysis was conducted with QSR NVivo9software. Results: Immigrants' discourse showed four categories of analysis: response to a health problem, system access, knowledge of social and health resources, and health literacy needs. Responses to health problems and the route of access to the health care system differed according to some sociodemographic characteristics (nationality/culture of origin, length of residence, and economic status). In general, immigrants primarily used emergency services, hampering health promotion and prevention.The health literacy needs identified concerned language proficiency and the functioning of the health system. Conclusions: There is a need to promote interventions to enhance health literacy among immigrants. These interventions should take into account diversity and length of residence, and should be based on anaction-participationmethodology. © 2014 SESPAS.

qualitative research Cultural diversity Health promotion Patient participation health service accessibility Health literacy Immigration Healthcare disparities

information processing perception health promotion human middle aged statistics and numerical data health service Medical Overuse Aged qualitative research Young Adult Humans migrant psychology Adolescent male Emigrants and Immigrants Spain female Socioeconomic Factors socioeconomics health services adult patient participation utilization hospital emergency service Emergency Service, Hospital Social Perception Focus Groups health literacy Healthcare Disparities health care disparity Health Services Accessibility health care delivery