Determinants of Health Education Utilization Among Afghan Immigrants in Southeast Iran: An Application of Anderson’s Model

Background and purpose: mmigration poses significant public health challenges for Iran, as foreign immigrants face restricted access to preventive healthcare, increasing their vulnerability to infectious diseases and chronic conditions. This research seeks to reveal and discover the determining factors related to the utilization of educational services as a key aspect of the services in primary health care for immigrants in Sistan and Baluchistan province, Iran. Methods: A sample of 1000 Afghan immigrants aged 18 and over was selected through a multi-stage sampling method. Efforts were made to minimize selection bias by ensuring diverse representation across socioeconomic and employment groups. Data collection was done using a structured questionnaire. Anderson's behavioral model of health service utilization was used to show the effects of predisposing and enabling variables, health behaviors, and needs on the utilization of health education services. Multivariable logistic regression analysis was used to predict potential main determining factors in the utilization of immigrant health education services and control variables potential confounders. Findings: This study showed that 60% of the immigrants received health education services in the last year. The health education provided was understandable and comprehensible to only 24.33% of the immigrants. There were differences in the amount of utilization and needs of health education among immigrants of different ages and genders. Given the preference for online health education among 57.5% of respondents, strategies should include multilingual digital resources and voice-assisted platforms for lower-literacy populations. Additionally, 88.92% of immigrants preferred obtaining health information from their fellow countrymen, emphasizing the importance of peer-led health education initiatives. The chi-square test showed that age, gender, marital status, religion, having at least one child, employment status, average daily working hours, exercising, health knowledge, smoking and self-assessment of general health status are the determining factors influencing immigrants to receive education. Health. The most types of health education that male and female immigrants wanted to receive The order were: prevention and treatment of non-communicable diseases (32%), and children's health care (49.04%). Multivariable logistic regression shows that the male group from the predisposing variable and the acquisition of health knowledge from the health behavior variables contribute significantly to the variance of the four types of utilization of health education. Compared to female immigrants, male immigrants have fewer utilization four types of health education (communicable diseases, non-communicable diseases, prenatal care, and child care). Conclusion The findings of this survey contribute to our understanding of the utilization of health education, determining factors, and needs for health education among foreign immigrants in Iran. There were specific gaps between the needs and utilization of different types of health education. It is necessary to pay attention to the utilization of health education services for unmarried immigrants and chronic patients. Also, it seems useful to create and strengthen a network of volunteers and health ambassadors among foreign immigrants to utilization more and more deeply from health education services. Findings suggest that policymakers should prioritize removing structural barriers by expanding culturally sensitive health education programs and integrating AI-driven health information tools to enhance accessibility for immigrants.