"It changed my whole entire thinking": Identifying narrative elements in medical affidavit writing for asylum seekers

The medical affidavit is critically significant for asylum seekers. Studies have shown that asylum seekers applying with a medical affidavit (versus without a medical affidavit) have double the success rate. There are many training resources for clinician-evaluators on the interviewing process, but little instruction exists on the affidavit writing process. Our objective was to identify the most common narrative elements in medical affidavits of successful (versus unsuccessful) asylum seekers to provide further writing guidance for clinician-evaluators. We hypothesized that these elements, when thoughtfully employed, help clinician-evaluators best represent their clients in the US immigration system. We focused on the most vulnerable applicants: those applying after the one-year deadline. Using grounded theory, we coded 23 affidavits filed after the one-year deadline for narrative elements. We identified seven narrative elements more common in medical affidavits of asylum seekers who filed after the one-year deadline and were successful: (1) Recommending specific clinical interventions; (2) Quoting elevated diction by the client; (3) Using headlines; including anecdotes that describe (4) The client forming human connections, (5) Archetypal female characters, (6) Love stories, or (7) Moments of realization.