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Malagón T, Botting‐Provost S, Moore A, El‐Zein M, Franco EL. Inequalities in relative cancer survival by race, immigration status, income, and education for 22 cancer sites in Canada, a cohort study. Int J Cancer 2025; 157:41-54. [PMID: 39821788 PMCID: PMC12062929 DOI: 10.1002/ijc.35337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 12/23/2024] [Accepted: 01/07/2025] [Indexed: 01/19/2025]
Abstract
There is a paucity of disaggregated data to monitor cancer health inequalities in Canada. We used data linkage to estimate site-specific cancer relative survival by race, immigration status, household income, and education level in Canada. We pooled the Canadian Census Health and Environment Cohorts, which are linked datasets of 5.9 million respondents of the 2006 long-form census and 6.5 million respondents of the 2011 National Household Survey. Individual-level respondent data from these surveys were probabilistically linked with the Canadian Cancer Registry up to 2015 and with the Canadian Vital Statistics Death database up to 2019. We used propensity score matching and Poisson models to calculate age-standardized relative survival by equity stratifiers for all cancers combined and for 22 individual cancer sites for the period 2006-2019. There were 560,905 primary cancer cases diagnosed over follow-up included in survival analyses; the age-standardized period relative survival was 72.9% at 5 years post-diagnosis. 5-year relative survival was higher in immigrants (74.1%, 95%CI 73.8-74.4) than in Canadian-born persons (69.6%, 95%CI 69.4-69.8), and higher in racial groups with high proportions of immigrants. There was a marked socioeconomic gradient, with 11%-12% lower relative survival in cancer patients in the lowest household income and education levels than in the highest levels. Socioeconomic gradients were observed for most cancer sites, though the magnitude varied by site. The observed differences in relative survival suggest there remain important inequities in cancer control and care delivery and quality even in a universal healthcare system.
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Affiliation(s)
- Talía Malagón
- Division of Cancer Epidemiology, Department of OncologyMcGill UniversityMontréalQuébecCanada
- St Mary's Research CentreMontreal West Island Integrated University Health and Social Services CentreMontréalQuébecCanada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontréalQuébecCanada
| | - Sarah Botting‐Provost
- Division of Cancer Epidemiology, Department of OncologyMcGill UniversityMontréalQuébecCanada
| | - Alissa Moore
- Division of Cancer Epidemiology, Department of OncologyMcGill UniversityMontréalQuébecCanada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontréalQuébecCanada
| | - Mariam El‐Zein
- Division of Cancer Epidemiology, Department of OncologyMcGill UniversityMontréalQuébecCanada
| | - Eduardo L. Franco
- Division of Cancer Epidemiology, Department of OncologyMcGill UniversityMontréalQuébecCanada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontréalQuébecCanada
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Damot H, Schafers S, Wiedmeyer ML, Machado S, Tayyar E, Thakore P, Lavergne R, Goldenberg SM. Impacts of local, provincial, and federal immigration policies on health and social services access among women with precarious immigration status. BMC Public Health 2025; 25:1570. [PMID: 40295969 PMCID: PMC12036235 DOI: 10.1186/s12889-025-22673-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/07/2025] [Indexed: 04/30/2025] Open
Abstract
OBJECTIVES Im/migrant women (e.g., non-status immigrants, refugee claimants, students, temporary foreign workers, visitors, and other migrants) face structural barriers to health and social services access. While immigration is an increasingly recognized social determinant of health, there remains a gap in literature on how structural determinants such as immigration policies and practices (e.g., 'status-checking', immigration status) shape im/migrant women's experiences navigating health and social services. This study aimed to examine the ways in which local, provincial, and federal immigration policies shape health and social services access among im/migrant women with precarious status. METHODS Between December 2018 and February 2020, we conducted and thematically analyzed qualitative in-depth interviews with im/migrant women (N = 51), and service providers (N = 10) across Metro Vancouver. Data were collected as part of the IRIS study, which is a community-based, mixed-methods study of im/migrants' healthcare access prior to and during the COVID-19 pandemic. RESULTS Despite policies that purportedly aim to grant access to health and social services in Vancouver regardless of immigration status, participants routinely described ineligibility and fear of detention and/or deportation as pervasive barriers to accessing services, including routine, preventive, and emergency health services, and enrolment of children in schools. Women described social isolation and exclusion as key consequences of federal immigration policies that produced precariousness through temporary and undocumented status. Overall, participants recommended for the elimination of immigration law enforcements and 'status-checking' practices in health and social settings. CONCLUSION Sanctuary City policies are recommended to advance im/migrants' human rights, reduce instances of delayed or denied care, untreated illnesses, and social isolation. Full implementation of Sanctuary principles at the local level (i.e., reduced collaboration between local service providers and federal immigration enforcement) is needed to improve access to health and other services based on need, regardless of immigration status. At the provincial level, elimination of 'status checking' in health settings and expansion of eligibility criteria for health, social, and education programs (e.g., Medical Services Plan, subsidized housing, and BC's School Act) to include all im/migrants should be considered. At the federal level, increased funding for programs that address inequities in health and social services produced by restrictive immigration policies and ensure pathways to more secure immigration status are recommended. Together, these policy reforms have the potential to address the structural barriers to im/migrant women's health and social services access, and ultimately improve overall public health outcomes.
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Affiliation(s)
- Hanah Damot
- Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
- Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC, V6 T 1Z3, Canada
| | - Shaina Schafers
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5 A 1S6, Canada
| | - Mei-Ling Wiedmeyer
- Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC, V6 T 1Z3, Canada
| | - Stefanie Machado
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5 A 1S6, Canada
| | - Elmira Tayyar
- Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC, V6 T 1Z3, Canada
| | - Padmini Thakore
- Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC, V6 T 1Z3, Canada
| | - Ruth Lavergne
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3 J 3 T4, Canada
| | - Shira Miriam Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182 - 4162, USA.
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 92093 - 0507, USA.
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Gonin A, Lévesque S, Lespérance P, Dubois C, Rodrigue M. Contraceptive practices in Québec in relation to immigration: A cross-sectional analysis of data from the Québec Population Health Survey. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2025:10.17269/s41997-025-01018-4. [PMID: 40198428 DOI: 10.17269/s41997-025-01018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/19/2025] [Indexed: 04/10/2025]
Abstract
OBJECTIVES This study aimed to examine the association between immigration status and women's contraceptive practices based on population data from government surveys. METHODS A secondary data analysis was conducted on the Quebec Population Health Survey (2014-2015), which aimed to represent 98.8% of the population of Quebec aged 15 years and older through stratified sampling and data weighting (response rate of 61%). Univariate and multivariable analyses were used to compare contraceptive practices between immigrant and Canadian-born women. Two dependent variables were considered: (1) women who used contraception vs. no contraceptive method of any kind, and (2) among women who used contraception, those who used methods that required them to access health care (birth control pill, IUD, or tubal ligation) vs. women who used other methods (condom, coitus interruptus, other). RESULTS The logistic regression results revealed a strong association between immigration status and contraceptive practices, at two levels: (1) immigrant women had lower odds to use contraception than Canadian-born women; and (2) of the women who use contraception, immigrants had lower odds than those born in Canada to use feminine medical contraception. These findings held true for immigrant women regardless of the number of years they have spent in Canada. Women who lived in low-income households or who had not had a medical consultation for more than one year also had lower odds to use feminine medical contraception. CONCLUSION Barriers in access to contraceptive care interfere with women's reproductive health and autonomy. The lower odds for immigrant women to use contraception, and particularly the most effective methods, suggest that their contraceptive care needs are at least partially unmet or inadequately addressed. This is concerning given that other studies show no differences in fertility intention between immigrant and Canadian-born women, and high rates of abortion for immigrant women.
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Affiliation(s)
- Audrey Gonin
- Université du Québec à Montréal, Montréal, QC, Canada.
| | | | | | - Cindy Dubois
- Université du Québec à Montréal, Montréal, QC, Canada
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Samuel S, Punjwani Z, San Martin-Feeney D, Allemang B, Guilcher GM, Lang E, Pacaud D, Pinzon J, Andrew G, Zwaigenbaum L, Perrott C, Andersen J, Hamiwka L, Nettel-Aguirre A, Klarenbach S, McBrien K, Scott SD, Patton M, Samborn S, Pfister K, Ryan L, Dimitropoulos G, Mackie AS. Effectiveness of Patient Navigation During Transition to Adult Care: A Randomized Clinical Trial. JAMA Pediatr 2025; 179:375-382. [PMID: 39928304 PMCID: PMC11811865 DOI: 10.1001/jamapediatrics.2024.6192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 10/24/2024] [Indexed: 02/11/2025]
Abstract
Importance Transition to adult care is a challenging and complex process for youth and emerging adults with chronic health and/or mental health conditions. Patient navigation has been proposed to improve care during transition, but previous studies have used single disease cohorts with a nonrandomized design. Objective To compare the effectiveness of a patient navigator service to reduce emergency department (ED) use among adolescents and emerging adults with chronic health and/or mental health conditions undergoing transition to adult-oriented health care. Design, Setting, and Participants This was a pragmatic, parallel-group, nonblinded randomized clinical trial design. Patients were followed up for a minimum 12 months and maximum 24 months after enrollment. The setting was the Canadian province of Alberta, with a population of 4.3 million inhabitants, having 3 tertiary care pediatric hospitals serving the entire population with universal health coverage. Participants included youth aged 16 to 21 years, followed up within a diverse array of chronic care clinics, expected to be transferred to adult care within 12 months, residing in Alberta, Canada. Interventions A 1:1 allocation to either access to a personalized navigator, an experienced social worker within the health services environment, or usual care, for up to 24 months after randomization. Main Outcomes and Measures All-cause ED visit rate while under observation. Results A total of 335 participants were randomized over a period of 45 months, 164 (49.0%) to the intervention arm and 171 (51.0%) to usual care. After 1 patient withdrew, 334 participants (usual care: mean [SD] age, 17.8 [0.7] years; 99 female [57.9%]; intervention: mean [SD] age, 17.7 [0.6] years; 81 male [49.7%]) were included in the final data analysis. Among the participants, 131 (39.2%) resided in a rural location, and 126 (37.7%) had a self-reported mental health comorbidity during baseline assessment. We observed significant effect modification in the relationship between intervention and ED visits based on mental health comorbidity. Among those with a self-reported mental health condition, ED visit rates were lower in those with access to the navigator, but the association was not significant (adjusted incidence rate ratio [IRR] 0.75; 95% CI, 0.47-1.19). Among those with no mental health comorbidity, the corresponding adjusted IRR was 1.45 (95% CI, 0.95-2.20). Conclusions and Relevance In this randomized clinical trial, the navigator intervention was not associated with a significant reduction in ED visits among youth with chronic health conditions transitioning to adult care. The study did not accrue sufficient sample size to demonstrate a significant difference between groups should it exist. Trial Registration ClinicalTrials.gov Identifier: NCT03342495.
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Affiliation(s)
- Susan Samuel
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Zoya Punjwani
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Brooke Allemang
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Gregory M.T. Guilcher
- Section of Pediatric Oncology and Blood and Marrow Transplant, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eddy Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Danièle Pacaud
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Jorge Pinzon
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Curtis Perrott
- Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Lorraine Hamiwka
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Alberto Nettel-Aguirre
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Services, University of Wollongong, Wollongong, New South Wales, Australia
| | | | - Kerry McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannon D. Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Patton
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sophie Samborn
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ken Pfister
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Laurel Ryan
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gina Dimitropoulos
- Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Andrew S. Mackie
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
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Allegri C, Belgiojoso EBD, Rimoldi SML. Immigrants' self-perceived barriers to healthcare: A systematic review of quantitative evidence in European countries. Health Policy 2025; 154:105268. [PMID: 39983630 DOI: 10.1016/j.healthpol.2025.105268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 11/18/2024] [Accepted: 02/13/2025] [Indexed: 02/23/2025]
Abstract
BACKGROUND with Europe's demographic diversity growing due to immigration, understanding and addressing the barriers to healthcare experienced by immigrants is of paramount importance. However, an updated systematic review of the literature on this topic is missing. METHODS we systematically searched the PubMed and Scopus databases to synthesise quantitative evidence regarding self-perceived barriers to healthcare access faced by immigrants in Europe. Peer-reviewed articles, written in English, published from 2011 onwards, studying adult populations not in detention centres were eligible for the review. Articles were charted according to the population of study, sample size, geographical area and level of study (local vs national), and applied methodology (descriptive vs inferential). RESULTS linguistic and health literacy barriers emerge as the most prominent, and most studied, barriers to healthcare for immigrants. The extant literature covers disproportionally Northern European countries; often uses small sample sizes and convenience sampling; and is particularly limited as far as the undocumented population is concerned. DISCUSSION policies should aim at increasing the availability of interpreters and healthcare materials translated in different languages, as well as at better training health professionals to address specific immigrants' needs. We encourage future research to focus on healthcare barriers faced by immigrants in Southern and Central European contexts; to improve results' robustness and external validity by using high quality sampling techniques and larger sample sizes, and including native populations as comparison groups; and to put more attention to the experience of undocumented immigrants, as they are the immigrant population with the most critical and precarious healthcare status.
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Affiliation(s)
- Chiara Allegri
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
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Lin J, Bates S, Allen LN, Wright M, Mao L, Chomik R, Dietz C, Kidd M. Uptake of patient enrolment in primary care and associated factors: a systematic review and meta-analysis. BMC PRIMARY CARE 2025; 26:76. [PMID: 40119278 PMCID: PMC11927268 DOI: 10.1186/s12875-025-02779-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Accepted: 03/05/2025] [Indexed: 03/24/2025]
Abstract
BACKGROUND Patient enrolment in primary care refers to the formal process of registering patients with a specific primary care provider, team, or practice. This approach is often expected to enhance continuity and coordination of care. However, limited information exists on the uptake of patient enrolment and its associated characteristics. This review aimed to estimate the uptake of patient enrolment in primary care and examine factors associated with decisions around enrolment. METHODS Eight electronic databases (PubMed, Cochrane Register of Systematic Reviews, Embase, CINAHL, PsycINFO, PAIS, Web of Science, and Scopus) were searched for peer-reviewed articles published from January 2014 to July 2024. Findings from included studies were extracted and synthesised, with uptake estimated through meta-analysis and factors associated with enrolment summarised narratively. REVIEW REGISTRATION PROSPERO CRD42024597078. RESULTS Ten studies across nine publications were included. Of these, eight studies with 27,919,216 participants were included in the meta-analysis. The results showed a pooled patient enrolment uptake rate of 71.4% (95% Confidence Interval [CI]: 13.6-97.5%). There was no significant difference in enrolment rates between population-wide and program-based enrolment (72.4% vs. 73.5%; p = 0.980). Several associated factors were identified in three publications. Women showed higher enrolment rates than men (adjusted odds ratio [aOR] = 1.07, 95% CI: 1.07-1.08), while recently arrived immigrants in a country had lower enrolment rates than the established population (aOR = 0.40, 95% CI: 0.40-0.41). Patients living in small urban/suburban/rural areas had higher enrolment rates than those in large urban/metropolitan regions (aORs: 1.17-2.18). Higher socioeconomic level was associated with increased rates of enrolment. Patients with some specific chronic health conditions, such as those with diagnosed mental illness or substance use disorders, had lower enrolment rates. CONCLUSIONS The findings reveal that more than two-thirds of patients were enrolled with a primary care provider or practice; enrolment was influenced by demographic, geographic, socioeconomic, and clinical factors. Lower enrolment among men, recent immigrants, individuals living in large urban/metropolitan areas, lower socioeconomic groups, and those with certain health conditions may indicate potential barriers to health service access and opportunities for enrolment. Addressing these disparities is essential to promote equitable access and enhance opportunities for continuity and coordination of primary care.
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Affiliation(s)
- Jialing Lin
- International Centre for Future Health Systems, University of New South Wales, Sydney, NSW, Australia.
- International Centre for Future Health Systems, University of New South Wales, UNSW Sydney, Level 2, AGSM Building, Kensington, NSW, 2052, Australia.
| | - Shona Bates
- International Centre for Future Health Systems, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Luke N Allen
- International Centre for Future Health Systems, University of New South Wales, Sydney, NSW, Australia
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Michael Wright
- International Centre for Future Health Systems, University of New South Wales, Sydney, NSW, Australia
| | - Limin Mao
- International Centre for Future Health Systems, University of New South Wales, Sydney, NSW, Australia
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Rafal Chomik
- International Centre for Future Health Systems, University of New South Wales, Sydney, NSW, Australia
| | - Chris Dietz
- International Centre for Future Health Systems, University of New South Wales, Sydney, NSW, Australia
| | - Michael Kidd
- International Centre for Future Health Systems, University of New South Wales, Sydney, NSW, Australia
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- College of Health & Medicine, Australian National University, Canberra, Australia
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
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Hu R, Krüsi A, Shannon K, Zhou H, Ge A, Chong G, Goldenberg SM. Intersectional associations between citizenship, English fluency and racialisation on access to health and sex work community services: findings from a prospective cohort of sex workers in Canada (2014-2022). BMJ Open 2025; 15:e092124. [PMID: 40107685 PMCID: PMC11927481 DOI: 10.1136/bmjopen-2024-092124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 02/27/2025] [Indexed: 03/22/2025] Open
Abstract
OBJECTIVES To examine the intersectional associations between migration experiences and use of health and sex work community-based services among women sex workers. DESIGN Data were drawn from An Evaluation of Sex Workers Health Access, a community-based cohort of sex workers from September 2014 to February 2022. Bivariate and multivariable regression with generalised estimating equations (GEEs) using interaction terms was used to separately model associations between intersectional aspects of the migration experience (citizenship, English fluency and Asian identity) and service access outcomes. SETTING Diverse community-based sex work venues in Metro Vancouver, Canada. PARTICIPANTS 652 cis and trans women sex workers, with 149 (22.8%) being immigrants/migrants born outside of Canada (n=149). PRIMARY OUTCOME MEASURES (1) Accessing health services when needed and (2) utilisation of sex work community-based services. RESULTS In separate adjusted multivariable GEE models, we found significantly reduced odds of accessing health services when needed for women without Canadian citizenship and with limited English fluency, as well as those lacking Canadian citizenship but speaking fluently. Significantly reduced odds of accessing health services were also found among sex workers without Canadian citizenship and who identified as Asian. Regarding using sex work community-based services, women sex workers lacking Canadian citizenship and with limited English fluency, and those who were Asian and lacked Canadian citizenship, had low odds of using sex work community-based services. CONCLUSIONS Findings show a gradient in the relationship between intersectional experiences of lack of citizenship, limited English fluency and Asian identity on sex workers' access to health services and sex work community-based services. Culturally responsive and language-tailored services that attend to and address these intersecting forms of structural marginalisation, along with the full decriminalisation of all aspects of sex work, and the removal of punitive sex work-related immigration policies, are recommended.
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Affiliation(s)
- Ran Hu
- College of Social Work, The Ohio State University, Columbus, Ohio, USA
| | - Andrea Krüsi
- School of Criminology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kate Shannon
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Haoxuan Zhou
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alaina Ge
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Grace Chong
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shira M Goldenberg
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, California, USA
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Ngondwe P, Tefera GM. Barriers and Facilitators of Access to Healthcare Among Immigrants with Disabilities: A Qualitative Meta-Synthesis. Healthcare (Basel) 2025; 13:313. [PMID: 39942501 PMCID: PMC11816456 DOI: 10.3390/healthcare13030313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 12/05/2024] [Accepted: 01/03/2025] [Indexed: 02/16/2025] Open
Abstract
BACKGROUND Immigrants with disabilities (IWDs) are disproportionately affected by a lack of access to healthcare services and face unique challenges compared to the general population. This qualitative meta-synthesis examines the barriers, facilitators, and lived experiences of IWDs accessing healthcare in the U.S. and Canada. METHODS A theory-generating qualitative meta-synthesis approach was used to analyze and synthesize raw qualitative data. Using eight databases, 752 studies were retrieved, and 10 were selected and synthesized after a three-stage review. The final articles were assessed using the Critical Appraisal Skills Program (CASP) checklist, and a PRISMA flow chart was used to report on the selection process. RESULTS The analysis identified structural barriers, including the bureaucracy and complexity of the system, healthcare costs, transportation, communication, long wait times, and a lack of integrated services. Cultural barriers included denial and trust, stigma and discrimination, awareness and language gaps, and lack of social support. Facilitators of access included support from immediate family members, community health centers, and social workers. CONCLUSIONS The findings highlight the need for policy reforms to reduce bureaucratic hurdles, improve communication within healthcare systems, and enhance cultural competence among healthcare providers. Addressing these issues through integrated service models and targeted support can significantly improve the quality of life as a result of improved healthcare access for IWDs.
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Affiliation(s)
- Ponsiano Ngondwe
- College of Social Work, Florida State University, Tallahassee, FL 32304, USA;
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Chowdhury D, Tong C, Lopez K, Neiterman E, Stolee P. "When in Rome…": structural determinants impacting healthcare access, health outcomes, and well-being of South Asian older adults in Ontario using a multilingual qualitative approach. Front Public Health 2024; 12:1405851. [PMID: 39741940 PMCID: PMC11685128 DOI: 10.3389/fpubh.2024.1405851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 11/06/2024] [Indexed: 01/03/2025] Open
Abstract
With the increase in international migration, the need for an equitable healthcare system in Canada is increasing. The current biomedical model of healthcare is constructed largely in the Eurocentric tradition of medicine, which often disregards the diverse health perspectives of Canada's racialized immigrant older adults. As a result, current healthcare approaches (adopted in the US and Canada) fall short in addressing the health needs of a considerable segment of the population, impeding their ability to access healthcare services. This study aimed to identify and understand the structural and systemic factors that influence healthcare experiences and well-being among South Asian older adults in Ontario, addressing a significant gap in empirical and theoretical knowledge in the Canadian context. We conducted in-depth individual and dyadic interviews (n = 28) utilizing a descriptive multilingual cross-cultural qualitative approach. Through this research, participants expressed that their understanding of well-being does not align with that of their healthcare providers, resulting in unmet health needs. Our study uses an intersectional lens to demonstrate participants' perceptions of virtual access to care and systemic factors, such as mandatory assimilation and whiteness as a taken-for-granted norm impacting the health and well-being of South Asian older adults. The findings of this research can offer valuable insights to healthcare providers and policymakers in developing culturally competent practices, guidelines, and training policies that effectively address the healthcare needs of the South Asian population in Canada.
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Manoharan B, Stennett R, de Souza RJ, Bangdiwala SI, Desai D, Kandasamy S, Khan F, Khan Z, Lear SA, Loh L, Nocos R, Schulze KM, Wahi G, Anand SS. Sociodemographic factors associated with vaccine hesitancy in the South Asian community in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:924-935. [PMID: 38713364 PMCID: PMC11638425 DOI: 10.17269/s41997-024-00885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/21/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE South Asians represent the largest non-white ethnic group in Canada and were disproportionately impacted by the COVID-19 pandemic. We sought to determine the factors associated with vaccine hesitancy in South Asian Canadians. METHODS We conducted a cross-sectional analysis of vaccine hesitancy using data collected at the baseline assessment of a prospective cohort study, COVID CommUNITY South Asian. Participants (18 + years) were recruited from the Greater Toronto and Hamilton Area in Ontario (ON) and the Greater Vancouver Area in British Columbia (BC) between April and November 2021. Demographic characteristics and vaccine attitudes measured by the Vaccine Attitudes Examination (VAX) scale were collected. Each item is scored on a 6-point Likert scale, and higher scores reflect greater hesitancy. A multivariable linear mixed effects model was used to identify sociodemographic factors associated with vaccine hesitancy, adjusting for multiple covariates. RESULTS A total of 1496 self-identified South Asians (52% female) were analyzed (mean age = 38.5 years; standard deviation (SD): 15.3). The mean VAX score was 3.2, SD: 0.8 [range: 1.0‒6.0]. Factors associated with vaccine hesitancy included: time since immigration (p = 0.04), previous COVID-19 infection (p < 0.001), marital status (p < 0.001), living in a multigenerational household (p = 0.03), age (p = 0.02), education (p < 0.001), and employment status (p = 0.001). CONCLUSION Among South Asians living in ON and BC, time since immigration, prior COVID-19 infection, marital status, living in a multigenerational household, age, education, and employment status were associated with vaccine hesitancy. This information can be used to address vaccine hesitancy in the South Asian population in future COVID-19 waves or pandemics.
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Affiliation(s)
- Baanu Manoharan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Rosain Stennett
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Dipika Desai
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Sujane Kandasamy
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Farah Khan
- Population Health Research Institute, Hamilton, ON, Canada
| | - Zainab Khan
- Population Health Research Institute, Hamilton, ON, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Lawrence Loh
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rochelle Nocos
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Karleen M Schulze
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
- Population Health Research Institute, Hamilton, ON, Canada.
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
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11
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Lee J, Watt JA, Mayhew A, Sinn CL, Schumacher CL, Costa AP, Jones A. Equity in home care use in Canada: a cross-sectional analysis of the Canadian longitudinal study on ageing. BMJ PUBLIC HEALTH 2024; 2:e000812. [PMID: 40018586 PMCID: PMC11816407 DOI: 10.1136/bmjph-2023-000812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/30/2024] [Indexed: 03/01/2025]
Abstract
Background Although home care is an essential service that enables older adults to age at home, there are concerns that not all populations have equitable access to home care services in Canada. The primary objective of this study is to describe formal home care use in Canada across a broad set of demographic and socioeconomic factors. Methods We conducted a cross-sectional analysis of formal home care use among community-dwelling adults aged 45+ using data from the Canadian longitudinal study on ageing (CLSA) at the 3-year post-baseline follow-up (2015-18). We calculated crude prevalences of formal home care use, stratified by functional status, within the following equity stratification factors: sex, gender, income, education, immigration history, rurality, social support and population group. We used logistic regression models with marginal effects to calculate prevalences of formal home care use while further adjusting for factors related to home care need such as functional impairment, chronic conditions, assistive device use and self-reported health. Results Of 43 115 CLSA participants included, we found that 8.0% used formal home care services in the previous 12 months. Higher levels of functional impairment were consistently associated with greater home care use. Our unadjusted analysis found significant variations in home care use by sex, gender, income, education, immigration history, rurality and social support. After adjusting for factors related to home care need, we found that individuals with lower income, recent immigration and lower education were significantly less likely to use formal home care services, while individuals with less social support were significantly more likely to use formal home care services. Conclusions This study highlights disparities in home care use in Canada by income, immigration, education and social support. These findings emphasise the importance of developing federal and provincial policies to address barriers and promote equitable access to home care.
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Affiliation(s)
- James Lee
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer A Watt
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Mayhew
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Chi-Ling Sinn
- St Joseph's Health System, Hamilton, Ontario, Canada
| | | | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- St Joseph's Health System, Hamilton, Ontario, Canada
| | - Aaron Jones
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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12
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Warrens H, Jeyapala J, Blakeway H, Craig A, Tol I. Proposing a curriculum framework for refugee and migrant health for UK medical students. Future Healthc J 2024; 11:100190. [PMID: 39502435 PMCID: PMC11536032 DOI: 10.1016/j.fhj.2024.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 09/08/2024] [Accepted: 09/17/2024] [Indexed: 11/08/2024]
Abstract
Introduction Migration to the UK continues to rise. Refugee and migrant health needs are complex and multifaceted, and UK medical schools do not equip trainees to care confidently for this population. Methods A systematic literature review was performed to design a curriculum, which includes core themes, learning objectives, and proposed teaching methods. This was mapped to the General Medical Council (GMC) outcomes for UK graduates. Results and discussion Core themes were identified from 30 publications: knowledge, skills, leadership, advocacy and support. Topics include legislation, common conditions, social determinants of health, safeguarding and barriers to accessing care. Communication skills included trauma-informed and culturally sensitive consultations and interpreter use. Experiential learning programmes demonstrated high student satisfaction, development and patient impact. However, structured student support should be incorporated. Conclusion This adaptable curriculum correlates with GMC outcomes and may better equip doctors to deliver care to refugees, migrants and the wider UK population.
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Affiliation(s)
| | | | | | - Amy Craig
- London North West University Healthcare NHS Trust, UK
| | - Isabel Tol
- St George's University Hospitals NHS Foundation Trust, UK
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13
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Persaud S, Fitzgerald M, Hawken S, Tanuseputro P, Boucher L, Petrcich W, Wellman M, Webber C, Shoemaker E, Ducharme R, Dahrouge S, Myran D, Bayoumi AM, Wanigaratne S, Bloch G, Ponka D, Smith BT, Lofters A, Zygmunt A, MacLeod KK, Turcotte LA, Sander B, Howard M, Funnell S, Rayner J, Kitagawa K, Ibrahim S, Kendall CE. The association of combinations of social factors and SARs-CoV-2 infection: A retrospective population-based cohort study in Ontario, 2020-2021. DIALOGUES IN HEALTH 2024; 5:100197. [PMID: 39717675 PMCID: PMC11664076 DOI: 10.1016/j.dialog.2024.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 10/28/2024] [Indexed: 12/25/2024]
Abstract
Objective The COVID-19 pandemic highlighted and exacerbated health inequities worldwide. While several studies have examined the impact of individual social factors on COVID infection, our objective was to examine how interactions of social factors were associated with the risk of testing positive for SARS-CoV-2 during the first two years of the pandemic. Study design and setting We conducted an observational cohort study using linked health administrative data for Ontarians tested for SARS-CoV-2 between January 1st, 2020, and December 31st, 2021. We constructed multivariable models to examine the association between SARS-CoV-2 positivity and key variables including immigration status (immigrants vs. other Ontarians), and neighbourhood variables for household size, income, essential worker status, and visible minority status. We report main and interaction effects using odds ratios and predicted probabilities, with age and sex controlled in all models. Results Of 6,575,523 Ontarians in the cohort, 88.5 % tested negative, and 11.5 % tested positive for SARS-CoV-2. In all models, immigrants and those living in neighbourhoods with large average household sizes had greater odds of testing positive for SARS-CoV-2. The strength of these associations increased with increasing levels of neighbourhood marginalization for income, essential worker proportion and visible minority proportion. We observed little change in the probability of testing positive across neighbourhood income quintiles among other Ontarians who live in neighbourhoods with smaller households, but a large change in probability among other Ontarians who live in neighbourhoods with larger households. Conclusion Our study found that SARS-CoV-2 positivity was greater among people with certain combinations of social factors, but in all cases the probability of testing positive was consistently greater for immigrants than for other Ontarians. Examining interactions of social factors can provide a more nuanced and more comprehensive understanding of health inequity than examining factors separately.
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Affiliation(s)
- Sydney Persaud
- Bruyère Health Research Institute, Ottawa, Ontario, Canada
| | | | - Steven Hawken
- ICES, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Bruyère Health Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Boucher
- Bruyère Health Research Institute, Ottawa, Ontario, Canada
| | | | - Martin Wellman
- ICES, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Colleen Webber
- Bruyère Health Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Robin Ducharme
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Simone Dahrouge
- Bruyère Health Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Myran
- Bruyère Health Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ahmed M. Bayoumi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Susitha Wanigaratne
- ICES, Ottawa, Ontario, Canada
- Edwin S.H. Leong Center for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Gary Bloch
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health, Toronto, Ontario, Canada
| | - David Ponka
- Bruyère Health Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brendan T. Smith
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Aisha Lofters
- ICES, Ottawa, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Austin Zygmunt
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Krystal Kehoe MacLeod
- Bruyère Health Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Luke A. Turcotte
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Beate Sander
- ICES, Ottawa, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Funnell
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jennifer Rayner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Alliance for Healthier Communities, Toronto, Ontario, Canada
| | | | - Sureya Ibrahim
- Centre for Community Learning & Development, Toronto, Ontario M5A 2B3, Canada
| | - Claire E. Kendall
- Bruyère Health Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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14
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MacNeil A, Taunque A, Leo SN, Li G, de Groh M, Jiang Y, Fuller-Thomson E. The Mental Health Toll of the COVID-19 Pandemic on Older Adults with Migraine: A Prospective Analysis of Depression Using the Canadian Longitudinal Study on Aging. J Pain Res 2024; 17:3845-3866. [PMID: 39583197 PMCID: PMC11586004 DOI: 10.2147/jpr.s469798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 10/29/2024] [Indexed: 11/26/2024] Open
Abstract
Background Individuals with migraine are recognized to have a heightened risk of depression compared to the general population. The COVID-19 pandemic and associated public health restrictions exacerbated several known risk factors for depression, but limited longitudinal research has examined the impact of the pandemic on the mental health of people with migraine. Aim To examine the cumulative incidence of depression and recurrent depression among older adults with migraine, and to identify factors associated with depression among older adults with migraine during the pandemic. Methods Data came from four waves of the Canadian Longitudinal Study on Aging's comprehensive cohort (n=2181 with migraine). The outcome of interest was a positive screen for depression based on the CES-D-10 during the autumn of 2020. Bivariate and multivariate logistic regression analyses were conducted. Results Older adults with migraine, both with and without a history of depression, experienced increases in depression when compared to pre-pandemic levels, and when compared to older adults without migraine. The risk of incident and recurrent depression was higher among those who felt lonely and those who experienced an increase in family conflict during the pandemic. The risk of incident depression only was higher among those who experienced difficulty accessing healthcare and those who experienced other family challenges, such as increased caregiving responsibilities. The risk of recurrent depression only was higher among those who felt left out socially, those with functional limitations, and those whose income did not satisfy their basic needs. Conclusion Targeted interventions are needed to support the mental health of older adults with migraine.
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Affiliation(s)
- Andie MacNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
| | - Aneisha Taunque
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
| | - Sarah N Leo
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Grace Li
- Department of Sociology, University of Victoria, Victoria, British Columbia, Canada
| | - Margaret de Groh
- Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Ying Jiang
- Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
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15
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Beck K, Pallot K, Amri M. A scoping review on barriers and facilitators to harm reduction care among youth in British Columbia, Canada. Harm Reduct J 2024; 21:189. [PMID: 39444020 PMCID: PMC11520168 DOI: 10.1186/s12954-024-01063-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/18/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Progressive harm reduction policies have been implemented in British Columbia, Canada. However, youth who use drugs face barriers to receiving harm reduction care, resulting in increasing opioid-related hospitalizations and drug toxicity deaths. This scoping review collates peer-reviewed evidence to understand the barriers and facilitators faced by youth who use drugs when accessing harm reduction programming in British Columbia, Canada. METHODS This scoping review entailed conducting a systematic search of relevant databases to identify relevant articles. Articles were included if they: (i) contained youth falling between the ages of 12 and 26 years old; (ii) explored accessibility, barriers, and/or facilitators to harm reduction care or related topics; (iii) were empirical research articles using primary data (i.e., reviews, grey literature, theoretical or conceptual papers, books, etc. were excluded); and (iv) were available in the English language, given the geographic focus on British Columbia. RESULTS A total of 398 sources were identified and ultimately, data from 13 sources were charted and extracted. When investigating barriers to harm reduction care among youth, four themes emerged: self-stigma, service navigation, service delivery, and negative provider interactions. Furthermore, in exploring factors that facilitate harm reduction care for youth, four themes surfaced: ability to meet basic needs, positive provider interactions, social networks, and risk mitigation guidance. CONCLUSIONS The expansion of harm reduction services in 2016 did not fully address accessibility challenges faced by youth who use drugs. Barriers continue to hinder harm reduction engagement, while supportive networks, positive provider interactions, and the ability to meet basic needs facilitated sustained access. Tailored policy interventions rooted in equity are crucial to improving access to harm reduction services for youth who use drugs.
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Affiliation(s)
- Kassey Beck
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Katija Pallot
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Michelle Amri
- The W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
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16
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Han HR, Yun JY, Min D, Razaz M. Health literacy demand and attitudes toward COVID-19 prevention measures among Korean American older adults and their caregivers. BMC Public Health 2024; 24:2941. [PMID: 39443891 PMCID: PMC11515590 DOI: 10.1186/s12889-024-20427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 10/16/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Health literacy has been linked to positive attitudes toward COVID-19 preventive measures among adolescents and young- or middle-aged adult populations. This study examined the relationship between health literacy and attitudes toward COVID-19 preventive measures among non-English speaking Korean American older adults and their caregivers. The study additionally investigated how sociodemographic characteristics were associated with attitudes. METHODS COVID-19 survey data was collected from potential participants for an ongoing randomized controlled trial involving both Korean American older adults and their caregivers in the Baltimore-Washington and the New York Metropolitan areas (ClinicalTrials.gov Identifier: NCT03909347). Korean American older adults with normal cognition and their caregivers were allowed to participate in the survey. We used latent profile analysis to find unique clusters of participants with a similar pattern of responses to attitudes toward COVID-19 preventive measures. Based on the analysis, we employed multinomial logistic regression to investigate how health literacy and sociodemographic characteristics were associated with the clusters. RESULTS We found three clusters based on participant responses to COVID-19 preventive measures-Positive, Negative, or Mixed. Health literacy was not associated with COVID-19 related attitudes in the study sample. Men were 2.37 times more likely to be categorized as Mixed than having Positive Attitudes compared to women. The odds of a person living in the New York metropolitan area being categorized as having Mixed Attitudes compared to Positive Attitudes were also 2.67 times more than for a person living in the Baltimore-Washington area. CONCLUSIONS Differences in attitudes toward COVID-19 preventive measures were found among sociodemographic variables but not health literacy. Investigating what information channels or methods drive perception of public health information such as COVID-19 may help identify effective dissemination strategies for non-English speaking Korean older adults.
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Affiliation(s)
- Hae-Ra Han
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, United States of America.
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, United States of America.
| | - Ji-Young Yun
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, United States of America
| | - Deborah Min
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, United States of America
- Grossman School of Medicine, New York University, New York, NY, United States of America
| | - Maryam Razaz
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, United States of America
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17
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Iwuagwu AO, Poon AWC, Fernandez E. A scoping review of barriers to accessing aged care services for older adults from culturally and linguistically diverse communities in Australia. BMC Geriatr 2024; 24:805. [PMID: 39358719 PMCID: PMC11446002 DOI: 10.1186/s12877-024-05373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 09/09/2024] [Indexed: 10/04/2024] Open
Abstract
The ageing population of the culturally and linguistically diverse (CALD) population is increasing in Australia. This is because the number of early migrants in Australia is ageing, coupled with increasing family reunification. This scoping review aimed to describe the nature and extent of research on the barriers to aged care services for CALD older adults in Australia using Penchansky and Thomas's Access to Care Framework of five A's dimensions: availability, accessibility, accommodation, affordability, and acceptability. Arksey and O'Malley's five-step scoping review framework was adopted to search 6 databases from inception till August 2024. Title/abstract and full-text screening were conducted using predefined inclusion and exclusion criteria, with supplementary search of references from included articles to identify additional articles. Findings show that while all the five A's of access to care services were barriers for CALD older adults, accommodation and acceptability of services were the major areas of concern due to the lack of cultural sensitivity of such services in Australia. An additional barrier captured and termed as Awareness was noted in some of the included studies, highlighting the need to expand the five A's to 6 A's. Researchers, practitioners, and policymakers on ageing could leverage these findings to improve cultural practice sensitivities when supporting these populations.
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Affiliation(s)
- Anthony Obinna Iwuagwu
- School of Social Sciences, University of New South Wales, Sydney, Australia.
- Department of Social Work, University of Nigeria, Enugu, Nigeria.
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18
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Zeng F, Zhang DY, Chen SJ, Chen RX, Chen C, Huang SM, Li D, Zhang XD, Chen JJ, Mo CY, Gao L, Zeng JT, Xiong JX, Chen Z, Bai FH. Application of fecal immunochemical test in colorectal cancer screening: A community-based, cross-sectional study in average-risk individuals in Hainan. World J Gastrointest Oncol 2024; 16:3445-3456. [PMID: 39171167 PMCID: PMC11334025 DOI: 10.4251/wjgo.v16.i8.3445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/19/2024] [Accepted: 06/18/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) in China is steadily rising, with a high proportion of advanced-stage diagnoses. This highlights the significance of early detection and prevention measures to enhance survival rates. Fecal immunochemical testing (FIT) is a globally recommended CRC screening method; however, limited research has been conducted on its application in Hainan. AIM To assess the efficacy and adherence of FIT screening among average-risk individuals in Hainan, while also examining the risk factors associated with positive FIT results. METHODS This population-based cross-sectional study implemented FIT screening for CRC in 2000 asymptomatic participants aged 40-75 years from five cities and 21 community health centers in Hainan Province. The study was conducted from August 2022 to April 2023, employing a stratified sampling method to select participants. Individuals with positive FIT results subsequently underwent colonoscopy. Positive predictive values for confirmed CRC and advanced adenoma were calculated, and the relationship between relevant variables and positive FIT results was analyzed using χ 2 tests and multivariate logistic regression. RESULTS A total of 1788 participants completed the FIT screening, with a median age of 57 years (interquartile range: 40-75). Among them, 503 (28.1%) were males, and 1285 (71.9%) were females, resulting in an 89.4% compliance rate for FIT screening. The overall positivity rate of FIT was 4.4% [79 out of 1788; 95% confidence interval (CI): 3%-5%]. The specific positivity rates for Haikou, Sanya, Orient City, Qionghai City, and Wuzhishan City were 9.6% (45 of 468; 95%CI: 8%-11%), 1.3% (6 of 445; 95%CI: 0.1%-3.1%), 2.7% (8 of 293; 95%CI: 1.2%-4.3%), 3.3% (9 of 276; 95%CI: 1.0%-6.3%), and 4.2% (11 of 406; 95%CI: 1.2%-7.3%), respectively. Significant associations were found between age, dietary habits, and positive FIT results. Out of the 79 participants with positive FIT results, 55 underwent colonoscopy, demonstrating an 82.2% compliance rate. Among them, 10 had a clean gastrointestinal tract, 43 had polyps or adenomas, and 2 were confirmed to have CRC, yielding a positive predictive value of 3.6% (95%CI: 0.9%-4.2%). Among the 43 participants with polyps or adenomas, 8 were diagnosed with advanced adenomas, resulting in an advanced adenoma rate of 14.5% (95%CI: 10.1%-17.7%). CONCLUSION In the Hainan region, FIT screening for CRC among asymptomatic individuals at average risk is feasible and well-received.
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Affiliation(s)
- Fan Zeng
- Graduate School, Hainan Medical University, Haikou 571199, Hainan Province, China
| | - Da-Ya Zhang
- Graduate School, Hainan Medical University, Haikou 571199, Hainan Province, China
| | - Shi-Ju Chen
- Graduate School, Hainan Medical University, Haikou 571199, Hainan Province, China
| | - Run-Xiang Chen
- Graduate School, Hainan Medical University, Haikou 571199, Hainan Province, China
| | - Chen Chen
- Graduate School, Hainan Medical University, Haikou 571199, Hainan Province, China
| | - Shi-Mei Huang
- Graduate School, Hainan Medical University, Haikou 571199, Hainan Province, China
| | - Da Li
- Graduate School, Hainan Medical University, Haikou 571199, Hainan Province, China
| | - Xiao-Dong Zhang
- Graduate School, Hainan Medical University, Haikou 571199, Hainan Province, China
| | - Jia-Jia Chen
- Department of Gastroenterology, Qionghai People’s Hospital, Qionghai 571400, Hainan Province, China
| | - Cui-Yi Mo
- Department of Gastroenterology, Qionghai People’s Hospital, Qionghai 571400, Hainan Province, China
| | - Lei Gao
- Department of Gastroenterology, Sanya Central Hospital, Sanya 572022, Hainan Province, China
| | - Jun-Tao Zeng
- Department of Gastroenterology, Sanya Central Hospital, Sanya 572022, Hainan Province, China
| | - Jian-Xin Xiong
- Department of Gastroenterology, Hainan Second People’s Hospital, Wuzhishang 572299, Hainan Province, China
| | - Zhai Chen
- Department of Gastroenterology, Dongfang People’s Hospital, Dongfang 572699, Hainan Province, China
| | - Fei-Hu Bai
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical University, Haikou 570216, Hainan Province, China
- The Gastroenterology Clinical Medical Center of Hainan Province, Haikou 570216, Hainan Province, China
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Tefera GM, Yu M, Robinson EL, Winter VR, Bloom T. Transition, Adjustment, and Healthcare Avoidance: African Immigrant Women's Experiences and Perceptions of Navigating Primary Healthcare in the USA. Healthcare (Basel) 2024; 12:1504. [PMID: 39120207 PMCID: PMC11311796 DOI: 10.3390/healthcare12151504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/10/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
This study explores the transition and adjustment of African immigrant women, particularly Ethiopian immigrant women (EIW), as they navigate the U.S. healthcare system and their ability to access and utilize healthcare services. A qualitative cross-sectional design with a mix of purposive and snowball sampling techniques was utilized to recruit EIW (N = 21, ≥18 years) who arrived in the U.S. within the last five years. One-on-one in-depth interviews were conducted to collect data. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically using Nvivo12 software. The thematic analysis revealed three major themes: (1) settling into new life in the U.S. delays EIWs' ability to access primary healthcare; (2) adjusting to the U.S. healthcare system: confusions and mixed perceptions; and (3) avoidance of care: EIW's reasons for PHC visits changed in the U.S. Participants avoided healthcare, except for life-threatening conditions, general check-ups, and maternal healthcare services. Transitional support for legal, residential, employment, and health information could help tackle the challenges of accessing primary healthcare for EIW. Future research should analyze access to healthcare in relation to the everyday struggles of immigrant women, as well as legal and complex structural issues beyond acculturative issues.
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Affiliation(s)
- Gashaye M. Tefera
- College of Social Work, Florida State University, Tallahassee, FL 32306, USA
| | - Mansoo Yu
- School of Social Work, University of Missouri, Columbia, MO 65201, USA; (M.Y.); (E.L.R.)
- Department of Public Health, University of Missouri, Columbia, MO 65201, USA
| | - Erin L. Robinson
- School of Social Work, University of Missouri, Columbia, MO 65201, USA; (M.Y.); (E.L.R.)
| | | | - Tina Bloom
- School of Nursing, Notre Dame of Maryland University, Baltimore, MD 21210, USA;
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20
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Mackie AS, Tulli-Shah M, Chappell A, Kariwo M, Ibrahim S, Salami B. Barriers and facilitators to transition from pediatric to adult healthcare for immigrant youth with chronic health conditions. J Pediatr Nurs 2024; 77:e487-e494. [PMID: 38760303 DOI: 10.1016/j.pedn.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/16/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE The objective of this study was to investigate the experience of first- and second- generation immigrant youth living with chronic health conditions in Canada, their parents or caregivers, and healthcare and service providers who care for immigrant youth, regarding the transition from pediatric to adult healthcare. DESIGN AND METHODS We conducted semi-structured individual interviews and focus groups. Youth were 1st or 2nd generation immigrants, aged 16-25, with pediatric-onset chronic health conditions. Parents or caregivers had raised youth children as described. Providers delivered healthcare or other services to immigrant populations. Thematic analysis was conducted of all transcripts. RESULTS Twenty youth, 14 parents/caregivers and five service providers participated. Most participants described healthcare transition as very difficult to navigate. Two major themes emerged across participant narratives: 1. Barriers to transition: lack of family experience in Canada, language, discrimination, financial strain, stigma, and long wait times. Some of these barriers are specific to newcomer families, but others are generalizable to the Canadian population. 2. Facilitators of transition: youth independence, youth acting as cultural bridges within their families, and cross-sector support between healthcare, education, social work and settlement services. CONCLUSIONS Immigrant youth and their families face a broad range of barriers to healthcare transition. The collaborative nature of cross-sector support effectively addressed some of the barriers faced by newcomer families. PRACTICE IMPLICATIONS Clinicians should provide immigrant youth and their families with accessible information about the health condition and how to navigate the adult healthcare system prior to transition, particularly when language barriers exist.
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Affiliation(s)
- Andrew S Mackie
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
| | - Mia Tulli-Shah
- Faculty of Nursing, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Alyssa Chappell
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Michael Kariwo
- Faculty of Education, University of Alberta, 11210 - 87 Avenue, Edmonton, Alberta T6G 2G5, Canada
| | - Siciida Ibrahim
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
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21
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Alshamary S, Bashir E, Salami B. Barriers and facilitators to health care access for migrant children in Canada: A scoping review. J Pediatr Nurs 2024; 77:e602-e615. [PMID: 38824079 DOI: 10.1016/j.pedn.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024]
Abstract
PROBLEM Migrant children face numerous challenges when settling in their new home. One of the challenges that exists is difficulties accessing health care, with many barriers existing and few facilitators to ease access. The goal of this paper is to analyze previous literature related to migrants' access to access to health care in Canada to better understand the barriers they face, and the factors that help them access services, or the facilitators. ELIGIBILITY CRITERIA Arksey and O'Malley's stages in scoping reviews was employed to search CINAHL, PubMed, Sociological Abstract, SocIndex, Scopus, Cochrane Library, Ovid MEDLINE(R), and Ovid Embase from 1997 to February 2020. SAMPLE A total of 26 Canadian studies met the inclusion criteria. RESULTS The review revealed the following barriers: language and culture barriers, low socioeconomic status, lack of health insurance, transportation, shortage of social support, lack of knowledge, fear of service providers/authorities, and discrimination. The facilitators for accessing health care for this population included outreach, benefit and assistance programs, cultural training, strengthening education, and various services. CONCLUSION The abundance of barriers to health care access and the existence of few facilitators may worsen migrant children's health, however further research is required to understand the impact. IMPLICATION There is a need to increase the understanding of migrant children's experiences with accessing health care services in order to inform policy, educate providers, and improve access and health outcomes.
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Affiliation(s)
| | - Elhan Bashir
- Faculty of Nursing, University of Alberta, Canada.
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22
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Ghabrial MA, Ferguson T, Scheim AI, Adams NJ, Khatoon M, Bauer GR. Factors associated with primary healthcare provider access among trans and non-binary immigrants, refugees, and newcomers in Canada. J Migr Health 2024; 10:100241. [PMID: 39040891 PMCID: PMC11261874 DOI: 10.1016/j.jmh.2024.100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/27/2024] [Accepted: 06/23/2024] [Indexed: 07/24/2024] Open
Abstract
Objective Trans and non-binary (TNB) immigrants, refugees, and newcomers (IRN) face intersecting challenges and barriers, including stigma and persecution in countries of origin, and others unique to the Canadian resettlement process. The present study aimed to investigate factors that are associated with having a primary healthcare provider among TNB IRN. Design Trans PULSE Canada was a community-based, national study of health and wellbeing among 2,873 TNB people residing in Canada, aged 14 and older, who were recruited using a multi-mode convenience sampling approach.. The survey asked questions about identity, community, service access, health - and IRN were asked questions specific to immigration/settlement. Results Of the 313 IRN participants who completed the full survey version (age M = 34.1, SE=0.75), 76.4 % had a primary healthcare provider. TNB IRN largely reported being Canadian citizens (59.8 %), gender non-binary or similar (46.9 %), currently living in Ontario (35.5 %), and having immigrated from the United States (32.1 %). Chi-square analyses revealed that having a primary healthcare provider was associated with age, gender identity, citizenship status, region of origin, current location in Canada, length of time since immigrating to Canada, status in gender affirming medical care, and having extended health insurance. With modified Poisson regression, we found that TNB IRN who were non-permanent residents, originating from European, African, and Oceania regions, or living in Quebec and the Prairie provinces were less likely to have a primary healthcare provider. Conclusion Results may inform settlement organizations of the unique needs and barriers of TNB IRN. Schools and LGBTQ+ organizations may better serve this population - especially those originating from highlighted regions, who live in Quebec or the Prairie provinces, and/or are non-permanent residents - by offering programs that connect them to primary healthcare providers who are competent in cross-cultural trans health.
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Affiliation(s)
- Monica A. Ghabrial
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Psychology, Algoma University, Brampton, ON, Canada
| | | | - Ayden I. Scheim
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
- Unity Health Toronto, Toronto, ON, Canada
| | - Noah J. Adams
- Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
- Center for Applied Transgender Studies, ON, Canada
- Transgender Professional Association for Transgender Health, ON, Canada
| | - Moomtaz Khatoon
- Salaam Canada, Vancouver, BC, Canada
- PHS Community Services Society, Vancouver, BC, Canada
| | - Greta R. Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Eli Coleman Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
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23
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Sundareswaran M, Martignetti L, Purkey E. Barriers to primary care among immigrants and refugees in Peterborough, Ontario: a qualitative study of provider perspectives. BMC PRIMARY CARE 2024; 25:199. [PMID: 38840096 DOI: 10.1186/s12875-024-02453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Canada's immigrants and refugees have often settled in large Canadian cities, but this is changing with rising costs of living and rural settlement initiatives. However, little consideration is made regarding systemic changes needed to accommodate this distribution, particularly in healthcare in medium-sized cities or smaller communities. For most Canadians, primary care is an entry point into the healthcare system but immigrants and refugees face unique barriers to accessing care compared to the general Canadian population. This project aimed to better understand the barriers to accessing primary care among newcomers in Peterborough, Ontario from the perspective of newcomer service providers. METHODOLOGY Participants were recruited from community organizations identified by the local settlement agency, the New Canadians Centre, as having regular interactions with newcomer clients including clinics, not-for-profit organizations, and volunteer groups. Four focus groups were completed, each with three participants (n=12). A coding grid was deductively developed to guide thematic analysis by adapting Levesque et al.'s conceptual framework defining access to healthcare with five specific dimensions: approachability, acceptability, availability and accommodation, affordability, and appropriateness. RESULTS Participants identified lack of awareness of the healthcare system, stigma, competing priorities, and direct costs as some of the barriers for newcomers. Participants highlighted barriers unique to Peterborough including proximity to services, social isolation, and a shortage of family physicians. The results also highlighted strengths in the community such as its maternal-child health programming. CONCLUSION The results provide a glimpse of the challenges to accessing primary care among newcomers in medium-sized communities and identify opportunities to prepare for changing settlement patterns.
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Affiliation(s)
- Madura Sundareswaran
- Department of Family Medicine, Queen's University, Peterborough-Kawartha Site, 737 Victory Crescent, Peterborough, ON, K9J 4T5, Canada.
| | - Lucas Martignetti
- Department of Family Medicine, Queen's University, Peterborough-Kawartha Site, 737 Victory Crescent, Peterborough, ON, K9J 4T5, Canada
| | - Eva Purkey
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 3G2, Canada
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24
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Vyas MV, Redditt V, Mohamed S, Abraha M, Sheth J, Shah BR, Ko DT, Ke C. Determinants, Prevention, and Incidence of Cardiovascular Disease Among Immigrant and Refugee Populations. Can J Cardiol 2024; 40:1077-1087. [PMID: 38387721 DOI: 10.1016/j.cjca.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 02/24/2024] Open
Abstract
Immigration policies shape the composition, socioeconomic characteristics, and health of migrant populations. The health of migrants is also influenced by a confluence of social, economic, environmental, and political factors. Immigrants and refugees often face various barriers to accessing health care because of factors such as lack of familiarity with navigating the health care system, language barriers, systemic racism, and gaps in health insurance. Social determinants of health and access to primary care health services likely influence the burden of cardiovascular risk factors among immigrants. The relatively low burden of many cardiovascular risk factors in many immigrant populations likely contributes to the generally lower incidence rates of acute myocardial infarction, heart failure, and stroke in immigrants compared with nonimmigrants, although cardiovascular disease incidence rates vary substantially by country of origin. The "healthy immigrant effect" is the hypothesis that immigrants to high-income countries, such as Canada, are healthier than nonimmigrants in the host population. However, this effect may not apply universally across all immigrants, including recent refugees, immigrants without formal education, and unmarried immigrants. As unfolding sociopolitical events generate new waves of global migration, policymakers and health care providers need to focus on addressing social and structural determinants of health to better manage cardiovascular risk factors and prevent cardiovascular disease, especially among the most marginalized immigrants and refugees.
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Affiliation(s)
- Manav V Vyas
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Division of Neurology, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health, Toronto, Ontario, Canada
| | - Vanessa Redditt
- Crossroads Clinic, Women's College Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sebat Mohamed
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mosana Abraha
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Javal Sheth
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Dennis T Ko
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Medicine, Schulich Heart Centre, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Calvin Ke
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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25
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Cordoba E, Garofalo R, Kuhns LM, Pearson C, Scott Batey D, Janulis P, Jia H, Bruce J, Hidalgo MA, Hirshfield S, Radix A, Belkind U, Duncan DT, Kim B, Schnall R. Neighborhood-level characteristics as effect modifiers on the efficacy of the MyPEEPS mobile intervention in same-sex attracted adolescent men. Prev Med Rep 2024; 42:102726. [PMID: 38689890 PMCID: PMC11059328 DOI: 10.1016/j.pmedr.2024.102726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
To estimate the effect of neighborhood-level modification on the efficacy of the MyPEEPS Mobile intervention on the reduction of condomless anal sex acts among same-sex attracted adolescent men. A series of generalized linear mixed model was used to examine if the effect of the MyPEEPS Mobile intervention on condomless anal sex acts was moderated by neighborhood-level factors using data from the 2019 American Community Survey US Census Bureau. "The magnitudes of intervention were significantly smaller at both 6- and 9-month follow-up among adolescents living in neighborhood with high proportions of Hispanic or Latino residents (IRR6M = 1.02, 95 % CI: 1.01, 1.02; IRR9M = 1.03, 95 % CI: 1.01, 1.05) and high proportions of families with income below the poverty level (IRR6M = 1.07, 95 % CI: 1.01, 1.12; IRR9M = 1.05, 95 % CI: 1.01, 1.10), which indicated that living in communities with a higher concentration of residents living under poverty or of Hispanic/and Latino ethnicity significantly modified the effective of program intervention on condomless sex among adolescent MSM. Understanding how neighborhood characteristics modify the effect of HIV prevention interventions may be useful in better targeting delivery and tailoring content of interventions based on neighborhood level characteristics such as the ones identified in this study.
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Affiliation(s)
- Evette Cordoba
- School of Nursing, Columbia University, New York, NY 10032, USA
| | - Robert Garofalo
- Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL 60611, USA
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Lisa M. Kuhns
- Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL 60611, USA
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Cynthia Pearson
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, 4101 15 Avenue Northeast, Seattle, WA, 98105, USA
| | - D. Scott Batey
- School of Social Work, Tulane University, 127 Elk Place, New Orleans, LA 70112, USA
| | - Patrick Janulis
- Department of Sociomedical Sciences, Northwestern University, Chicago, IL 60611, USA
| | - Haomiao Jia
- School of Nursing, Columbia University, New York, NY 10032, USA
| | - Josh Bruce
- Birmingham AIDS Outreach, 205 32 Street, Birmingham, AL 35233, USA
| | - Marco A. Hidalgo
- Division of Internal Medicine-Pediatrics and Preventive Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, 911 Broxton Avenue, Los Angeles, CA 90024, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC 1240, Brooklyn, NY 11203, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, 356 West 18 Street, New York, NY, 10011, USA
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY 10032, USA
| | - Uri Belkind
- Callen-Lorde Community Health Center, 356 West 18 Street, New York, NY, 10011, USA
| | - Dustin T. Duncan
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY 10032, USA
| | - Byoungjun Kim
- Department of Surgery, New York University, New York, NY, 10016, USA & Department of Population Health, New York University, New York, NY 10016, USA
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, NY 10032, USA
- Columbia University, Mailman School of Public Health, Department of Population and Family Health, New York, NY, 10032, USA
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26
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Rishworth A, Wilson K, Adams M, Galloway T. Landscapes of inequities, structural racism, and disease during the COVID-19 pandemic: Experiences of immigrant and racialized populations in Canada. Health Place 2024; 87:103214. [PMID: 38520992 DOI: 10.1016/j.healthplace.2024.103214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
The COVID-19 pandemic has disproportionately affected immigrant and racialized communities globally and revealed another public health crisis - structural racism. While structural racism is known to foster discrimination via mutually reinforcing systems, the unevenness of COVID-19 infections, hospitalizations, and deaths across societies has precipitated attention to the impacts of structural racism. Research highlights the inequitable burden of COVID-19 among immigrant and racialized groups; however, little is known about the synergistic impacts of structural racism and COVID-19 on the health and wellbeing of these groups. Fewer studies examine how structural racism and COVID-19 intersect within neighbourhoods to co-produce landscapes of disease exposure and management. This article examines the pathways through which structural racism shapes access, use, and control of environmental resources among immigrant and racialized individuals in the neighbourhoods of the Peel Region and how they converged to shape health and disease dynamics during the height of Canada's COVID-19 pandemic. Findings from in-depth interviews reveal that mutually reinforcing inequitable systems created environments for COVID-19 to reinscribe disparities in access, use, and control of key resources needed to manage health and disease, and created new forms of disparities and landscapes of inequality for immigrants and racialized individuals. We close with a discussion on the impacts for policy and practice.
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Affiliation(s)
- Andrea Rishworth
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Kathi Wilson
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Matthew Adams
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Tracey Galloway
- Department of Anthropology, University of Toronto, Mississauga, ON, Canada.
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Fong M, Liu A, Lung B, Alayche I, Sayfi S, Kirenga RY, Chomienne MH, Saad A, Grenier J, Kassam A, Ahmed R, Pottie K. From struggle to strength in African and Middle Eastern newcomers' integration stories to Canada: A participatory health equity research study. PLoS One 2024; 19:e0302591. [PMID: 38687776 PMCID: PMC11060515 DOI: 10.1371/journal.pone.0302591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Newcomers (immigrants, refugees, and international students) face many personal, gender, cultural, environmental and health system barriers when integrating into a new society. These struggles can affect their health and social care, reducing access to mental health care. This study explores the lived experiences of African and Middle Eastern newcomers to Ontario, Canada. An understanding of newcomer integration challenges, successes and social justice issues is needed to improve health equity and social services. METHODS In this qualitative study, we used a participatory research approach to collect stories reflecting participants' integration perspectives and experiences. Beginning with our immigrant community network, we used snowball sampling to recruit newcomers, ages 18 to 30, originating from Africa or the Middle East. We used qualitative narrative analysis to interpret stories, identifying context themes, integrating related barriers and facilitators, and resolutions and learnings. We shared our findings and sought final feedback from our participants. FINDINGS A total of 18 newcomers, 78% female and approximately half post-secondary students, participated in the study. Participants described an unknown and intimidating migration context, with periods of loneliness and isolation aggravated by cold winter conditions and unfamiliar language and culture. Amidst the struggles, the support of friends and family, along with engaging in schoolwork, exploring new learning opportunities, and participating in community services, all facilitated integration and forged new resilience. CONCLUSIONS Community building, friendships, and local services emerged as key elements for future immigrant service research. Utilizing a participatory health research approach allowed us to respond to the call for social justice-oriented research that helps to generate scientific knowledge for promoting culturally adaptive health care and access for marginalized populations.
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Affiliation(s)
- Maggie Fong
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Amy Liu
- Department of Interdisciplinary Medical Sciences, Western University, London, Ontario, Canada
| | - Bryan Lung
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
- Department of Biochemistry, Western University, London, Ontario, Canada
| | - Ibrahim Alayche
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shahab Sayfi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ryan Yuhi Kirenga
- The Vulnerability, Trauma, Resilience and Culture Research Laboratory (V-TRaC), University of Ottawa, Ottawa, Ontario, Canada
| | - Marie Hélène Chomienne
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Ammar Saad
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean Grenier
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Azaad Kassam
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Rukhsana Ahmed
- Department of Communication, University at Albany, State University of New York, Albany, New York, United States of America
| | - Kevin Pottie
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Family Medicine, Western University, London, Ontario, Canada
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28
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Krzyż EZ, Lin HR. Meta-synthesis of mental healthcare-seeking behavior - Perspectives of refugees and asylum seekers. Arch Psychiatr Nurs 2024; 49:10-22. [PMID: 38734444 DOI: 10.1016/j.apnu.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 10/31/2023] [Accepted: 01/13/2024] [Indexed: 05/13/2024]
Abstract
The number of refugees and asylum seekers worldwide is increasing, and these populations often experience significant mental health challenges due to their difficult life experiences. This study aims to explore the perspectives of refugees and asylum seekers regarding their behavior when seeking mental healthcare. We conducted a meta-synthesis of thirteen articles published between January 2000 and January 2023. The study identified four main themes: understanding of mental health, utilization of health services, the role of society, and necessary interventions. Based on our findings, we provided recommendations for healthcare providers, governments, and researchers to improve the mental healthcare-seeking behavior of these populations in the future.
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Affiliation(s)
- Ewa Zuzanna Krzyż
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hung-Ru Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Raza MA, Aziz S, Iftikhar D, Anjum I, Fialova D. Addressing quality medication use among migrant patients: Establishment of an organization to provide culturally competent medication care. Saudi Pharm J 2024; 32:101922. [PMID: 38318317 PMCID: PMC10840353 DOI: 10.1016/j.jsps.2023.101922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/12/2023] [Indexed: 02/07/2024] Open
Abstract
As the global landscape continues to witness an increase in migration, the healthcare community faces an evolving challenge: the provision of quality medication care to migrant patients. Language barriers, cultural differences, and a lack of understanding of the local healthcare system can often impede the effective management of medications and access to healthcare services among migrant populations. Pharmacists, as medication experts, are dignified to make a substantial impact in bridging the gap between migrants and quality healthcare. Their expertise in medication management, accessibility, and counseling positions them as critical healthcare providers for this patient population. Pharmacies and pharmacists can serve as trusted hubs where migrants receive not only essential medications but also culturally sensitive support in navigating the healthcare system. This commentary article highlights the critical importance of culturally competent medication care for migrant patients and the central role that pharmacists can play in this endeavor. By establishing organization dedicated to this cause lead by pharmacists, we can not only address an urgent healthcare concern but also set a precedent for a healthcare system that values inclusivity, cultural competence, and equitable access to quality medication care for all, regardless of their cultural background.
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Affiliation(s)
- Muhammad Ahmer Raza
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Czech Republic
| | - Shireen Aziz
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Czech Republic
| | | | - Irfan Anjum
- Department of Basic Medical Sciences, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Daniela Fialova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Safarov N, Kemppainen L, Wrede S, Kouvonen A. Self-identified barriers to health services among migrants 50 years of age or older: population-based survey study of Russian speakers in Finland. BMC Health Serv Res 2024; 24:252. [PMID: 38414040 PMCID: PMC10900858 DOI: 10.1186/s12913-024-10728-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The compounded effect of a migratory background and ageing increases the risk of unequal medical treatment opportunities. The aim of this article is to investigate the social determinants of barriers to health services. METHODS The study uses population-based survey data of Russian-speaking migrants (50 + years) residing in Finland (n = 1082, 57% of men, mean age 63 years). Multiple correspondence analysis was performed as a dimension reduction procedure on six barriers to health services. Multiple ordinary least-squares linear regression was used for the predicted score of the barriers as an outcome variable. RESULTS Most of the sociodemographic characteristics were not associated with barriers to health services, except gender, as women tended to face more disadvantages. Migration-related factors, such as the need for interpreters for health services and experienced discrimination, were associated with an increased likelihood of reporting barriers to health services. Using the internet as a primary source of health information was associated with more access barriers to health services. CONCLUSIONS Migrants 50 years of age or older face multiple barriers to health services. Given that the healthcare needs increase with age, addressing this issue becomes crucial, necessitating improved access to health services for older migrants.
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Affiliation(s)
- Nuriiar Safarov
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
| | - Laura Kemppainen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Sirpa Wrede
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
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Bjørneboe J, Bratsberg A, Brox JI, Skatteboe S, Wilhelmsen M, Samuelsen KM, Marchand GH, Flørenes T, Kielland MG, Røe C. Symptom burden and follow-up of patients with neck and back complaints in specialized outpatient care: a national register study. Sci Rep 2024; 14:3855. [PMID: 38361115 PMCID: PMC10869734 DOI: 10.1038/s41598-024-53879-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
Back and neck pain are common in the population, especially among immigrants. In Norway's specialist care system, treating these patients typically involves a multidisciplinary approach based on the biopsychosocial model. However, language and cultural differences may create barriers to participation. Immigrants are often underrepresented in clinical studies, but a register-based approach can enhance their participation in research. This study aimed to compare both the symptom burden, and treatment, among Norwegians, non-Norwegians, and patients requiring translator service for back and neck pain within the Norwegian specialist care system. The Norwegian neck and back registry is a National Quality Register, established in 2012 and fully digitized in late 2020. The baseline data includes demographics and patient recorded outcome measures including Oswestry Disability Index, Fear-Avoidance Beliefs, pain rating on a numeric rating scale, Hopkins Symptom Checklist and EuroQol five-dimensional questionnaire on health related quality of life. During the two-year study period, a total of 14,124 patients were invited, and 10,060 (71%) participated. Norwegian patients reported less pain, better function assessed by Oswestry Disability Index, lower fear avoidance beliefs, less emotional distress, and higher health related quality of life compared to non-Norwegians. We found that patients with female gender, who were younger, more educated and exhibited fear-avoidance behavior were significantly more likely to receive multidisciplinary treatment. We found no difference in the proportion of Norwegian and non-Norwegian patients receiving multidisciplinary treatment [odds ratio (OR) 1.02 (95% confidence interval (CI) 0.90-1.16)]. However, patients needing a translator were less likely to receive multidisciplinary treatment compared to those who didn't require translation [OR 0.41 (95% CI (0.25-0.66)]. We found that non-Norwegian patients experience a higher symptom burden compared to Norwegian. We found that both non-Norwegians and patient in need of translator were to a greater extent recommended treatment in primary health care. The proportion of non-Norwegians patients receiving multidisciplinary treatment was similar to Norwegians, but those needing a translator were less likely to receive such treatment.
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Affiliation(s)
- John Bjørneboe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
| | - Andrea Bratsberg
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University in Oslo, Oslo, Norway
| | - Sigrid Skatteboe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Maja Wilhelmsen
- Department of Physical Medicine and Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Norwegian Neck and Back Registry, UNN Tromsø, Tromsø, Norway
| | - Kjetil Magne Samuelsen
- Department of Physical Medicine and Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Norwegian Neck and Back Registry, UNN Tromsø, Tromsø, Norway
| | - Gunn Hege Marchand
- Department of Physical Medicine and Rehabilitation, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tonje Flørenes
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Maja Garnaas Kielland
- Department of Health Care Coordination, Health Literacy and Health Equity, Oslo University Hospital, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University in Oslo, Oslo, Norway
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Sacks E, Brizuela V, Javadi D, Kim Y, Elmi N, Finlayson K, Crossland N, Langlois EV, Ziegler D, Parmar SM, Bonet M. Immigrant women's and families' views and experiences of routine postnatal care: findings from a qualitative evidence synthesis. BMJ Glob Health 2024; 8:e014075. [PMID: 38351019 PMCID: PMC10897958 DOI: 10.1136/bmjgh-2023-014075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/06/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Uptake of postnatal care (PNC) is low and inequitable in many countries, and immigrant women may experience additional challenges to access and effective use. As part of a larger study examining the views of women, partners, and families on routine PNC, we analysed a subset of data on the specific experiences of immigrant women and families. METHODS This is a subanalysis of a larger qualitative evidence synthesis. We searched MEDLINE, PUBMED, CINAHL, EMBASE, EBM-Reviews and grey literature for studies published until December 2019 with extractable qualitative data with no language restrictions. For this analysis, we focused on papers related to immigrant women and families. Two reviewers screened each study independently; inclusion was agreed by consensus. Data abstraction and quality assessment were carried out using a study-specific extraction form and established quality assessment tools. Study findings were identified using thematic analysis. Findings are presented by confidence in the finding, applying the GRADE-CERQual approach. FINDINGS We included 44 papers, out of 602 full-texts, representing 11 countries where women and families sought PNC after immigrating. All but one included immigrants to high-income countries. Four themes were identified: resources and access, differences from home country, support needs, and experiences of care. High confidence study findings included: language and communication challenges; uncertainty about navigating system supports including transportation; high mental health, emotional, and informational needs; the impact of personal resources and social support; and the quality of interaction with healthcare providers. These findings highlight the importance of care experiences beyond clinical care. More research is also needed on the experiences of families migrating between low-income countries. CONCLUSIONS Immigrant families experience many challenges in getting routine PNC, especially related to language, culture, and communication. Some challenges may be mitigated by improving comprehensive and accessible information on available services, as well as holistic social support. TRIAL REGISTRATION NUMBER CRD42019139183.
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Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Dena Javadi
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Yoona Kim
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Nika Elmi
- School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth Finlayson
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Etienne V Langlois
- Partnership for Maternal, Newborn, and Child Health, World Health Organization, Geneva, Switzerland
| | - Daniela Ziegler
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | | | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Waqar M, Kuuire VZ. "The Critical Services Are Out of Reach": Diabetes Management and the Experiences of South Asian Immigrants in Ontario. J Prim Care Community Health 2024; 15:21501319241240635. [PMID: 38523416 PMCID: PMC10962024 DOI: 10.1177/21501319241240635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/13/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
Type 2 diabetes is a serious chronic condition affecting millions of people worldwide. South Asians (individuals originating from Pakistan, India, Bangladesh, Sri Lanka, and Nepal) represent a high-risk ethnicity for developing type 2 diabetes (T2D) and experience a high prevalence of the disease, even in migrant populations. The objective of this study was to investigate perceptions and experiences of South Asians living with T2D in Ontario, and their utilization of diabetes related services within the provincial healthcare system. Data were obtained from 20 in-depth interviews with South Asian participants diagnosed with T2D and living in the Greater Toronto Area. Our findings indicate a dissatisfaction with Ontario's coverage for diabetes services; varying uptake of recommended health tests, exams, and monitoring equipment; low utilization of additional resources (diabetes centers); and a need for primary care physicians to better facilitate awareness and utilization of available coverages and resources in the community. This study provides support for the fact that even in Canada's universal healthcare system, disparities exist, particularly for ethnic minorities, and that a universal prescription drug coverage component is a crucial step forward to ensure equitable access to health services utilization for all.
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Affiliation(s)
- Minal Waqar
- Department of Geography, Geomatics & Environment, University of Toronto – Mississauga, Mississauga, ON, Canada
| | - Vincent Z. Kuuire
- Department of Geography, Geomatics & Environment, University of Toronto – Mississauga, Mississauga, ON, Canada
- Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto – St. George, Toronto, ON, Canada
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Mason J, Laporte A, McDonald JT, Kurdyak P, Fosse E, de Oliveira C. Assessing the "healthy immigrant effect" in mental health: Intra- and inter-cohort trends in mood and/or anxiety disorders. Soc Sci Med 2024; 340:116367. [PMID: 38039769 DOI: 10.1016/j.socscimed.2023.116367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/11/2023] [Accepted: 10/25/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND The healthy immigrant effect implies that, at the time of immigration, new immigrants are typically healthier than the Canadian-born population. Furthermore, this health advantage fades the longer cohorts of immigrants remain in the host country. METHODS Most studies assessing the healthy immigrant effect rely on strong, untestable assumptions to extract unique effects for length of stay (LOS) (i.e., how long an immigrant has been in a host country), period (i.e., year of observation), and cohort (i.e., year of immigration). Rather than attempting to parse out separate effects for LOS, period, and cohort, we adopt a descriptive, cohort-centric approach to study immigrant mental health, which examines intra- and inter-cohort trends, that is, joint LOS-period and cohort-period parameters, respectively. While intra-cohort trends show how immigrants' mental health change with LOS across periods, inter-cohort trends reveal how the mental health of successive cohorts of immigrants differ across time periods. To provide a thorough assessment of the healthy immigrant effect, we use both survey and administrative data on cohorts of Canadian immigrants from 2003 to 2013. RESULTS The survey data reveal that mental health declines steeply (i.e., there is an increase in mood and/or anxiety disorders) within and across immigrant cohorts, while the administrative data show little overall change in mental health care utilization within and across cohorts. The divergent results may reflect issues related to barriers in access to mental health services because the administrative data, which are based on health care utilization, do not the capture the increase in mental disorders seen in the survey data. CONCLUSION This study highlights the benefit of a cohort-based approach to assess the healthy immigrant effect as it pertains to mental health as well as the importance of using different types of data, which may be measuring different aspects of immigrant mental health and health care utilization.
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Affiliation(s)
- Joyce Mason
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Audrey Laporte
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Economics, University of Toronto, Toronto, Ontario, Canada
| | - James Ted McDonald
- Department of Economics, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ethan Fosse
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada; Data Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
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Krystallidou D, Temizöz Ö, Wang F, de Looper M, Di Maria E, Gattiglia N, Giani S, Hieke G, Morganti W, Pace CS, Schouten B, Braun S. Communication in refugee and migrant mental healthcare: A systematic rapid review on the needs, barriers and strategies of seekers and providers of mental health services. Health Policy 2024; 139:104949. [PMID: 38071855 DOI: 10.1016/j.healthpol.2023.104949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 12/31/2023]
Abstract
BACKGROUND Migrants and refugees may not access mental health services due to linguistic and cultural discordance between them and health and social care professionals (HSCPs). The aim of this review is to identify the communication needs and barriers experienced by third-country nationals (TCNs), their carers, and HSCPs, as well as the strategies they use and their preferences when accessing/providing mental health services and language barriers are present. METHODS We undertook a rapid systematic review of the literature (01/01/2011 - 09/03/2022) on seeking and/or providing mental health services in linguistically discordant settings. Quality appraisal was performed, data was extracted, and evidence was reviewed and synthesised qualitatively. RESULTS 58/5,650 papers met the inclusion criteria. Both TCNs (and their carers) and HSCPs experience difficulties when seeking or providing mental health services and language barriers are present. TCNs and HSCPs prefer linguistically and culturally concordant provision of mental health services but professional interpreters are often required. However, their use is not always preferred, nor is it without problems. CONCLUSIONS Language barriers impede TCNs' access to mental health services. Improving language support options and cultural competency in mental health services is crucial to ensure that individuals from diverse linguistic and cultural backgrounds can access and/or provide high-quality mental health services.
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Affiliation(s)
- Demi Krystallidou
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom.
| | - Özlem Temizöz
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom
| | - Fang Wang
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom
| | - Melanie de Looper
- Tilburg Social and Behavioural Sciences, Centre for Care and Wellbeing (Tranzo), University of Tilburg, the Netherlands
| | - Emilio Di Maria
- Department of Health Sciences, University of Genoa, Italy; University Unit of Medical Genetics, Galliera Hospital, Genoa, Italy
| | - Nora Gattiglia
- Department of Modern Languages and Cultures, University of Genoa, Italy
| | | | - Graham Hieke
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom
| | - Wanda Morganti
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Ente Ospedaliero Galliera Hospital, Genoa, Italy
| | | | - Barbara Schouten
- Amsterdam School of Communication Research (ASCoR)/Centre for Urban Mental Health, University of Amsterdam, the Netherlands
| | - Sabine Braun
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom
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Vincent R, Coulibaly KS, Ahmed A, Ahmed Y, Hanna TA, Ravi S, Hawkes MT, Gnidehou S. Access to healthcare services and confidence in healthcare professionals' management of malaria: the views of Francophone sub-Saharan African Immigrants living in western Canada. BMC Public Health 2023; 23:2456. [PMID: 38066503 PMCID: PMC10704657 DOI: 10.1186/s12889-023-17266-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND There is a paucity of knowledge about the healthcare attitudes and practices of French-speaking immigrants originating from Sub-Saharan Africa (FISSA) living in minority settings. The purpose of this study was to characterize FISSA healthcare experiences and confidence in the malaria-related knowledge of health professionals in Edmonton. METHODS A structured survey was used to examine a cohort of 382 FISSA (48% female; 52% male) living in Edmonton. FISSA general healthcare attitudes, experiences and satisfaction with the Canadian healthcare system were studied. Healthcare Competency Perception (HCP) was characterized by using an index score. Statistical analyses were performed to evaluate the impact of healthcare experiences and other outcomes. RESULTS Intriguingly, while only 42% of FISSA had a French-speaking family physician, 83% (197/238) of those who had received health care services in Alberta found that access to medical treatment was easy, and 77% (188/243) were satisfied with received care. Although 70% (171/243) of FISSA did not receive services in French, 82% (199/243) surprisingly reported having good levels of comprehension during their visits. Satisfaction with care was associated with having a family physician (p = 0.018) and having health insurance (p = 0.041). Nevertheless, confidence in the healthcare system's ability to treat malaria effectively was significantly lower, with only 39% (148/382) receiving a positive score on the HCP index. CONCLUSION This study provides an important insight into FISSA experience with and perception of the Alberta's healthcare system.
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Affiliation(s)
- Rémi Vincent
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | | | - Ali Ahmed
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | - Youssef Ahmed
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | - Taylor A Hanna
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | - Srilata Ravi
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | - Michael T Hawkes
- Department of Pediatrics, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sedami Gnidehou
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada.
- Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada.
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Wood J, Stolee P, Tong C. Understanding the Patient Experience of Foreign-Born Older Adults: A Scoping Review of Older Immigrants Receiving Health Care in Canada. Can J Aging 2023; 42:657-667. [PMID: 37424439 DOI: 10.1017/s0714980823000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
In Canada, foreign-born older adults (FBOAs) have a higher prevalence of chronic conditions and poorer self-reported physical and mental health than their Canadian-born peers. However, very little research has explored FBOAs' experiences of health care after immigration. This review aims to understand the patient experiences of older immigrants within the Canadian health care system. Employing Arksey and O'Malley's framework for scoping reviews, we searched six databases and identified 12 articles that discussed the patient experience of this population. Although we sought to understand patient experience, the studies largely focused on barriers to care, including: communication difficulties, lack of cultural integration, systematic barriers in health care, financial barriers, and intersecting barriers related to culture and gender.This review provides insight into new areas of research and advocates for strengthened policy and/or programming. Our review also highlights that there is a paucity of literature for an ever-growing segment of the Canadian population.
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Affiliation(s)
- Jessica Wood
- Global Health, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Paul Stolee
- School of Public Health & Health Systems, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Catherine Tong
- School of Public Health & Health Systems, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
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Ho CH, Denton AH, Blackstone SR, Saif N, MacIntyre K, Ozkaynak M, Valdez RS, Hauck FR. Access to Healthcare Among US Adult Refugees: A Systematic Qualitative Review. J Immigr Minor Health 2023; 25:1426-1462. [PMID: 37009980 DOI: 10.1007/s10903-023-01477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
Refugees encounter numerous healthcare access barriers in host countries, leading to lower utilization rates and poorer health outcomes. In the US, social inequities and fragmented health systems may exacerbate these disparities. Understanding these factors is necessary to ensure equitable care of refugee populations. A systematic literature review of qualitative studies on US adult refugee healthcare access from January 2000 to June 2021 was performed in accordance with PRISMA. Studies were analyzed deductively and then inductively to incorporate previous findings in other resettlement countries and emergence of US-specific themes. 64 articles representing 16+ countries of origin emerged from the final analysis, yielding nine interrelated themes related to health literacy, cost of services, cultural beliefs, and social supports, among others. The main challenges to refugees' healthcare access emerge from the interactions of care fragmentation with adverse social determinants. Given diverse barriers, integrated care models are recommended in treating refugee populations.
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Affiliation(s)
- Chi H Ho
- Department of Public Health Sciences, Frank Batten School of Leadership and Public Policy, University of Virginia, Charlottesville, VA, USA
| | - Andrea H Denton
- Claude Moore Health Sciences Library, University of Virginia, Charlottesville, VA, USA
| | - Sarah R Blackstone
- Office of Institutional Research, James Madison University, Harrisonburg, VA, USA
| | - Nadia Saif
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Kara MacIntyre
- Office of Institutional Research, James Madison University, Harrisonburg, VA, USA
| | - Mustafa Ozkaynak
- College of Nursing, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Rupa S Valdez
- Department of Public Health Sciences, Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, USA
| | - Fern R Hauck
- Department of Family Medicine, Department of Public Health Sciences, University of Virginia, PO Box 800729, Charlottesville, VA, 22908-0729, USA.
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Graf J, Ng HS, Zhu F, Zhao Y, Wijnands JMA, Evans C, Fisk JD, Marrie RA, Tremlett H. Multiple sclerosis disease-modifying drug use by immigrants: a real-world study. Sci Rep 2023; 13:21235. [PMID: 38040796 PMCID: PMC10692166 DOI: 10.1038/s41598-023-46313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023] Open
Abstract
Little is known about disease-modifying drug (DMD) initiation by immigrants with multiple sclerosis (MS) in countries with universal health coverage. We assessed the association between immigration status and DMD use within 5-years after the first MS-related healthcare encounter. Using health administrative data, we identified MS cases in British Columbia (BC), Canada. The index date was the first MS-related healthcare encounter (MS/demyelinating disease-related diagnosis or DMD prescription filled), and ranged from 01/January/1996 to 31/December/2012. Those included were ≥ 18 years old, BC residents for ≥ 1-year pre- and ≥ 5-years post-index date. Persons becoming permanent residents 1985-2012 were defined as immigrants, all others were long-term residents. The association between immigration status and any DMD prescription filled within 5-years post-index date (with the latest study end date being 31/December/2017) was assessed using logistic regression, reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). We identified 8762 MS cases (522 were immigrants). Among immigrants of lower SES, odds of filling any DMD prescription were reduced, whereas they did not differ between immigrants and long-term residents across SES quintiles (aOR 0.96; 95%CI 0.78-1.19). Overall use (odds) of a first DMD within 5 years after the first MS-related encounter was associated with immigration status.
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Affiliation(s)
- Jonas Graf
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Huah Shin Ng
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Feng Zhu
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Yinshan Zhao
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - José M A Wijnands
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D Fisk
- Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Helen Tremlett
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia Vancouver, Rm S126, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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Beauchesne R, Birch P, Elliott AM. Genetic counselling resources in non-english languages: A scoping review. PEC INNOVATION 2023; 2:100135. [PMID: 37214519 PMCID: PMC10194398 DOI: 10.1016/j.pecinn.2023.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 05/24/2023]
Abstract
Objective Genetic counselling is essential for individuals seeking genetic or genomic testing. Whereas innovative strategies for GC delivery are being explored to meet the growing demand on the clinical genetics workforce, it is essential to consider the unique needs of culturally and linguistically diverse populations. Methods We conducted a scoping review to examine the extent, range, and gaps in the body of non-English, patient-facing educational resources available for Limited English Proficient (LEP) patients accessing clinical genetics and genomics services. Results The literature search returned 246 unique resources, most available in several languages. Forty-six languages were represented, with Spanish, Russian, and French being the most common. Resources were in various formats and were of varying quality. Conclusions There is a lack of high-quality supplementary genetics education material available in languages other than English, which limits the quality-of-care that LEP families may receive compared to their English-speaking counterparts. Of equal concern is the difficulty in finding existing resources and in determining their quality. Innovation This research highlights the important need for genetics education material that is of good quality in languages other than English and the challenges associated with identifying this material. A central, curated repository, perhaps sponsored by a genetic counselling organization, would be of great benefit to help genetic counsellors meet the needs of their culturally and linguistically diverse patients.
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Affiliation(s)
- Rhea Beauchesne
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia Birch
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - GenCOUNSEL Study
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison M. Elliott
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, British Columbia, Canada
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Archibald M, Makinde S, Tongol N, Levasseur-Puhach S, Roos L. Experiences and Priorities in Youth and Family Mental Health: Protocol for an Arts-Based Priority-Setting Focus Group Study. JMIR Res Protoc 2023; 12:e50208. [PMID: 37934557 PMCID: PMC10664011 DOI: 10.2196/50208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, eHealth services enabled providers to reach families despite widespread social distancing restrictions. However, their rapid adoption often occurred without community partners' involvement and without an understanding of how they prioritize aspects of their mental health and associated service provision, both of which promote family and community-centered health care delivery. Establishing priorities in health care is essential for developing meaningful and reliable health services. As such, there is an urgent need to understand how eHealth service users, especially families who may have historically faced oppression and systemic barriers to service access, can best benefit from them. Arts-based approaches can elicit an understanding of priorities by providing an engaging and expressive means of moving beyond readily expressible discursive language and stimulating meaningful dialogue reflective of participants' lived experiences. OBJECTIVE The purpose of this research is to determine the priorities and preferences of youth; parents or caregivers; newcomers and immigrants; and Indigenous community members regarding the use of eHealth in supporting their mental health using an innovative arts-based priority-setting method. METHODS This study uses a mixed-methods approach combining qualitative, quantitative, and arts-based research. It follows a survey used to identify key knowledge partners who are interested in improving eHealth services for mental health support in Manitoba, Canada. Knowledge partners interested in group-based priority setting will be contacted to participate. We will facilitate approximately two focus groups across each subgroup of youth, parents or caregivers, newcomers or immigrants, and Indigenous community members using an integrative, quantitatively anchored arts-based method termed the "Circle of Importance" to understand participants' mental health priorities and how eHealth or technology may support their mental well-being. The Circle of Importance involves placing small objects, whose meaning is determined by participants, on a visual board with concentric circles that correspond to a 5-point Likert scale of importance. Following each focus group, we will evaluate participants' and focus group facilitators' experiences of the Circle of Importance using a survey and follow-up structured in-person interviews to garner how we can improve the arts-based approach used in the focus groups. RESULTS The PRIME (Partnering for Research Innovation in Mental Health through eHealth Excellence) theme received institutional ethics approval on August 23, 2023. Data collection is projected for August 2023, with follow-up focus groups occurring in early 2024 as required. Data analysis will occur immediately following data collection. CONCLUSIONS Findings will directly inform a multiyear applied research agenda for PRIME aimed at improving mental health services through engaging key knowledge partners. The results may inform how arts-based methods in a priority setting can reflect aspects of experience beyond the capacities of qualitative or quantitative methods alone, and whether this approach aligns well with a positive experience of research participation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50208.
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Affiliation(s)
- Mandy Archibald
- University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | | | | | | | - Leslie Roos
- University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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Muhammad MI, Abdulsalam AH, Petit-Clair F, Acquaye A, Nobles A, Fleischer B, Konkwo C, Ransome Y, Paintsil E. Almajiri health; a scoping review on disease, health literacy and space for participatory research. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001641. [PMID: 37819921 PMCID: PMC10566680 DOI: 10.1371/journal.pgph.0001641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/12/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Almajirai are male children in Northern Nigeria and Southern Niger who study Islam in the almajiranci system. Almajiranci has been associated with non-participation in formal education, abuse, poverty, and underdevelopment. However, the peer-reviewed literature around health among almajirai remains limited. We conduct a scoping review around almajiri health to synthesize evidence for health problems, draw links between findings, identify research gaps, indicate areas for intervention, and assess participatory approaches in this literature. METHODS We searched the academic literature for articles concerning almajiri heath using a framework integrating the biopsychosocial and socio-ecological models of health. We included articles in English and French published between 2000 and 2022. For each study we collected information regarding authorship, study year and location(s), study design and aims, sample characteristics, findings, and almajiri participation in research design, execution, interpretation and dissemination. RESULTS Of 1,944 studies, 17 were found relevant for data extraction. These included 14 cross-sectional studies, 2 descriptive articles, and one case-control study. All were conducted in Nigeria, though one included Nigerien almajirai. No study engaged almajirai in participatory roles. Domains evaluated included infectious disease (10 studies), oral health (2 studies), workplace injury, nutrition, health status, health determinants, and mental health (1 study each). Almajirai included ranged from 3 to 28 years old. Included studies found high rates of malaria, intestinal parasitosis, urinary tract infection, N. meningitidis, and occupational injury among almajirai. Studies comparing almajirai to controls found significantly higher rates of cholera, urinary schistosomiasis, and psychiatric disorders, lower levels of rabies awareness and poorer oral hygiene among almajirai (p<0.05). One study, concerning nutrition, described an intervention to improve almajiri health, though did not provide health outcomes for that intervention. CONCLUSION We find that the literature around almajiri health has concerned a broad range of domains, though the number of studies within each domain remains limited. We further note limitations in the geographic scope of this literature, interventions to improve almajiri health, and the consideration of demographic features, like age, that may influence almajiri health. We stress the need for further study in these areas, and for participatory approaches, which may be more likely to effectively improve almajiri health.
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Affiliation(s)
| | | | | | - Amber Acquaye
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Autumn Nobles
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Brian Fleischer
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Chigoziri Konkwo
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Elijah Paintsil
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, New Haven, Connecticut, United States of America
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MacPherson M. Immigrant, Refugee, and Indigenous Canadians' Experiences With Virtual Health Care Services: Rapid Review. JMIR Hum Factors 2023; 10:e47288. [PMID: 37812489 PMCID: PMC10594134 DOI: 10.2196/47288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/28/2023] [Accepted: 08/04/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND The remote, dispersed, and multicultural population of Canada presents unique challenges for health care services. Currently, virtual care solutions are being offered as an innovative solution to improve access to care. OBJECTIVE Given the inequities in health care access faced by immigrant, refugee, and Indigenous Canadians, this review aimed to summarize information obtained from original research regarding these people's experiences with virtual care services in Canada. METHODS We conducted a rapid review following published recommendations. MEDLINE and CINAHL were searched for studies relating to virtual care and Canadian immigrants, refugees, or Indigenous peoples. Peer-reviewed articles of any type were included so long as they included information on the experiences of virtual care service delivery in Canada among the abovementioned groups. RESULTS This review demonstrates an extreme paucity of evidence examining the experiences of immigrant, refugee, and Indigenous groups with virtual care in Canada. Of the 694 publications screened, 8 were included in this review. A total of 2 studies focused on immigrants and refugees in Canada, with the remaining studies focusing on Indigenous communities. Results demonstrate that virtual care is generally accepted within these communities; however, cultural appropriateness or safety and inequitable access to wireless services in certain communities were among the most cited barriers. CONCLUSIONS Little evidence exists outlining immigrants', refugees', and Indigenous peoples' perspectives on the landscape of virtual care in Canada. The development of virtual care programming should take into consideration the barriers, facilitators, and recommendations outlined in this review to improve equitable access. Further, developers should consult with local community members to ensure the appropriateness of services for immigrant, refugee, and Indigenous communities in Canada.
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Bhargava S, Botteri E, Berthelsen M, Iqbal N, Randel KR, Holme Ø, Berstad P. Lower participation among immigrants in colorectal cancer screening in Norway. Front Public Health 2023; 11:1254905. [PMID: 37822535 PMCID: PMC10562536 DOI: 10.3389/fpubh.2023.1254905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
Introduction Organized cancer screening programs should be equally accessible for all groups in society. We assessed differences in participation in colorectal cancer (CRC) screening among different immigrant groups. Methods Between 2012 and 2019, 140,000 individuals aged 50 to 74 years were randomly invited to sigmoidoscopy or repeated faecal immunochemical test (FIT) in a CRC screening trial. In this study, we included 46,919 individuals invited to sigmoidoscopy and 70,018 invited to the first round of FIT between 2012 and 2017. We examined difference in participation between non-immigrants and immigrants, and within different immigrant groups by geographic area of origin, using logistic regression models, adjusted for several sociodemographic factors and health factors. Results In total, we included 106,695 non-immigrants and 10,242 immigrants. The participation rate for FIT was 60% among non-immigrants, 58% among immigrants from Western countries and 37% among immigrants from non-Western countries. The participation rate for sigmoidoscopy was 53% among non-immigrants, 48% among immigrants from Western countries and 23% among immigrants from non-Western countries. Compared to non-immigrants, multivariate adjusted odds ratio for non-participation in FIT screening was 1.13 (95% confidence interval 1.04-1.23) and 1.82 (1.69-1.96) for immigrants from Western and non-Western countries. The corresponding numbers in sigmoidoscopy screening were 1.34 (1.21-1.48) and 2.83 (2.55-3.14). The lowest participation was observed in immigrants from Eastern Europe, Northern Africa and Western Asia, and South-Central Asia. Conclusion Participation in CRC screening in Norway was particularly low among non-Western immigrants, which could put them at increased risk for late stage diagnosis of CRC. Participation was lower in sigmoidoscopy screening than in FIT screening, especially among immigrants from non-Western countries.
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Affiliation(s)
- Sameer Bhargava
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - Edoardo Botteri
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Mona Berthelsen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Nadia Iqbal
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | | | - Øyvind Holme
- Department of Research, Sorlandet Hospital, Kristiansand, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Paula Berstad
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
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Luig T, Ofosu NN, Chiu Y, Wang N, Omar N, Yip L, Aleba S, Maragang K, Ali M, Dormitorio I, Lee KK, Yeung RO, Campbell-Scherer D. Role of cultural brokering in advancing holistic primary care for diabetes and obesity: a participatory qualitative study. BMJ Open 2023; 13:e073318. [PMID: 37709303 PMCID: PMC10921915 DOI: 10.1136/bmjopen-2023-073318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Diabetes and obesity care for ethnocultural migrant communities is hampered by a lack of understanding of premigration and postmigration stressors and their impact on social and clinical determinants of health within unique cultural contexts. We sought to understand the role of cultural brokering in primary healthcare to enhance chronic disease care for ethnocultural migrant communities. DESIGN AND SETTING Participatory qualitative descriptive-interpretive study with the Multicultural Health Brokers Cooperative in a Canadian urban centre. Cultural brokers are linguistic and culturally diverse community health workers who bridge cultural distance, support relationships and understanding between providers and patients to improve care outcomes. From 2019 to 2021, we met 16 times to collaborate on research design, analysis and writing. PARTICIPANTS Purposive sampling of 10 cultural brokers representing eight different major local ethnocultural communities. Data include 10 in-depth interviews and two observation sessions analysed deductively and inductively to collaboratively construct themes. RESULTS Findings highlight six thematic domains illustrating how cultural brokering enhances holistic primary healthcare. Through family-based relational supports and a trauma-informed care, brokering supports provider-patient interactions. This is achieved through brokers' (1) embeddedness in community relationships with deep knowledge of culture and life realities of ethnocultural immigrant populations; (2) holistic, contextual knowledge; (3) navigation and support of access to care; (4) cultural interpretation to support health assessment and communication; (5) addressing psychosocial needs and social determinants of health and (6) dedication to follow-up and at-home management practices. CONCLUSIONS Cultural brokers can be key partners in the primary care team to support people living with diabetes and/or obesity from ethnocultural immigrant and refugee communities. They enhance and support provider-patient relationships and communication and respond to the complex psychosocial and economic barriers to improve health. Consideration of how to better enable and expand cultural brokering to support chronic disease management in primary care is warranted.
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Affiliation(s)
- Thea Luig
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Nicole N Ofosu
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Yvonne Chiu
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Nancy Wang
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Nasreen Omar
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Lydia Yip
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Sarah Aleba
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Kiki Maragang
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Mulki Ali
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Irene Dormitorio
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Karen K Lee
- Division of Preventive Medicine, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Roseanne O Yeung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Denise Campbell-Scherer
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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Lin S(L. Inequities in Mental Health Care Facing Racialized Immigrant Older Adults With Mental Disorders Despite Universal Coverage: A Population-Based Study in Canada. J Gerontol B Psychol Sci Soc Sci 2023; 78:1555-1571. [PMID: 36842070 PMCID: PMC10461535 DOI: 10.1093/geronb/gbad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Indexed: 02/27/2023] Open
Abstract
OBJECTIVES Contemporary immigration scholarship has typically treated immigrants with diverse racial backgrounds as a monolithic population. Knowledge gaps remain in understanding how racial and nativity inequities in mental health care intersect and unfold in midlife and old age. This study aims to examine the joint impact of race, migration, and old age in shaping mental health treatment. METHODS Pooled data were obtained from the Canadian Community Health Survey (2015-2018) and restricted to respondents (aged ≥45 years) with mood or anxiety disorders (n = 9,099). Multivariable logistic regression was performed to estimate associations between race-migration nexus and past-year mental health consultations (MHC). Classification and regression tree (CART) analysis was applied to identify intersecting determinants of MHC. RESULTS Compared to Canadian-born Whites, racialized immigrants had greater mental health needs: poor/fair self-rated mental health (odds ratio [OR] = 2.23, 99% confidence interval [CI]: 1.67-2.99), perceived life stressful (OR = 1.49, 99% CI: 1.14-1.95), psychiatric comorbidity (OR = 1.42, 99% CI: 1.06-1.89), and unmet needs for care (OR = 2.02, 99% CI: 1.36-3.02); in sharp contrast, they were less likely to access mental health services across most indicators: overall past-year MHC (OR = 0.54, 99% CI: 0.41-0.71) and consultations with family doctors (OR = 0.67, 99% CI: 0.50-0.89), psychologists (OR = 0.54, 99% CI: 0.33-0.87), and social workers (OR = 0.37, 99% CI: 0.21-0.65), with the exception of psychiatrist visits (p = .324). The CART algorithm identifies three groups at risk of MHC service underuse: racialized immigrants aged ≥55 years, immigrants without high school diplomas, and linguistic minorities who were home renters. DISCUSSION To safeguard health care equity for medically underserved communities in Canada, multisectoral efforts need to guarantee culturally responsive mental health care, multilingual services, and affordable housing for racialized immigrant older adults with mental disorders.
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Affiliation(s)
- Shen (Lamson) Lin
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong Special Administrative Region, China
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Shamputa IC, Law MA, Kelly C, Nguyen DTK, Burdo T, Umar J, Barker K, Webster D. Tuberculosis related barriers and facilitators among immigrants in Atlantic Canada: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001997. [PMID: 37276222 DOI: 10.1371/journal.pgph.0001997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/09/2023] [Indexed: 06/07/2023]
Abstract
Tuberculosis (TB) is a disease caused by the bacterium Mycobacterium tuberculosis and affects approximately one-quarter of the world's population. Immigrant populations in Canada are disproportionately affected by TB. Canada's immigration medical examinations include screening for active TB but not latent TB infection (LTBI). In LTBI, the bacterium remains dormant within the host but can reactivate and cause disease. Once active, TB can be transmitted to close contacts sharing confined spaces leading to the possibility of outbreaks in the broader community. This study aimed to 1) assess the current TB knowledge, perceived risk, and risk behaviors of immigrants in Atlantic Canada as well as 2) identify barriers and facilitators to testing and treatment of TB among this population. Three focus group discussions were conducted with a total of 14 non-Canadian born residents of New Brunswick aged 19 years and older. Data were analyzed using inductive thematic analysis. Four themes were identified from the data relating to barriers to testing and treatment of LTBI: 1) Need for education, 2) stigma, 3) fear of testing, treatment, and healthcare system, and 4) complacency. Results included reasons individuals would not receive TB testing, treatment, or seek help, as well as facilitators to testing and treatment. These findings may inform the implemention of an LTBI screening program in Atlantic Canada and more broadly across the country.
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Affiliation(s)
- Isdore Chola Shamputa
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Moira A Law
- Department of Psychology, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Clara Kelly
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Duyen Thi Kim Nguyen
- Government of New Brunswick, Department of Health, Saint John, New Brunswick, Canada
- Faculty of Business, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Tatum Burdo
- Dalhousie University New Brunswick, MD Program, Saint John, New Brunswick, Canada
| | - Jabran Umar
- Dalhousie University New Brunswick, MD Program, Saint John, New Brunswick, Canada
| | - Kimberley Barker
- Government of New Brunswick, Department of Health, Saint John, New Brunswick, Canada
| | - Duncan Webster
- Division of Microbiology, Department of Laboratory Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Dalhousie Medicine New Brunswick, Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- Division of Infectious Diseases, Department of Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
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Koshy L, Burns K, Godinho Nascimento MH, Ike NAU, Herati H, Filice E, Rotolo B, Betini GS, Ward PR, Dubé È, Meyer SB. Newcomer perceptions of COVID-19 countermeasures in Canada. Health Promot Int 2023; 38:daad051. [PMID: 37326406 PMCID: PMC10273828 DOI: 10.1093/heapro/daad051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Newcomers to Canada have been disproportionally affected by COVID-19, with higher rates of infection and severity of illness. Determinants of higher rates may relate to social and structural inequities that impact newcomers' capacity to follow countermeasures. Our aim was to describe and document factors shaping newcomers' acceptance of COVID-19 countermeasures. Semi-structured qualitative interviews were conducted with individuals living in Canada for <5 years. Participants were asked to discuss their pandemic experiences, and perceptions and acceptance of measures. Five themes were identified: (i) belief in the necessity and efficacy of countermeasures; (ii) negative impact of measures on health/wellbeing; (iii) existing barriers to newcomer settlement exacerbated by pandemic measures; (iv) countermeasure adherence related to immigration status and (v) past experiences shaping countermeasure acceptance. Government should continue to provide messaging regarding the importance of measures for individual and population heath and continue to demonstrate a commitment to the interests of citizens. Importantly, newcomer trust in government should not be taken for granted, as this trust is critical for the acceptance of government interventions now and moving forward. It will be important to ensure that newcomers are given support to overcome challenges to settlement that were intensified during the pandemic.
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Tsai PL, Ghahari S. Immigrants' Experience of Health Care Access in Canada: A Recent Scoping Review. J Immigr Minor Health 2023; 25:712-727. [PMID: 36870008 DOI: 10.1007/s10903-023-01461-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/05/2023]
Abstract
Existing literature has reported inequities in access to Canadian health care services among immigrants. The aim of this scoping review was (a) to explore research regarding Canadian immigrants' unique experiences in accessing healthcare, and (b) to provide suggestions for future research and programming considering the identified immigrant-specific service gaps in health care. We searched MEDLINE, CINAHL, EMBASE, and Google Scholar, following the Arksey and O'Malley (2005) framework. The review's findings suggest unmet health care access needs specific to immigrants in Canada, with the most common access barriers including communication, socioeconomic, and cultural barriers. The scoping review expands on the immigrant health care experiences and accessibility factors through a thematic analysis. Findings suggest that developing community-based programming, improving training for health care providers in culturally competent care, and policies that address the social determinants of health can improve health care accessibility among immigrants.
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Affiliation(s)
- Pei-Ling Tsai
- Faculty of Arts and Sciences, Queen's University, 94 University Ave, Kingston, ON, Canada
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, 31 George St, Kingston, ON, K7L 3N6, Canada.
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Kehoe MacLeod K, Flores KN, Chandra K. Identifying facilitators and barriers to integrated and equitable care for community-dwelling older adults with high emergency department use from historically marginalized groups. Int J Equity Health 2023; 22:97. [PMID: 37208757 PMCID: PMC10198019 DOI: 10.1186/s12939-023-01900-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/27/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND High rates of emergency department (ED) use by older adults persist despite attempts to improve accessibility of appropriate and comprehensive care. Understanding the drivers of ED visits from the perspective of older adults from historically marginalized groups could help reduce ED use by patients with needs that are preventable or could have been treated in a more appropriate setting. This interpretivist, feminist study aims to explore the unmet care needs of older adults (age 65 +) with high ED use and belonging to historically marginalized groups to better understand how social and structural inequities reinforced by neoliberalism; federal and provincial governance structures and policy frameworks; and regional processes and local institutional practices, shape the experiences of these older adults, particularly those at risk of poor health outcomes based on the social determinants of health (SDH). METHODS/DESIGN This mixed methods study will employ an integrated knowledge translation (iKT) approach, starting with a quantitative phase followed by a qualitative phase. Older adults self-identifying as belonging to a historically marginalized group, having visited an ED three or more times in the past 12 months, and living in a private dwelling, will be recruited using flyers posted at two emergency care sites and by an on-site research assistant. Data obtained through surveys, short answer questions, and chart review will be used to compile case profiles of patients from historically marginalized groups with potentially avoidable ED visits. Descriptive and inferential statistical analyses and inductive thematic analysis will be conducted. Findings will be interpreted using the Intersectionality-Based Policy Analysis Framework to identify the interconnections between unmet care needs, potentially avoidable ED admissions, structural inequalities, and the SDH. Semi-structured interviews will be conducted with a subset of older adults at risk of poor health outcomes based on SDH, family care partners, and health care professionals to validate preliminary findings and collect additional data on perceived facilitators and barriers to integrated and accessible care. DISCUSSION Exploring the linkages between potentially avoidable ED visits by older adults from marginalized groups and how their care experiences have been shaped by inequities in the systems, policies, and institutions that structure health and social care provision will enable researchers to offer recommendations for equity-focused policy and clinical practice reforms to improve patient outcomes and system integration.
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Affiliation(s)
- Krystal Kehoe MacLeod
- Bruyère Research Institute, Ottawa, Ontario, Canada.
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
- Horizon Health Network, Saint John, New Brunswick, Canada.
| | - Karyle Nama Flores
- Horizon Health Network, Saint John, New Brunswick, Canada
- Faculty of Health Sciences and Nursing, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Kavish Chandra
- Horizon Health Network, Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
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