Sense of community belonging among immigrants: perspective of immigrant service providers

Barriers to primary care among immigrants and refugees in Peterborough, Ontario: a qualitative study of provider perspectives

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.

Activism and immigrant women's mental health and wellbeing: Building Canadian service provider capacity in the settlement and mental health sectors

In this qualitative community-based research, we explore service providers' use of activism-based resources and the supports they need to use activism as a tool to promote the mental health and wellbeing of racialized immigrant women. 19 service providers working in settlement and mental health services in the Greater Toronto Area, Canada, participated in one of three focus groups. We analyzed the data using a postcolonial feminist lens. Service providers' understandings of activism, strategies for promoting client mental health and wellbeing, and organizational barriers shaping their practice emerged as relevant. We offer recommendations for building activism-based resources, programs and services that include collaborations with racialized immigrant women communities and action at the organizational level to support service provider practice.

Unpacking the Association Between Length of Residence and Health Among Immigrants in Canada: A Moderated Mediation Approach

The present study examines (1) whether perceived life stress mediates the associations between length of residence in Canada and self-rated mental health and general health and (2) how these processes differ across levels of perceived local community belonging. Data are from the 2017-2018 Canadian Community Health Survey (N = 14,570)-a nationally representative survey collected by Statistics Canada. Simple mediation and moderated mediation models are employed. The simple mediated associations are evaluated first and found to be statistically significant for both self-rated mental health (b = 0.046, 95% PBCI = 0.035, 0.058) and general health (b = 0.045, 95% PBCI = 0.034, 0.056). Moderated mediation analysis then reveals that while perceived local community belonging does not moderate the effects of length of residence on perceived life stress, it does moderate the effects of perceived life stress on self-rated mental health (b = - 0.042, 95% PBCI = - 0.057, - 0.028) and general health (b = - 0.026, 95% PBCI = - 0.042, - 0.011), suggesting that the adverse associations between perceived life stress and self-rated mental health and general health are weaker among immigrants with greater perceived local community belonging. Consistent with the predictions, the indirect effects are significant at all levels of local community belonging. Findings from this study highlight the need to focus more research and policy interventions on community-based coping resources.

Improving the sense of city belonging among migrant elderly following family from an elderly service perspective: a cross-sectional study

Background

The migrant elderly following family (MEFF), who migrates to new community to reunite with families, may face challenges of city integration and belonging. This study aims to explore from an elderly service perspective how to improve the sense of city belonging for MEFFs with and without hypertension/diabetes conditions.

Methods

Data were derived from the 2017 China Migrants Dynamic Survey and China National Statistical Yearbooks in 2017. The study included 882 MEFFs with hypertension or diabetes and 1266 MEFFs without hypertension and diabetes. Hierarchical linear modeling was applied to analyze the effects of individual and provincial elderly services on sense of city belonging among the MEFF with and without hypertension/diabetes.

Results

The MEFFs with hypertension or diabetes exhibited a greater sense of city belonging when they were familiar with a wider range of health education topics (γ = 0.05, p = 0.033) and were in those provinces with a greater number of licensed doctors (γ = 0.39, p < 0.001) and hospitals (p = 0.042). For those MEFFs without hypertension or diabetes, social security cards (γ = 0.57, p < 0.001) and awareness of a wider range of health education topics (γ = 0.07, p = 0.018) may help to improve their sense of city belonging.

Conclusion

This study calls for strengthening the accessibility in inclusive elderly services, and minimizing or even eliminating the inequality in elderly services at the individual and provincial levels to increase sense of city belonging among the MEFFs. For the MEFFs with hypertension or diabetes, health managers should focus on improving health information dissemination and increasing the number of doctors per 1000 people as well as and the number of hospitals to enhance the sense of city belonging. Moreover, the government should strengthen social security and health education to facilitate the adaptation and integration of MEFFs without hypertension and diabetes into the host city.

The welfare of immigrants: Resilience and sense of community

The accessibility to national health services by immigrants residing in our country has produced a widespread improvement of health indicators and health prevention for the entire population. The main goal of this study is to investigate the welfare conditions of immigrants, alongside two fundamental sources of psychological resources. In particular, the role of resilience and sense of community as protective factors against the risk of developing negative welfare outcomes, including life satisfaction and the perception of general health (physical and mental), were considered as indicators. The following self-report questionnaires were sent to a sample of 354 immigrants, stratified by ethnicity and gender: Life Satisfaction Scale (SWLS), General Health Questionnaire, CD-RISC 10 Scale, and the Sense of Community Index SCI-2. The results obtained through regression models show how resilience and a sense of community are significant protective factors in terms of life satisfaction and general health. From an applicative point of view, it is highlighted that public and political bodies take a leading role in the design of public health interventions; in fact, their intervention should be aimed at increasing the psychological resources and ability to fulfill the health needs of specific populations.

Toward Unity and Inclusion in the Clinical Workplace: An Evaluation of Healthcare Workforce Belonging During the COVID-19 Pandemic

Introduction: In a challenging time for the healthcare workforce responding to the coronavirus disease 2019 (COVID-19) pandemic, it is critical to identify factors contributing to team members' feelings of “belonging” in the workplace. The Institute for Healthcare Improvement’s Quintuple Aim’s principle of improving healthcare worker well-being could be applied to explore the implications of the increased turnover and stress, which connect to components of belonging. This study applies a qualitative approach to the organizational issues impacting healthcare teams, particularly during a complex and uncertain time.

Methods: To elucidate factors contributing to belonging, we conducted a series of semi-structured interviews with an interdisciplinary cross-sectional sample of healthcare workers. Interviews were conducted with 23 total staff members in two clinical settings, the emergency department and hospital medicine groups at a large urban teaching hospital, to evaluate team members’ perspectives of the work environment.

Results: Participants discuss their degree of inclusion, excitement, challenges, and respective needs from the organization. Perspectives of workers representing varied professional roles of the healthcare team were gathered to provide robust and unique insights into initiatives that can enhance belonging in the clinical workplace.

Conclusion: Our findings provide a preliminary framework to identify strategies that can potentially reinforce collective team member belonging and consequently improve staff well-being, morale, and retention.

Leisure Satisfaction Changes and Stress-coping during the Pandemic

Objectives: Leisure engagement has been considered as a salient stress-coping strategy. However, during the COVID-19 pandemic, people's leisure engagement has been restricted due to COVID-19- related regulations and policies. Moreover, many Asian immigrants, including Korean immigrants in the US, have been exposed to additional challenges (e.g., discrimination and harassment), which negatively affected their leisure experiences. Methods: in this study, we categorized participants into 3 groups based on their leisure satisfaction changes before and during the pandemic and compared the groups regarding COVID-19 risk perception, stress-coping, and life satisfaction. Results: The Maintained or Increased Group (MIG) scored significantly lower stress than the Highly Decreased group (HDG); the MIG scored significantly higher life satisfaction than both the Slightly Decreased Group (SDG) and the HDG. Conclusion: The research demonstrated the importance of satisfactory leisure experience to cope with stress and be satisfied with their life in a stressful life event.

Investigating the influencing factors of incentive-based household waste recycling using structural equation modelling

Household waste recycling management is one of the primary challenges of urban development. Incentive-based recycling systems have been used worldwide to increase the willingness of residents to take part in waste recycling. However, the factors that influence the amount of recyclables collected under the current incentive-based recycling systems have not been investigated thoroughly. In this study, the relationships between influencing factors and recycling behaviour were analysed using partial least squares structural equation modelling under a proposed analysis framework. A real-world case study in Shanghai of China was employed to demonstrate the framework's effectiveness. Six major observations were uncovered based on the studied communities: (1) The amount of recyclables collected increased by 190.9% during the pilot period of the new incentive-based recycling policy. (2) The recycling promotion effect of the new policy reached a peak after approximately three months during the pilot period. (3) Recycling motivation and publicity efforts improved recycling behaviour significantly, but the sense of community belonging and exogenous factors like rainy days and holidays did not necessarily have direct impacts on recycling behaviour. (4) Recycling motivation significantly mediated the relationship between the sense of community belonging and waste recycling behaviour. (5) Although publicity efforts in the studied communities did not necessarily enhance recycling motivation, publicity efforts promoted recycling behaviour significantly in the incentive-based recycling system in Shanghai. (6) Although the studied recycling company has made substantial efforts to formulate attractive recycling prices, its current pricing mechanism still has much room for improvement. This analysis framework and our observations offer insights for government authorities to move towards an enhanced incentive-based recycling system.

Health of African Refugee Children Outside Africa: A Scoping Review

PROBLEM

Africa is the largest source continent of refugee children. However, we found no published synthesis of the literature on the health of African refugee children outside Africa. Conducting a review of the literature on this particular population will help illuminate the particular contextual health issues faced by African child refugees who live outside Africa. The purpose of this review is to synthesize what is known from the existing literature regarding the health of sub-Saharan African refugee children who live outside Africa.

METHODS

We completed a scoping review of the published literature. We included articles published in English with a focus on the health of sub-Saharan African refugee children living outside Africa. We excluded studies of refugees in Africa as the living conditions of these refugees, most of whom reside in camps, are very different from those outside Africa. Using relevant keywords, we searched 10 databases to identify and screen 6602 articles after duplicates were eliminated.

SAMPLE

A total of 20 studies were included in this review.

FINDINGS

Published research articles on sub-Saharan African child refugees living outside Africa focus on infectious diseases, mental health and neurodevelopmental disorders, food insecurity and psychosocial adjustment, physical health (including obesity), and health promotion strategies. This population is characterized by a high rate of infectious diseases (e.g., malaria), obesity, and mental health problems, especially post-traumatic stress disorder (PTSD).

CONCLUSIONS AND IMPLICATIONS

To attend to the health needs of sub-Saharan African refugee children who live outside Africa, interventions should address pre-migration factors as well as post-migration factors (including income and community belonging) while employing a strengths-based perspective.

Cultivating social occupations, spaces, and networks: service providers’ perspectives on enabling immigrants’ social participation

Abstract Introduction Immigrants may experience many barriers to social participation within host societies. Immigrants’ integration into Canadian society is supported through government-funded services. Objective In the present study, we explored the perspectives of service providers working in community organizations regarding their role in enabling immigrants’ social participation through occupations in British Columbia, Canada. Method Representatives from twenty different organizations providing services to the community participated in a constructivist qualitative study aiming to uncover aspects shaping opportunities for occupational participation provided for immigrants. Results Drawing on semi-structured interviews and using thematic analysis, we identified three main themes relating to cultivating social occupations, spaces, and networks. Findings illustrate that service providers’ cultivation of these opportunities can support immigrants’ desired social roles and social identities, further enabling their participation in receiving societies. Conclusion Emphasis upon supporting socio-economic integration into society appears to limit a client-centred approach to developing opportunities for social participation through occupation. Implications for occupational therapists and scientists are discussed.