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Scott D, Bird E. Local Dynamics of Intersectional Stigma for Black LGBTQ People in Montreal, Quebec. JOURNAL OF HOMOSEXUALITY 2024:1-19. [PMID: 39158504 DOI: 10.1080/00918369.2024.2392681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Much academic literature on intersectional stigma is limited by a focus on relatively static and "universal" identity traits, such as ethnicity, gender, and sexuality. This paper addresses local dynamics of intersectional stigma for Black LGBTQ people in Montreal, QC, Canada. Findings draw from fourteen semi-structured, virtual interviews with key informants providing critical services to Black LGBTQ people living in Montreal. Findings suggest intersectional stigmatization via social identity and local power dynamics converge. Specifically, language and immigration are two domains determining intersectional stigma challenges and ameliorative opportunities for Black LGBTQ people in the city. Specific immigration-related challenges included (1) insecurity (e.g. concerning Canadian residency), (2) barriers to resource access (e.g. social and legal services), and (3) stressful identity challenges. Specific language issues included (1) Francophone limitations for expressing gender and sexual diversity and (2) exclusionary linguistic divisions (i.e. Franco/Anglo, Franco/non-Franco, and Western/non-Western). Local, place-based power inequities may determine black LGBTQ experiences of intersectional stigma.
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Affiliation(s)
- Darius Scott
- Department of Geography, McGill University, Montreal, Canada
| | - E Bird
- Department of Geography, McGill University, Montreal, Canada
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Wu J, Yang Y, Sun T, He S. Inequalities in unmet health care needs under universal health insurance coverage in China. HEALTH ECONOMICS REVIEW 2024; 14:2. [PMID: 38165496 PMCID: PMC10759442 DOI: 10.1186/s13561-023-00473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Expanding health insurance is a critical step towards universal health coverage due to its positive effect on reducing unmet health care needs and enhancing equitable access to health care. Despite previous studies on the socioeconomic factors associated with unmet health care needs, few studies have analysed the inequalities in such needs and the impact of universal health insurance coverage on addressing them. This study aimed to measure the contribution of social health insurance (SHI) coverage to inequalities in financially and non-financially constrained unmet health care needs among middle-aged and elderly Chinese adults. METHODS The study data were obtained from the China Health and Retirement Longitudinal Study (2011-2015). A total of 11,592 respondents reporting outpatient care needs and 6320 reporting inpatient care needs were included. The concentration index (CI) was employed to measure the extent of income-related inequalities in unmet health care needs. A decomposition method based on a probit model was used to investigate the contribution of SHI to the inequalities. RESULTS The incidence rates of unmet outpatient needs due to financial and non-financial constraints were 4.68% and 24.78%, respectively; these rates were 18.69% and 15.73% for unmet inpatient needs. The CIs of unmet outpatient needs due to financial and non-financial constraints were - 0.1872 and 0.0195, respectively; these values were - 0.1558 and 0.0352 for unmet inpatient needs. The percentages of the contribution of SHI to the CIs of financially constrained unmet outpatient and inpatient needs were 0.2639% and 1.8898%, respectively. Moreover, the percentages of the contribution of SHI to the CIs of non-financially constrained unmet outpatient and inpatient needs were - 0.4513% and - 6.4192%, respectively. CONCLUSION The universal coverage of SHI in China increased pro-poor inequalities in financially constrained unmet health care needs but decreased pro-rich inequalities in non-financially constrained unmet needs. Additionally, the contribution of SHI to inequalities in financially constrained unmet needs for inpatient care was stronger than that for outpatient care. Policy-makers are advised to introduce favourable reimbursement policies for patients with poor socioeconomic conditions and address both financial and non-financial barriers to promote equitable access to health care for the entire population.
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Affiliation(s)
- Jingxian Wu
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.
| | - Yongmei Yang
- School of Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Ting Sun
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | - Sucen He
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
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Akokuwebe ME, Osuafor GN, Likoko S, Idemudia ES. Health services satisfaction and medical exclusion among migrant youths in Gauteng Province of South Africa: A cross-sectional analysis of the GCRO survey (2017-2018). PLoS One 2023; 18:e0293958. [PMID: 38019834 PMCID: PMC10686501 DOI: 10.1371/journal.pone.0293958] [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: 12/08/2022] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Medical xenophobia of migrant (either in-migrants or immigrants) youths is an ongoing problem in contemporary South African society. Medical mistreatment by healthcare workers and social phobia from migrant youths have been attributed to major obstacles to healthcare utilization as well as health services satisfaction. This study aimed to determine the prevalence and factors contributing to health services satisfaction and medical exclusion among migrant youths in Gauteng province in South Africa. METHODS The Round 5 Gauteng City-Region Observatory (GCRO) Quality of Life (QoL) survey was conducted in 2017‒2018, a nationally representative survey piloted every two years in South Africa, was utilized in this study. A 2-year cohort study of 24,889 respondents aged 18 to 29 and a baseline data consisted of 4,872 respondents, comprising non-migrants, in-migrants and immigrants, from where 2,162 in-migrants and immigrants were utilized as the sample size. The data was analysed using descriptive statistics, Chi-Square analysis and logistic regression. RESULTS A total of 2,162 migrants, comprising 35.4% in-migrants and 9.0% of immigrants, from the 4,872 respondents, were included in the analysis. The prevalence of medical exclusion of in-migrant and immigrant youths were 5.5% and 4.2%, and the majority of them reported the use of public health facilities (in-migrants ‒ 84.3% vs. immigrants ‒ 87.1%). At the bivariate level, demographic (age, sex, and population group), economic (employed and any income) and health-related (no medical aid and household member with mental health) factors were significantly associated with medical exclusion (ρ≤0.05). The adjusted odds ratio showed that only female gender (AOR: 1.07, 95% CI: 0.678, 1.705), no medical aid cover (AOR: 1.23, 95% CI: 0.450, 3.362), and neither (AOR: 1.59, 95% CI: 0.606, 4.174) or dissatisfied (AOR: 4.29, 95% CI: 2.528, 7.270) were independent predictors of medical exclusion. CONCLUSION Having no medical aid cover, being a female and dissatisfied, or neither satisfied nor dissatisfied with health services significantly increased the odds of medical exclusion among migrant youths. To increase healthcare utilization and ensuring adequate medical care of migrant youths, opting for medical aid insurance without increasing costs should be guaranteed. Therefore, there should be no consequences for lack of residence status or correct documentation papers when accessing healthcare services among migrant youths in South Africa.
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Affiliation(s)
| | - Godswill Nwabuisi Osuafor
- Population Studies and Demography, Faculty of Humanities, North-West University, Mafikeng, South Africa
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Gautier L, Di Ruggiero E, Jackson C, Bentayeb N, Blain MJ, Chowdhury F, Gueye STM, Haydary M, Maillet L, Mahmoudi L, Mondal S, Ouffouet Bessiranthy A, Pluye P, Ziam S, Touati N. Learning from intersectoral initiatives to respond to the needs of refugees, asylum seekers, and migrants without status in the context of COVID-19 in Quebec and Ontario: a qualitative multiple case study protocol. Health Res Policy Syst 2023; 21:59. [PMID: 37340475 DOI: 10.1186/s12961-023-00991-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/08/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Refugees, asylum seekers, and migrants without status experience precarious living and working conditions that disproportionately expose them to coronavirus disease 2019 (COVID-19). In the two most populous Canadian provinces (Quebec and Ontario), to reduce the vulnerability factors experienced by the most marginalized migrants, the public and community sectors engage in joint coordination efforts called intersectoral collaboration. This collaboration ensures holistic care provisioning, inclusive of psychosocial support, assistance to address food security, and educational and employment assistance. This research project explores how community and public sectors collaborated on intersectoral initiatives during the COVID-19 pandemic to support refugees, asylum seekers, and migrants without status in the cities of Montreal, Sherbrooke, and Toronto, and generates lessons for a sustainable response to the heterogeneous needs of these migrants. METHODS This theory-informed participatory research is co-created with socioculturally diverse research partners (refugees, asylum seekers and migrants without status, employees of community organizations, and employees of public organizations). We will utilize Mirzoev and Kane's framework on health systems' responsiveness to guide the four phases of a qualitative multiple case study (a case being an intersectoral initiative). These phases will include (1) building an inventory of intersectoral initiatives developed during the pandemic, (2) organizing a deliberative workshop with representatives of the study population, community, and public sector respondents to select and validate the intersectoral initiatives, (3) interviews (n = 80) with community and public sector frontline workers and managers, municipal/regional/provincial policymakers, and employees of philanthropic foundations, and (4) focus groups (n = 80) with refugees, asylum seekers, and migrants without status. Qualitative data will be analyzed using thematic analysis. The findings will be used to develop discussion forums to spur cross-learning among service providers. DISCUSSION This research will highlight the experiences of community and public organizations in their ability to offer responsive services for refugees, asylum seekers, and migrants without status in the context of a pandemic. We will draw lessons learnt from the promising practices developed in the context of COVID-19, to improve services beyond times of crisis. Lastly, we will reflect upon our participatory approach-particularly in relation to the engagement of refugees and asylum seekers in the governance of our research.
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Affiliation(s)
- Lara Gautier
- School of Public Health, University of Montreal, Suite 3076, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada.
- Centre de recherche en Santé Publique (CReSP), University of Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada.
- SHERPA University Institute, CIUSSS West Central Montreal, Montreal, Canada.
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carly Jackson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Naïma Bentayeb
- SHERPA University Institute, CIUSSS West Central Montreal, Montreal, Canada
- École Nationale d'Administration Publique, Montreal, Canada
- McGill University, Montreal, Canada
| | - Marie-Jeanne Blain
- Centre de recherche et de partage des savoirs InterActions, Université de Montréal, Montreal, Canada
| | - Fariha Chowdhury
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | | | | | - Lara Maillet
- École Nationale d'Administration Publique, Montreal, Canada
| | - Laila Mahmoudi
- School of Public Health, University of Montreal, Suite 3076, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada
| | - Shinjini Mondal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Armel Ouffouet Bessiranthy
- School of Public Health, University of Montreal, Suite 3076, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada
| | | | - Saliha Ziam
- École des Sciences de l'administration, Université TÉLUQ, Montreal, Canada
| | - Nassera Touati
- École Nationale d'Administration Publique, Montreal, Canada
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Sanchez MC, Nyarko D, Mulji J, Džunić A, Surti M, Mangat A, Mainali D, Spitzer DL. Health Care for All: Undocumented Migrants and the COVID-19 Pandemic in Alberta, Canada-A Scoping Review. J Migr Health 2023; 7:100192. [PMID: 37317684 PMCID: PMC10249367 DOI: 10.1016/j.jmh.2023.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
- Marian C Sanchez
- School of Public Health, University of Alberta, ECHA 3-300, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada
| | | | - Jenna Mulji
- School of Public Health, University of Alberta
| | - Anja Džunić
- School of Public Health, University of Alberta
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Beaujoin C, Gautier L, Gagnon-Dufresne MC, Mikanagu R, Savard-Lamothe A, Cloos P, Ridde V, Zinszer K. "It felt like building a plane while in flight": the consideration of social inequalities in the design and planning of a contact-tracing intervention for COVID-19 in Montreal, Quebec. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:346-357. [PMID: 36940083 PMCID: PMC10026798 DOI: 10.17269/s41997-023-00759-4] [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: 02/28/2022] [Accepted: 02/23/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE In Canada and globally, the COVID-19 pandemic has increased social inequalities in health (SIH), furthering the vulnerability of certain groups and communities. Contact-tracing is a cornerstone intervention with COVID-19 prevention and control programs. The aim of this study was to describe whether and how SIH were considered during the design of the COVID-19 contact-tracing intervention in Montreal. METHODS This study is part of the multi-country research program HoSPiCOVID, looking at the resilience of public health systems during the COVID-19 pandemic. A descriptive qualitative study was carried out in Montreal, based on a "bricolage" conceptual framework describing the consideration for SIH in intervention and policy design. Qualitative data were collected using semi-structured interviews with 16 public health practitioners, recruited using both purposive and snowball sampling. Data were analyzed thematically, both inductively and deductively. RESULTS According to participants, SIH were not initially considered during the design of the contract-tracing intervention in Montreal. The participants were frustrated by the Minister of Health's initial resistance to integrating SIH into their public health response. However, adaptations were gradually made to better meet the needs of underserved populations. CONCLUSION There is a need for a clear and common vision of SIH within the public health system. Decision-makers need to consider SIH prior to designing public health interventions in order for these not to further increase SIH in the future, especially in the face of a health crisis.
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Affiliation(s)
- Camille Beaujoin
- School of Public Health, University of Montréal, Montréal, QC, Canada.
| | - Lara Gautier
- School of Public Health, University of Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), University of Montréal, Montréal, QC, Canada
| | - Marie-Catherine Gagnon-Dufresne
- School of Public Health, University of Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), University of Montréal, Montréal, QC, Canada
| | - Rachel Mikanagu
- School of Public Health, University of Montréal, Montréal, QC, Canada
| | | | - Patrick Cloos
- School of Public Health, University of Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), University of Montréal, Montréal, QC, Canada
- School of Social Work, University of Montréal, Montréal, QC, Canada
| | - Valéry Ridde
- Centre Population et Développement (CEPED), Institut de Recherche pour le Développement (IRD), Université de Paris, Paris, France
| | - Kate Zinszer
- School of Public Health, University of Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), University of Montréal, Montréal, QC, Canada
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Niraula A, Ratti N, Colley M, Rosenberg M, Ghassemi E, Wilson K. Negotiating precarity: Recent immigrants' perceptions of waiting for public healthcare in Ontario, Canada. Health Policy 2023; 133:104843. [PMID: 37262964 DOI: 10.1016/j.healthpol.2023.104843] [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: 03/24/2022] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
Canada is widely known for its universal publicly funded health care system. While its health care system is an important part of Canadian identity, recent immigrants living in some provinces and territories are not covered by the publicly funded healthcare system until they have met a minimum residency requirement. This article seeks to understand the multiple manifestations of financial and emotional precarity that recent immigrants face as they navigate a lack of access to health care during their first three months of arrival in Ontario. This paper draws on qualitative semi-structured interview data from 46 recent immigrants who came from 12 different countries and had been living in Ontario, Canada. We found that the wait period to obtain health care often added to the prohibitive costs associated with immigration and settlement. During the wait period, recent immigrants faced financial burdens and their inability to access publicly funded hospitals and medical services when needed which resulted in feelings of vulnerability, anxiety, and emotional hardship. Given the financial and emotional precarities faced by recent immigrants during the wait period, we argue that the Canadian 'universal' healthcare system excludes and creates barriers to timely and equitable access to healthcare services for recent immigrants. We recommend to permanently eliminate the wait period policy to ensure the health and wellbeing of recent immigrants.
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Affiliation(s)
- Ashika Niraula
- Canada Excellence Research Chair in Migration & Integration Program, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
| | - Nicole Ratti
- York Region Transit, The Regional Municipality of York, 50 High Tech Rd, 4(th) Floor, Richmond Hill, ON L4B 4N7, Canada
| | - Michele Colley
- Dept. of Geography, Geomatics & Environment, University of Toronto, 3359 Mississauga Road, Mississauga, ON, L5L 1C6, Canada
| | - Mark Rosenberg
- Dept. of Geography and Planning, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Effat Ghassemi
- Newcomer Centre of Peel, 165 Dundas Street West, Suite 116, Mississauga, ON, L5B 2N6, Canada
| | - Kathi Wilson
- Dept. of Geography, Geomatics & Environment, University of Toronto, 3359 Mississauga Road, Mississauga, ON, L5L 1C6, Canada
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İkiışık H, Surmeli A, Sever F, Maral I. Perceived Risk of COVID-19 and Anxiety in Syrian Refugees in Turkey. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:259-267. [PMID: 36242533 DOI: 10.1080/19371918.2022.2134251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Pandemics are amongst the most destructive disasters to have afflicted humankind through history. These disasters entail a disproportionate effect on refugee populations, who are already in a state of high vulnerability. This study aims to assess the perception of risk of COVID-19 in the refugee populations in Turkey, in addition to evaluating anxiety levels during the pandemic. The participants of this study were refugees enrolled in a local nonprofit organization in Istanbul. They were asked to complete questionnaires which asked about COVID-19 and any self-protection measures. The questionnaire also incorporated the General Anxiety Disorder-7 screening test. In this young, male and mostly unemployed population, knowing someone who experienced COVID-19 was associated with a greater likelihood of compliance with hygiene and physical distancing measures. Anxiety levels were above 29%, and the highest scores were in the age group between 25 and 55 years. We argue that comprehensive public health measures against COVID-19 should include focused interventions for refugee populations that take the extra vulnerability (health, financial, and other) into account.
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Affiliation(s)
- Hatice İkiışık
- Department of Public Health, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Aral Surmeli
- Department of Executive Office, HERA Inc ., Boston, Massachusetts, USA
| | - Filiz Sever
- Department of Public Health, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Isil Maral
- Department of Public Health, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
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Garasia S, Bishop V, Clayton S, Pinnington G, Arinze C, Jalil E. Health outcomes, health services utilization, and costs consequences of medicare uninsurance among migrants in Canada: a systematic review. BMC Health Serv Res 2023; 23:427. [PMID: 37138351 PMCID: PMC10154752 DOI: 10.1186/s12913-023-09417-4] [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: 01/25/2022] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Medically uninsured groups, many of them migrants, reportedly delay using healthcare services due to costs and often face preventable health consequences. This systematic review sought to assess quantitative evidence on health outcomes, health services use, and health care costs among uninsured migrant populations in Canada. METHODS OVID MEDLINE, Embase, Global Health, EconLit, and grey literature were searched to identify relevant literature published up until March 2021. The Cochrane Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool was used to assess the quality of studies. RESULTS Ten studies were included. Data showed that there are differences among insured and uninsured groups in reported health outcomes and health services use. No quantitative studies on economic costs were captured. CONCLUSIONS Our findings indicate a need to review policies regarding accessible and affordable health care for migrants. Increasing funding to community health centers may improve service utilization and health outcomes among this population.
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Affiliation(s)
- Sophiya Garasia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.
| | - Valerie Bishop
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Stephanie Clayton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Genevieve Pinnington
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Chika Arinze
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Ezza Jalil
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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[Les personnes âgées immigrantes et leurs proches à Montréal : des vies oubliées durant la pandémie]. Can J Aging 2023; 42:177-183. [PMID: 36574964 DOI: 10.1017/s0714980822000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Malgré l'attention renouvelée de plusieurs médias sur la question des risques liés à la COVID-19 au sein de diverses communautés marginalisées au Québec, nous entendons encore très peu parler des personnes âgées immigrantes et de leurs proches. Dans cette note sur les politiques et pratiques, nous aborderons l'expérience du contexte pandémique chez les personnes âgées immigrantes montréalaises et leurs réseaux. Nous présenterons d'abord quelques données sociodémographiques sur les immigrants âgés montréalais. Nous exposerons ensuite nos constats sur les impacts de la COVID-19 sur les personnes âgées immigrantes, en particulier en ce qui concerne l'accès aux soins de la santé et aux services sociaux, la proche-aidance, l'emploi et le logement, à partir de nos travaux et de la littérature en gérontologie sociale. Nous terminerons en proposant quelques recommandations qui permettraient d'améliorer l'inclusion sociale des personnes âgées immigrantes et de leurs proches, autant en matière de politiques publiques que de pratiques sur le terrain.
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Park S, Kim HY, Lee YM. Unmet Healthcare Needs and Related Factors Among Immigrants: A Cross-Sectional Secondary Analysis of 2019 Korea Community Health Survey Data. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580221146828. [PMID: 36625003 PMCID: PMC9834933 DOI: 10.1177/00469580221146828] [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] [Indexed: 01/11/2023]
Abstract
Immigrants in Korea face numerous difficulties in seeking medical services due to language and cultural differences. Providing medical services to them could be beyond the institutional capacity of the host country owing to factors such as, physical and psychological problems, social unrest, language barriers, and problems adapting to unfamiliar environments. According to Andersen's health service use behavioral model, we used a multifaceted approach to explore the factors influencing the unmet healthcare needs of immigrants in Korea from the Korean health system. This cross-sectional secondary analysis study used data from the 2019 Korea Community Health Survey of 3524 immigrants. Their unmet healthcare needs were calculated using a complex, weighted sample design. Group differences in categorical variables were analyzed using the Rao-Scott chi-square test. Logistic regression analysis was used to analyze the association between unmet healthcare needs and ageing factors. Overall, 262 (7.4%) of surveyed immigrants experienced unmet healthcare needs. Factors influencing unmet healthcare needs were being a woman (OR = 1.41, 95% CI = 1.03-1.94), national primary livelihood security receiver (OR = 1.44, 95% CI = 1.29-1.68), stress (OR = 1.34, 95% CI = 1.26-1.45), perceived health status (poor: OR = 2.35, 95% CI = 1.58-3.52), and perceived health status (moderate: OR = 1.62, 95% CI = 1.18-2.20). Policymakers could focus on these predictors when formulating policy strategies to reduce unmet health care needs. In addition, by effectively delivering services that meet the unmet healthcare needs of immigrants, their right to health is protected.
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Affiliation(s)
- SookKyoung Park
- College of Nursing, Research Institute
of Nursing Science, Jeonbuk National University, Jeonju, South Korea
| | - Hye Young Kim
- College of Nursing, Research Institute
of Nursing Science, Jeonbuk National University, Jeonju, South Korea,Hye Young Kim, College of Nursing, Research
Institute of Nursing Science, Jeonbuk National University, 567 Baekje-daero,
deokjin-gu, Jeonju-si, Jeollabuk-do, Jeonju 54896, South Korea.
| | - Young-Me Lee
- School of Nursing, DePaul University,
Chicago IL, USA
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Goldenberg SM, Schafers S, Grassby MHS, Machado S, Lavergne R, Wiedmeyer ML. 'We don't have the right to get sick': A qualitative study of gaps in public health insurance among Im/migrant women in British Columbia, Canada. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001131. [PMID: 36962991 PMCID: PMC10022316 DOI: 10.1371/journal.pgph.0001131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023]
Abstract
Globally, the exclusion of im/migrants from public health care systems remains a significant health and human rights issue, calling into question claims of 'universality' of public health systems where eligibility for coverage is determined by immigration status. We aimed to describe lived experiences of health insurance coverage and the health and social impacts of gaps in health insurance amongst im/migrant women in British Columbia (BC), Canada. This analysis draws on qualitative in-depth interviews (n = 78) with im/migrant women and im/migrant-focused service providers (n = 10) conducted between July 2018-March 2021 in Metro Vancouver, BC, as part of a larger community-based, mixed-methods study of im/migrants' health access (IRIS). In contrast to common perceptions of Canada's health system as 'universal', participants faced multifaceted barriers to health insurance and necessary healthcare for themselves and their families following arrival in BC. Narratives highlighted the ways in which ineligibility for public health insurance coverage resulted in unmet needs for essential sexual and reproductive health and preventive care among im/migrant women, children, and families. Participants also described ineligibility for public health insurance as resulting in a high economic burden, and that exclusion from public health insurance perpetuated experiences of discrimination, invisibility, and exclusion from systems of care amongst im/migrant participants. Despite these structural challenges, participant narratives highlighted the crucial role of community-based supports for minimizing harm and navigating oppressive immigration and health systems. Changes to immigration and health policies are required to remove barriers to public health care for im/migrant women and ensure that Canada's health system is accessible to all. Expanding health insurance options to cover all residents and decoupling health insurance eligibility from immigration status are recommended, alongside implementation of 'Sanctuary' policies at the local level.
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Affiliation(s)
- Shira M Goldenberg
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, CA, United States of America
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Shaina Schafers
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Maggie Hamel-Smith Grassby
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Stefanie Machado
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Ruth Lavergne
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mei-Ling Wiedmeyer
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, University Boulevard, Vancouver, BC, Canada
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Experiences of Migrant People Living with HIV in a Multidisciplinary HIV Care Setting with Rapid B/F/TAF Initiation and Cost-Covered Treatment: The ‘ASAP’ Study. J Pers Med 2022; 12:jpm12091497. [PMID: 36143282 PMCID: PMC9503330 DOI: 10.3390/jpm12091497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to explore the experiences of migrant people living with HIV (MLWH) enrolled in a Montreal-based multidisciplinary HIV care clinic with rapid antiretroviral treatment (ART) initiation and cost-covered ART. Between February 2020 and March 2022, 32 interviews were conducted with 16 MLWH at three time-points (16 after 1 week of ART initiation, 8 after 24 weeks, 8 after 48 weeks). Interviews were analyzed via the Framework Method. Thirty categories were identified, capturing experiences across the HIV care cascade. At diagnosis, most MLWH described “initially experiencing distress”. At linkage, almost all MLWH discussed “navigating the health system with difficulty”. At treatment initiation, almost all MLWH expressed “being satisfied with treatment”, particularly due to a lack of side effects. Regarding care retention, all MLWH noted “facing psychosocial or health-related challenges beyond HIV”. Regarding ART adherence, most MLWH expressed “being satisfied with treatment” with emphasis on their taking control of HIV. At viral suppression, MLWH mentioned “finding more peace of mind since becoming undetectable”. Regarding their perceived health-related quality of life, most MLWH indicated “being helped by a supportive social network”. Efficient, humanizing, and holistic approaches to care in a multidisciplinary setting, coupled with rapid and free ART initiation, seemed to help alleviate patients’ concerns, address their bio-psycho-social challenges, encourage their initial and sustained engagement with HIV care and treatment, and ultimately contribute to positive experiences.
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14
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Borghi J, Brown GW. Taking Systems Thinking to the Global Level: Using the WHO Building Blocks to Describe and Appraise the Global Health System in Relation to COVID-19. GLOBAL POLICY 2022; 13:193-207. [PMID: 35601655 PMCID: PMC9111126 DOI: 10.1111/1758-5899.13081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 06/15/2023]
Abstract
Adequately preparing for and containing global shocks, such as COVID-19, is a key challenge facing health systems globally. COVID-19 highlights that health systems are multilevel systems, a continuum from local to global. Goals and monitoring indicators have been key to strengthening national health systems but are missing at the supranational level. A framework to strengthen the global system-the global health actors and the governance, finance, and delivery arrangements within which they operate-is urgently needed. In this article, we illustrate how the World Health Organization Building Blocks framework, which has been used to monitor the performance of national health systems, can be applied to describe and appraise the global health system and its response to COVID-19, and identify potential reforms. Key weaknesses in the global response included: fragmented and voluntary financing; non-transparent pricing of medicines and supplies, poor quality standards, and inequities in procurement and distribution; and weak leadership and governance. We also identify positive achievements and identify potential reforms of the global health system for greater resilience to future shocks. We discuss the limitations of the Building Blocks framework and future research directions and reflect on political economy challenges to reform.
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15
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Clech L, Meister S, Belloiseau M, Benmarhnia T, Bonnet E, Casseus A, Cloos P, Dagenais C, De Allegri M, du Loû AD, Franceschin L, Goudet JM, Henrys D, Mathon D, Matin M, Queuille L, Sarker M, Turenne CP, Ridde V. Healthcare system resilience in Bangladesh and Haiti in times of global changes (climate-related events, migration and Covid-19): an interdisciplinary mixed method research protocol. BMC Health Serv Res 2022; 22:340. [PMID: 35291985 PMCID: PMC8921708 DOI: 10.1186/s12913-021-07294-3] [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: 04/08/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022] Open
Abstract
Background Since climate change, pandemics and population mobility are challenging healthcare systems, an empirical and integrative research to studying and help improving the health systems resilience is needed. We present an interdisciplinary and mixed-methods research protocol, ClimHB, focusing on vulnerable localities in Bangladesh and Haiti, two countries highly sensitive to global changes. We develop a protocol studying the resilience of the healthcare system at multiple levels in the context of climate change and variability, population mobility and the Covid-19 pandemic, both from an institutional and community perspective. Methods The conceptual framework designed is based on a combination of Levesque’s Health Access Framework and the Foreign, Commonwealth and Development Office’s Resilience Framework to address both outputs and the processes of resilience of healthcare systems. It uses a mixed-method sequential exploratory research design combining multi-sites and longitudinal approaches. Forty clusters spread over four sites will be studied to understand the importance of context, involving more than 40 healthcare service providers and 2000 households to be surveyed. We will collect primary data through questionnaires, in-depth and semi-structured interviews, focus groups and participatory filming. We will also use secondary data on environmental events sensitive to climate change and potential health risks, healthcare providers’ functioning and organisation. Statistical analyses will include event-history analyses, development of composite indices, multilevel modelling and spatial analyses. Discussion This research will generate inter-disciplinary evidence and thus, through knowledge transfer activities, contribute to research on low and middle-income countries (LMIC) health systems and global changes and will better inform decision-makers and populations. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07294-3.
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Affiliation(s)
- Lucie Clech
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France.
| | - Sofia Meister
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France
| | - Maeva Belloiseau
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health & Scripps Institution of Oceanography University of California, San Diego, CA, USA
| | - Emmanuel Bonnet
- IRD, UMR 215 Prodig, 5, cours des Humanités, Cedex, F-93 322, Aubervilliers, France
| | - Alain Casseus
- Zanmi Lasante, Cange, Haiti.,École supérieure d'infotronique d'Haïti, Port-au-Prince, Haiti
| | - Patrick Cloos
- Département de médecine sociale et préventive, École de santé publique, École de travail social, Centre de recherche en santé publique (CRESP), Université de Montréal, Québec, Canada
| | | | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Annabel Desgrées du Loû
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France.,fellow of the French Collaborative Insitute on Migration, Paris, France
| | - Lucas Franceschin
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France
| | - Jean-Marc Goudet
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France
| | - Daniel Henrys
- École supérieure d'infotronique d'Haïti, Port-au-Prince, Haiti
| | - Dominique Mathon
- École supérieure d'infotronique d'Haïti, Port-au-Prince, Haiti.,Université du Québec, Montréal, Québec, Canada
| | - Mowtushi Matin
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Malabika Sarker
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, University of Heidelberg, Heidelberg, Germany.,BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Charlotte Paillard Turenne
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France
| | - Valéry Ridde
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France.,fellow of the French Collaborative Insitute on Migration, Paris, France
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16
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Shah SA, Safian N, Ahmad S, Nurumal SR, Mohammad Z, Mansor J, Wan Ibadullah WAH, Shobugawa Y, Rosenberg M. Unmet Healthcare Needs Among Elderly Malaysians. J Multidiscip Healthc 2021; 14:2931-2940. [PMID: 34703245 PMCID: PMC8526943 DOI: 10.2147/jmdh.s326209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/30/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose Older people often have chronic diseases which require a continuity of care over the long term. Countries undergoing population aging need to ensure that older people are receiving the care they need. This study assesses the prevalence of, reasons for, and factors associated with unmet healthcare needs among older people individuals in Malaysia. Patients and Methods This cross-sectional study used data collected during 2018–2020 from 1204 older adults aged 60 and older selected from Selangor state, Malaysia. A comprehensive face-to-face interview based on the Bahasa Malaysia version of the Japan Gerontological Evaluation Study (JAGES-BM) questionnaire was administered to gain information on unmet healthcare needs, socioeconomic factors, health-related factors, and measures of function (activities of daily living, depression, visual impairment, hearing impairment, memory impairment, and walking impairment). Multivariate logistic regression was used to analyze factors associated with their unmet healthcare needs. Results Overall, the percentage of older people respondents with unmet healthcare needs is 6.6%. The most reported reasons for forgoing or delaying healthcare were lack of knowledge about healthcare and financial barriers to care. The inability to travel alone (adjusted odds ratio [aOR] 2.51), being overweight (aOR 1.88), and having self-reported depression (aOR 2.23) were each associated with a higher likelihood of having unmet healthcare needs in their daily life. Conclusion The prevalence of unmet healthcare needs among older people in this part of Malaysia is lower than that reported in some other countries. However, it is possible to further reduce unmet healthcare needs by improving people’s knowledge and attitudes about appropriate healthcare utilization, strengthening financial protection measures and providing support to people at high risk of having unmet healthcare needs.
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Affiliation(s)
- Shamsul Azhar Shah
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nazarudin Safian
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Saharuddin Ahmad
- Department of Family Medicine, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Siti Rohani Nurumal
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Zulkefley Mohammad
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Juliana Mansor
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Yugo Shobugawa
- Department of Active Aging, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Megumi Rosenberg
- Centre for Health Development, World Health Organization, Kobe, Japan
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17
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Gautier L, Casseus T, Blanc J, Cloos P. What links can be made from narratives of migration and self-perceived health? A qualitative study with Haitian migrants settling in Quebec after the 2010 Haiti earthquake. J Migr Health 2021; 1-2:100017. [PMID: 34405170 PMCID: PMC8352163 DOI: 10.1016/j.jmh.2020.100017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022] Open
Abstract
In January 2010, Haiti was hit by a terrible earthquake that pushed thousands of people to migrate. Many of them chose to settle in Quebec, Canada. Years after the earthquake, many Haitians continue to migrate to the Quebec province. Several studies however have shown that this population's socioeconomic status is lower than the provincial average. Given the potential multiple stressors that affect Haitian migrants in Quebec, there are concerns about their health status. Located at the intersection of international migration studies and global public health, this paper offers an in-depth qualitative investigation of Haitian migrants' representations of both their situation and self-perceived health in Montreal, Quebec. Our perspective on migrant health was inspired by the World Health Organisation's framework on the social determinants of health and recent studies in the field of migrant health. We collected and analysed qualitative data from 23 key informants (i.e., 12 women and 11 men, aged 21-76 years old) from diverse socioeconomic backgrounds. The analysis of the data from these people's narratives revealed the importance of structural determinants such as social position, and intermediate determinants such as living and working conditions. Our analysis also highlighted several interrelations between those determinants. Specifically, participants reported coping with issues related to migration status, income, occupation, language, challenging living and working conditions, and chronic stress. This study also shows that racism and social support each relate to both the structural and intermediate levels of the social determinants of health. The importance of social support brought by relatives, friends, as well as community-based organisations and religious practice, was underscored. Our findings were coherent with available literature looking at the determinants of health of racialized and migrant minorities in other high-income regions of the world. Our conclusive remarks featured reflections on three cross-cutting issues and their practical implications for policy and practices.
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Affiliation(s)
- Lara Gautier
- Département de Gestion, d'Évaluation et de Politique de Santé, École de Santé Publique de l'Université de Montréal; Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - Thierry Casseus
- École de travail social, Université de Montréal, Montréal, Canada
| | - Judite Blanc
- Department of Population Health, Center for Healthful Behavior Change, New York University Grossman School of Medicine, New York, USA
| | - Patrick Cloos
- École de travail social, et Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal; Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
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18
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Merry L, Pelaez S. Knowledge translation and better health and health care for migrants in Canada: What is the responsibility of health funders and researchers? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:403-405. [PMID: 34127460 DOI: 10.46747/cfp.6706403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lisa Merry
- Assistant Professor in the Faculty of Nursing at the University of Montreal in Quebec.
| | - Sandra Pelaez
- Assistant Professor in the Faculty of Nursing at the University of Montreal in Quebec
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19
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Kim JY, Kim DI, Park HY, Pak Y, Tran PNH, Thai TT, Thuy MTT, Dung DV. Unmet Healthcare Needs and Associated Factors in Rural and Suburban Vietnam: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176320. [PMID: 32878012 PMCID: PMC7503302 DOI: 10.3390/ijerph17176320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to examine the current utilization of healthcare services, exploring unmet healthcare needs and the associated factors among people living in rural Vietnam. This cross-sectional study was conducted with 233 participants in a rural area. The methods included face-to-face interviews using a structured questionnaire, and anthropometric and blood pressure measurements. We considered participants to have unmet health needs if they had any kind of health problem during the past 12 months for which they were unable to see a healthcare provider. Multivariate logistic regression analysis was performed to determine the factors associated with unmet healthcare needs. Of the participants, 18% (n = 43) had unmet healthcare needs, for reasons like transportation (30%), a lack of available doctors or medicine (47%), and communication issues with healthcare providers (16%). The multivariate logistic regression showed that living in a rural area, having stage 2 hypertension, and having insurance were associated with unmet healthcare needs. To better meet the healthcare needs in rural or suburban areas of Vietnam, allocation of adequate healthcare resources should be distributed in rural areas and insurance coverage for personalized healthcare needs might be required. Efforts should focus on availability of medicine, improvement of transportation systems, and communication skills of healthcare providers to improve access to healthcare services.
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Affiliation(s)
- Ju Young Kim
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (J.Y.K.); (D.I.K.); (H.Y.P.)
| | - Dae In Kim
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (J.Y.K.); (D.I.K.); (H.Y.P.)
| | - Hwa Yeon Park
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (J.Y.K.); (D.I.K.); (H.Y.P.)
| | - Yuliya Pak
- Office of External Affairs, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - Phap Ngoc Hoang Tran
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 72714, Vietnam; (P.N.H.T.); (T.T.T.); (M.T.T.T.)
| | - Truc Thanh Thai
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 72714, Vietnam; (P.N.H.T.); (T.T.T.); (M.T.T.T.)
| | - Mai Thi Thanh Thuy
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 72714, Vietnam; (P.N.H.T.); (T.T.T.); (M.T.T.T.)
| | - Do Van Dung
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 72714, Vietnam; (P.N.H.T.); (T.T.T.); (M.T.T.T.)
- Correspondence: ; Tel.: +84-91-838-2253
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