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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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AlSaeed H, Sucha E, Bhatt M, Mitsakakis N, Bresee N, Bechard M. Rates of pediatric emergency department visits vary according to neighborhood marginalization in Ottawa, Canada. CAN J EMERG MED 2024; 26:119-127. [PMID: 38117415 DOI: 10.1007/s43678-023-00625-9] [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: 06/30/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To determine the association between neighborhood marginalization and rates of pediatric ED visits in Ottawa, Ontario. Secondary objectives investigated if the association between neighborhood marginalization and rates varied by year, acuity, and distance to hospital. METHODS We calculated rates of pediatric ED visits per 1000 person-years for census dissemination areas within 100 km of the Children's Hospital of Eastern Ontario for patients < 18 years old from January 2018 through December 2020. The 2016 Ontario Marginalization Index categorized neighborhoods along quintiles of residential instability, material deprivation, ethnic concentration, and dependency. Generalized mixed-effects models determined the incidence rate ratios of pediatric ED visits for each quintile of marginalization; multivariate models were used to control for year of presentation and distance to hospital. Analysis was repeated for low versus high acuity ED visits. RESULTS There were 154,146 ED visits from patients in 2055 census dissemination areas within 100 km of CHEO from 2018 to 2020. After controlling for year and distance from hospital in multivariate analyses, there were higher rates of pediatric ED visits for dissemination areas with high residential instability, high material deprivation, and low ethnic concentration. These findings did not change according to visit acuity. CONCLUSIONS Neighborhood residential instability and material deprivation should be considered when locating alternatives to emergency care.
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Affiliation(s)
- Habeeb AlSaeed
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Ewa Sucha
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Maala Bhatt
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Nicholas Mitsakakis
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Natalie Bresee
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Melanie Bechard
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
- University of Ottawa, Ottawa, ON, Canada.
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Leps C, Monteiro J, Barozzino T, Bowry A, Rashid M, Sgro M, Suleman S. Interim Federal Health Program: Survey of access and utilization by paediatric health care providers. Paediatr Child Health 2022; 27:19-24. [DOI: 10.1093/pch/pxab045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/16/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Interim Federal Health Program (IFHP) provides health care coverage to refugees and refugee claimants, yet remains underused by providers. The objective of this study was to assess Canadian paediatricians’ current understanding and utilization of the IFHP, and perceived barriers to utilization.
Methods
A one-time survey was administered via the Canadian Paediatric Surveillance Program in February 2020. In addition to descriptive statistics, multinomial logistic regressions were built to examine paediatrician use of the IFHP, and characteristics associated with registration and use.
Results
Of the 2,753 physicians surveyed, there were 1,006 respondents (general paediatricians and subspecialists). 52.2% of respondents had provided care to IFHP-eligible patients in the previous 6 months. Of those participants, only 26.4% were registered IFHP providers, and just 16% could identify 80% or more of IFHP-covered services. Knowledge of 80% or more of IFHP-covered services was associated with registration status (adjusted odds ratio [aOR] 1.92; 95%CI 1.09 to 3.37). Among those who knew they were not registered, 70.2% indicated they did not know they had to register. aOR demonstrated that those with fewer years of practice had higher odds of not knowing that they had to register (aOR 1.22; 95%CI 1.01 to 1.49).
Conclusions
We demonstrate that IFHP is poorly utilized by paediatric providers, with low registration rates and poor understanding of IFHP-covered supplemental services, even among those who have recently provided care to IFHP-eligible patients. Efforts to improve registration and knowledge of IFHP are essential to improving access to health care for refugee children and youth.
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Affiliation(s)
- Caroline Leps
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, OntarioCanada
| | - Jessica Monteiro
- McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Tony Barozzino
- Women and Children’s Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ashna Bowry
- Department of Family and Community Medicine, St Michael’s Hospital, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Meb Rashid
- Department of Family and Community Medicine, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Sgro
- Women and Children’s Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shazeen Suleman
- Women and Children’s Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Salam Z, Odenigbo O, Newbold B, Wahoush O, Schwartz L. Systemic and Individual Factors That Shape Mental Health Service Usage Among Visible Minority Immigrants and Refugees in Canada: A Scoping Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:552-574. [PMID: 35066740 DOI: 10.1007/s10488-021-01183-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
There exists considerable research which reports that mental health disparities persist among visible minority immigrants and refugees within Canada. Accessing mental health care services becomes a concern which contributes to this, as visible minority migrants are regarded as an at-risk group that are clinically underserved. Thus, the purpose of this review is to explore the following research question: "what are the barriers and facilitators for accessing mental health care services among visible immigrants and refugees in Canada?". A scoping review following guidelines proposed by Arksey and O'Malley (International Journal of Social Research Methodology 8(1): 19-32, 2005) was conducted. A total of 45 articles published from 2000 to 2020 were selected through the review process, and data from the retrieved articles was thematically analyzed. Wide range of barriers and facilitators were identified at both the systemic and individual levels. Unique differences rooted within landing and legal statuses were also highlighted within the findings to provide nuance amongst immigrants and refugees. With the main layered identity of being a considered a visible minority, this yielded unique challenges patterned by other identities and statuses. The interplay of structural issues rooted in Canadian health policies and immigration laws coupled with individual factors produce complex barriers and facilitators when seeking mental health services. Through employing a combined and multifaceted approach which address the identified factors, the findings also provide suggestions for mental health care providers, resettlement agencies, policy recommendations, and future directions for research are discussed as actionable points of departure.
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Affiliation(s)
- Zoha Salam
- Department of Global Health, McMaster University, 1280 Main St. West MDCL 3500, Hamilton, ON, L8S 4L8, Canada.
| | - Odera Odenigbo
- School of Counselling, Psychotherapy, and Spirituality, Saint Paul University, Ottawa, Canada
| | - Bruce Newbold
- School of Earth, Environment and Society, McMaster University, Hamilton, Canada
| | - Olive Wahoush
- School of Nursing, McMaster University, Hamilton, Canada
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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Peckham A, Wright JG, Marani H, Abdelhalim R, Laxer D, Allin S, Alam N, Marchildon G. Putting the Patient First: A Scoping Review of Patient Desires in Canada. Healthc Policy 2021; 16:46-69. [PMID: 34129478 PMCID: PMC8200834 DOI: 10.12927/hcpol.2021.26499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.
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Affiliation(s)
- Allie Peckham
- Assistant Professor, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; North American Observatory on Health Systems and Policies, University of Toronto, Toronto, ON
| | - James G Wright
- Chief, Economics, Policy and Research, Ontario Medical Association, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Husayn Marani
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Reham Abdelhalim
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Dara Laxer
- Executive Director, Health Policy and Promotion, Ontario Medical Association, Toronto, ON
| | - Sara Allin
- Director of Operations, North American Observatory on Health Systems and Policies; Assistant Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Nadia Alam
- Past President, Ontario Medical Association, Toronto, ON
| | - Greg Marchildon
- Director, North American Observatory on Health Systems and Policies; Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Brandenberger J, Tylleskär T, Sontag K, Peterhans B, Ritz N. A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries - the 3C model. BMC Public Health 2019; 19:755. [PMID: 31200684 PMCID: PMC6567460 DOI: 10.1186/s12889-019-7049-x] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migrants and refugees have important health needs and face inequalities in their health status. Health care delivery to this patient group has become a challenging public health focus in high income countries. This paper summarizes current knowledge on health care delivery to migrants and refugees in high-income countries from multiple perspectives. METHODS We performed a systematic literature review including primary source qualitative and quantitative studies between 2000 and 2017. Articles were excluded if the study setting was in low- or middle-income countries or focused on skilled migration. Quality assessment was done for qualitative and quantitative studies separately. Predefined variables were extracted in a standardized form. Authors were approached to provide missing information. RESULTS Of 185 identified articles, 35 were included in the final analysis. We identified three main topics of challenges in health care delivery: communication, continuity of care and confidence. All but one study included at least one of the three main topics and in 21/35 (60%) all three topics were mentioned. We further developed the 3C model and elaborated the interrelatedness of the three topics. Additional topics identified showed that the specific regional context with legal, financial, geographical and cultural aspects is important and further influences the 3C model. CONCLUSIONS The 3C model gives a simple and comprehensive, patient-centered summary of key challenges in health care delivery for refugees and migrants. This concept is relevant to support clinicians in their day to day practice and in guiding stakeholders in priority setting for refugee and migrant health policies.
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Affiliation(s)
- Julia Brandenberger
- University Children's Hospital Basel, Migrant Health Service, University of Basel, Spitalstr.33, Basel, Postbox CH 4031, Switzerland. .,Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland. .,University of Basel, P.O. Box, CH-4003,, Basel, Switzerland. .,Paediatric Emergency Department, Inselspital, University of Bern, Bern, Switzerland.
| | | | - Katrin Sontag
- University of Basel, P.O. Box, CH-4003,, Basel, Switzerland.,Department of Social Sciences, Subject Area Cultural Anthropology, University of Basel, Basel, Switzerland
| | - Bernadette Peterhans
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003,, Basel, Switzerland
| | - Nicole Ritz
- University Children's Hospital Basel, Migrant Health Service, University of Basel, Spitalstr.33, Basel, Postbox CH 4031, Switzerland.,University of Basel, P.O. Box, CH-4003,, Basel, Switzerland.,University Children's Hospital Basel, Pediatric Infectious Disease and Vaccinology, University of Basel, Basel, Switzerland.,Royal Children's Hospital Melbourne, Department of Pediatrics, University of Melbourne, Parkville, Australia
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Robert E, David PM. “Healthcare as a refuge”: building a culture of care in Montreal for refugees and asylum-seekers living with HIV. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTH CARE 2019. [DOI: 10.1108/ijhrh-01-2018-0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Between 2012 and 2016, the Government of Canada modified health insurance for refugees and asylum seekers. In Quebec, this resulted in refusals of care and uncertainties about publicly reimbursed services, despite guaranteed coverage for people with this status under the provincial plan. The Chronic Viral Illness Service (CVIS) at the McGill University Health Centre in Montreal continued to provide care to refugees and asylum seekers living with HIV. The purpose of this paper is to explain how and why challenges brought by this policy change could be overcome.
Design/methodology/approach
A qualitative case study was conducted using interviews with patients and staff members, observation sessions and a review of media, documents and articles. A discussion group validated the interpretation of preliminary results.
Findings
The CVIS provides patient-centered care through a multidisciplinary team. It collectively responds to medical, social and legal issues specific to refugees. Its organizational culture and expertise explain the sustained provision of care. The team’s empathetic view of patients, anchored in the service’s history, care for men who have sex with men and commitment to human rights, is key. A culture of care developed over time thanks to the commitment of exemplary figures. Because they countered the team’s values, changes in refugee healthcare coverage strengthened the service’s culture of care. However, the healthcare system reform launched in 2014 in Quebec is perceived as jeopardizing the culture of care, as it makes, refugee and asylum-seeker patients a non-lucrative venture for providers.
Originality/value
This research analyzes the origin of sustained provision of care to refugees and asylum seekers living with HIV through the lens of culture of care. It considers the historical and political contexts in which this culture developed.
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Moreau AM, Hennous F, Dabbagh B, Ferraz Dos Santos B. Oral Health Status of Refugee Children in Montreal. J Immigr Minor Health 2018; 21:693-698. [PMID: 30406328 DOI: 10.1007/s10903-018-0835-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study aimed to assess the oral health status of refugee children in comparison with that of Canadian children. In addition, we investigated the extent to which demographic factors are associated with caries experience in this population. Children with a confirmed refugee status and Canadian children (control group) matched for age and sex composed the study population. A comprehensive review of dental charts was completed to assess children's demographic data, caries experience, oral hygiene and gingival health status. The majority of refugee children had never seen a dentist before their arrival to Canada. Refugee children had significant higher dmft/DMFT scores than Canadian children (7.29 ± 5.1 and 4.47 ± 5, respectively; p < 0.0001). Furthermore, individual factors, such as refugee status (OR = 5.08; 95% CI = 2.31-11.1) and child age (OR = 2.17; 95% CI = 1.04-4.51) were significantly associated with caries experience. Access to appropriate dental care to refugee children should be a key priority for health care providers and policy makers.
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Affiliation(s)
- Anne-Marie Moreau
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, 1040 Atwater Avenue, Montreal, QC, H3Z 1X3, Canada
| | - Fatima Hennous
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, 1040 Atwater Avenue, Montreal, QC, H3Z 1X3, Canada
| | - Basma Dabbagh
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, 1040 Atwater Avenue, Montreal, QC, H3Z 1X3, Canada
| | - Beatriz Ferraz Dos Santos
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, 1040 Atwater Avenue, Montreal, QC, H3Z 1X3, Canada.
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